Summary Of The First Ortho And Jaw Surgery Gone Wrong
Here's a run down of my failed first ortho work and jaw surgery. It's a long story!
I always knew I needed braces and jaw surgery. It was something mentioned to my parents when I was as young as 5 years old. For a few different reasons, I never got the ortho work let alone the big jaw surgery that comes with it. Fast forward to my late 20's when I am in a better position to get the work done, and I decide to go for it when I started seeing more and more issues with my joints, muscles, tooth ware to the point of requiring restoration, and increasing headaches thanks to my jaws and teeth. All of the dentists and specialists I've seen over the years said I should get the work done. Many even push this whole doom and gloom "it's only going to get worse from here. You may need total joint replacement later, crown restoration, etc, etc." Looking back on that now, I think I would have rather rolled the dice and seen what happened. Who knows. Maybe it wouldn't have gotten worse and it could have been something I could have gone on living life with.
After a few ortho consults I chose a local orthodontist in May 2013 and got fitted for braces with the intention of pursuing the double jaw surgery. It took me two months to come to the decision to do it. In my gut I felt like I should just do the ortho only, but after a lot of research, it seemed like I was just being a chicken and this would all work out fine and I just needed to dive in to the deep end of the pool. At the time, a few orthos (including the one I had ended up getting braces with) recommended I see this maxillofacial surgeon from Kaiser. I wasn't a Kaiser patient, but was able to pick up Kaiser insurance in open season. Jan 2014 when I was able to utilize my new Kaiser insurance, I had my first consult with my surgeon after having braces on the 8 months prior. This is already odd as most patients getting set up for jaw surgery start off under the guidance of a surgeon. A surgeon is largely the one to dictate the plan and set up and should be meeting with your ortho and talking about that. In hindsight, this was an early red flag that my ortho marched to the beat of his own drum and did what he wanted and how he wanted, no matter how damaging it ended up being to me. Anyway, first surgeon appointment 8 months after I got braces on. I saw her resident for most of the appointment with a brief look over from her. They took some measurements and just did a general look over to diagnose what is basically an overbite/overjet and gummy smile. They scheduled me for an April surgery date pending how ortho goes.
I did a lot of research and I was pretty active in a bunch of online jaw surgery groups and message boards. Being a scientists, I had to understand this stuff more than the average patient to make my brain at ease. Between Jan 2014 and March 2014 I never heard from my surgeon again. My ortho didn't tell me what he was doing to set me up for surgery except for that he was doing what needed to be done for surgery. There was no plan despite my multiple requests for one, even in the vaguest of senses. Through research though I knew your bite was supposed to be exaggerated and made worse prior to surgery. My bite was dramatically improved. So much so that my 8mm overjet was now 4mm around March, and I actually had thoughts of backing out of the surgery; wondering if I could live with these improvements that I saw through ortho. I was also uneasy that I had not seen my surgeon and was not given any kind of surgical plan despite multiple requests. Just something in my gut told me things felt off. I brought my feelings up to my ortho, and he smoothed things over. Told me to trust them, relax, and just go with it, as this is how they've done this a bunch of times over many years. I did and proceeded.
Late March 2014 I got scheduled for my final 2 week pre op appointment and a class to let us know what to expect from surgery and how to deal with recovery. This is now only the second time I am seeing my surgeon before she breaks my face in to multiple pieces in a major surgery. And again, I saw mostly her resident, and this time it was a different one. She still couldn't give me measurements or a super detailed surgical plan past "we're going to move your upper jaw forward a smidge, up, and lower jaw forward and that will be that! It's going to be great!" I still didn't like it but I kept remembering the words of my orthodontist and tried to have faith that she knew what she was doing and I was just being a paranoid patient. The class was a joke. I knew more through my research than the RN teaching the class. For somebody walking in to the surgery with absolutely zero knowledge on any of it, it was probably informative, but even to a patient who had done even the most minimal of research in to things, it was a joke. So, that was it. Surgery in two weeks.
