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

Message

#136 Post by **phil** » Wed Oct 03, 2007 1:47 pm

Hey Lo, and Sandra, thanks for your posts.

I just finished teaching day TWO with the splint in all day, except for lunch, of course. I think I'm doing better all the time at talking with it!

This morning I woke up and my mouth actually felt good! I wasn't as sore as usual, and had no pain in my face. And, I hadn't taken anything the night before (tylenol or ibuprofen). So, I think this is a move in the right direction.

I get tired after a day of talking and singing, but things seem to be going well.

My bite is not nearly what it was post-operatively. On the right side, I am really Class I, spot on. On the left, I'm just BARELY a Class I. It's the blasted asymmetry. The OD is hoping that I heal soon so that he can get me quick quick back into elastics. He says that as long as I'm end on end in the front, he can work with that. If I develop an anterior crossbite, It's back to the OR for another surgery. Sigh. So far, I'm staying in place. I really don't think my bite has changed at all since August 24th. That's a good sign! I think it's about as bad as it's going to get. The OD seems very confident that it's a maxillary relapse that caused it. When the elastics came off on August 20th, in a matter of four short days my maxilla shifted about 1.5-2 mm. At least it has stayed there for now. Maybe that also indicates that I've developed some bone growth that's holding things in place. I don't really feel that much more stable, but I also think that I may not be the best judge right now.

So, good news is that things don't seem to be moving now. We want things stable so that the bone can heal! Here are some pics to show: the first one is August 24th, and the second one is today.

I really can't tell any difference at all. So, I am tending to think that IF I heal, this will be the position that I will heal in. And, if that is the case, the orthodontist will say that there is no need for another surgery.

That would make me a very happy camper!

#137 Post by **phil** » Wed Oct 03, 2007 2:17 pm

Meryaten,

I like your current motto: "finish the fight." That is one thing I intend to do!!!

Onward and upward!

#138 Post by **smile2006** » Wed Oct 03, 2007 4:09 pm

Hi Phil-

I was catching up on your story. I actually think the picture of your bite today looks better than the August picture so I think you're right in that it hasn't gotten worse. Do stick with it. I've had my share of trama on this end of things as well. I ended up getting my top braces back on because of some upward movement of upper two teeth after they (braces) were initially removed in July. I can say however, that my ortho has been really diligent at getting things right and my bite has never felt better. So persistance pays off. My bite was so whacky it, as was yours I believe, that it might take just take longer than average in some cases. I was upset at first but just plugged along. You seem to have good and caring doctors which is a great help. Good luck and bless you heart for teaching with that split!!!!

#139 Post by **phil** » Wed Oct 03, 2007 6:44 pm

smile2006,

Thank you for your kind words. The kids don't seem to care whether I can enunciate clearly or not! The show must go on, and so it does. At this point, I'm definitely more comfortable with the splint IN than OUT, so I guess I'll just wear it 24/7, except of course to eat and brush.

I can see what you're saying--the bite looks slightly better today than it did on August 24th. It might be the incisor angles already correcting--I have my lowers chained, and the OD took the chain off of the top so that the teeth would begin to tip out just a bit. He says that given my current angle, they can do that just fine.

All I really care about right now is that THE BONE HEALS!!! That is priority one for me.

Onward and upward!

#140 Post by **phil** » Sat Oct 06, 2007 12:15 pm

Well everyone, it's been SIX DAYS in my splint. The last couple of days I have had a change in sensation, and have finally felt more stable!

I'm VERY cautiously optimistic, but I have to say that I have had significantly less facial pain in the last couple of days, and while I'm still mobile, I'm definitely a little LESS mobile. Who would have thought that things would have changed so quickly after getting the splint? Evidently my clenching habit has played a larger role in my delayed union than we thought.

Now if only I can heal quickly enough to get back into elastics, and finish my bite, everything will be hunky-dory. Keep thinking those good thoughts for me--we're not out of the woods yet.

#141 Post by **ohmyjaw** » Sat Oct 06, 2007 2:01 pm

Hey Phil, that's great news! Hope things keep progressing for you.

Happy (Canadian) Thanksgiving!

#142 Post by **phil** » Tue Oct 09, 2007 3:24 pm

Don't mean to scare anyone, but...

I just returned from the orthodontist. I needed my splint adjusted a bit, because it shifted a tad, and my lower incisors were hitting it (they're not supposed to). My OD had such a refreshing attitude about the whole thing. He said, "well, we're all learning from this, aren't we?" I love that.

Anyway, he spoke with me a bit about his other patient with a maxillary delayed union/nonunion. Adult male like myself, but different surgeon than mine. He was put back together with very big plates all round. Anyway, it was about a year after his surgery, and he broke a plate! OUCH!

Now, I KNOW that mine aren't broken, because I can feel where they are attached when I bite (which is why I don't bite). So, anyway, you can imagine that one year after surgery, this guy's occlusion was just perfect! And, after the break, his bite became traumatic, like mine, only perhaps even worse. So, he's going back to surgery. Unbelievable. And, they would have never known that he was a nonunion case if the plate hadn't broken.

