DEVASTATED - Just Told I Require Full Revision of Bi-Max Surgery

[Eranthe]

Hello,

Today I have been given the absolutely devastating news that "something went wrong" with my bimax surgery, and that I require a complete revision of the entire surgery - both jaws. I have been completely distraught all day ... I just walked out of my surgeons office this afternoon, walked to my car and sat there and sobbed for two hours and then drove home. Now I just feel like I am in shock. I have posted before on this forum in the past, but to briefly recap my history, I had my SARME in August 2014, and had the bi-maxillary on 16 October, 2015. My reasons for surgery were primarily functional (sleep apnea and tmj since childhood) but also cosmetic as I did not like my weak/receding chin and long face. I was due to have my braces removed around about now, but now they must stay on as I prepare for revision surgery.

I remember seeing my face for the first time, 24 hours after surgery when the intensive care nurse took me to the bathroom for a chair-shower. I knew then and there that something was wrong. My maxilla appeared slanted/canted, and even though I still had a bit of a gap between my front teeth from the SARME, I could see that my midline was way off to the left.

For the last ten months since the bimax, I have continued to feel that things are not right. I have a crooked nose (to the left), my left nostril is completely blocked (deviated septum), my midline is off at least 5mm to the left (my frenum is off 5 mm to the left), and when I smile my whole face hitches up to the left which makes me look like I am sneering at best, at worst as it looks as if I have had a mild stroke. My left tmj muscles have seized up pull very tightly each time I try to move my bottom jaw jaw from side to side. In terms of both aesthetics and function, my surgery has been a failure in my eyes.

Each time I have tried to discuss this with my surgeon or the registrars at the public hospital over the last ten months, they have never been able to give me much time. My surgeon is always in a rush, and can only spend a few minutes at a time with me. Each time he has had a cursory look at my mouth and face, and I have been dismissed with the line "wait for things to settle down, there is still residual swelling"! Finally this week, after months of depression and anxiety (this whole process has been dragging on for two years so far) I made an appointment to meet my surgeon in his private offices. I was willing to pay his consultation fee just to have a decent amount of his time and attention. I took a male friend and typed up a list of concerns to give to my surgeon. I was distraught. He finally listened, finally gave me a proper examination in the chair and immediately agreed that "yes, the top jaw is definitely off ... for some reason the maxilla has slipped out to one side. That is why you have strain on your left tmj. The mandible is in the correct position, but the maxilla is not. I'm so sorry this is happened. I don't know why this is happened. I don't understand it at all. Please allow me to fix it for you personally".

Having my concerns finally validated, after being dismissed for so long, was a mixed blessing. Whilst I am relieved that he has accepted responsibility for the mistake and has offered to redo the surgery, the fact that I have to go through the whole process again has left me feeling very emotional and overwhelmed. Having this surgery was the most difficult thing I have ever done in my life, and when I look back I feel like I barely survived those three days in hospital. It was an extremely traumatic experience for me, and I often say to people "if I had know how hard it was going to be, I wouldn't have done it". Well, now I have no choice, I have to do it again, and I know exactly what is ahead.

I feel angry, tired and overwhelmed ... but somehow I have to start preparing to redo the whole journey. So I guess I thought a good starting point would be to check back in here and reconnect with others on the same road. I could really do with some support this time around.

Thanks so much for reading this far.

Liz

[Eranthe]

I also wanted to add that, my chin and bottom lip are still almost completely numb, ten months after my last surgery. Now because of this, my surgeon has told me that after this revision surgery it will take at least 24 months to recover any feeling in that area IF I DO AT ALL, as the nerves will be so damaged/traumatized. I am so scared to the trauma of surgery, both psychologically and physically, but I don't want to be left like this either. I am so upset, I would be so greatful for any advice anyone out there may be able to offer. Thanks again, Liz

[Lostfaith]

I can understand the devastation as I'm going through the same thing , only mine hasn't shifted they took away to much bone from upper jaw which leaves me looking old. If you don't feel comfortable with the same surgeon can you ask to be referred to someone else? My surgeon won't take any responsibility for the fact it doesn't look right and I have been referred to a NHS consultant to hopefully correct. It's meant to be a positive life changing surgery but equally when it goes wrong it can leave you with major depression and anxiety.

[Snophik]

Hi guys,
I am also having a redo of my surgery. The surgeon placed my maxilla a few mm off center, and removed a lot of bone. The operation was supposed to make me show more teeth, and now it looks like I don't have any. This has also made my nose really different and I show very much of my lower teethe.
I had the same feelings when I woke up. I thought that if I had known about how hard the recovery is, I'm not sure I had done it. But I can't live like this and have to do it again. I'm sorry you have to go through this. But I hope we can support each other in the process of getting everything right and where is suppose to be.

[Lostfaith]

Yes that's exactly the same as me , now show hardly any upper tooth and to much lower , it makes me look older than I am. When I smile it all scrunches up , so unattractive.