I got surgical hooks placed on my arch wires the day before surgery. I was still super uneasy about the whole thing. Looking back on it now, I should have listened to my gut screaming at me, but at the time I just tried to tell myself to quit being a paranoid for nothing patient or that I was just experiencing normal anxiety leading up to a major procedure, which was my first ever hospital experience. April 9th I showed up to Kaiser Richmond around 6am to get checked in to the hospital. Again, I barely saw my surgeon. This time it was the one resident I saw at the two week preop appointment and a new resident I had never seen before. Right away he seemed to be the one to jump in and take charge of my case. He gave me my forms, chatted me up, took a final look at everything, wrote "yes" on each side of my face that was to be operated on. Dr. O'Ryan finally breezed in around 7:35-7:45am, only saying a quick hello. I got taken back to the OR at 8am, where again I just remember seeing the faces of the two residents and the anesthesiologist. The one resident who seemed to be heading up everything from the start was the one to later wheel me out of the OR, tell my family how I was, write my operative report, and later do my exam and discharge me from the hospital the next morning.
I spent 1 night at Kaiser Richmond and went home to begin the 12 days of being wired shut. You're so swollen and numb from this surgery that you can't tell what is what at first. And then couple that with being wired shut. I couldn't tell which teeth were touching and which weren't. Unfortunately I didn't know what I didn't know regarding the standard of care you should receive with jaw surgery. The 12 days wired shut I never had a check up with my surgeon. The resident who discharged me did a quick look over, but that was it. I got xrays done as part of my post op instructions. I remember walking out of the xray center around day 6 post op and holding them up to the light. Through wired clenched teeth I said to my mom, "I'll be damned if this looks slanted and crooked!!" I just told myself that I was being paranoid again and I didn't really know what I was looking at. I was a little nervous walking in to get unwired and have my check up at 12 days, wondering if the crookedness I saw on the xray would be a problem. Again, super quick look over, but I was so relieved when I got a huge thumbs up and told all looked well outside of a hematoma and infection on my left side. I had a bulge on that side from day 1 post op. I didn't think anything of it since swelling is sometimes lopsided. So, I get antibiotics, get unwired, and I am sent home. Next check up isn't until 4 weeks post op.
A few days after being unwired and have more swelling drop, I started to notice my smile looked very crooked. My upper lip also felt really full and was hard to close my lips, but I chalked that up to swelling. I also didn't freak out about the crooked smile since I thought it could be swelling and muscle weakness. Within about a week, it really hit me that something was wrong. My smile was VERY crooked. To the point where I looked like a stroke patient when I smiled. I showed a ton more gum on my right but not on my left. The midliines of my teeth were also shifted almost a whole tooth off to my right, but I figured that is something ortho would fix soon. As I began to get feeling back, I could start to feel that my teeth were not meeting right at all. I was biting edge to edge on my left (K9 tip to K9 tip) and I had a few mm overjet on my right still. It was really odd. But again, thought it was just the normal that would be fixed with post op ortho. 3.5 weeks post op I saw my ortho for the first time. The looks on everybody's faces when they came up to see my new smile...... it was devastating. I knew right away that all the fears I had of this being off were coming to reality. It wasn't me being paranoid. Right away they smoothed it all over and said they should be able to fix it with ortho. I had a 4 week follow up with my surgeon scheduled a few days after that ortho visit, and my ortho said to talk with my surgeon and see what she says about everything.
My 4 week follow up started like all of my other appointments-- with the resident doing everything. I waited for the resident to say something after checking me, but all I got was another thumbs up and everything looks good. I finally said that things looked off to me and my ortho agrees. She fetches my surgeon and after standing back and looking at me for a second, she admits to my upper jaw being canted down to my right 2-3mm. I was expecting her to take a look at other things and start the process of really taking a good look at me to see what else was off-- order more scans, xrays, do a full exam, etc, but she started jotting a few things down in my chart and told me she'll talk with my ortho and see what they're going to do. If it's something he wants to try to fix with ortho or if I would be a case to pull in and fix surgically. Again in hindsight, this was yet another major red flag at this point, as my ortho had ZERO business being the one to decide if I required immediate revision surgery or not. At this point my surgeon literally grabbed me by the arm to usher me out of her office quickly. I'll never forget what I said to her. I looked her in the eye before being shoved out of the door and said, "OK, lets see what he (the ortho) says. For what it's worth, I am not upset or anything. There's no going back and undoing this, so I just need to know that we're in this together and we're going to find out X is wrong and do Y to fix it." Her response was something along the lines of, "sounds good. I'll get with Dr. Wadden and I'll be in touch." I remember walking out of the office completely shell shocked, but extremely calm and understanding given what was happening.
