Bimax / Trimax complications

[Rea]

I'd read it before going to sleep

 

[BimaxLaser]

View attachment 3214013
Wtf is that guy doing, no way thats not causing permanent damage

 

[NZb6Air]

@BimaxLaser did you quote the indian surgeon vid?

 

[BimaxLaser]

@BimaxLaser did you quote the indian surgeon vid?

Yeah, hes so fucking rough jesus

 

[dookielooksmaxxer]

Yeah, hes so fucking rough jesus

what'd you expect its india, they cant afford hammers to properly seperate the maxilla safely

i think they use a hammer or some tool to properly do it not their bare hands jfl

 

[BimaxLaser]

what'd you expect its india, they cant afford hammers to properly seperate the maxilla safely

i think they use a hammer or some tool to properly do it not their bare hands jfl

That nigga turned him into an infomercial

 

[dookielooksmaxxer]

That nigga turned him into an infomercial

observantcel

i didnt know any of that shit before this thread

 

[hekch]

its not safe with richardson

 

[Deleted member 85196]

its not safe with richardson

Why do you say that lol

 

[hekch]

Why do you say that lol

look up "the looksmaxxing channel" he got butchered by him

 

[NZb6Air]

Why do you say that lol

the last vid on my post is sunil, the maxilla finger crack

 

[MA_ascender]

the last vid on my post is sunil, the maxilla finger crack

bro how the fuck is he allowed to do this

 

[97baHater]

Great thread bhai

 

[CookieGuy]

Lowkey Lifefuel. Way more safe than I thought.

Plus: also doesn’t BiMax make lips fuller and wider and make nose look smaller due to maxilla advancement?

 

[badsurzzy]

good thread

 

[letme-in]

First of all, botch i.e. malpractice ≠ complications, the former is ohio surgeon trolling (not following the protocol) and the latter is usually expected and followed postoperatively.

A way to avoid botches would be to look at the quality and quantity of papers published by the surgeon you're interested in as I wouldn't rely on before/afters since most of them are private, nor would I rely on reviews since they're mostly botted and a great portion of the human ones are left by people who never went under the scalpel https://sci-hub.se/10.1097/PRS.0000000000004268


I will be talking about complications in this thread.
Most complications can be managed and are, in theory, predicted.

---

Some complication occurrence data if you don't intend on reading the whole thing :

LF1 (2000's) :

"The LeFort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra- or perioperative complications in a series of 1000 consecutive LeFort I osteotomies performed within a 20-year period. In total, 64 (6.4%) patients experienced complications. Anatomical complications affected 26 (2.6%), patients, including 16 (1.6%) with a deviation of the nasal septum and 10 (1.0%) with non-union of the osteotomy gap. Extensive bleeding that required blood transfusion occurred in 11 (1.1%) patients exclusively after bimaxillary corrections; in 1 patient a ligation of the external carotid artery became necessary. Significant infections such as abscesses or maxillary sinusitis occurred in 11 (1.1%) patients. No patient experienced an osteomyelitis. Ischemic complications affected 10 (1.0%) patients, including 2 (0.2%) who experienced an aseptic necrosis of the alveolar process and 8 (0.8%) who, under critical revision, were affected by retractions of the gingiva. Five (0.5%) patients experienced an insufficient fixation of the osteosynthesis material. The risk and the extent of complications was enhanced in patients with anatomical irregularities (eg, in patients with craniofacial dysplasias, orofacial clefts, or vascular anomalies). The risk of ischemic complications was enhanced in extensive dislocations or transversal segmentation of the maxilla. The authors conclude that patients with major anatomical irregularities should be informed about an enhanced risk of Le-Fort I osteotomies. Preoperative planning avoiding transversal segmentation or extensive dislocations of the maxilla should reduce the occurrence of complications. For healthy individuals, the risk of complications with the LeFort I osteotomy is considered low."¹

BSSO (2000's) :

"Jung et al. reported a rate of complication of 9.76% (67/686 sites) among 343 patients (686 sites) who had undergone orthognathic surgery for mandibular prognathism between January 1990 and December 2002. Individual rates of different types of complications were 4.08% (28/686) for infections, 2.49% (17/686) for fixation device fracture, 1.89% (13/686) for inferior alveolar nerve injury, 1.02% (7/686) for temporomandibular disorder (TMD), and 0.29% (2/686) for facial nerve problems"²

In general, including the orthodontic part (1983 to 1996) :

"Patients and Methods: The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. Results: The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Conclusions: Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure."³

In general (1998 to 2009)¹⁷ :

---

I'll be skipping irrelevant shit like delayed union/nonunion since it's caused by wire fixations (old af) and ultra rare shit like otitis media due to the presence of a foreign body in the opening of the left eustachian tube ye ok buddy (1 case btw).

If you still don't want to read but want to skim thru it then just read the coloured words, look at the images and skim thru these vids since you have to know what it looks like when it goes well (most of the time), lol, you prolly never did that, did you?

​

There's 2 types of complications : Intraoperative & Postoperative

Intraoperative :

I - Hemorrhage* :

*It's when you lose a lot of blood and shit, it could become dangerous

Risk increases with being a twink (low bmi) and extensive surgery (high operating time)⁴, no significant correlation with age and sex
View attachment 3213856

A significant difference was observed in relative blood loss between BSSO and Lefort I osteotomy with segmentation since LF1 is performed in an area with extensive vascularization.

View attachment 3215498​

Basically vessels and shit , small ones u apply pressure or electrocautery etc , large vessels u have to ligate them i.e. tie that shit back to prevent secondary delayed hemorrhage, arterial bleeding during lefort 1 -> nasal packing (View attachment 3213876), cell saver etc.

