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

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#16 Post by **HighandLo** » Tue Aug 21, 2007 9:43 am

Phil,

I had certainly never heard my surgeon mention it and I read all the fine print before I signed up for surgery!

So you have to wait two weeks for any new info? Are you supposed to take calcium or something to help with bone formation? Maybe all the super-tight elastics didn't allow your bones to fuse properly, since they were always being tugged this way and that. But, I shouldn't speculate. I would just like to have some positive answers for you. I'll do some research.

Go ahead and celebrate! You can celebrate your patience and persistence and it'll make you feel better. 8 weeks deserves some attention. It seems like just the other day we were preparing for surgery. Have a brewsky for me

!

Lo

#17 Post by **phil** » Tue Aug 21, 2007 9:48 am

Lo,

You are SUCH a surgery buddy! Thanks for stickin' with me through thick and thin.

I'm going to talk to my surgeon friend and go from there. Maybe he'll recommend an orthopedic specialist that I can see. He also knows my surgeon, and has said good things about him.

I have a meeting tonight, but I think I'll sneak in a beer somewhere!

#18 Post by **dubnobass** » Tue Aug 21, 2007 9:55 am

Oh Phil, I'm sorry it wasn't better news

Presumably the surgeon wants to give it a chance to mend by removing all the forces on your jaws - if this wasn't at least a possibility, I don't think he'd have suggested it. I did wonder if having lots of elastics on post-surgery would affect healing.. Could this be a factor in your case?
I also wonder if the amount and direction of jaw movement in surgery affects the outcome in terms of healing?

#19 Post by **phil** » Tue Aug 21, 2007 10:03 am

dubnobass,

The surgeon just wants to give the bones every fighting chance possible by removing all force. I think that's wise.

Who knows what has caused this? Elastics? Me chewing too soon? Just plain bad luck? At the end of the day, it doesn't really matter, as long as we can get the problem solved.

I told a friend of mine today that if in the end I'll never be able to eat a good steak again, I will seriously cry!

#20 Post by **phil** » Tue Aug 21, 2007 11:21 am

Thanks, Meryaten.

What I'm trying to do right now is educate myself, but there's scant information available online. Most cases of "fibrous union," (as they call it) occurring in orthognathic cases are found in the mandible, not the maxilla, probably due to blood flow issues.

I'm going to see what I can do about a second opinion in the next few days. I want to know if there's something that I should be doing in the meantime to encourage my healing. It's disconcerting, but I'm not giving up.

#21 Post by **smile2006** » Tue Aug 21, 2007 1:57 pm

Hmmm, Phil. I was sorry to read what you posted. I remember my surgeon saying that upper jaw healing is "bone to bone" if you had the vertical dimension reduced. "Bone to bone" should heal up because a good deal of bone doesn't need to fill in the space and the plates and screws hold things pretty snugly together together. Is there a chance the plates and screws aren't holding things tight enough together? My experience is bone formation is a slow process, my jawline from lower jaw advancement took nearly a year to look "unbumpy" and even out as the new bone formed. Maybe it is just to early to know yet. Good luck and I love your humor about it all

#22 Post by **phil** » Tue Aug 21, 2007 2:13 pm

smile2006,

Thanks for your response and well wishes.

It was a 5 mm advancement, with no change in vertical dimension. In other words, it was just "slid forward," as I understand it.

I just don't think that my surgeon has had enough experience with this to really know what's going on, which brings me to my next point...

...I need every person who is reading this message, if you can, to ask your surgeons if they have ever had a case of maxillary "fibrous union" or "delayed union," and if so, what they did to ensure a satisfactory outcome for their patients. I am really serious. I need all the help I can get, and I'm asking everyone to gather as much information for me as you can. In the meantime, I am going to try to get a consult with another specialist, and get a second opinion on what is possibly going on here.

I also think the possibility exists that my 42 (almost 43!) year-old bones were not healed sufficiently when I tried to start chewing, and that perhaps I have refractured the bone. My surgeon did not seem to consider that as an option, but I'm going to present it to him--as they say, hoist it up the pole, and see who salutes!

Many thanks to everyone who has responded, and all the support I've received on Archwired. I really don't think I'm going to make it through this without you!