I waited to hear from my surgeon in the next days, but I never really heard from her. Days turned in to weeks. I had a few more ortho appointments and each time I followed up to see if they'd talked about anything and my ortho claimed to never really hear much from her either. So, he basically starts shoving my teeth all over. Rebonded a ton of brackets, puts me in rubber bands, puts springs on my front teeth to open up space and correct what he thinks was something he missed leading in to surgery called a tooth size discrepancy, and do a bunch of other things. I figured it was worth a shot to try to fix this with ortho, but I knew from the start that this was not an ortho problem. I could feel it in my bite. This was the bones being completely off and not the teeth. I respectfully told both my ortho and my surgeon that I could feel I was all twisted up and knew this was not problem for ortho to fix. The only time I heard from my surgeon is if I emailed her to ask what was going on. I kept trying to check in and get her to book an appointment with me. I always got the same response: "Keep working with your ortho and I'll be in touch." She was never in touch. By 6 weeks post op, my ortho declares me a surgical case and says he can't fix me. All the while my bite is getting outrageously bad (and not in a good 'prep you for surgery' way), my teeth are being yanked all over the place in a short time, and now I've been told I am a revision case with no other information. Not a peep from my surgeon and nothing from my ortho. I just felt lost in space and in limbo; beginning to feel done over by my ortho and completely abandoned by the surgeon who did me over too. I decided to finally take charge of everything and at 8 weeks postop (June 2014), I booked an appointment for a consult with one of the leading names in jaw surgery, Dr. Gunson down in Santa Barbara, CA. I was able to get in and see him by 10 weeks post op. The consult with him was amazing, and I finally got answers after being in the dark anxiously the prior two months since surgery. Unfortunately, my situation was far worse than I even feared. My results were pretty much catastrophic and I shouldn't have even been discharged from the hospital as bad as I was, let alone passed over at my post op check ups. It should have been immediately obvious to my ortho that I was a revision case and that he had no business yanking my teeth all over for no reason except to try and cover up my surgeons mistakes. It should have been painfully obvious to my surgeon what was wrong and that it required an immediate revision. I saw 3 other surgeons, including some other big names, and all of the diagnosis were unanimous. I was not only a revision case, but now a pretty complicated one.
Turns out there was anything and everything wrong. More so that I ever thought originally. That full feeling I had in my upper lip? What I felt was a monkey face and thought was swelling? That was my upper jaw moved forward a whopping 4mm!!!!! Yes, 4mm advancement on a patient that went in to surgery with an overbite/overjet and an upper jaw that was already too far forward!! I was never given measurements as part of my surgical plan, but was told my upper jaw would come forward a "smidge." This is not a smidge!! So, my upper jaw was advanced 4mm without my knowledge or consent both preop and was never told to me post op. My lower jaw that was supposed to come forward 6mm? It's only been moved 3-4mm forward, so I am still class II both skeletal and dental. Why did my surgeon do these movements (which were not part of my "plan")? Surgeons I consulted with said the ortho was set up terribly wrong. My 8mm overjet was taken down to 4mm and this gave the surgeon no room to move my lower jaw forward 6mm. It would have given me an underbite. So, the upper jaw saw a huge advancement and lower jaw still didn't come forward enough. I couldn't close my lips and the muscles around my mouth severely cramped and I had severe mentalis strain. Then there is the cant. 2-3mm lower on the right vs the left. When they impacted my jaw they left me lopsided, so the right half of my jaw hung much lower than the left. They also didn't impact me at all in the back of my mouth, so there was a posterior open bite too on top of the lateral and anterior sections I was open in. The upper and lower jaw was also yawed and only saw rotation on one side. My midlines were shifted over almost 3mm. Remember the lump/bulge that my surgeon said was hematoma and infection? That she said I caused from ripping a stitch out? Well, turns out that it's not that at all and is in fact the bones of my jaw set all bowed out and yawed where only one proximal segment was rotated on that side. Bones that revision surgeons told me healed bowed out and could be a permanent disfiguring of my face. So, everything was basically twisted, crooked, and lopsided. Work so sloppy that almost all of the surgeons I saw can not believe it is the work of an experienced surgeon like Dr. O'Ryan.