II - Bad split :

You have to split the mandible to advance it, right? Sometimes it doesn't split in a favourable & predicted pattern.
View attachment 3213895
Risk increases with having third molars (wisdom teeth)⁵ ​

The rate of bad splits during sagittal split ramus osteotomy (SSRO) which is the reduction one has been reported to be approximately 2.3%.
Occurs more frequently during SSRO than BSSO, for mandibular splits, if you care, the literature is conflicting, some say you should extract impacted teeth way before ( at least 6 months before surgery to allow for filling and maturation of the alveolar socket bone) and some say at the same time, read more here : https://sci-hub.se/10.1016/j.ijom.2016.05.003 - https://sci-hub.se/10.1016/s1079-2104(98)90057-9 - https://sci-hub.se/10.1016/j.ijom.2016.02.011 - BSSO tho : https://sci-hub.se/10.1016/j.ijom.2016.02.011 - https://sci-hub.se/10.1053/joms.2002.33114 - https://sci-hub.se/10.1016/s1079-2104(00)80008-6

---

Young adults seem to be the least susceptible to unwanted splits.

When a bad split happens, they will have to visualize the split pattern then strip off the periosteum to assure vascularization of the fractured segment and then a salvage surgical approach depending on which type of split, read more here : https://sci-hub.se/10.1016/j.ijom.2016.02.001


Postoperative :

I - Relapse :

Risk increases when resorbable plates are used instead of titanium (overall complications 18.3% vs 8.6%)⁶, but also and especially when you have an open bite ("Kim JW, Jeon HR, Hong JR. The study on vertical stability of anterior open bite patients after bssro. J Korean Assoc Oral Maxillofac Surg. " argues that relapse can be prevented in patients with an open bite by using the modified Epker technique / Ferri's or by performing detachment of the pterygomasseteric sling, overcorrection, angle shaving, or genioplasty during SSRO. https://koreascience.kr/article/JAKO200503534147157.pdf (niggas got 0 relapse) @depressionmaxxing @truthhurts )

Risk increase with the amount of initial advancement (study assessing genioplasty relapse with rigid fixation) and with control of the proximal segment (it's the part of the mandible that's in the back, the distal segment being the teeth-bearing part you move forward -> MOA even tho this is old af) and change in the mandibular plane.⁷

Pterygomasseteric tension which concerns mandibular setbacks : https://sci-hub.se/10.1016/S0929-6646(09)60264-3

CW aka Clockwise rotation of the proximal segment, also concerns mandibular setbacks : https://sci-hub.se/10.1016/j.jcms.2013.05.034 - https://sci-hub.se/10.1097/SCS.0b013e3181be87ba

II - Nerve damage :

The nerves usually affected are :

The inferior alveolar nerve, the infraorbital nerve, the mental nerve and the incisive nerve :






During a LF1, the nasopalatine nerve, the anterior middle and posterior alveolar nerves and the small terminal nerves in the buccal mucosa along the incision line between the upper first molars are always divided. This is further exacerabted by moving the fragement in horizontal and vertical planes. Movement may also stretch or divide the greater palatine nerves or they may be electively sectioned to facilitate larger movements. The infraorbital nerve maybe injured indirectly by pressure, retraction, or fixation with plate or screws.


Since these are peripheral nerves : they can regen

View attachment 3214210
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Concerning BSSO and inferior alveolar nerve :
"Older age was a significant risk factor for permanent hypoaesthesia, with an incidence of 4.8% per patient aged <19 years, 7.9% per patient aged 19–30 years, and 15.2% per patient aged >30 years. These findings show that the risk of Neurosensory disturbance after BSSO is significantly higher in older patients." ⁸

This basically results in numbness of the lower lip, it resolves within several months after surgery in most patients⁹ but it's considered permanent after a year.
During mandibular surgery, iatrogenic nerve damage and subsequent NeuroSensoryDisturbance can occur because of several factors. For example, IAN bruising can be caused by nerve compression during soft tissue dissection near the mandibular foramen, excessive nerve manipulation during splitting, the use of sharp instruments (chisels) during BSSO, or the incorrect placement of screws. Large mandibular advancements and increasing age have also been described as risk factors for NSD.


View attachment 3214219

You will most likely get back your preoperative sensation levels if your nerves aren't too mutilated, or if there isn't much scar tissue to block them from reconnecting, etc. This is a surgeon skill issue. Even if the great maxfacs don't necessarily need guides, I'd still advise for it, look at how easy it is to get clean cuts :



Since, it seems like age is a major risk factor we can safely assume, it's heavily dependent on NERVE HEALING ABILITY, therefore i advise hoping on TB500, BPC 157 and GhkCu (not only direct nerve outgrowth but also, the minimization of scar tissue formation indirectly helps nerve healing by allowing them to reconnect) postoperatively :
View attachment 3214231​

JFL at this peptide

If functional recovery does not occur within 4-8 months, re-exploration with nerve grafting or reanimation surgery must be considered.

Facial nerve injuries, which are fucked up are rare af.

