Permanent Numbness

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arbat
Posts: 15
Joined: Sun Dec 27, 2015 12:58 am

Permanent Numbness

#1 Post by arbat »

I was wondering whether there are any reliable statistics out there as to the percentage of MMA/genioplasty patients suffer from permanent numbness after surgery. I realise that this is a grey area as many seem to have a degree of feeling loss which might not pose a particular problem. But there are also those unlucky ones who suffer permanent significant nerve damage which does impact their lives such as loss of control of their mouth etc. Does the sliding genioplasty surgery put one more at risk of this or is it as common with BSSO?

Is this a survey that could be carried out on this website? One could grade numbness after 6 (or 12?) months post surgery as follows:

A. Some permanent loss of sensation but really not a problem.
B. Some permanent loss of sensation which one is always aware of and is the source of ongoing annoyance (but does not impact on functionality).
C. Significant permanent numbness which is a real problem in terms of functionality.

This could be very helpful in helping one decide whether to proceed with surgery!

Thanks

snapdresser
Posts: 941
Joined: Wed Feb 18, 2015 7:31 am

Re: Permanent Numbness

#2 Post by snapdresser »

Lol well, it seems to me that most people have some "altered sensation" but few experience any permanent numbness. When doing a BSSO the mandible is severed. When severing the mandible, extreme care has to be taken to avoid also severing the nerve that runs inside it. As my surgeon described it to me, they cut back and forth with the bone saw at two angles until they reach the nerve. If they pull back on the saw diligently when they break through, the nerve is preserved (tho it will be traumatized to some degree anyways, resulting in some temporary numbness and altered sensation) and all feeling will likely return to the lower mouth/chin/etc. If the saw isn't pulled back diligently at exactly that time, the nerve can be partially or (unlikely) fully severed, resulting in permanent numbness. I was told that that happens in fewer than 5% of patients and it's related to your surgeon's skill. That's one good reason you want a surgeon who performs at least a half dozen procedures a year. Most of us have some altered sensation, but it's still getting better at least for me, and I'm 6 months post-op. I think most of us expect all feeling to return to normal by 12 mos post-op.
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
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arbat
Posts: 15
Joined: Sun Dec 27, 2015 12:58 am

Re: Permanent Numbness

#3 Post by arbat »

Thanks snapdresser. I understand the procedure which is well illustrated on You Tube under BSSO etc. which shows the vulnerability of the alveolar nerves to surgery. Excluding the worst case scenario of a severed nerve, the general cause of nerve trauma must be the stretching of the nerve as the jaw is advanced (or compression if it is shortened).
Clearly the skill and experience of the surgeon is one of the key factors to a successful outcome.....as are the individual patient's powers of recovery and general health. Age must also therefore be a consideration as younger folk will generally recover faster and probably more completely. There is probably also a small element of luck!
Ultimately the decision to proceed with surgery must be an assessment of risks vs. rewards and the more information that one has to make this assessment the better....but one has to accept that all surgery carries risks...You are fortunate to be on the other side!!

NumbFace
Posts: 2
Joined: Sat Apr 09, 2016 9:55 am

Re: Permanent Numbness

#4 Post by NumbFace »

Prior to this surgery, I also would have liked to have seen comprehensive numbness statistics. As it is, I think this surgery exists in a Wild West scenario. I'm 22 months post op and can't feel the left-side of my face. I'm suicidal. My surgical outcome is not being collected or recorded by anyone. Now, I may be an "outlier" but chances are there are many other people in a similar situation to my own.

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Mart
Posts: 128
Joined: Sun Oct 16, 2005 7:25 am
Location: south west UK

Re: Permanent Numbness

#5 Post by Mart »

NumbFace wrote:Prior to this surgery, I also would have liked to have seen comprehensive numbness statistics. As it is, I think this surgery exists in a Wild West scenario. I'm 22 months post op and can't feel the left-side of my face. I'm suicidal. My surgical outcome is not being collected or recorded by anyone. Now, I may be an "outlier" but chances are there are many other people in a similar situation to my own.
I'm sorry to hear about your situation, have you tried consulting a nerve specialist? It's still possible to regain at least some sensation even if it hasn't worked out during your recovery.
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arbat
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Joined: Sun Dec 27, 2015 12:58 am

Re: Permanent Numbness

#6 Post by arbat »

Numbface, it sounds to me as though your surgeon might have severed the alveolar nerve. From all I have read, I do not think this is a common outcome so it sounds as though your surgeon has a lot to answer for.....Have you consulted your surgeon as to whether anything can be done to improve your situation?

MagnoliaMama
Posts: 50
Joined: Thu Mar 24, 2016 2:33 pm

Re: Permanent Numbness

#7 Post by MagnoliaMama »

arbat wrote:Numbface, it sounds to me as though your surgeon might have severed the alveolar nerve. From all I have read, I do not think this is a common outcome so it sounds as though your surgeon has a lot to answer for.....Have you consulted your surgeon as to whether anything can be done to improve your situation?
Trigeminal nerve injuries that persist aren't common, but unfortunately they aren't unheard of. Trigeminal neuralgia is a game changer, so much so that it's been nicknamed 'the suicide disease'. My doctors were very upfront about the risks and the ways they actively try to avoid any unnecessary manipulation of the nerves. I was terrified of being left with painful dysesthesia, but I was equally terrified of losing my teeth two by two as my bite ground them into nubbins.

