Daughter had Le Fort I surgery 7 weeks ago and upper jaw is already retracting. She is a cleft lip/cleft palate patient. From early childhood she’s had 6 prior surgeries and she just wants to look “normal” (her words), improve her self-esteem and get on with her life. Dr. A was successful in moving jaw forward so upper/lower teeth met, but due to scar tissue (two previous palate surgeries) could not stretch palate far enough forward to allow for any slight relapse. Daughter was wired for 2-1/2 weeks, but Dr. A did not attach any fixed splint/retainer. Dr. B (another member of the team) wants to operate on her nose to correct deviated septum and to redo Le Fort I (without wiring jaws) and attach splint/retainer as soon as possible.
I have read many of the posts here and on other blogs of patients having successful Le Fort I and Le Fort II surgeries and totally confused by what the team of doctors are telling us. We were told that Le Fort I surgery only was recommended as there have been recent AMA reports that Le Fort II surgery could compromise a patient’s throat airways, lead to possible nerve damage and could lead to double chin. One of the team members (senior orthodontist) suggested before surgery that to get the desired result, the surgeon would have to perform both Le Fort I and Le Fort II. Dr. A said it was the surgeon’s call and that they intended to only perform Le Fort I. When I asked Dr. A about the team Orthodontist’s recommendation to do both Le Fort I and Le Fort II, Dr. A said it’s the surgeon’s call. Doesn’t it make sense that upon reviewing daughter’s medical chart, seeing that she’s had previous palate surgeries that there would be a fair amount of scar tissue
and thereby anticipate limitations in advancing the upper jaw? Doctors know there is a 30% failure rate of Le Fort I surgeries and the patients end up having a second surgery. Why wouldn’t a surgeon want to perform only one surgery on the patient and avoid possible risks from a second surgery? I keep hearing the term “risks versus benefits,” well, doesn’t this apply in my daughter’s case? What am I missing here? Are the doctors trying to limit further liability and/or because of departmental budget cuts at the hospital (OR time and surgeon’s operating time would cost the hospital more money, right)? Your thoughts and advice would be appreciated.
Maxine