In fact, the rate of facial nerve paralysis reported by other scholars varies from 0.17% to 0.75%. Causes of facial nerve paralysis after orthognathic surgery include ischemic paralysis of the facial nerve caused by deep injection of vasoconstrictors, physical damage by a chisel or osteotome used for segment separation, fracture of the styloid process with posterior displacement, slipping of a drill ( ) or a bur to the perimandibular soft tissues during medial osteotomy, and facial nerve compression due to a posteriorly displaced segment, and surgical retractors or hematoma. Since the distance between the ascending ramus posterior border and facial nerve is less than 1 to 2 cm while the mouth is open, the facial nerve may become pressed or directly damaged.
Read more relating to this : https://sci-hub.se/10.1016/s0278-2391(10)80239-3


III- Neuropathic pain :

Which is basically chronic pain and shit, in this study out of 982 BSSO, 563 LF1 and 335 SARPE, only 6 niggas developed debilitating chronic neuropathic pain (mean age at surgery : 43 yo).
View attachment 3214288View attachment 3214292

IV - Nose widening and Nasal deviation :

Secondary changes of the nasolabial region after the LF1 are well known and include widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip, and downturning of the commissures of the mouth. Of these postsurgical changes, widening of the alar base of the nose probably is the most common. Surgical techniques can modify undesirable secondary changes.
To reorient the displaced perinasal musculature and to control alar base width after maxillary osteotomies, many have advocated that an alar-base cinch suture be used in addition to other adjunctive procedures (e.g. anterior nasal spine reduction, nasal floor reduction, and V-Y suturing) before incision closure.

Here's an effective version¹⁰ :
View attachment 3215562

Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Basically just this : "Postoperative nasal septum deviation can be caused by insufficient reduction of the septum when performing maxillary impaction, incorrect bringing back of muscle adjacent to the nose, altered position and/or shape of the anterior nasal spine, postoperative swelling, and nasotracheal intubation. Precise surgical skill, careful extubaction, and meticulous examination of the nose are very important to avoid nasal septum deviation. If it exists after the surgery, septal cartilage reduction/repositioning, ANS recontouring, and alar base cinch suture can be used to solve these problems. The surgical method that is used in our case series can be a suitable method for secondary correction of the septal deviation. This surgical method also can be used intraoperatively and can minimize the potential deviation of the septal cartilage after maxillary surgery."¹¹

View attachment 3215574

​

V - TMD :

You really don't want condylar resorption :


Basically don't be female and stop chewmaxxing and doing retarded shit like nail biting and shit, also fix any TMJ problem before surgery.

View attachment 3215665¹²
View attachment 3215667View attachment 3215668¹³


VI - Infection :

Postoperative infections include cellulitis, abscess, maxillary sinusitis, and osteomyelitis. Rates of postoperative infections are low thanks to aseptic techniques, surgeons' excellent skills, antibiotics, and a good blood supply into the oral and maxillofacial area. Even when infections do occur, they can be fully cured through early diagnosis and management. Davis et al.¹⁴ reported that the rate of infections was 8% among 2,521 patients who underwent orthognathic surgery, and that infections occurred mostly in the mandible. Posnick et al.¹⁵ reported that the rate of infections was merely 1% when antibiotics such as cefazolin or cephalexin were administered.

Better if you stop smoking like a retard tho, thanks

View attachment 3215695View attachment 3215697


VII - Psychological :


View attachment 3215718View attachment 3215729
View attachment 3215730


Basically, a pattern of improvement in the quality of life in psychological and social aspects was observed following orthognathic surgery. HOWEVER, i don't think this applies to abused PSLers whose seeking for surgery is motivated by social anxiety disorder. Disfigured people have problems with social interaction (Macgregor,1951, 1990; Rumsey, 1983; Malt & Ug-1951, 1990; Rumsey, 1983; Malt & Ugland, 1989) and are discriminated against (Houston & Bull, 1994). Negative stereotyping of disfigured people begins in childhood (Rumsey, 1983) and continues into adulthood, where facially disfigured people meet repeated verbal abuse, disgust and pity from others (Macgregor, 1951,1989).

"Social anxiety disorder (SAD) has been defined as an enduring fear of social situations where the individual may be subject to evaluation by others. It is the most common type of anxiety disorder, with a prevalence of up to 18% in the general population. Fear of negative evaluation is said to be the trademark of social anxiety, as this fear often leads to an illogical and exaggerated anxiety in social situations. This may be a factor motivating orthognathic patients to seek treatment."¹⁶

We know that if you're depressed, anxious, young and incel, your QoL won't improve much when compared to the QoL improvements of bluepilled normies

https://sci-hub.se/10.1016/j.ijom.2015.07.020

So don't expect SHIT, goes for me too



VIII - Death :

Main causes of death during or after orthognathic surgery are accidents related to severe intraoperative hemorrhage, delayed secondary hemorrhage, airway obstruction, and general anesthesia. Fourteen cases of serious complications such as death and falling into a vegetative state after jaw bone surgery such as the orthognathic surgery (10 cases) and facial contouring surgery (4 cases) were reported in the period from 2000 to 2016. Causes of these complications were bleeding in two cases, respiratory problems in four cases, surgical errors in one case, and unknown in six cases. The procedures were performed by plastic surgeons in 12 cases, by dentists in one case, and in a university hospital in one case (Exact department is unknown). An underreporting of cases of death after orthognathic surgery is suggestive since only four cases of death have been reported in the last 16 years despite the fact that around 5,000 cases of orthognathic surgery are performed in Korea every year. Serious complications such as death rarely occurs when orthognathic surgery is performed by experienced surgeons with all the necessary equipment, and orthognathic surgery can be considered a safe procedure as long as these conditions are met¹⁸

TLDR : it's safe af

View attachment 3214013

Thanks for reading!

Bonus : yes shorterning the mandible actually induces sleep apnea https://sci-hub.se/10.1016/j.ijom.2011.01.011- https://sci-hub.se/10.1016/j.tripleo.2007.11.012 ,
So if you actually have mandibular proghnatism get bimax not just mandibular setback.