The really scary and disheartening thing about TN is that medical solutions are usually temporary and only marginally effective at best. Some surgical procedures carry the risk of Anesthesia Dolorosa, which is like jumping from the frying pan into the fire. If anything, I would suggest a neurosurgical consult with a doctor that specializes in Trigeminal nerve repair/disorders.

Numbface, please know that you're not alone in feeling the way you do. You are suffering from something that most people will never understand. I understand why you're feeling suicidal and I don't judge you harshly for it. But please, please know that there ARE treatments and there will be better days ahead for you. If I could lift your pain away I would. I'm so sorry you've been dealt this hand. Biggest hugs coming your way. Please feel free to reach out if you ever need someone to talk to, I'd be honored to listen.
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Segmental LeFort I and BSSO at 34 years old, 8 months after being back in braces for the third time. First two rounds of ortho were as a kid and teenager. I was originally slated for surgery at 16 until a new orthodontist convinced my parents that she could "fix" me non-surgically. Twenty years and loads of molar wear later...here I am!

snapdresser
Posts: 941
Joined: Wed Feb 18, 2015 7:31 am

Re: Permanent Numbness

#8 Post by snapdresser »

Numbface, is it literally the entire left side of your face, or is it the nose/chin area? Does it include facial paralysis i.e. eyelid drooping, inability to move the lips on that side, etc?
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
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Tgirl22
Posts: 16
Joined: Sat Feb 20, 2016 2:36 pm

Re: Permanent Numbness

#9 Post by Tgirl22 »

I'm at 6 months post op and I still don't have feeling in my upper jaw. I can't feel my gums but feel pressure. I feel my lips and face... If the oral surgeon does impact the nerve do you think they would actually admit it????

underbitewars
Posts: 20
Joined: Thu Jul 07, 2016 1:50 pm

Re: Permanent Numbness

#10 Post by underbitewars »

[quote="Tgirl22"]I'm at 6 months post op and I still don't have feeling in my upper jaw. I can't feel my gums but feel pressure. I feel my lips and face... If the oral surgeon does impact the nerve do you think they would actually admit it????[/quote]

My daughter's surgeon told us that she would never regain feeling in the part of her gumline that is directly under her nose. Only problem is, he didn't tell us that until the first post-op visit!! Gee, thanks.

snapdresser
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Joined: Wed Feb 18, 2015 7:31 am

Re: Permanent Numbness

#11 Post by snapdresser »

underbitewars wrote:My daughter's surgeon told us that she would never regain feeling in the part of her gumline that is directly under her nose. Only problem is, he didn't tell us that until the first post-op visit!! Gee, thanks.
Reeeeeally.... My surgeon said that the feeling "always" comes back in the upper gums. I'm 13 months post-op and I still have significant numbness there. I guess it's not coming back :( Still, I'm very happy with my results; they've changed my life in a very real way. If I have to be careful flossing on the top for the rest of my life, I guess I just have to deal with that. It could be a LOT worse, that's for sure!
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
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Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Permanent Numbness

#12 Post by Sideways »

I've heard the same thing about upper gums almost always making a full recovery. However, one of my friends said that she lost some sensation in the soft tissue of her upper jaw, 2 years post-op. She says she can feel dull pressure, but not much else. Another acquaintance of mine has lost all feeling in her lower jaw, 6 years post-op. When I brought it up with her surgeon, he went "Huh, yeah, that was odd," and shrugged. She says she's learned to live with it and the results were worth it, so that's all that really matters, I guess!

Metalmouth33
Posts: 33
Joined: Fri Mar 10, 2017 10:53 am

Re: Permanent Numbness

#13 Post by Metalmouth33 »

Sideways wrote: Another acquaintance of mine has lost all feeling in her lower jaw, 6 years post-op. When I brought it up with her surgeon, he went "Huh, yeah, that was odd," and shrugged.
This post perpetuates my belief that some oral surgeons are very dumb people who are not willing to think critically or problem solve whatsoever. Every complicated case is a chance for them to learn something new, so why shrug and shy away? They can't say it's not their job, because it is their job! lol. I honestly wonder how someone like that figures out how to tie their shoes in the morning.

Let's see..30 seconds to tie your shoes x 250 business days a year. That's enough time to perform another surgery. I bet they wear Velcro.

snapdresser
Posts: 941
Joined: Wed Feb 18, 2015 7:31 am

Re: Permanent Numbness

#14 Post by snapdresser »

To be fair, it seems reasonably likely to me that the surgeon did learn something from the experience (perhaps a lesson on how careful you have to be when severing the mandible) and just didn’t want to share that with a potential patient/customer lest the patient become wary and seek out another surgeon.
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
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Metalmouth33
Posts: 33
Joined: Fri Mar 10, 2017 10:53 am

Re: Permanent Numbness

#15 Post by Metalmouth33 »

snapdresser wrote:....just didn’t want to share that with a potential patient/customer lest the patient become wary and seek out another surgeon.
Yes I edit quotes to snip out just the words I want :p


"Lest the patient become wary and seek out another surgeon".

personally, I'd feel much more comfortable with a surgeon who was upfront about everything. my surgeon wasn't one of those, and even when I would try to talk to him about the issues surgery created he was still was a brick wall. He flat out said nothing when I asked about the TMJ pains I got. :shock: <----- but his eyes looked like that! The eyes (usually) never lie, he knew all about the stuff that could/would happen, he just lied about it.

leaves you feeling like he was mostly interested in having another customer, regardless of the results for that person. I'm sure he has good intentions in his heart. But I think his ego blinds him somewhat.

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