2nd BSSO attempt (after failed surgery)?

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nullalux
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Nullalux disheartened after failed BSSO

#16 Post by nullalux »

So here's what happened with my surgery on 9 June. We completed everything on my to-do-before-the-surgery list by the previous night, and I went into the hospital with Dennis in the wee hours of that Monday morning. I was excited and a bit apprehensive, but ready. Staff at the hospital were friendly and helpful, and the pre-op procedures were smooth. Smiling and waving, I let go of his hand as they wheeled me into the operating room. Stereotypically, the last things I remember seeing were my main surgeon, my anesthesiologist, and a half-dozen other masked faces over me, and the bright lights above the table.

Apparently, my mandible (lower jaw) is very slight (i.e. not very thick). In addition, the bone is quite dense (i.e. there's no marrow or spongy middle). Both of these issues, not ascertained during pre-op scans, caused surgical complications so that the left side of my jaw shattered into three pieces during the osteotomy. Rather than risk something similar on the right side as well (and possible permanent nerve damage), the surgical team chose to screw the bone back together without moving the jaw forward. The main surgeon even called in two reconstructive maxillofacial surgeons to make sure the double fracture would not have additional adverse effects. It took them several hours to wrap that up and then complete the osteotomy and bone graft in my chin. Unfortunately, this means that I am having to undergo the same long recovery process as we had anticipated even though the mandibular advancement was unsuccessful. The surgeon explained the situation to Dennis and my grandparents while I was still under general anesthesia in the PACU. When I awoke, my surgeon was there to tell me that they had been unable to complete the surgery, but I wasn't really clear on what had occurred or what that meant. Staff took me to my hospital room, where my family was waiting, and after a while the main surgeon arrived. When she explained that the mandibular osteotomy had failed in a spectacular fashion, and that there was no chance of trying again, I had no energy to do anything but close my eyes and cry. We've been preparing for this surgery for almost nine years, and I've been undergoing various invasive pre-op treatments for almost a year now, at an out-of-pocket cost of nearly 10K. I had been aware of possible negative outcomes like permanent nerve damage, scarring, or eventual regression, but we were completely unprepared for something like this.

The immediate situation was further complicated by difficulties with pain medication. Thankfully, there was very little nerve damage, but this also meant that I could feel everything. First, I was given ketorolac (Toradol, a muscle relaxant) by IV, and then oral hydrocodone (Vicodin). Nothing, and by that point I really needed enough relief so that I could sleep for a few hours. Sleeping pills are contraindicated with this type of procedure, since, in conjunction with the swelling of the respiratory passages, there's a danger of suffocation. So they administered dextropropoxyphene (Darvocet) and Promethazine (Phenergan, a sedative) via IV, promising that this combo would knock me out. No such luck. The next step was morphine, and surely, I thought, Morpheus of the Oneiroi, son of Hypnos, would smile on me then. But even after multiple doses through the IV, I was still awake (and in pain) hours later. Finally, after the cumulative effect of all these as well as oxycodone (Percocet) and diazepam (Valium), I was able to rest on Tuesday. Because of the complications, my hospital stay was extended through Wednesday. These were a couple of dark days, and a few more followed. Although we had a great deal of support from our friends and families during this time, one face was missing. A friend had let us down. As my room filled with flowers and cards, and we received frequent visits and assistance from loved ones, however, I realized that I needed to let go of these disappointments and focus on the physical healing before me. There would be time enough to discuss other treatment options and to forgive mistakes.

Still, this is easier said than done, and it is a process, not something I can do once and for all. I couldn't bring myself to post about what had happened with the procedure, here or in my blog (http://chalepa-ta-kala.livejournal.com/tag/jaw), for some time. But even as I trembled in mind and body, many things brought me joy. Much gratitude, of course, to Dennis, who has rarely left my side. Visits from friends continue to buoy my spirits immensely, and many others are sending notes and expressions of care. I had absolutely no post-surgery nausea, a common complication we'd been hoping to avoid. My jaw is healing rapidly, and I'm not wired shut (although I must still adhere to the six-week liquid diet). The osteotomy and bone graft in my chin were successful, and I have a more balanced profile. I look just fine; the bruising faded quickly, and the little bit of swelling that remains should fade completely over the next month or so, and isn't really noticeable now unless one knows my face. I only have two teeny places where I feel a bit numb (on the right side of my chin and my lower gums in front), and they will likely not be permanent. My incisions healed cleanly, and I've been able to do an excellent job brushing with my infant toothbrush (I chose the popular 'duckies' theme, although the 'ladybugs' were also a strong contender). I've unfortunately lost 10 lbs in the last three weeks (which my doctor isn't thrilled about), but my meals have been varied and healthful. Several relationships have strengthened during this time, and in particular, the cats have been more than happy to minister to me during my convalescence. Looking back over the past month, I am pleased with my progress, both physically and mentally. I shall save discussion of my treatment options for another post, but I know they're there. My surgeon required me to take a fourth week off work, but I finally returned today, Monday, 7 July. I have my third post-op with my surgeon tomorrow morning.

Also, I now have awesome-looking x-rays.