¹Kramer FJ, Baethge C, Swennen G, Teltzrow T, Schulze A, Berten J, et al. Intra- and perioperative complications of Le Fort I osteotomy: a prospective evaluation of 1000 patients. J Craniofac Surg 2004;15:971–7
²Jung JY, Park JH, Sin SH, Lee HK, Lee SW, Kim WH, et al. Postoperative complications of bilateral sagittal split ramus osteotomy of mandible. Korean J Hosp Dent. 2006;4:67–81.
³Panula K, Finne K, Oikarinen K. Incidence of and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg 2001;59:1128–36.
⁴Thastum M, Andersen K, Rude K, Nørholt SE, Blomlöf J. Factors influencing intraoperative blood loss in orthognathic surgery. Int J Oral Maxillofac Surg. 2016;45:1070–1073.
⁵Beukes, J., Reyneke, J.P., & Becker, P.J. (2013). Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy. International Journal of Oral and Maxillofacial Surgery, 42, 303–307.
⁶Ahn, Y.-S., Kim, S.-G., Baik, S.-M., Kim, B.-O., Kim, H.-K., Moon, S.-Y., Lim, S.-H., Kim, Y.-K., Yun, P.-Y., & Son, J.-S. (2010). Comparative study between resorbable and nonresorbable plates in orthognathic surgery. Journal of Oral and Maxillofacial Surgery, 68(2), 287-292. https://doi.org/10.1016/j.joms.2009.07.020
⁷Van Sickels JE, Dolce C, Keeling S, Tiner BD, Clark GM, Rugh JD. Technical factors accounting for stability of a bilateral sagittal split osteotomy advancement: wire osteosynthesis versus rigid fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
⁸Verweij JP, Mensink G, Fiocco M, van Merkesteyn JP. Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients. Int J Oral Maxillofac Surg. 2016;45:898–903.
⁹Monnazzi MS, Real-Gabrielli MF, Passeri LA, Gabrielli MA. Cutaneous sensibility impairment after mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery. J Oral Maxillofac Surg 2012;70:696–702.
¹⁰Shams MG, Motamedi MH. A more effective alar cinch technique. J Oral Maxillofac Surg. 2002;60:712–715.
¹¹Shin YM, Lee ST, Kwon TG. Surgical correction of septal deviation after Le Fort I osteotomy. Maxillofac Plast Reconstr Surg. 2016;38:21.
¹²Gunson MJ, Arnett GW, Milam SB. Pathophysiology and pharmacologic control of osseous mandibular condylar resorption. J Oral Maxillofac Surg. 2012;70:1918–1934.
¹³Winocur, E., Littner, D., Adams, I., & Gavish, A. (Year). Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: A gender comparison. Journal Name, Volume(Issue), Pages. Tel Aviv University.
¹⁴Davis CM, Gregoire CE, Steeves TW, Demsey A. Prevalence of surgical site infections following orthognathic surgery: a retrospective cohort analysis. J Oral Maxillofac Surg. 2016;74:1199–1206.
¹⁵Posnick JC, Choi E, Chavda A. Surgical site infections following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study. J Oral Maxillofac Surg. 2016 doi: 10.1016/j.joms.2016.09.018.
¹⁶Ryan FS, Moles DR, Shute JT, Clarke A, Cunningham SJ. Social anxiety in orthognathic patients. Int J Oral Maxillofac Surg. 2016;45:19–25.
¹⁷Kim, J.-H., Kim, S.-G., & Oh, J.-S. (Year). Complications related to orthognathic surgery. Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea.
¹⁸Kim, Y.-K. (2017). Complications associated with orthognathic surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 43(1), 3–15. https://doi.org/10.5125/jkaoms.2017.43.1.3

10/10 Harvard nigga

 

[Mr.Proper]

What autism plus stimulants do to mf...
Anyway, do you know anything about usage of piezielectric cuts and/or less invasive technologies in general? Are laser cuts better than saw cuts?

 

[NZb6Air]

What autism plus stimulants do to mf...
Anyway, do you know anything about usage of piezielectric cuts and/or less invasive technologies in general? Are laser cuts better than saw cuts?

piezo is bone only, not soft tissue and laser is always theoretically better but who the fuck/there's no point using it for bimax

 

[Alex_notmogging]

Read every single letter , really good thread mirin

 

[Roge]

I'll give this thread to read to my surgeon, he needs to know this info to operate well on me

 

[Mr.Proper]

I'll give this thread to read to my surgeon, he needs to know this info to operate well on me

Inb4: That Indian surgion video where he cracks skull using hands.

 

[idkwhattoputhere]

bump, ultra high IQ

 

[Acromegaly_Chad]

water

 

[UrGirlsMcm]

Good thread

 

[Mewton]

Imagine getting your maxilla played with by
Sunil sarr only for Looksmaxxers to tell you "from invisible to invisible"

 

[Vercel]

also fix any TMJ problem before surgery

Hi, is this still accurate?

I listed to a Podcast with Dr. David Alfi and this is what he says about the topic:



What he says is basically:

Using Custom Guides & Plates on the BSSO has the advantage that you can avoid torquing the Condyles / keep them in a neutral position and plan for TMJ Health because apparently you don't really have much control over it with the traditional method. When i was checked for TMJ (i don't have any issues luckily) i hypothetically asked what if i had TMJ, and he said it could become better or worse after the Surgery - basically a gamble.

Alfi actually performs Jaw Surgery purely to fix TMJ on many patients

Also, thanks for the Post.

 

[NZb6Air]

Hi, is this still accurate?