[BrooklynsOwn]

I also wanted to add that, my chin and bottom lip are still almost completely numb, ten months after my last surgery. Now because of this, my surgeon has told me that after this revision surgery it will take at least 24 months to recover any feeling in that area IF I DO AT ALL, as the nerves will be so damaged/traumatized. I am so scared to the trauma of surgery, both psychologically and physically, but I don't want to be left like this either. I am so upset, I would be so greatful for any advice anyone out there may be able to offer. Thanks again, Liz

Hi Liz I am sorry for all you are going through. You mentioned that the first 3 days in the hospital were really bad, can you elaborate? What was the most troublesome? I have the same reasons for jaw surgery that you have, Sleep Apnea, recessed lower jaw, my teeth or my jaws just dont feel like they are in the correct position and at night I can't even keep my teeth closed which I dont think is normal. I have heard so many mixed reviews about the recovery process the first few days after. Some people like yourself and there are quite a few who say its the hardest things they ever experienced and then you have people who said by the 2nd or 3rd day they were already taking short walks with almost no pain at all! Is your surgeon from the US? Good luck with your revision!!

[Eranthe]

Hello everyone, my apologies for my delayed response. In the midst of all of this, a family member became quite ill and this has been taking up much of my time. You may recall that, after ten months of trying to alert the young registrars in the public hospital clinic that my maxilla was reattached canted and several mm off to the LHS, I finally made an appointment with the surgeon supervising the operation in his private rooms. He agreed there was an error, has not been able to explain what went wrong, and has booked me in for revision surgery - maxilla only.

My problem is this. He originally saw me as a public patient - so whilst he was overseeing my surgery, he works in a teaching hospital, so he had a surgical registrar "assisting" him with the procedure. Herein lies the rub, as I am unsure as to how much "hands on" involvement surgical registrars have during surgery. He explains it to me as the registrar is an assistant, but that he performs all the substantial activities whilst the registrar, I guess, performs ancilliary duties. I guess this was something I was prepared to accept first time around - however, I have been reading a lot of research and personal stories which suggest that revision surgery is a delicate and often precarious procedure that should only performed by a surgeon with considerable experience and expertise.

It seems as though my surgeon has agreed a mistake has been made, but has not explained what that mistake actually was, or who is responsible for it, and has offered to do a revision surgery personally to correct it "please let me do it personally" ...

but ...

he is now asking me to sign consent forms between myself and the current registrar.

Whilst it didn't bother me having my original surgery performed by my surgeon with his registrar assisting/supervising, I feel it only appropriate that the revision surgery he offers me be carried out solely by an experienced surgeon ... ie. him? That is what I took him to mean when he said "please let me do it personally". Is this an appropriate way to view the situation?

I guess I am anxious now that I realize that things can and do go wrong occassionally, and I just don't know the full extent of the registrars involvement. I just can't help but feel that things went wrong last time because my surgeon allowed that particular registrar too much independent activity and that might be the reason I have to go through this whole ordeal again.

As a public patient, in a teaching hospital, who has gone through one surgery that has failed and needs to be redone, do I have the right to insist my surgeon make good on his promise of doing it himself this time - and would it be appropriate to ask that this be reflected in the Surgical Consent Forms?

I hope this rambling entry makes sense, feeling overwhelmed and would appreciate all advice. I only have a few days to sort this out, and I am feeling anxious.

Many thanks

[glennstanzalone]

I'm sorry you are experiencing all of that. It must be very traumatic and frustrating. I can't imagine. Unfortunately, I'm not familiar with the public hospitals or hierarchies you are describing. My surgeon had an assistant with him but I don't think the assistant did anything except ancillary duties. You do have a right to ask these questions and get more information before you go in for surgery. My surgeon walked me through every single detail.

[iamamused]

How did you make out with the consent form?

[Eranthe]

Hi iamamused, the forms I finally signed for this revision stated that I am undergoing surgery "under the care of Dr XXX" (my senior surgeon). However, Dr XXX and I have been meeting in his private consulting rooms this time (not the public hospital rooms) for each appointment, and he has personally done the surgical workups, records, molds, etc. Each time I meet with Dr XXX, his registrar is present to observe, but is not really all that involved in our discussions. When I asked my surgeon directly what the extent of the registrars involvement would be this time around, he told me he personally would be doing the surgery, and his registrar would be there in more of an observation capacity. As a public patient, I think this is the best I can hope for at this point. Besides it is in Dr XXX's best interests to make sure absolutely nothing goes wrong this time around, and I guess I now must accept this and stop worrying about it as my surgery is only a few days away. Time to let go (not easy for an anxious girl who likes to be in control)!

My revision surgery is booked for 10th October ... only five days away! Here we go again!

