[T-2 wks] Questions to the Surgeon before MMA

Questions to the surgeon 2 weeks before MMA

Sep 9, 2009

These are questions to Dr. Robert Riley and Dr. Donald Sesso about 2 weeks before surgery when I went to see him to get my casts done and also my X-rays taken.

1. How often will he perform nasal cleaning? Will he do it on weekends as well?
Surgery is on Tuesday, nasal cleaning will be on Friday. Nose is very dry after surgery, needs to be irrigated every day. Will also need to take showers twice a day. The moist air helps a lot. They never see patients on weekends but are available on call.


2. Counter-clock wise rotation, is that practiced Dr. Riley and Powell? This is used for mandible-movement and aesthetics?
Counter-clockwise
rotation may be performed, it depends on molds. The molds are cast in hard stone and viewed on something called an articulator. Decisions are based on the stone cast.



3. Do they ever use screws instead of mandibular plates based on anatomy?
When this surgery was first invented in 1984, they used to wire the jaw shut similar to a bone cast. For the last 10 years, they have been using titanium plates with 4 screws and 2 corticular screws. They always use both, never only screws as the outcome is better. These plates and screws are fully removable but are usually left in as the patient does not feel them.



4. How much airway increase can I expect?
Studies have shown that 8mm
bony advancement shows little long term sleep apnea reoccurence. They shoot for 12mm on both jaws but really as big as possible. The airway increase is variable and depends on the patient.



5. How many days in the hospital?
3 days in hospital. The release criterion from the hospital is be able to drink and be comfortable on liquid pain medicine. Expect less days in the hospital than the uvulopalatal flap surgery. Also 2/3 of the patients report that jaw surgery is easier than soft tissue surgery.



6. Will you use the unit of blood I gave last week?
Patients on an average lose about 400cc of blood. 50% of patients need blood.


7. Do I need a pain management specialist? Do I need a full-time nurse during the first week if my wife is working?
Pain Management surgery is not routinely needed. You don't need anyone full-time help, maybe for a couple of hours per day.


8.  I have had RF turbinectomy 2-times and my turbinate is still swollen. What if they shrink my turbinates from under during MMA?
They open the turbinate from the inside, remove the bone inside as it does not perform much function. They also remove additional tissue. Nose will bleeds due to this. This procedure is much better than the alternative where an ENT specialist simply goes into the nose and removes the turbinate from the outside. He does not expect to add to complications due to this.


9. Will the staff have access to Drs. RP if needed during their time off the following week? How long are they away?
Yes will have access. They will be away for only a few days.


10. My bite is perfect now. Will my teeth need to be adjusted after surgery for bite-correction?
Since the muscles are relaxed during surgery there is a chance that the bite may be off after surgery. Hopefully this does not happen, but if it happens, then a few teeth may need to be adjusted.



11.
I have had Uvula removed before with you and you made a deep cut during that time. With the movement of the jaw, will
there be any issues with swallowing liquids?
No, this is a very rare occurence.



12. Can my lower lip numbness pain be treated from the removal of cyst in the last surgery since he can see my nerve under the wisdom tooth?
Typically not. Since it is 18 months from the last surgery, there is a chance that the nerve will continue to heal till about 3 years.