Stability Questions, LeFort I--Life with a delayed Union

Message

#151 Post by **Delag** » Fri Oct 12, 2007 4:06 pm

Phil - I noticed on the yahoo site 2 that there is a post by a guy who sounds like he is going through the same thing. It is posted under Lefort I on the current page. It sounds like he is just discovering he has a problem and -pushy me- thought you might want to help him out

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#152 Post by **sweetpea** » Fri Oct 12, 2007 5:08 pm

Hi Phil

Just to say I'm watching your difficult situation, and I'm rooting for you. (Not sure if that expression works on your side of the world?).

#153 Post by **phil** » Sat Oct 13, 2007 6:04 am

Delag and sweetpea,

Thanks for your posts. Yes, I understand "rooting for you" quite well. I need as many folks as possible doing that!

Delag, I'm not sure I'd be help to anyone right now, except that I might draw his attention to my thread here on AW. I woke up this morning feeling very discouraged and depressed. I'm probably going to have to sort out another surgery (AGAIN) in between two jobs. I'm not sure that I can wait until June--my brain might not be able to withstand that! I feel pretty beat down as it is. My original plan was to be in really good shape by now, having taken most of the summer to recover. That plan definitely got flushed down the cr***er, didn't it? So, just when my OD would have thought I would be done with treatment (next June), I may be going through another LeFort I. SIGH. I'm sure that my OS and OD will protest strongly at me waiting until June for another surgery, anyway (if we decide I need it). It's just that my life is such a busy mesh of work that I can't have it any other time without a standstill to some part of it. But, I guess that's everyone's life, isn't it?

So, I'll keep plugging along, I guess. What else can I do?

#154 Post by **Delag** » Sat Oct 13, 2007 1:51 pm

Unfortunatly we can't plan medical emergencies Phil, and that might just be what this is - a medical emergency. I can understand your desire to have everything orginized and in a good place before undergoing another surgery, but there are some things that just can't wait. If your experienced, trusted, valued....(you get the picture)....medical professionals say you have to do this now, then you have to do this now. If you were in a car accident I am sure your employer would find a way to manage - this isn't that different IMO. Granted you will have a bit more warning than with a head on collision, but it is no less important to get the proper care for your body.

OMG! I sound like my mother. Sorry Phil, I didn't mean to preach

. I guess I just wanted to tell you that YOU are more important than your job, and for better or worse we do get through them eventually. Keep you chin up Phil....or should I say maxilla

#155 Post by **phil** » Sat Oct 13, 2007 3:47 pm

Delag,

If it were truly a medical emergency, I would have no qualms completely putting my life on hold, and having the surgery again. Quite honestly, it's not an emergency right now, except for the mental strain that increases with every passing day. The other issue is that even though I eat EVERYTHING I want (as long as it's blended), I can't seem to gain any weight--in fact, I'm still dropping (nearing 160# now, down from 175# or so). At this rate, I'll be next to nothing if I have to wait too long for surgery. If I try to up my calorie intake, I end up with indigestion issues. Go figure!

I don't think I'm putting myself in jeopardy by holding off, except for those two issues, and I guess I shouldn't underestimate the importance of those two issues. Psychologically I'm a strong person, and I've been through some really tough things in my life, but I'm just getting plain tired of this now. Thinking about it requires so much mental energy! Thank God for the children I teach, because when I am teaching, they are all that exists in the world! They truly are a gift, and help me get my mind off of my problems.

One other issue is making a decision about WHO will operate on me if I do indeed end up needing another surgery. Do I have enough confidence in my surgeon that he knows how to handle this so that we don't have a repeat performance? I can't answer that question right now, so I guess some time is not a bad thing--it will allow me to mull that question over. Another friend of mine did suggest that I get a THIRD opinion, since the first and second don't agree, and I am considering that as well. But, then, ANOTHER friend of mine told me, "YOU are the third opinion! You're going to have to become the expert on your case, because you may not find ANYONE who really knows how to deal with it!" Actually, I think I've done a pretty good job so far of standing up to the guys in the white coats, and engaging them in helpful dialogue.

So, back to the original point...yes, my employers can live without me for a couple of weeks if need be. And if I need to take off a couple of weeks, I will. I just didn't want to do that THIS year!

#156 Post by **Happysmiler** » Sat Oct 13, 2007 4:52 pm

Well Said Delag!

Phil, it is obvious that you put your career very highly in your life - but at this point you do need to consider yourself first above anyone or anything else.

I can totally understand that after what you have been through, you don't want to go through another operation this year. All being well if things rectify themselves you may not need further surgery (fingers crossed!) ..... however you say "it's not an emergency right now, except for the mental strain that increases with every passing day" - just bear in mind the strain it IS putting on you and if things DO need to be done, June is a lot of days away!

Good Luck Phil, you are coping with this really well and I hope this splint is going to fix your problem quickly for you.

Best Wishes
Happysmiler

#157 Post by **smile2006** » Sun Oct 14, 2007 5:18 am

Hi Phil-

Did I read your post correctly in that you only have 2 plates in your upper jaw? Out of curiousity where are they placed? I actually have 6 if I recall the x-ray correctly which is interesting to me....two of them (one each side) very high near the orbital sockets (nose). Did you surgeon say why only two were used?