[LyraM45]

I'm so sorry. I know what you're going through. Unfortunately I've been there and done that. I've got lots of useful information and words of support for revision patients on my website if you want to check it out. My contact info is on there, so don't hesitate to shoot me a message any time if you need anything or just want to talk about it all. It can be a really sad and confusing time. I am a pretty tough chick who has never been so broken before... but this process is so tough even when it all goes right, let alone when it doesn't go right. Keep your head up!

http://www.confessionsofametalmouth.com

[CandyApple]

http://www.jawsurgerytips.com/pictures

Hi Just wanted to share this guys blog with you. He went through 2 jaw surgeries and seemed to do much better the second time. Hope it helps and good luck to you things can definitely be improved. Don't give up!

[SingleJawMelb]

Hello everyone, my apologies for my delayed response. In the midst of all of this, a family member became quite ill and this has been taking up much of my time. You may recall that, after ten months of trying to alert the young registrars in the public hospital clinic that my maxilla was reattached canted and several mm off to the LHS, I finally made an appointment with the surgeon supervising the operation in his private rooms. He agreed there was an error, has not been able to explain what went wrong, and has booked me in for revision surgery - maxilla only.

My problem is this. He originally saw me as a public patient - so whilst he was overseeing my surgery, he works in a teaching hospital, so he had a surgical registrar "assisting" him with the procedure. Herein lies the rub, as I am unsure as to how much "hands on" involvement surgical registrars have during surgery. He explains it to me as the registrar is an assistant, but that he performs all the substantial activities whilst the registrar, I guess, performs ancilliary duties. I guess this was something I was prepared to accept first time around - however, I have been reading a lot of research and personal stories which suggest that revision surgery is a delicate and often precarious procedure that should only performed by a surgeon with considerable experience and expertise.

It seems as though my surgeon has agreed a mistake has been made, but has not explained what that mistake actually was, or who is responsible for it, and has offered to do a revision surgery personally to correct it "please let me do it personally" ...

but ...

he is now asking me to sign consent forms between myself and the current registrar.

Whilst it didn't bother me having my original surgery performed by my surgeon with his registrar assisting/supervising, I feel it only appropriate that the revision surgery he offers me be carried out solely by an experienced surgeon ... ie. him? That is what I took him to mean when he said "please let me do it personally". Is this an appropriate way to view the situation?

I guess I am anxious now that I realize that things can and do go wrong occassionally, and I just don't know the full extent of the registrars involvement. I just can't help but feel that things went wrong last time because my surgeon allowed that particular registrar too much independent activity and that might be the reason I have to go through this whole ordeal again.

As a public patient, in a teaching hospital, who has gone through one surgery that has failed and needs to be redone, do I have the right to insist my surgeon make good on his promise of doing it himself this time - and would it be appropriate to ask that this be reflected in the Surgical Consent Forms?

I hope this rambling entry makes sense, feeling overwhelmed and would appreciate all advice. I only have a few days to sort this out, and I am feeling anxious.

Many thanks

I was a private patient and asked if my surgeon would perform all of the surgey. He said yes. In public hospitals Doctors have to learn and they will be conducting surgery on some patients. They will however be supervised. Much like when you go to the hairdresser.

Can you speak to your surgeon again? I can't tell you for sure if the surgery failed because the junior did it, but you would assume that the doctor would fully supervise.

You need to have a frank convo with the surgeon, maybe contact the surgeon board (?) for assistance as I'm sure this is causing you a lot of anxiety.

[Eranthe]

Well here I am ... 2 weeks and 2 days post-revision.

I wish I had good news to report ... but I don't.

Long story short, my surgeon decided he could fix this problem by only moving my maxilla. I asked him several times if he felt that he could rectify things by only moving the maxilla and he assured me he could. However, as I predicted, by opting to only move the maxilla and not both jaws, I feel he restricted himself in terms of how far he could rotate the maxilla back to the centre/midline - because he still had to ensure that he maintained the relationship between maxilla and mandible (and the mandible was in the wrong position). Long story short, even after this revision, both jaws are still positioned too far to the left-hand side, making 2/3 of my face slope to the left.

When I tried to speak to him about it one week post-op, he became inappropriately emotional, and spent almost the entire appointment interrupting me when I was trying to quietly explain my concerns and gather information, speaking over the top of me, all the time telling him how hard my surgery has been for him, what a stressful time it has been for him. He made me feel as though, by raising my concerns, I was being ungrateful for his revision. But if he hadn't got it wrong the first time, he would not have needed to do the revision?? He told me he would not be doing anything more and if I wanted more surgery I would have to find someone else to do it. I had not even raised the possibility of more surgery, I just wanted to understand what had gone wrong, but I got no real answer to this question.

I am not the most assertive person, so in the end I just sat there listening to him tell me his tale of woe, and left feeling unheard and terribly alone.

I am now left with the same problem I had before the revision, but with more numbness and bone healing concerns. My friends are furious. I am depressed.

I'm not sure what happpens next ... my face is really really numb, much more numb than previous surgery. Now I'm scared that I will be left with permanent neuropathy, as well as a crooked face and constant pulling on my tmj.

I just don't know what to do ...

[jawregret1]

Eranthe, why wouldn't he move both jaws?

I'm so sorry to hear about this.