So, I just wanted to throw that information out there. Read it, and be informed!

#143 Post by **phil** » Thu Oct 11, 2007 6:44 pm

Call me neurotic...

Today, when I looked at my bite, it appeared to me that my maxillary relapse had worsened a bit. So, I called my surgeon, and asked him if I could pop in for a check. Well, he says that things are pretty much the same as when he saw me last. I'm not sure I agree with him, but there isn't much we can do right now anyway. He said that I'm still in the ballpark for orthodontic compensation without further surgery, if the bone will heal. We actually talked about surgery as well, although briefly. At some point in the future (still undetermined), we'll decide what has to be done if I don't heal. I was very clear with him today about what I wanted--bone grafts, four plates instead of just two, the works! He listened and agreed. Of course we're not there yet, but it's good for me to prepare myself psychologically, in case I DO have to go under the knife again. I know one thing: I CAN'T LIVE FOREVER WITH THINGS LIKE THIS!!!

Thu Oct 11, 2007 7:33 pm

It's not a bite.

It's a job.

#145 Post by **phil** » Thu Oct 11, 2007 7:47 pm

4beauty4symmetry,

YOU SAID IT! I have spent so many hours and so much energy on this problem, that if I were paid for my work, I could retire, and I'm only 42!

Believe me, at this point, if I could afford to take the time off, I would be saying to my surgeon, "how soon can you book me?" just so I could get this over with. As things look right now, the soonest I could do it would be spring break (the week after Easter), and maybe take an additional week or so off after that. That's, of course, assuming that my surgeon could work me in then! Maybe I should get it on the books now, and then if I don't need it I can cancel!

Thu Oct 11, 2007 7:55 pm

That's what I would do: schedule a surgery.

But only if the act of doing so doesn't either eases or at least does not intensify your burden of psychic stress.

If you can tell yourself, well, at least if I need surgery I won't have to wait forever to have it, then maybe it would be a good move.

You sound much more tolerant and open about your attending medical/dental professionals than I think I would be in your case.

#147 Post by **phil** » Thu Oct 11, 2007 8:01 pm

4beauty4symmetry,

I have new respect for both my OD and OS this week, and I will tell you why, plain and simple: they both admitted that they are learning from my case, and that they don't have all the answers. It actually increased my confidence in them, because as a teacher, I know that the students I am most likely to reach are those who know they have something to learn. Now that they have both admitted that to my face, maybe they will actually learn something, and grow as professionals! And, not that I would ever wish this on anyone, but if I have to go through it, somebody ought to learn something as a result of it! Otherwise, it would be a lot of pain and suffering for nothing.

#148 Post by **HighandLo** » Fri Oct 12, 2007 5:30 am

Hey Phil!

I was glad to hear you thought the splint was doing you some good! Then, not so glad that you are having doubts about your bite now. Have they done more x-rays recently? Maybe that would ease your mind?

I agree with 4beauty, I would schedule the surgery just in case! Although, I'm sure your OS would do everything to accommodate your schedule with all the problems you've had.

Take care,

Lo

#149 Post by **phil** » Fri Oct 12, 2007 2:04 pm

Lo,

I've had to panorexes done since the surgery. No Ceph (profile). If they had done a Ceph the week after surgery, and then did one now, it might be helpful to note a difference. Since they didn't, I guess as a diagnostic tool, it would be limited. The panorex probably wouldn't do a very good job of showing anterior/posterior shift. Nobody really seems too interested in doing to many radiographs, and actually, that's fine with me. The OS and OD can pretty much see how I've relapsed by dental relationship. I can tell from my own thorough photo documentation that the majority of relapse occurred between August 20th and August 24th, immediately after my elastics were removed (evidently they were the only thing at that point that was holding my maxilla that far forward). Once we got to August 24th, any change from then on has been quite slight--barely detectable. Believe me, I document frequently with my digital camera, and save it to my PC. I did think that I had shifted ever so slightly this week, but in retrospect, I think the changes might be dental. I am in very flexible wires, and even though the splint does stabilize the upper arch, things still move just a bit.

So, we're playing the waiting game--STILL! I am not going to wait forever, though. If I don't heal by January, I'm planning on going back to the OR, and this time we're going to get it right! We're taking every precaution we can: complete mobilization of the maxilla, thoroughly clearing the bone surfaces of fibrous tissue, even burring the surface if needed, four bone plates instead of two, bone grafts from my hip, and a post-operative splint if necessary. I have done my homework, and if I don't get these requests next time in the OR (if I DO go back to the OR), then maybe it's time for me to find another surgeon.

Onward and upward!

Or, as Meryaten says, "FINISH THE FIGHT!"

Fri Oct 12, 2007 3:40 pm

It sounds like your Dental People are classy and patient gents. That's nice. It's as it should be, but it is still nice.

But I would still schedule the damn surgery--but then again, I live in an area where it can take months to get all that lined up.