Not to steal Phil's thread but I was 41 when I had double jaw surgery. I was able to run 2 weeks after surgery and rode my stationary cycling trainer after 1 week, however, riding in the car made me feel weird (sort of dizzy, not really nauseous). I would say give yourself at least a week to ten 10 days before flying. You really get tired easily after surgery and you need a plan for good oral hygeine. Good luck!
FOR PHIL- I beleive you are a teacher...have you returned yet????? I was wondering how speaking a full day went. That was challenging for me. I felt like I had a little itty bitty voice after surgery and a splint for 6 weeks! Also, good luck with your current issue. I'll be curious to see what becomes of it. It is something I hadn't heard of. Everything aside, you look great, the surgery did so much for your face and profile! If it makes you feel better, I still don't chew things like steak, I'm a weeny. I did bite corn off the cob for the first time in my life the other day though!!!! (my open bite used to make that impossible and then when that was corrected I still had braces)
Stability Questions, LeFort I--Life with a delayed Union
Moderator: bbsadmin
smile2006,
I am an elementary music specialist. I use my voice a LOT all day every day. To top that off, I am a church music director. My chops get a workout on a regular basis!
Next Wednesday is the first day with students--staff returns to work on Monday. I will somehow find what I need inside of me to get the job done. I always have! In the middle of this surgery recovery crisis, I have been working like the devil to get my year plan whipped into shape. I just finished the bulk of it today. Something inside of me SNAPPED today--in a good way. I really got off of my keester, and cranked it into gear on both topics! I guess I stopped feeling sorry for myself.
So, that's where I am right now, enjoying a few more precious days before life becomes fast and furious again!
I am an elementary music specialist. I use my voice a LOT all day every day. To top that off, I am a church music director. My chops get a workout on a regular basis!
Next Wednesday is the first day with students--staff returns to work on Monday. I will somehow find what I need inside of me to get the job done. I always have! In the middle of this surgery recovery crisis, I have been working like the devil to get my year plan whipped into shape. I just finished the bulk of it today. Something inside of me SNAPPED today--in a good way. I really got off of my keester, and cranked it into gear on both topics! I guess I stopped feeling sorry for myself.
So, that's where I am right now, enjoying a few more precious days before life becomes fast and furious again!
HERE'S THE SCOOP!
I finally talked with my surgeon today. He agreed to send a letter of referral to another surgeon. The one I'm going to see is the head of the Oral/Maxillofacial dept. at the local university. It's a huge department, and hopefully, with the larger case load, they will have seen more cases like mine than my surgeon has.
My surgeon also told me that he consulted with all four of his colleagues in his own practice (it's a huge practice), two of which are his senior by eight years, and one who is an instructor at the local university. They all agree that things are going to be fine, and in time that bone will heal. We just don't know exactly how much time. So, I suppose that's good news. The more brain power we have working together on this case, the better.
Here are the factors that my surgeon says may have played into my delayed union:
1) My age (grrrrrr)
2) Use of elastics during the healing phase
3) The change of blood flow patterns as a result of last summer's SARPE surgery
4) My clenching habit at night (I really can't do anything about this)
Of the four of these, numbers one and three seem to make most sense. I can't imagine that the elastics would have had that much effect. After all, just about everyone has them, and not everyone has maxillary delayed union.
I have also made an interlibrary loan request of "Peterson's Principles," which has a section in one chapter on maxillary delayed union. As soon as I get THAT, you better believe that I'll be reading!
I finally talked with my surgeon today. He agreed to send a letter of referral to another surgeon. The one I'm going to see is the head of the Oral/Maxillofacial dept. at the local university. It's a huge department, and hopefully, with the larger case load, they will have seen more cases like mine than my surgeon has.
My surgeon also told me that he consulted with all four of his colleagues in his own practice (it's a huge practice), two of which are his senior by eight years, and one who is an instructor at the local university. They all agree that things are going to be fine, and in time that bone will heal. We just don't know exactly how much time. So, I suppose that's good news. The more brain power we have working together on this case, the better.
Here are the factors that my surgeon says may have played into my delayed union:
1) My age (grrrrrr)
2) Use of elastics during the healing phase
3) The change of blood flow patterns as a result of last summer's SARPE surgery
4) My clenching habit at night (I really can't do anything about this)
Of the four of these, numbers one and three seem to make most sense. I can't imagine that the elastics would have had that much effect. After all, just about everyone has them, and not everyone has maxillary delayed union.