I listed to a Podcast with Dr. David Alfi and this is what he says about the topic:



What he says is basically:

Using Custom Guides & Plates on the BSSO has the advantage that you can avoid torquing the Condyles / keep them in a neutral position and plan for TMJ Health because apparently you don't really have much control over it with the traditional method. When i was checked for TMJ (i don't have any issues luckily) i hypothetically asked what if i had TMJ, and he said it could become better or worse after the Surgery - basically a gamble.

Alfi actually performs Jaw Surgery purely to fix TMJ on many patients

Also, thanks for the Post.

TMJ is unpredictable on large advancements ye (because of soft tissue variability) so u have to fix it before surgery and stop having retarded habits like I said nail biting etc (causes muscular asymmetries and shit)

The shit I saw you already say before I think, that no custom guides allows you to play with the condyles and shit is fucking retarded and yes Alfi is retarded , he was basically saying perma wrong shit on that podcast to advertise (I guess he's selling custom plates as well lol)

https://looksmax.org/threads/what-is-this-nigga-alfi-yapping-about.1169409/

thanks for reading tbh

 

[Vercel]

TMJ is unpredictable on large advancements ye (because of soft tissue variability) so u have to fix it before surgery and stop having retarded habits like I said nail biting etc (causes muscular asymmetries and shit)

The shit I saw you already say before I think, that no custom guides allows you to play with the condyles and shit is fucking retarded and yes Alfi is retarded , he was basically saying perma wrong shit on that podcast to advertise (I guess he's selling custom plates as well lol)

Yeah, i said it before...

Reasoning sounds logic on the surface and its coming from one of the most well know surgeon in this field (66.000 followers on instagram) who is also one of the first who adopted full custom

I actually don't know a single Surgeon in my Country who uses custom for the BSSO yet either, everyone i asked who uses custom (not many) only use it on the Maxilla.

I asked Alfi myself why that is because im curious and he told me it's because its new tech and they most likely aren't trained / used to using it for the BSSO yet (which is true to some extend, it's definitely new tech for many surgeons)

https://looksmax.org/threads/what-is-this-nigga-alfi-yapping-about.1169409/

I noticed the High Le-Fort I part too and was pretty confused

thanks for reading tbh

Thanks for writing, very informative.

I've been seriously lied to from multiple orthodontists so i see no other option besides informing myself.

My Orthodontist referred and pushed me to a Surgeon who didn't even take a CBCT or CT, so no 3D Planing - only x-rays

Ortho lied to me by telling me every surgeon does the same thing, taking a CBCT or CT is completely unnecessary and never heard of Custom Guides and Plates, you can't even evaluate and correct Asymetries that way without doing 3D Planing and capturing the Natural Head Position (NHP).

I'm glad i didn't listen, give in and go with that surgeon back then.

I spoke with someone who was also pushed into a surgeon like that (who isn't even using BSSO, but high oblique sagittal osteotomy), didn't inform himself well enough, gave in, and this happend:

In March, Dr. Dr. Kater performed a jaw adjustment procedure on my upper and lower jaw. During and as a result of the procedure, several complications occurred, including an unplanned fracture of the lower jaw, non-healing bones, the upper jaw being held only by plates, incorrect positioning of the jaws, bone loss in the jaw joint, painful disc displacement in the jaw joint, an abscess in the lower jaw, temporomandibular disorder (TMD), strabismus (crossed eyes), and double vision.

This was the outcome:

 

[badsurzzy]

TLDR : it's safe af

View attachment 3214013

 

[JustBeConfidentBruh]

First of all, botch i.e. malpractice ≠ complications, the former is ohio surgeon trolling (not following the protocol) and the latter is usually expected and followed postoperatively.

A way to avoid botches would be to look at the quality and quantity of papers published by the surgeon you're interested in as I wouldn't rely on before/afters since most of them are private, nor would I rely on reviews since they're mostly botted and a great portion of the human ones are left by people who never went under the scalpel https://sci-hub.se/10.1097/PRS.0000000000004268


I will be talking about complications in this thread.
Most complications can be managed and are, in theory, predicted.

---

Some complication occurrence data if you don't intend on reading the whole thing :

LF1 (2000's) :

"The LeFort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra- or perioperative complications in a series of 1000 consecutive LeFort I osteotomies performed within a 20-year period. In total, 64 (6.4%) patients experienced complications. Anatomical complications affected 26 (2.6%), patients, including 16 (1.6%) with a deviation of the nasal septum and 10 (1.0%) with non-union of the osteotomy gap. Extensive bleeding that required blood transfusion occurred in 11 (1.1%) patients exclusively after bimaxillary corrections; in 1 patient a ligation of the external carotid artery became necessary. Significant infections such as abscesses or maxillary sinusitis occurred in 11 (1.1%) patients. No patient experienced an osteomyelitis. Ischemic complications affected 10 (1.0%) patients, including 2 (0.2%) who experienced an aseptic necrosis of the alveolar process and 8 (0.8%) who, under critical revision, were affected by retractions of the gingiva. Five (0.5%) patients experienced an insufficient fixation of the osteosynthesis material. The risk and the extent of complications was enhanced in patients with anatomical irregularities (eg, in patients with craniofacial dysplasias, orofacial clefts, or vascular anomalies). The risk of ischemic complications was enhanced in extensive dislocations or transversal segmentation of the maxilla. The authors conclude that patients with major anatomical irregularities should be informed about an enhanced risk of Le-Fort I osteotomies. Preoperative planning avoiding transversal segmentation or extensive dislocations of the maxilla should reduce the occurrence of complications. For healthy individuals, the risk of complications with the LeFort I osteotomy is considered low."¹

