Two options on Lower Jaw (BSSO) (Cuts v's Plates)

[Beebop]

Surgery is pending - And my surgeon has given me two options on the lower JAW procedure, one is where they cut far back against the vertical away from the main nerve and the other is further down the horizontal jaw line.

With the vertical cut they are away from the main nerve, which in turn reduces the risk of permanent numbness. However, this means that I will be fully wired shut for approx. 6-weeks whilst the bones heal.

With the cut further down the horizontal part of the jaw, there is no need to wire me shut and at worst I will be banded for approx. 2 weeks and then ok. They will cut and plate this if done, but there is more risk in permanent numbness (10%).

I am really not sure what way to go, my heart is telling me to do the less risky one as I really don't want to be numb, but my head is saying what if you need to open or breathe (I suffer from nasal breathing issues which is part of my upper jaw issues) and go with the plated method, as breathing is more important than numbness!

Any advice or experience in either, feedback would be great thank you...

[Alicia110613]

I'm terrible with medical terms, but I think the vertical cut you're referring to is called IVRO, which has been the "traditional" surgical method, while the horizontal is BSSO. Most surgeons tend to do BSSO now because the patient doesn't have to be wired shut for 6 weeks.

My surgeon presented me with both options as well, but he recommended BSSO because the recovery is easier on the patient. It's also a little easier for the surgeon, I think, because the cut isn't as far back. I went with his recommendation. Prior to the surgery, I was mentally prepared for the possibility of some degree of numbness. I ended up getting very lucky and currently have none.

I can definitely see the benefit of IVRO -- 1) no numbness, and 2) no sticking metal plate/screw inside your mouth permanently! I think some primary items you should consider are: a) how long you can take off work/school for recovery, as you will likely want some more time with IVRO; b) whether you can psychologically deal with being wired shut for 6 weeks; c) whether numbness is a very important issue to you; d) whether you care about having some permanent plates or screw in your mouth; e) if your surgeon mostly performs one procedure over another.

There are a lot of discussions on this topic. I have also seen people talk about the issue of asymmetry and stability and one procedure being better than the other. Hope this helps!

[sirwired]

You'll need to discuss it with your surgeon, but I'm under the impression that most of the "permanent numbness" consists of slightly reduced sensation on the chin, which is not something I'd personally really miss.

Being wired shut for 6 weeks would be really unpleasant to me. I thought the soft diet I had until my splint came off was bad; I think a liquid diet would have driven me nuts.

[Beebop]

Thanks for the feedback guys, and like you Alicia I am rubbish with medical terms! Have done some googling and yes IVRO is one way and BSSO the other, I just couldn't remember what they told me

They are also on about doing Genioplasty, so that does carry some nerve damage rick, perhaps if that was not the case IVRO is the way to go, but if I did IVRO and the Genio damaged the nerves, it could all be in vain being wired for 6 weeks. Who knows!

I'd like to try a dry run of being wired before surgery for a few days to see how I fare, as after it's done is too late to change your mind. What a decision

[sirwired]

I like the "dry run" idea... just ask your ortho (or oral surgeon) for some really heavy bands and that should do the trick, and you could abort the experiment at any time, unlike actual wires.

[boodles8]

If it's any help in deciding, I'll tell you about my numbness. I had BSSO in August last year. The right side of my face is almost completely numb from the far corner of my lower lip over to the very middle of my chin, and down from the lip to the corner of my of face, where what I would call my "face" becomes "under my face". It's probably 2 square inches of area.

It doesn't bother me much. Mostly, it's a social issue if I happen to drop food on it because I don't know it. So far, I've only had that happen once (at least that I know of, haha) when it was embarrassing. The other times I have been home with my family, and they all know about the numbness. Anymore, they just look at me and point at their faces. This is infrequent, less than once a month. Ice cream is the worst offender: I would never eat a cone in public.

Other than the food issue, I could care less. It's really been a non-issue once I got used to it.

[Beebop]

Thanks for the info Boodles, I am still in a quandary what to go with, I am also not sure now IVRO is best after reading that it can be trickier to do due to the position (although my surgeon says no difference in trickyness) and to me there could be stability issues until it's all healed, with bsso everything plated into correct position. Decisions!

[Beebop]

Ok people, thought I'd update on this query and my thoughts post surgery...

I ended up going with BSSO in the end, and to be honest. I am glad I did. Nothing can make you understand what it's like the first few days after surgery until your there, and being able to open my mouth was a god send. I had all sorts of berating issues, nose bleeds and nasal blockages. I think being wired shut would have caused me even more distress and discomfort.

I am still pretty numb in my chin and bottom lip, but have only just passed the 3 week stage after surgery. As I am lightly banded for guiding my bite, I am able to eat soft food and drink without using a syringe, therefore taking in more calories and aiding my recovery. I can also take bands off to exercise the jaw and eat a bit more

I am crossingmy fingers I get feeling back, it's early days yet. But in all I am glad I did not go IVRO and wired shut!

[deathorglory]

Congrats on making it to the post surgery portion of braces!!!

Thank you for posting your experience - my surgeon recommended the BSSO but also mentions the IVRO as an option if my nerves were found to be in a less than optimal placement. This makes me much less worried about the numbness associated with the BSSO...and I'll be super excited to eat solids so quickly once the ordeal is over!!!

[Beebop]

Congrats on making it to the post surgery portion of braces!!!

Thank you for posting your experience - my surgeon recommended the BSSO but also mentions the IVRO as an option if my nerves were found to be in a less than optimal placement. This makes me much less worried about the numbness associated with the BSSO...and I'll be super excited to eat solids so quickly once the ordeal is over!!!

No problem and thank you! My surgeon did say that if the Splits didn't go right, he may end up doing it differently which would mean being wired, so I did know before going under it was a slight possibility, but luckily didn't happen and all went well. Just bear that in mind, the split and how that goes can have a bearing on things... Good luck with your journey