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(BSSO and genio)

loulou123
Posts: 716
Joined: Fri Jul 14, 2006 4:33 am
Location: United Kingdom

#17 Post by loulou123 »

Sorry to hear whats happened :( big hug from me too.

From someone whose also encountered a far from smooth ride - it will get better, tho i know it may not feel like it at this moment.

Best of luck too you.
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Braces on 11th June 2006,~ BSSO and Wisdom tooth removal 11th February 2008,~ Plate Removal 14th May 2008,~ Braces off 28th August 2008.

http://adultwithbraces.blogspot.com/

Andantae
Posts: 546
Joined: Thu May 24, 2007 6:26 pm
Location: Outside Minneapolis

#18 Post by Andantae »

HUGE HUG, Nullalux.

I would feel the exact same way as you do about not wanting to post until now. A 'regroup' was required.

You know, looking at the soft tissue of your x-ay, your profile is really quite good given there was no advancement. I don't know what your before looked before, but the genioplasty certainly disguises your rethoganthic jaw--it looks almost spot on.

Nullalux, I will just echo Meryaten's post. (Personally, when I get too much sympathy I begin to feel like a victim or pitied, so I will temper my response.) Remember, many, many people opt to address their bite issues without sugery and have excellent results. By the sounds of you and your post, you will get this sorted out and move on in examplarery fashion. I already admire your grit and your attitude.

Andi

PS Shame, shame on your friend---he/she doesn't deserve you. Beyond lame :( .
Braced 5-30-07 for 18-24 months
In-Ovation Uppers, Metal Lowers, TPA upper arch, Lower Lingual arch, no elastics.
100% Deep Bite, Crowding, Over Extrusion
BSSO & Genio surgery June 4th '08!


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"Truth is a bully we all pretend to like." Gregory David Roberts -SHANTARAM

nullalux
Posts: 42
Joined: Fri May 02, 2008 7:56 pm
Location: Bay Area, CA
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#19 Post by nullalux »

Andantae wrote:I would feel the exact same way as you do about not wanting to post until now. A 'regroup' was required.

You know, looking at the soft tissue of your x-ay, your profile is really quite good given there was no advancement. I don't know what your before looked before, but the genioplasty certainly disguises your rethoganthic jaw--it looks almost spot on.
Thank you, although much of that could be still be swelling; it was taken only 2.5 weeks after the surgery.

And thank you, everyone, for your kindness and well-wishes.
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(BSSO and genio)

kaycee
Posts: 189
Joined: Wed Dec 12, 2007 8:50 am
Location: Vermont

#20 Post by kaycee »

I am very sorry to learn what happened, please share with us what your surgeon is recommending. A very big hug from me too.

When I read about all of the possible side effects, it was a little scary, but to learn when that has happened to one of us, well it affects us all.

kaycee
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NoCPAPPleez
Posts: 24
Joined: Sat Jul 05, 2008 7:23 am

#21 Post by NoCPAPPleez »

I'm very sorry to hear of your disappointing experience.

It sounds to me as though your mandible is "brittle." Have you ever been checked for osteoporosis or osteopenia? (US of the heel for screening or a full DEXA scan to check bone density.) Frequently it shows up first in the jawbone, especially in females.

For the record, bone density is a good thing, not bad. Osteoporosis is lack of bone density, and its precursor, osteopenia, is lack of bone mass. In addition to plenty of minerals like vitamin D (calciferol, or vitamin D3, is the active form, and, contrary to popular belief, sunlight is NOT the best way to get it), calcium, magnesium, boron (apples are a good source), and silica, in addition to performing weight-bearing exercise. Estrogen levels can affect bone density (and mass) as well. Also contrary to pop belief, milk contains one of the least-absorbable forms of calcium --- leafy, dark greens like kale are a much better dietary choice.

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fromjersey
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#22 Post by fromjersey »

nullalux: So sorry and hope you are feeling better each day! I don't know if I missed it, but where did you have your surgery? Stanford? San Francisco?
Helen

jmrut22
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Location: Tennessee

#23 Post by jmrut22 »

nullalux

I AM SO SORRY!! I cannot imagine what you are going through. Please keep us updated.

Hang in there!!
Brace Date 6/2006
BSSO 5/2008
Debanded 10/8/08 YAY!!
Hawleys top and bottom 24/7

Arvensis
Posts: 514
Joined: Thu May 03, 2007 5:23 pm
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#24 Post by Arvensis »

Nullalux: Sorry to hear about your troubles in surgery!!! Let me know when you are feeling better, we'll get some rolling pins, dress up as old ladies like the Car Max commercial, and terrorize whomever is responsible. I suppose, if needed, bricks in purses would be less conspicuous than swinging rolling pins, but the effect isn't the same.

(Hang in there!)
[8 Months, 4 days with Braces]
Braces off 4/17/2008 - Rockstar!

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Before and After.

nullalux
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2nd BSSO attempt (after previously failed surgery)?

#25 Post by nullalux »

Hey everyone!