I went back to my ortho and presented him with the surgical plans from my consults, including their opinions on how wrong they deemed my pre op and post op ortho. At this point it's now been 3 months since I last heard from Dr. O'Ryan. Not a peep from her. I sent her the consult notes from each doctor I saw, and still heard nothing. At the time I had just lodged a formal complaint against her with Kaiser. A few weeks later, about the time when she probably heard about the complaint, all of the sudden she reaches out to my ortho and said she's going to take a look at the records and be in touch. We're now almost 4 most post op without a single word from her and she basically left me for dead. Why would I care to talk to her at this point? No thanks. My trust was 110% gone. I needed to choose a new surgeon and during this time I was also going on ortho consults to get a new ortho as well. I needed a whole new team. I asked my ortho to put me in wires that would just retain my current bite until I could figure out what I was doing (ortho pause set up). I am pretty sure my ortho just strung me along and was only covering up for my surgeon. There is no other reason why he would not be banging down her door to get her involved with the case after my disastrous results and her actions and silence that followed. So, I assembled a whole new team and transferred over to begin my revision process in late Oct 2014, 6 months post op.
All of this has come with other issues. I also found out in my post op consults that some of my teeth were seeing severe root resorption. Something my ortho should have been monitoring and never did in the year plus time I was in his care. Not only was he not monitoring it, but he was also wildly yanking my teeth all over the place for nothing but to string me along and try to "correct"" all of the surgical errors and he was worsening the resorption that was already going strong. I started seeing a prosthodontist to keep tabs on everything. One tooth was so severe that my dentist even talked options with me on what we would do if it fell out before I was done ortho. These are upper front teeth, so this was pretty devastating news. Ended up that all 4 of my main front upper teeth had severe-extreme root and bone resorption and was easily seen on film and either purposely ignored or grossly misdiagnosed. I later found out that my lower front teeth also had the same kind of damage. I am in the works to have 5-7 implants on those teeth after my revision treatment. So now I am looking at probably $25,000 plus of restorative work after this is all done. It's been a long hard road through all of this. And all of this thanks in good part to the substandard care from Dr. Felice O'Ryan, Kaiser HMO, and my first orthodontist. Here is a few take aways to minimize your risk of ending up in my shoes:
- Take your time and choose an ortho wisely. Try to find one who has done a lot of surgical cases. Go on as many consults as you can. I would say at least 4-5.
- Take your time and do a lot of research on surgeons. Don't automatically rush to the one guy your ortho is pushing. Do your own research and, like orthos, go on as many consults as possible.
- Vet the surgeon you chose. Look up their info, find blogs from other patients who have gone through them, check on message boards to see if anybody knows anything about them, read their peer reviewed articles and papers, look up their info in your states medical board history and check to see if they have any complaints or charges against them. Check court data bases and see if they've gone to trial for negligence.
- Make sure you are seeing your surgeon enough. If you feel like you have not seen them enough or that enough planning is not being done for your case, then speak up. The time to express concerns is BEFORE surgery.
- Your team should be willing to share all of your surgical plans and details with you. They should be able to walk you through the surgery, giving you the measurements and plans. If they can't, this is a HUGE red flag. Like, uber huge. In my case they didn't give me any info because they barely did any planning and probably didn't have the info to give. And what planning they did was so terrible. If my surgeon told me she wanted to move my upper jaw forward 4mm, I would have NEVER EVER consented to that. Ever. So, be in the know on your case. Get your records and make sure you're given all of your surgical plan and details.
- Residents. This is a tough topic because I am not against residents. Everybody has to start somewhere. I am the kind of girl who goes in to donate blood and lets the new guy stick me as many times as they need to get it. But, in my case I feel like it was 80% resident work and 20% surgeon. That may even be too optimistic given the fact that the top theory as to why my surgery turned out so awful is that not only did a resident do it, but we wonder if Dr. O'Ryan was even in the room to supervise and check everything. I'll never know. But if you get the feeling like the resident is doing more work that the surgeon or you're seeing the resident a lot more than you're seeing and talking to your surgeon, then run as quick as you can. I am not saying residents shouldn't be involved, but they shouldn't be the ones running the majority of your case and performing your surgery unsupervised.
- Trust your gut. If you feel like something is off, then speak up. Don't be afraid to go for second opinions. I started questioning things about two months pre op and felt in my gut I should back out of the surgery and I didn't. It's something I regret deeply. I've learned in this process that my gut has been right. Every. Single. Time.