lefort 1 non union. 2nd operation possibly 3. Interesting!

[uknhs1]

Before I start. I would just like to say that my intension is by no means to upset anyone who is having any surgery planned. I hope it doesn't make anyone more nervous than they already probably are.

My situation is as follows. And apologise for the length of this post. It's as short as possible whilst containing the most information.

Since 2008 I started consultations in the UK for my class 3 malloclusion. I had braces fitted Jan 2011 and had my 1st surgery in Sept 2012 (lefort 1). My jaw was moved forward 5.5mm and 3mm removed to correct the anterior open bite resulting from the orthodontic teeth movement.
I had elastics the morning after surgery and see my surgeon once a week for the 1st 4 weeks. This was the last time I saw my surgeon before problems occurred. On the 6th week I saw a different surgeon who finalised my 6 week check ie- off soft food.
Swelling was huge and took along time to go down and i was in a really dark place about my new appearance and after around 3 months post op my wife noticed all my teeth moving. Concerned we mention this to the head of the department and assured me I was still in the early stages of recovery. It wasn't until 4 months a consultant removed the elastics and soft food was gain the order of the day to help the jaw to knit together. During which excruciating burning was felt which rushed me back in for them to suggest it's nerves re attaching. 8 weeks later the the consultant said that it was non-union and small movement was acceptable or another re-do operation with hip graft to fix it. Weeks and weeks of continuous frustrating calling to arrange my re-do resulted in a 2nd surgery in Jun 2013.
10 months after my first op I had the same op with hip graft.
Heres the interesting part. My new surgeon said it was obvious there was a problem. Out of the 4 titanium plates installed, 1 had completely snapped and 2 were bent. The gap in the join had shown signs of infection and soft tissue had tried to grow in between the join to fill the void.
I had replacement plates installed (6 instead of 4) and bone graft to aid healing and also no elastics.
It is now 9 months after my 2nd op and although everything seems solid. I have a huge gap where my molars are supposed to meet making eating uncomfortable and (possibly) giving me digestive problems which I'm being seen for. My team wish to finish my treatment.
I have seen another orthodontist I recently for his opinion said he would actually refer my for orthagnatic surgery for my current jaw position.
I'm extremely upset, the whole experience has been awful, stressful and nearly broke a marriage up. Along with my chewing of food being hindered and possible digestive issues. I have really bad Rhinitis, I have stopped running to to hip ache, my nose has changed so much I'm desperately long for rhinoplasty of some kind.

Do I insist on elastics to try close the gap at a risk of possibly damaging the join. Opt for a 3rd operation. Accept the situation and pursue damages for medical neglegence. The stability issues following surgery should have been noticed and acted upon. Bearing in mind I had only 4 weeks of surgical interaction and "we" had to ask the question - is this movement normal to get answers.

[sirwired]

Don't have any advice for you, but I do have a question... were you in a splint post-surgery, or just elastics? For my LeFort I, they fixed a splint to my upper arch, and when things weren't stable at six weeks, they left it in for another three. My surgeon (who does well north of a hundred jaw surgeries a year) said I had the thinnest bone he had seen in years, and he wasn't surprised it took a while to heal.

I hated, Hated, HATED, that splint, but I know I would have hated those plates failing even more!

[uknhs1]

I had a splint made for my 1st surgery as a guide to drop the upper teeth into position. It was a surgical giude and wasn't left in place following the surgery.
They used the same splint for the second operation.

The whole ordeal just makes me go from being sad then angry then sad again. There's seems no conscience with some medical staff although the other orthodontist I saw for his opinion said that if I was his patient with all the complications I've had, wouldn't be able to sleep at night.

I can't find anything anywhere on folks who've had a second operation (as rare as it is anyway) and been absent from the elastics to close the teeth together leaving them with a posterior open bite.

[boodles8]

Gosh, what a mess. I'm sorry this happened to you! I'm afraid I really don't know what to tell you regarding a third surgery. There have been several on this board who have gone for second surgeries, but I don't remember any third surgery stories.

On the lawsuit question, I'd say it sounds like you could have one. Talk to a lawyer if you want to pursue it, and keep in mind that suits can take years to resolve.

Good luck with these hard decisions.

[uknhs1]

Yes-what a mess. The whole ordeal is starting to wear me down mentally and that is definitely harder to fix.

Has anyone who's had a (successful) 2nd operation and had elastics?

Following my second op, I have had no elastics as they think that the "pull" made by them to guide the teeth into position the first time has the upper jaw to pull away from the skull. Also with all the bite weight bearing down on the front teeth, the forces so far away fron the fulcrum has contributed. I'm my eyes, there should have been some sort of stabilisation on the molars to ballance out the bite forces. This theory has been seconded by a foreign surgeon I have contacted to try learn some details about what goes on.
They've steered clear of elastics this time but my jaw is solid, I've had nearly 8 months on healing (where bone takes 6-8 weeks), I have hip bone grafting in there and 6 plates and 24 screws (apposed to 4 and 16).
Surely it can't pull it apart now.
The chewing food with incisors must be doing more damage in the long run if the forces are not distributed even.
I do have some engineering skills and whats occured/happening is ringing alarm bells with me.
Imagine walking round on tip toes as instead of your weight normal through your feet and it starts to make sense.

[Jimson134]

WHo did you see, this sounds pretty bad, do they know why things moved and the plates broke after surgery

[uknhs1]

Without naming and shaming. The female surgeon along with her foreign trainee who operated on me at Aintree in Sept 2012 saw me for the 1st 4 weeks. Then she went off work sick (which made me wonder if she was in the right frame of mind to begin with) and I never saw her until 8 months after to a range the re-do but was deemed to unwell to perform surgery. After 4-5 months of asking questions it was too late to get the areas to knit together. This is when another (male) surgeon stepped in and sorted me out (somewhat) 10 months after my 1st op. He's performed many operations but only ever seen non union cases in textbooks which shows how rare my case is. Personally I belive that the fixing plates were not suitably installed, too much bone was removed leaving such a huge gap at the back for the bite forces and elastics to cause undesirable movement to the healing surfaces as there was so much force biting down just on my incisors and nowhere else. All this leading to the 2 bent and 1 broken plate.
I have now had my brackets removed but still have a 3mm gap at both sides at the rear making chewing with molars impossible. They were removed as the braces had been on longer than like. Such as stressful time and hope anyone else doest go through it. There's no way I would have had this done if I knew the stress it would cause. I wish that my 2nd surgeon operated 1st, I have had 0 confidence in my 1st surgeon since she left me. It almost feels like she has tried to run away from her mistakes but that's just me feeling bitter over the whole ordeal.