To recap: In June of this year, I underwent lower jaw surgery (BSSO and genio). Unfortunately, the surgery was unsuccessful, and my surgeon told us that I wasn't a good candidate for further attempts. Read about it in previous post here:

We resigned ourselves to this news, and I made an appointment with a different specialist (Dr. Poor at Kaiser Oakland) to find out about alternate therapies, etc. To our surprise, he seems to think that if he attempted the same surgery (a bilateral sagittal split osteotomy, like I underwent with Dr. Townsend at Kaiser Santa Clara), it would be successful. I'm cautiously optimistic, and the procedure is scheduled for 16 Jan 09.

I guess I just want to make sure that he works closely with my previous surgeon to ensure success with as little nerve damage as possible, since my surgical team ran into trouble before. I'm worried about pain management as well, since we had some trouble there also.

Regarding recovery, he does things a little differently. I will have a splint between my teeth and I will be wired shut this time, but only for ten days. All incisions are intraoral, so he won't need to go through my cheek again. There will be metal plates to anchor the bone, instead of just screws.

I can't say that I'm looking forward to another surgery, but if it succeeds, I'll feel that all the time, effort and money we've invested hasn't been wasted.
Last edited by nullalux on Sun Oct 05, 2008 3:52 am, edited 1 time in total.
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(BSSO and genio)

Foxface
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#26 Post by Foxface »

I hope all goes well for you this time, nullalux! It's great that you have the courage to go through with it after the first surgery, and I can certainly understand that you don't want to give up after preparing for so long.
I'll keep my fingers crossed.
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ohmyjaw
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Joined: Thu Jun 22, 2006 12:09 pm

#27 Post by ohmyjaw »

Hi Nullalux,

I read your story, and I really hope things go much better for you on your next surgery. I will keep you in my thoughts. For what it's worth, it sounds like your new surgeon does things very much like mine did, and I had great results. I had intraoral incisions only, plates in my jaw, and was wired shut for ten days. No splint though.

Being wired shut is not so bad, except when it comes to eating. I recommend preparing soups/shakes that are completely blended, because if there are any particles they will not fit through your teeth.

I also hope they do better with the pain management. Hopefully they can learn from what went wrong in the first surgery, and you will have a much easier time.

chicago29
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Joined: Tue Jul 22, 2008 12:34 pm
Location: Chicago Suburbs, IL

#28 Post by chicago29 »

Nullalux,

I was not familiar with your story until I just read it today. I am so sorry to hear what you had to go through in the first surgery. However, just take a moment and think what a strong person you are for getting through this!!! It sounds like you are in much better spirits now, and you're working hard to try again early next year. You have my utmost respect...

I will be thinking about you and I hope you keep us updated on your journey.

Best Wishes, and I wish you all the best with your new surgeon.

Regards
Chicago29

sylvi
Posts: 20
Joined: Tue Jan 22, 2008 11:47 pm

#29 Post by sylvi »

I had my BSSO and genio at Kaiser Oakland by one of Dr. Poor's colleagues. Tomorrow I'll be two weeks post-op; I was just unwired yesterday.

My recovery has been pretty good, just taking some antibiotics and being super conscientious about oral hygiene because my genio incision popped open and a hematoma had to be drained on the right BSSO site yesterday... hoping these spots don't get infected, but they look fine so far.

I'm so glad you sought out a second opinion and somehow ended up at the Oakland office. They have a great reputation and from the numbers they gave at the pre-op class, they do LOTS of orthognathic procedures. Apparently the docs at Oakland Kaiser MFS are often consulted by doctors from all over the world for their expertise. I've always felt like I'm being competently cared for, and am grateful that my orthodontist connected me with these specialists.

Good luck to you! I hope everything works out well.

Andantae
Posts: 546
Joined: Thu May 24, 2007 6:26 pm
Location: Outside Minneapolis

#30 Post by Andantae »

Nullalux~

I am so glad to see you back here! I have thought about you a half a dozen times since last May wondering how you were doing.

That is very good news that you are able to try this again with a doctor who is confident he can get you the results you expected the first time. I'm especially impressed that you went to him for alternative therapies and his opinion was to do the same surgery. He must have seen something obvious to correct/change/improve from the first surgery for him to be so confident to make that recommendation. I'm not sure how much you want to discuss this, but did he give you any indication as to what could have been done differently the first time, or more specifically, what he is going to do differently this surgery? (I am unable to retrieve your link right now for some reason, so I can't refresh my memory with the details, but I think you had an unfavorable break due to brittleness of the bone???)

Just out of curiosity, what does your previous surgeon say? Is he willing to work with your new OS?

Soooo happy and impressed that you have the fortitiude to work this out, Nullalux. I don't know if you remember kaycee? Her surgery date was just after ours. She, too, is facing similar challenges. But I agree with both of you in wanting to get it right after investing so much time, energy sacrifice and emotion into this. We'll be there for you!

Andi
Braced 5-30-07 for 18-24 months
In-Ovation Uppers, Metal Lowers, TPA upper arch, Lower Lingual arch, no elastics.
100% Deep Bite, Crowding, Over Extrusion
BSSO & Genio surgery June 4th '08!


Image

"Truth is a bully we all pretend to like." Gregory David Roberts -SHANTARAM

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