#23 Post by **HighandLo** » Tue Aug 21, 2007 2:26 pm

Phil,

I'll see me surgeon tomorrow afternoon and I'll ask him and let you know what he says. Your sense of humor is refreshing, as usual

.

Talk to you soon,

Lo

#24 Post by **HowlingWolf** » Tue Aug 21, 2007 2:36 pm

Phil-

That is a bummer. hope you receive better new soon.

#25 Post by **Brandyleigh35** » Tue Aug 21, 2007 2:59 pm

Wow Phil,
I have never heard of such a thing! Your surgery sounds like the Lefort 1 was pretty straight forward, I'm just confounded as to how something like this happens, and like you said what do they do to fix it?

Man...make me glad that I wasn't eating anything other then liquids and super soft stuff for 6 weeks.

Glad you checked in with your surgeon though, and that you knew something wasn't right. I can tell you that I really noticed when my ortho had me start using rubberbands at 2 weeks that things got kindof wonky with my maxilla. I would wake up in the morning and remove them and actually feel my maxilla move upward. It was very disconcerting. My OS seem to not think it was a problem and I noticed that eventually by about 2.5 months things were feeling much more solid. I can actually feel new bone growth on my jawline where they cut out the bone graft and the area they placed it in. It has actually filled in quite a bit like half or even less of what it initially was.

So he wants you to give it a bit more time to heal right? But what then if it doesn't get better? I wonder too like beauty, is it due to the plates not holding things together well? I mean bone on bone should heal! Your theory of possibly refracturing it though is a good one too. I will be interested to hear what other doctors say about this. I won't be seeing my OS for another couple of months so I really can't ask him, but this has really peaked my curiosity so I'm curious to learn more. My surgeon is really good so I wish I had the opportunity to ask him! Oh....I think I know who I can ask. I will gt back with you!

Brandy

#26 Post by **phil** » Tue Aug 21, 2007 3:14 pm

Brandy,

Thank you so much for your response.

I would appreciate any information that you can gather for me--all the way from the north country!!!

#27 Post by **ohmyjaw** » Tue Aug 21, 2007 3:49 pm

Hi Phil,

I'm really sorry to hear about the difficulties you are having. I have never heard of this problem, and I am not seeing my surgeon for anymore check-ups so I can't ask him about it. However, I don't really think you could have done damage by chewing too soon. I was cleared to "eat anything that doesn't cause you pain" after about two weeks. Obviously my bones were not healed at two weeks, but I believe that is why the plates and screws are there. That's just my two cents. I hope things get better for you soon.

#28 Post by **phil** » Tue Aug 21, 2007 6:16 pm

Thank you again to everyone who has posted.

I am even more strongly thinking that a second opinion is necessary, considering that my surgeon has limited experience with this. I'm going to take care of getting that appointment set up tomorrow.

I never thought that I would be saying this, but...
I MISS MY ELASTICS! WAHHH!!!
Just from one day of no elastics, I am officially Mr. Wonky Bite. I'm very sad about this, because I had made amazing progress in the last couple of weeks with the muscles, and now, like wayward children that have no one to guide them, they go where they want. Sigh.

I'll keep you all posted.

#29 Post by **Happysmiler** » Wed Aug 22, 2007 1:43 am

Hi Phil,

Really sorry to hear you are having this problem, it must be a real worry for you, but I'm sure they will sort it out somehow.

I found this article on the use of Ultrasound to help with non union / delayed union which is very long winded but some of the information may be of interest.

Incidentally, it appears the term 'delayed union' is given to bones that have not healed from 3 - 9 months (which is you) and 'non union' is anything from 9 months and above. (or so it states in this article)

This is the link - http://crobm.iadrjournals.org/cgi/content/full/14/1/63

I would also seek an opinion from a bone specialist if I were you.

Good Luck, try not to panic, from reading this article it appears this is a problem that does occur from time to time so there must be ways to correct it - its just one more challenge for you to face I'm afraid.

Happysmiler

#30 Post by **phil** » Wed Aug 22, 2007 2:03 am

Happysmiler,

Thanks for showing me the article. I had found it as well, and I'm planning on presenting this as an option to my surgeon.

By the way, it is hopeful (in a way) that I haven't even made it to the three month mark yet--just out eight weeks so far. So, perhaps we will wait another month, and then see what we see. I am going to seek a second opinion, however.