#158 Post by **phil** » Sun Oct 14, 2007 11:14 am

smile2006,

Yes, I only have two plates. They are L-shaped, and are on either side of my nose--the ends are VERY close to the orbital sockets! I can feel them quite easily up there, especially with all the weight I have lost.

I was also secured with two wire loops in the rear--one on each side at the back end. That's it! I don't know why my surgeon only uses two, but they say every surgeon does it slightly different. There is one thing I know for sure--if I have surgery again, we're using more than two plates! Six sounds like a lot to me, but if he decided on six, I would be fine with it. I want at least four!

#159 Post by **smile2006** » Sun Oct 14, 2007 12:36 pm

I can also feel one of the ones around the orbital socket (left side)....way too much in my opinion. At first I thought a screw was coming out! Anyway, each surgeon does have their own way. My x-rays look a mess after upper, lower and genio. Some of the hardwhere is even visible in routine dental x-rays I noticed.

#160 Post by **phil** » Mon Oct 15, 2007 3:27 pm

Greetings all! Here is another page in this chapter of the neverending saga otherwise known as "My Bite." Gentle reader, be forewarned!

I spent the morning at the orthodontist, waiting to get into a chair so that he could adjust my splint yet ANOTHER time. I don't think he was happy to see me, and told me (slightly grumbling as he did), "I don't normally do splints." My reply was that I didn't normally do them either. Later on, I apologized for having to take up time from both of our busy lives, and he replied, "well, this is just the way it works." A much more civilized reply, I think!

After he adjusted my splint, he asked to see my horrendous bite (and I am not exaggerating when I say "horrendous"). After he took a glance, it went something like this:

phil: so, tell me, if I DO heal in this position, and even with elastic therapy, will my molars ever be in Class I relationship?

OD: No, they will be class III.

phil: (heavy sigh) That is VERY disappointing.

OD: Well, you are in the driver's seat here. If you are dissatisfied with your outcome, you have a right to say so.

(phil's brain churns a bit)

phil: well, I think I'll be talking to Dr. *********** about a second surgery, then. After all I've been through, It ought to be better than this!

(no disagreement from the OD)

(other miscellaneous comments back and forth)

The bottom line is, I am not satisfied with my current outcome, even if I DO heal (and there is NO evidence of THAT taking place as near as I can see, in spite of me being a model patient in the compliance department!). So, time to talk about heading back to the ol' CHOP CHOP.

So, then I call the surgeon's office, asking to leave a message for him. The receptionist wants to know what this is in regards to. I tell her plainly, "to discuss a second surgery." The next thing I know, I have my surgeon on the phone. Amazing.

I tell him that I would like him to be thinking in these terms. He says that he will be talking to OD to make sure we're all on the same page, but it's really too early to discuss this. My reply: "whether I heal or not, I am not satisfied with my surgical outcome!!!" He says he will consider it, communicate with the OD, and then talk with me about it at the end of the month. I re-iterate, "I just would like you to begin to think in those terms." He chuckles. We say goodbye to each other and hang up.

#161 Post by **phil** » Mon Oct 15, 2007 3:27 pm

Duplicate Post

#162 Post by **smile2006** » Mon Oct 15, 2007 4:58 pm

Good luck Phil. Sorry it might come to another surgery but it's better than being in forever limbo as you sort of seem to be now. It'll work out. Do they actually have to cut anything again or just slide things a bit and affix with more plates and screws??????

#163 Post by **phil** » Mon Oct 15, 2007 5:07 pm

smile2006,

From what I've read (and I've read a LOT!), they absolutely MUST:

1) completely mobilize the maxilla
2) remove all fibrous tissue
3) resurface the bone if necessary for good contact

The things that OFTEN happen with a repeat surgery are:

1) autogenous bone graft (usually from the pelvis)
2) alloplastic material if necessary, to fill in gaps
3) more rigid fixation than was previously used

I am also going to insist on a post-operative occlusal splint, for at least two weeks, and possibly more, just to be safe.

Again, I consider myself to be rather well read on this subject for a layperson. It probably makes my surgeon nervous that I have so much information, but I really don't care. I WANT TO GET WELL, AND I WANT A GOOD RESULT!!!

#164 Post by **ohmyjaw** » Mon Oct 15, 2007 8:57 pm

Hi Phil,

I just looked at my x-rays. I have six plates!

You are really brave to be contemplating another surgery. I am hoping for the best for you!

#165 Post by **phil** » Tue Oct 16, 2007 3:49 am

ohmyjaw,

Interesting...so you're the second person now who has told me that they have SIX plates, and I only have two...

The more I think about it, the more the second surgery makes sense. I have not even a HINT of bone consolidation yet, and with this relapse, why not go back and get it right? With the exception of some nausea, I tolerated both of my other surgeries reasonably well. I'm young and healthy, except for this problem. And, if I were the surgeon, I would not want my patient to settle for an inferior result. So, I think this is the way to go.