BSSO (2000's) :

"Jung et al. reported a rate of complication of 9.76% (67/686 sites) among 343 patients (686 sites) who had undergone orthognathic surgery for mandibular prognathism between January 1990 and December 2002. Individual rates of different types of complications were 4.08% (28/686) for infections, 2.49% (17/686) for fixation device fracture, 1.89% (13/686) for inferior alveolar nerve injury, 1.02% (7/686) for temporomandibular disorder (TMD), and 0.29% (2/686) for facial nerve problems"²

In general, including the orthodontic part (1983 to 1996) :

"Patients and Methods: The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. Results: The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Conclusions: Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure."³

In general (1998 to 2009)¹⁷ :

---

I'll be skipping irrelevant shit like delayed union/nonunion since it's caused by wire fixations (old af) and ultra rare shit like otitis media due to the presence of a foreign body in the opening of the left eustachian tube ye ok buddy (1 case btw).

If you still don't want to read but want to skim thru it then just read the coloured words, look at the images and skim thru these vids since you have to know what it looks like when it goes well (most of the time), lol, you prolly never did that, did you?

​

There's 2 types of complications : Intraoperative & Postoperative

Intraoperative :

I - Hemorrhage* :

*It's when you lose a lot of blood and shit, it could become dangerous

Risk increases with being a twink (low bmi) and extensive surgery (high operating time)⁴, no significant correlation with age and sex
View attachment 3213856

A significant difference was observed in relative blood loss between BSSO and Lefort I osteotomy with segmentation since LF1 is performed in an area with extensive vascularization.

View attachment 3215498​

Basically vessels and shit , small ones u apply pressure or electrocautery etc , large vessels u have to ligate them i.e. tie that shit back to prevent secondary delayed hemorrhage, arterial bleeding during lefort 1 -> nasal packing (View attachment 3213876), cell saver etc.

II - Bad split :

You have to split the mandible to advance it, right? Sometimes it doesn't split in a favourable & predicted pattern.
View attachment 3213895
Risk increases with having third molars (wisdom teeth)⁵ ​

The rate of bad splits during sagittal split ramus osteotomy (SSRO) which is the reduction one has been reported to be approximately 2.3%.
Occurs more frequently during SSRO than BSSO, for mandibular splits, if you care, the literature is conflicting, some say you should extract impacted teeth way before ( at least 6 months before surgery to allow for filling and maturation of the alveolar socket bone) and some say at the same time, read more here : https://sci-hub.se/10.1016/j.ijom.2016.05.003 - https://sci-hub.se/10.1016/s1079-2104(98)90057-9 - https://sci-hub.se/10.1016/j.ijom.2016.02.011 - BSSO tho : https://sci-hub.se/10.1016/j.ijom.2016.02.011 - https://sci-hub.se/10.1053/joms.2002.33114 - https://sci-hub.se/10.1016/s1079-2104(00)80008-6

---

Young adults seem to be the least susceptible to unwanted splits.

When a bad split happens, they will have to visualize the split pattern then strip off the periosteum to assure vascularization of the fractured segment and then a salvage surgical approach depending on which type of split, read more here : https://sci-hub.se/10.1016/j.ijom.2016.02.001


Postoperative :

I - Relapse :

Risk increases when resorbable plates are used instead of titanium (overall complications 18.3% vs 8.6%)⁶, but also and especially when you have an open bite ("Kim JW, Jeon HR, Hong JR. The study on vertical stability of anterior open bite patients after bssro. J Korean Assoc Oral Maxillofac Surg. " argues that relapse can be prevented in patients with an open bite by using the modified Epker technique / Ferri's or by performing detachment of the pterygomasseteric sling, overcorrection, angle shaving, or genioplasty during SSRO. https://koreascience.kr/article/JAKO200503534147157.pdf (niggas got 0 relapse) @depressionmaxxing @truthhurts )

Risk increase with the amount of initial advancement (study assessing genioplasty relapse with rigid fixation) and with control of the proximal segment (it's the part of the mandible that's in the back, the distal segment being the teeth-bearing part you move forward -> MOA even tho this is old af) and change in the mandibular plane.⁷

Pterygomasseteric tension which concerns mandibular setbacks : https://sci-hub.se/10.1016/S0929-6646(09)60264-3

CW aka Clockwise rotation of the proximal segment, also concerns mandibular setbacks : https://sci-hub.se/10.1016/j.jcms.2013.05.034 - https://sci-hub.se/10.1097/SCS.0b013e3181be87ba

II - Nerve damage :

The nerves usually affected are :

The inferior alveolar nerve, the infraorbital nerve, the mental nerve and the incisive nerve :






During a LF1, the nasopalatine nerve, the anterior middle and posterior alveolar nerves and the small terminal nerves in the buccal mucosa along the incision line between the upper first molars are always divided. This is further exacerabted by moving the fragement in horizontal and vertical planes. Movement may also stretch or divide the greater palatine nerves or they may be electively sectioned to facilitate larger movements. The infraorbital nerve maybe injured indirectly by pressure, retraction, or fixation with plate or screws.


Since these are peripheral nerves : they can regen

View attachment 3214210
View attachment 3214211
View attachment 3214212

Concerning BSSO and inferior alveolar nerve :
"Older age was a significant risk factor for permanent hypoaesthesia, with an incidence of 4.8% per patient aged <19 years, 7.9% per patient aged 19–30 years, and 15.2% per patient aged >30 years. These findings show that the risk of Neurosensory disturbance after BSSO is significantly higher in older patients." ⁸

This basically results in numbness of the lower lip, it resolves within several months after surgery in most patients⁹ but it's considered permanent after a year.
During mandibular surgery, iatrogenic nerve damage and subsequent NeuroSensoryDisturbance can occur because of several factors. For example, IAN bruising can be caused by nerve compression during soft tissue dissection near the mandibular foramen, excessive nerve manipulation during splitting, the use of sharp instruments (chisels) during BSSO, or the incorrect placement of screws. Large mandibular advancements and increasing age have also been described as risk factors for NSD.