I have also made an interlibrary loan request of "Peterson's Principles," which has a section in one chapter on maxillary delayed union. As soon as I get THAT, you better believe that I'll be reading!
-
SandraJones
- Posts: 333
- Joined: Wed Aug 01, 2007 10:23 am
- Location: Chicago
I feel bad for you that you have to go through this, but it's clear you're doing your research and doing everything else you need to do to take care of it in the best way possible, and you've got a team of skilled MDs to assist, so on top of all of that I think you just need some good luck !!
I wonder if your SARPE expansion produced a similar result, you just wouldn't notice it because the palate centerline doesn't have the kinds of forces on it that the maxilla le fort 1 line does. Or maybe it does, what do I know !!
I wonder if your SARPE expansion produced a similar result, you just wouldn't notice it because the palate centerline doesn't have the kinds of forces on it that the maxilla le fort 1 line does. Or maybe it does, what do I know !!
Nov 1960: born
1973 ?: palate expander
1973-1977: braces
Aug 1981: Le Fort I, posterior impaction to correct anterior open bite and class II malocclusion
Aug 2007: braces again to correct various alignment issues and class II malocclusion
1973 ?: palate expander
1973-1977: braces
Aug 1981: Le Fort I, posterior impaction to correct anterior open bite and class II malocclusion
Aug 2007: braces again to correct various alignment issues and class II malocclusion
-
4beauty4symmetry
- Posts: 226
- Joined: Thu Nov 16, 2006 5:58 pm
- Location: boston
It seems like having Sarpe before Lefort, rather than combing both in the 'segmented lefort," has been more the norm in recent years, at least in the US. And so we would be seeing higher incidences of fibrous union.
I dunno. Seems to me chewing or biting too hard could prevent the fusion that is needed.
Phil, why rule out clenched teeth?
Of course, you can drive yourself mad trying to figure out the cause, when it might just be something that goes away in time. It's not as if you've been developing growth that obstructs the fusion, are you? Could fibrous union, at least in your case, be simply a matter of 'bones taking forever to fuse?'
I dunno. Seems to me chewing or biting too hard could prevent the fusion that is needed.
Phil, why rule out clenched teeth?
Of course, you can drive yourself mad trying to figure out the cause, when it might just be something that goes away in time. It's not as if you've been developing growth that obstructs the fusion, are you? Could fibrous union, at least in your case, be simply a matter of 'bones taking forever to fuse?'
Dec 2006--RPE followed by SARPE surgery
Jan 2007--Braces
Nov 2007 BSSO mandibular setback, genioplasty, and two implant anchors. Surgery-eve reprieve from Lefort.
May 2008--Debraced
Surgeries in Costa Rica, Orthodontics in Massachusetts.
All to fix an openbite, crossbite, underbite, and two missing bottom molars.
Jan 2007--Braces
Nov 2007 BSSO mandibular setback, genioplasty, and two implant anchors. Surgery-eve reprieve from Lefort.
May 2008--Debraced
Surgeries in Costa Rica, Orthodontics in Massachusetts.
All to fix an openbite, crossbite, underbite, and two missing bottom molars.
-
4beauty4symmetry
- Posts: 226
- Joined: Thu Nov 16, 2006 5:58 pm
- Location: boston
It seems like having Sarpe before Lefort, rather than combing both in the 'segmented lefort," has been more the norm in recent years, at least in the US. And so we would be seeing higher incidences of fibrous union.
I dunno. Seems to me chewing or biting too hard could prevent the fusion that is needed.
Phil, why rule out clenched teeth?
Of course, you can drive yourself mad trying to figure out the cause, when it might just be something that goes away in time. It's not as if you've been developing growth that obstructs the fusion, are you? Could fibrous union, at least in your case, be simply a matter of 'bones taking forever to fuse?'
I dunno. Seems to me chewing or biting too hard could prevent the fusion that is needed.
Phil, why rule out clenched teeth?
Of course, you can drive yourself mad trying to figure out the cause, when it might just be something that goes away in time. It's not as if you've been developing growth that obstructs the fusion, are you? Could fibrous union, at least in your case, be simply a matter of 'bones taking forever to fuse?'
