Posted by sleepsurgeon on February 26, 2009 at 20:58:30:In Reply to: Re: 24 hour MMA update posted by Needssleep on February 26, 2009 at 16:18:45:
Having discussed the option to answer some worthwhile questions in the open forum with Sandman, I have decided to give it a try, when time allows. I am quite amazed at the quality of questions raised in the forum, which reflects the research that patients have done. I hope all of your hard work pays off in dealing with the syndrome.
You have raised some great questions and here is my response to them:
Numbness is one of the most commonly discussed issues by surgeons and patients because it is something that can be permanent. Permanent numbness of the gums, palate or lower lip can happen. In general, it certainly relates to the skill of the surgeon. Regarding the palate and gums, it happens much more often in the maxilla as oppose to the mandible. Two major factors are involved. First, it is due to the extent of manipulation of the maxilla. In another word, it can be related to how much the soft tissue of the maxilla is stretched, i.e., how much the maxilla is advanced. It mean that the greater the advancement, the higher chance of some degree of numbness. The second factor is actually just as important, which is the age of the patient. In my experience, there is a greater chance of some degree of numbness in patients are older than 50. I actually have not encounter any numbness in patients less than early 40s (knock on wood¡K)
The inferior alveolar nerve exits the skull and enters the mandible at the inner surface of the mandible towards the back. There is always a certain portion of the nerve that is exposed, especially at the proximal end when the nerve just enters the bone. When the bone cut is made, it is done above the nerve and then the cut is extended carefully, with a splitter in order to avoid injury of the nerve. Whether the entire portion of the nerve is exposed or only a part of the nerve is exposed really depends on the particular patient's anatomy as the nerve's path is slightly different in everyone.
When the inferior alveolar nerve is minimally exposed, the chance of numbness is lower. However, it does not mean that certain degree of numbness won¡¦t happen. On the other hand, even when the entire path of the nerve in the bone cut is exposed, it doesn¡¦t mean that numbness will happen either, even when there is a certain amount of ¡§stretch¡¨. Actually, I find that many patients are not numbness immediately after the operation. Again, I find the most important of factor is really the age of the patient. Since I am approaching 50, I know my healing capacity is not the same as 20 years ago¡Kƒ¼. I know all patients are concerned about being ¡§permanently numbed¡¨. I certainly understand it. I don¡¦t want to down play it either. I can only say that in my experience, I can only recall 3 or 4 patients telling me that the numbness bothers them.
Finally, septoplasty is routinely done when maxillary osteotomy is done. I generally tell my patients that I can correct septal deviation in the lower aspect of the septum but because when endotracheal tube is in the nose, it is much more difficult to reach the superior aspect of the septal problem during maxillary osteotomy. The traditional septoplasty via the nose would be necessary to reach that superior aspect of the septum. Although the endotracheal tube can be changed during the operation, it is certainly not worth the risk, in my opinion.
Finally, I am glad bruinmd¡¦s operation went well. It is great to have a patient that has such great attitude and trust in his surgeon. The positive attitude of the patients makes all the difference in recovery. Congratulations!
- Re: 24 hour MMA update SFdreamer 04:58 2/27/09 (0)
- Re: 24 hour MMA update Needssleep 00:17 2/27/09 (0)