View attachment 3214219

You will most likely get back your preoperative sensation levels if your nerves aren't too mutilated, or if there isn't much scar tissue to block them from reconnecting, etc. This is a surgeon skill issue. Even if the great maxfacs don't necessarily need guides, I'd still advise for it, look at how easy it is to get clean cuts :



Since, it seems like age is a major risk factor we can safely assume, it's heavily dependent on NERVE HEALING ABILITY, therefore i advise hoping on TB500, BPC 157 and GhkCu (not only direct nerve outgrowth but also, the minimization of scar tissue formation indirectly helps nerve healing by allowing them to reconnect) postoperatively :
View attachment 3214231​

JFL at this peptide

If functional recovery does not occur within 4-8 months, re-exploration with nerve grafting or reanimation surgery must be considered.

Facial nerve injuries, which are fucked up are rare af.

In fact, the rate of facial nerve paralysis reported by other scholars varies from 0.17% to 0.75%. Causes of facial nerve paralysis after orthognathic surgery include ischemic paralysis of the facial nerve caused by deep injection of vasoconstrictors, physical damage by a chisel or osteotome used for segment separation, fracture of the styloid process with posterior displacement, slipping of a drill ( ) or a bur to the perimandibular soft tissues during medial osteotomy, and facial nerve compression due to a posteriorly displaced segment, and surgical retractors or hematoma. Since the distance between the ascending ramus posterior border and facial nerve is less than 1 to 2 cm while the mouth is open, the facial nerve may become pressed or directly damaged.
Read more relating to this : https://sci-hub.se/10.1016/s0278-2391(10)80239-3


III- Neuropathic pain :

Which is basically chronic pain and shit, in this study out of 982 BSSO, 563 LF1 and 335 SARPE, only 6 niggas developed debilitating chronic neuropathic pain (mean age at surgery : 43 yo).
View attachment 3214288View attachment 3214292

IV - Nose widening and Nasal deviation :

Secondary changes of the nasolabial region after the LF1 are well known and include widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip, and downturning of the commissures of the mouth. Of these postsurgical changes, widening of the alar base of the nose probably is the most common. Surgical techniques can modify undesirable secondary changes.
To reorient the displaced perinasal musculature and to control alar base width after maxillary osteotomies, many have advocated that an alar-base cinch suture be used in addition to other adjunctive procedures (e.g. anterior nasal spine reduction, nasal floor reduction, and V-Y suturing) before incision closure.

Here's an effective version¹⁰ :
View attachment 3215562

Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Basically just this : "Postoperative nasal septum deviation can be caused by insufficient reduction of the septum when performing maxillary impaction, incorrect bringing back of muscle adjacent to the nose, altered position and/or shape of the anterior nasal spine, postoperative swelling, and nasotracheal intubation. Precise surgical skill, careful extubaction, and meticulous examination of the nose are very important to avoid nasal septum deviation. If it exists after the surgery, septal cartilage reduction/repositioning, ANS recontouring, and alar base cinch suture can be used to solve these problems. The surgical method that is used in our case series can be a suitable method for secondary correction of the septal deviation. This surgical method also can be used intraoperatively and can minimize the potential deviation of the septal cartilage after maxillary surgery."¹¹

View attachment 3215574

​

V - TMD :

You really don't want condylar resorption :


Basically don't be female and stop chewmaxxing and doing retarded shit like nail biting and shit, also fix any TMJ problem before surgery.

View attachment 3215665¹²
View attachment 3215667View attachment 3215668¹³


VI - Infection :

Postoperative infections include cellulitis, abscess, maxillary sinusitis, and osteomyelitis. Rates of postoperative infections are low thanks to aseptic techniques, surgeons' excellent skills, antibiotics, and a good blood supply into the oral and maxillofacial area. Even when infections do occur, they can be fully cured through early diagnosis and management. Davis et al.¹⁴ reported that the rate of infections was 8% among 2,521 patients who underwent orthognathic surgery, and that infections occurred mostly in the mandible. Posnick et al.¹⁵ reported that the rate of infections was merely 1% when antibiotics such as cefazolin or cephalexin were administered.

Better if you stop smoking like a retard tho, thanks

View attachment 3215695View attachment 3215697


VII - Psychological :


View attachment 3215718View attachment 3215729
View attachment 3215730


Basically, a pattern of improvement in the quality of life in psychological and social aspects was observed following orthognathic surgery. HOWEVER, i don't think this applies to abused PSLers whose seeking for surgery is motivated by social anxiety disorder. Disfigured people have problems with social interaction (Macgregor,1951, 1990; Rumsey, 1983; Malt & Ug-1951, 1990; Rumsey, 1983; Malt & Ugland, 1989) and are discriminated against (Houston & Bull, 1994). Negative stereotyping of disfigured people begins in childhood (Rumsey, 1983) and continues into adulthood, where facially disfigured people meet repeated verbal abuse, disgust and pity from others (Macgregor, 1951,1989).