Dec 2006--RPE followed by SARPE surgery
Jan 2007--Braces
Nov 2007 BSSO mandibular setback, genioplasty, and two implant anchors. Surgery-eve reprieve from Lefort.
May 2008--Debraced
Surgeries in Costa Rica, Orthodontics in Massachusetts.
All to fix an openbite, crossbite, underbite, and two missing bottom molars.
Jan 2007--Braces
Nov 2007 BSSO mandibular setback, genioplasty, and two implant anchors. Surgery-eve reprieve from Lefort.
May 2008--Debraced
Surgeries in Costa Rica, Orthodontics in Massachusetts.
All to fix an openbite, crossbite, underbite, and two missing bottom molars.
SandraJones,
Ultimately, I am the person who is responsible for my health care, not the professionals. They do the work, but I am really the person who has to make the decisions, based on what they tell me.
Funny you should bring up the SARPE, becuase I brought it up to my surgeon when I talked to him on the phone today. He said that my bone formation results from SARPE were typical--there were a few small (less than 1 mm) holes in the bone, which in no way compromised the stability of the maxilla. In other words, I healed from SARPE, and the bone healed in a typical fashion. However, SARPE surgery is much more stable, and much less drastic than a LeFort I, where the maxilla is completely detached and moved. Definitely not the case in SARPE! Believe me, when it came time for me to expand that palate 1/4 mm every day, I could tell that it was still attached!!!
Ultimately, I am the person who is responsible for my health care, not the professionals. They do the work, but I am really the person who has to make the decisions, based on what they tell me.
Funny you should bring up the SARPE, becuase I brought it up to my surgeon when I talked to him on the phone today. He said that my bone formation results from SARPE were typical--there were a few small (less than 1 mm) holes in the bone, which in no way compromised the stability of the maxilla. In other words, I healed from SARPE, and the bone healed in a typical fashion. However, SARPE surgery is much more stable, and much less drastic than a LeFort I, where the maxilla is completely detached and moved. Definitely not the case in SARPE! Believe me, when it came time for me to expand that palate 1/4 mm every day, I could tell that it was still attached!!!
Hi Phil,
Good that you got some answers today! It sounds like they know what's going on.
I did speak to my OS today and he was kind enough to spend 15 minutes answering my questions. Basically, he said the same things as what you already mentioned. Here is some info for consideration:
It is very rare and has never happened to his patients, but he did have a case where a woman came to him 6 months post-op and her jaw hadn't healed yet! He consulted with a colleague 20 yrs his senior on it and the woman's jaw did heal eventually. They have seen it take 4-6 months for jaws to heal and 8 weeks out is not cause for alarm. He said he would recommend what your OS said to do - wait. He has never seen a case that didn't heal eventually and doesn't have knowledge of any extraordinary treatments being used.
Delayed or nonunion usually only happens in maxillary cases. The maxilla is not nearly as think as the mandible. Parts of it may only be 1mm thick. Think of the tiny blood vessels that need to go through that in order to heal. He had a patient with a maxilla so thin, the screws would practically fracture the bone and he had to re-do the screws (I asked if this was me - no
). And density of the maxilla doesn't necessarily have to do with how big a guy or gal is.
Dr. G said elastics are important because when you chew or speak, etc., the elastics (especially our heavy ones) are basically working against keeping your maxilla together (somewhat obvious, but I had never thought of it!). The elastics are attached to the teeth which are attached to the lower part of the maxilla and this leaves the two surgically separated parts of the maxilla trying to hold together for dear life - with the screws, of course. Even while sleeping, your jaw could be moved by strong elastics in a way you don't realize when awake.
I didn't mean to write a book. Just trying to record all the OS told me.
It sounds like you're in good hands! All your doctors are concerned about you
.
Lo
Good that you got some answers today! It sounds like they know what's going on.
I did speak to my OS today and he was kind enough to spend 15 minutes answering my questions. Basically, he said the same things as what you already mentioned. Here is some info for consideration:
It is very rare and has never happened to his patients, but he did have a case where a woman came to him 6 months post-op and her jaw hadn't healed yet! He consulted with a colleague 20 yrs his senior on it and the woman's jaw did heal eventually. They have seen it take 4-6 months for jaws to heal and 8 weeks out is not cause for alarm. He said he would recommend what your OS said to do - wait. He has never seen a case that didn't heal eventually and doesn't have knowledge of any extraordinary treatments being used.
