Q: Dr. Eppley, I have had two double-jaw orthognathic surgeries that didn't cause any lasting problems to the sensation in my nose or upper lip, but this last surgery did. Ever since the last surgery, the area just inside and under my nose is constantly aching and my upper front teeth and gums are still numb. Could the hardware that that I've circled in the panorex x=ray be causing these problems for me? Do you think that removing this hardware could resolve it? I'm asking because even if I don't have more jaw surgery, I don't think that I can stand this aching/burning/numb feeling inside my nose and upper teeth much longer. I was on Tramadol for several months and then switched to Lyrica – but nothing really helps.
A: While titanium plates and screws are non-ferromagnetic and do not corrode, the location of the metal hardware could certainly be a contributing cause as it is positioned around the pyriform aperture directly above the tooth roots and at the base of the nose. While most LeFort osteotomy patients do have hardware in similar areas, the right-sided location of the hardware does cross over the premaxilla more than is customarily seen. While no one can say for sure if this hardware is the cause of your dysesthesia, there is one way to answer that question definitely…remove it. I would remove both medial or paranasal maxillary plates and screws to be sure all devices are gone from the paranasal areas.
Dr. Barry Eppley