"Social anxiety disorder (SAD) has been defined as an enduring fear of social situations where the individual may be subject to evaluation by others. It is the most common type of anxiety disorder, with a prevalence of up to 18% in the general population. Fear of negative evaluation is said to be the trademark of social anxiety, as this fear often leads to an illogical and exaggerated anxiety in social situations. This may be a factor motivating orthognathic patients to seek treatment."¹⁶

We know that if you're depressed, anxious, young and incel, your QoL won't improve much when compared to the QoL improvements of bluepilled normies

https://sci-hub.se/10.1016/j.ijom.2015.07.020

So don't expect SHIT, goes for me too



VIII - Death :

Main causes of death during or after orthognathic surgery are accidents related to severe intraoperative hemorrhage, delayed secondary hemorrhage, airway obstruction, and general anesthesia. Fourteen cases of serious complications such as death and falling into a vegetative state after jaw bone surgery such as the orthognathic surgery (10 cases) and facial contouring surgery (4 cases) were reported in the period from 2000 to 2016. Causes of these complications were bleeding in two cases, respiratory problems in four cases, surgical errors in one case, and unknown in six cases. The procedures were performed by plastic surgeons in 12 cases, by dentists in one case, and in a university hospital in one case (Exact department is unknown). An underreporting of cases of death after orthognathic surgery is suggestive since only four cases of death have been reported in the last 16 years despite the fact that around 5,000 cases of orthognathic surgery are performed in Korea every year. Serious complications such as death rarely occurs when orthognathic surgery is performed by experienced surgeons with all the necessary equipment, and orthognathic surgery can be considered a safe procedure as long as these conditions are met¹⁸

TLDR : it's safe af

View attachment 3214013

Thanks for reading!

Bonus : yes shorterning the mandible actually induces sleep apnea https://sci-hub.se/10.1016/j.ijom.2011.01.011- https://sci-hub.se/10.1016/j.tripleo.2007.11.012 ,
So if you actually have mandibular proghnatism get bimax not just mandibular setback.



¹Kramer FJ, Baethge C, Swennen G, Teltzrow T, Schulze A, Berten J, et al. Intra- and perioperative complications of Le Fort I osteotomy: a prospective evaluation of 1000 patients. J Craniofac Surg 2004;15:971–7
²Jung JY, Park JH, Sin SH, Lee HK, Lee SW, Kim WH, et al. Postoperative complications of bilateral sagittal split ramus osteotomy of mandible. Korean J Hosp Dent. 2006;4:67–81.
³Panula K, Finne K, Oikarinen K. Incidence of and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg 2001;59:1128–36.
⁴Thastum M, Andersen K, Rude K, Nørholt SE, Blomlöf J. Factors influencing intraoperative blood loss in orthognathic surgery. Int J Oral Maxillofac Surg. 2016;45:1070–1073.
⁵Beukes, J., Reyneke, J.P., & Becker, P.J. (2013). Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy. International Journal of Oral and Maxillofacial Surgery, 42, 303–307.
⁶Ahn, Y.-S., Kim, S.-G., Baik, S.-M., Kim, B.-O., Kim, H.-K., Moon, S.-Y., Lim, S.-H., Kim, Y.-K., Yun, P.-Y., & Son, J.-S. (2010). Comparative study between resorbable and nonresorbable plates in orthognathic surgery. Journal of Oral and Maxillofacial Surgery, 68(2), 287-292. https://doi.org/10.1016/j.joms.2009.07.020
⁷Van Sickels JE, Dolce C, Keeling S, Tiner BD, Clark GM, Rugh JD. Technical factors accounting for stability of a bilateral sagittal split osteotomy advancement: wire osteosynthesis versus rigid fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
⁸Verweij JP, Mensink G, Fiocco M, van Merkesteyn JP. Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients. Int J Oral Maxillofac Surg. 2016;45:898–903.
⁹Monnazzi MS, Real-Gabrielli MF, Passeri LA, Gabrielli MA. Cutaneous sensibility impairment after mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery. J Oral Maxillofac Surg 2012;70:696–702.
¹⁰Shams MG, Motamedi MH. A more effective alar cinch technique. J Oral Maxillofac Surg. 2002;60:712–715.
¹¹Shin YM, Lee ST, Kwon TG. Surgical correction of septal deviation after Le Fort I osteotomy. Maxillofac Plast Reconstr Surg. 2016;38:21.
¹²Gunson MJ, Arnett GW, Milam SB. Pathophysiology and pharmacologic control of osseous mandibular condylar resorption. J Oral Maxillofac Surg. 2012;70:1918–1934.
¹³Winocur, E., Littner, D., Adams, I., & Gavish, A. (Year). Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: A gender comparison. Journal Name, Volume(Issue), Pages. Tel Aviv University.
¹⁴Davis CM, Gregoire CE, Steeves TW, Demsey A. Prevalence of surgical site infections following orthognathic surgery: a retrospective cohort analysis. J Oral Maxillofac Surg. 2016;74:1199–1206.
¹⁵Posnick JC, Choi E, Chavda A. Surgical site infections following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study. J Oral Maxillofac Surg. 2016 doi: 10.1016/j.joms.2016.09.018.
¹⁶Ryan FS, Moles DR, Shute JT, Clarke A, Cunningham SJ. Social anxiety in orthognathic patients. Int J Oral Maxillofac Surg. 2016;45:19–25.
¹⁷Kim, J.-H., Kim, S.-G., & Oh, J.-S. (Year). Complications related to orthognathic surgery. Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea.
¹⁸Kim, Y.-K. (2017). Complications associated with orthognathic surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 43(1), 3–15. https://doi.org/10.5125/jkaoms.2017.43.1.3

duddddde the way he just pushed his lefort I region down shit got me cringing hard

 

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