Delayed or nonunion usually only happens in maxillary cases. The maxilla is not nearly as think as the mandible. Parts of it may only be 1mm thick. Think of the tiny blood vessels that need to go through that in order to heal. He had a patient with a maxilla so thin, the screws would practically fracture the bone and he had to re-do the screws (I asked if this was me - no
). And density of the maxilla doesn't necessarily have to do with how big a guy or gal is. Dr. G said elastics are important because when you chew or speak, etc., the elastics (especially our heavy ones) are basically working against keeping your maxilla together (somewhat obvious, but I had never thought of it!). The elastics are attached to the teeth which are attached to the lower part of the maxilla and this leaves the two surgically separated parts of the maxilla trying to hold together for dear life - with the screws, of course. Even while sleeping, your jaw could be moved by strong elastics in a way you don't realize when awake.
I didn't mean to write a book. Just trying to record all the OS told me.
It sounds like you're in good hands! All your doctors are concerned about you
.Lo
4beauty4symmetry,
In regards to SARPE/LeFort I combination: yes, that would be the case, if indeed there is a correlation. We don't know if there IS a correlation, though. For instance, Brandy had SARPE/LeFort I, and no complication with bone healing. But, two cases does NOT a study make! There are also too many variables to compare our cases, I think.
In regards to clenched teeth, I just don't think that putting pressure on the maxilla (not pull away from it) would be as strong a factor in it NOT fusing. Makes sense to me, but maybe it's not that simple.
Nobody seems to think that anything is forming that would OBSTRUCT bone growth. I guess I don't know enough about that to respond with an educated statement. Actually, I'm using the term "delayed union" now, which more addresses the time frame, and none of the doctors are arguing with me, so it must not be incorrect. Technically, though, I couldn't be diagnosed with delayed union for another couple of weeks.
Wait til my textbook arrives, though! I'll have more information.
LO,
Thank you so much for your lengthy post. The information that you bring just increases our collective brain power all the more.
The next time you see your surgeon, please pass on a big thank you from me for taking the time to answer that question. I'm extremely grateful!
In regards to SARPE/LeFort I combination: yes, that would be the case, if indeed there is a correlation. We don't know if there IS a correlation, though. For instance, Brandy had SARPE/LeFort I, and no complication with bone healing. But, two cases does NOT a study make! There are also too many variables to compare our cases, I think.
In regards to clenched teeth, I just don't think that putting pressure on the maxilla (not pull away from it) would be as strong a factor in it NOT fusing. Makes sense to me, but maybe it's not that simple.
Nobody seems to think that anything is forming that would OBSTRUCT bone growth. I guess I don't know enough about that to respond with an educated statement. Actually, I'm using the term "delayed union" now, which more addresses the time frame, and none of the doctors are arguing with me, so it must not be incorrect. Technically, though, I couldn't be diagnosed with delayed union for another couple of weeks.
Wait til my textbook arrives, though! I'll have more information.
LO,
Thank you so much for your lengthy post. The information that you bring just increases our collective brain power all the more.
The next time you see your surgeon, please pass on a big thank you from me for taking the time to answer that question. I'm extremely grateful!
HERE'S WHAT I KNOW:
My friend who is a surgeon just got back from vacation, and called me tonight. He is not an oral/maxillofacial, but a head/neck surgeon, so he's at least familiar with the territory!
He said that the current game plan is a good one, and it sounds like we're doing everything we should be doing. He had no experience with the use of ultrasonic therapy for healing of delayed union. He didn't have any other unique comments to add to the mix. That was very comforting!
He did add: Immobilization (the titanium pretty much does that) and Good Nutrition (I do fairly well in this department).
That's all for now!
My friend who is a surgeon just got back from vacation, and called me tonight. He is not an oral/maxillofacial, but a head/neck surgeon, so he's at least familiar with the territory!
He said that the current game plan is a good one, and it sounds like we're doing everything we should be doing. He had no experience with the use of ultrasonic therapy for healing of delayed union. He didn't have any other unique comments to add to the mix. That was very comforting!
He did add: Immobilization (the titanium pretty much does that) and Good Nutrition (I do fairly well in this department).
That's all for now!
