* MBS 5/03 and 12/03 - still images
Stills from Video Fluoroscopy
Left: 5/03 ~~~ Right 12/03
Image on right (12/03) was taken while pulling up on platysma/SMAS at angles of jaw. You can see the forceps in the image as two dark horizontal lines just above the upper teeth (on left side of image) and angling slightly downward where they grasp the flesh at the angle of the jaw. Note the way this “corrective tension” repositions the hyoid and trachea into a more normal position. Also, note the difference in both images, between the amount of soft tissue in front of the trachea. The “lifting” with forceps restores support to the floor of the mouth and position of the trachea. The image on left (5-03), without any manual maneuver, shows the trachea pulled forward. This is due to weakening of soft tissue and muscles which elevate the tongue base, etc. The tension, created by the surgery, OPPOSES the upward tension employed in every properly executed neck lift. The force exerted on the internal structures of the neck has permanently thinned and weakened the supportive tissue.
Photo below demonstrates forceps “lifting maneuver” used in MBS of 12/03, however, I was not able to get as good a grasp for the fluoroscopy as I was able to accomplish for the photo. This maneuver repositions the entire upper airway, allowing me to breathe through my nose, which I cannot do with my head in the same position WITHOUT the maneuver. The jaw retracts with such great force that it prevents closure of the mouth. This “mandibular retraction” contributes to the decrease of the hypopharangeal space, which many studies have shown, is a cause of sleep apnea in patients who undergo mandibular retraction surgery.
A definate visible, measurable retraction of the mandible was evident immediately after this surgery. The CAUSE of this permanent retraction makes NO difference in the reaction of the soft tissue structures to the change in the position of a skeletal structure. It has not improved with time, as one surgeon with whom I consulted in the early post op days had hoped. It has actually increased in severity, as the contracture of the platysma and SMAS have increased with time. It is impossible to “stretch” a muscle beyond its biomechanical capacity without consequence. In facial surgery, such inappropriate manipulation of layers of tissue (fascia-like tissue which contributes to animation, etc.) have the potential to create serious functional problems. As many of these procedures are “guinea pig” techniques, there is more reason for surgeons to pay attention to complications such as mine. Instead, it has been my experience that these mishaps are more conveniently swept under the rug, ignored and denied.
Stumble It!