Guess what? I found Peterson's Principles online. Read to your heart's content.
http://dentistry.tums.ac.ir/Files/lib/M ... s/ch60.pdf
Page 1250 has the section on delayed or nonunion of the maxilla. Sounds like my surgeon is doing everything right. The only thing that I surmise from this article that could have been done to prevent my delayed union is the use of a splint for a couple of weeks postoperatively. Why my surgeon chose not to do that...hmmm.
The jury seems out on IMF (intermaxillary fixation) as a response to delayed union. Thank God! Being wired shut the week before school starts. No thank you!
http://dentistry.tums.ac.ir/Files/lib/M ... s/ch60.pdf
Page 1250 has the section on delayed or nonunion of the maxilla. Sounds like my surgeon is doing everything right. The only thing that I surmise from this article that could have been done to prevent my delayed union is the use of a splint for a couple of weeks postoperatively. Why my surgeon chose not to do that...hmmm.
The jury seems out on IMF (intermaxillary fixation) as a response to delayed union. Thank God! Being wired shut the week before school starts. No thank you!
-
SandraJones
- Posts: 333
- Joined: Wed Aug 01, 2007 10:23 am
- Location: Chicago
First of all, let me tell you how happy I am for you that you're on top of your situation and you're feeling like it's going to work out well after all. Whew !!! You must feel SO much better now.
I also want to thank you for the link you just posted. I'm going to spend hours scouring this document, for no other reason than I am fascinated by maxillofacial surgery. I just hate that I'm at work right now and can't possible read such a complex doc during my lunch break. I know what I'm going to be doing this evening !
Added note: I'm reading, and I can't put this doc away !!!! LOL
I also want to thank you for the link you just posted. I'm going to spend hours scouring this document, for no other reason than I am fascinated by maxillofacial surgery. I just hate that I'm at work right now and can't possible read such a complex doc during my lunch break. I know what I'm going to be doing this evening !
Added note: I'm reading, and I can't put this doc away !!!! LOL
Nov 1960: born
1973 ?: palate expander
1973-1977: braces
Aug 1981: Le Fort I, posterior impaction to correct anterior open bite and class II malocclusion
Aug 2007: braces again to correct various alignment issues and class II malocclusion
1973 ?: palate expander
1973-1977: braces
Aug 1981: Le Fort I, posterior impaction to correct anterior open bite and class II malocclusion
Aug 2007: braces again to correct various alignment issues and class II malocclusion
SandraJones,
It all goes back to the old adage, "two heads are better than one." The more collective brainpower/information I can gather, the greater the likelihood of a satisfactory resolution to this problem.
I think sometimes patients assume that they can't understand what their physicians are doing, and/or what is going on in their own bodies. I believe in the patient being as educated as is possible, because as I have said before, I am ultimately the person responsible for my health!
The "Peterson's Principles" text seems like a good one. Most of the terminology I can understand, and figure out by context if not literal definition. I did get a little information from it about my case, including post-operative relapse of mandibular setback in skeletal class III patients (that's a MOUTHFUL--no pun intended). Evidently, for postsurgical orthodontic corrections, 3 mm is the "magic number." Well, that's what Van Sickels says, anyway! Any discrepancies greater than that, and you may have to go under the knife again!
All of mine are fortunately about 1 mm or less. Not a big deal at all in the orthodontic world!
Meryaten, impressive about chapter 56! I'll have to read it just for fun.
Onward and upward!
It all goes back to the old adage, "two heads are better than one." The more collective brainpower/information I can gather, the greater the likelihood of a satisfactory resolution to this problem.
I think sometimes patients assume that they can't understand what their physicians are doing, and/or what is going on in their own bodies. I believe in the patient being as educated as is possible, because as I have said before, I am ultimately the person responsible for my health!
The "Peterson's Principles" text seems like a good one. Most of the terminology I can understand, and figure out by context if not literal definition. I did get a little information from it about my case, including post-operative relapse of mandibular setback in skeletal class III patients (that's a MOUTHFUL--no pun intended). Evidently, for postsurgical orthodontic corrections, 3 mm is the "magic number." Well, that's what Van Sickels says, anyway! Any discrepancies greater than that, and you may have to go under the knife again!
All of mine are fortunately about 1 mm or less. Not a big deal at all in the orthodontic world!Meryaten, impressive about chapter 56! I'll have to read it just for fun.
Onward and upward!