I thought you might be interested in the consent form, so here it is: everything that could possibly go wrong with your surgery, but probably won't.
Orthognathic surgery is sometimes called "Surgical Orthodontics" because, just as an orthodontist repositions teeth, an oral and maxillofacial surgeon uses orthognathic surgery to reposition one or both jaws. Just as "orthodontics" means "straight teeth", "orthognathic" means "straight jaws." In fact, because moving the jaws also moves the teeth, orthognathic surgery is usually performed in conjunction with orthodontics so that the teeth are in proper position after surgery.
The objective of orthognathic surgery is the correction of a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak and breathe. In many cases, an enhanced appearance can also result.
Orthognathic surgery is being planned for you and it is important that you understand the risks and benefits of the surgery. This is NOT a minor surgery and you have the right to be fully informed about your condition and the recommended treatment plan. It is important you are fully aware of all material risks and effects during and after the surgery.
For this reason, we are recommending that you read and review this document and ask any questions prior to the surgery. The disclosures and information in this consent are not meant to alarm you, but rather to provide information you need in order to give or withhold your consent to the planned surgery.
1. This is my consent for Dr. X and/or any other oral and maxillofacial surgeon(s) working with him and/or such assistants as may be selected by him/them to perform a mandibular advancement in order to treat the condition described as Class II malocclusion secondary to mandibular retrognathia.
2. The surgical procedure planned to treat the above condition has been explained to me and I understand the nature of the treatment to be to advance the lower jaw to improve the bite.
3. I have been informed of the possible alternative forms of treatment (if any).
4. My surgeon has explained to me that there are normal sequelae (after effects) and certain potential risks of the surgery, some of which may be serious. They include but are not limited to:
*Facial and jaw swelling after the surgery, usually lasting several days or weeks.
*Bleeding, both during and after the surgery, which may sometimes be severe enough to require a blood transfusion (less than one per cent). I have been advised of the opportunity for blood donation before surgery (if applicable) such that my own blood may be given back to me (auto transfusion if necessary). I further understand that there are risks with the process of auto transfusion.
*Allergic reaction to any of the medications or materials used during or after the surgery (less than one per cent).
*Delayed or non-healing of the bony segments; sometimes requiring a second surgery and/or bone graft to repair (less than one per cent).
*Relapse - the tendency for the repositioned bone segments to return to their original position, which may require additional treatment including additional orthodontics, surgery and/or bone grafting.
*Bruising and discolouration of the skin around the jaws, eyes and nose.
*Diminished sense of smell (if upper jaw surgery is done).
*A change in cosmetic appearance. Although this procedure is usually in part to restore jaw function, I am aware of some expected change in my appearance. This change is typically favourable; however, I understand that the changes cannot be exactly predicted.
*Loss of feeling, pain or tingling numbness in my chin, lips, tongue, gums or teeth, which occurs in a significant number of patients. These symptoms may last for several days, weeks or months, and I have been advised that there is a small chance that these changes may be permanent.
*Possible decreased function of the muscles of facial expression, which are typically transient or temporary but may be permanent in rare cases (less than one per cent).
*Scarring from the external incisions if any are required.
*The possible need for additional surgical procedures to remove wires, plates or screws (less than one per cent).
*In certain cases requiring bone cuts to be made in the narrow spaces between teeth, there is the possibility of devitalization of those teeth, which may later require root canal procedures and rarely may result in loss of those teeth (less than one per cent).
*In upper jaw surgery, the sinus will be affected for several weeks and there may be the need for further sinus surgery to remedy any lingering problems.
*Post-operative infection which may cause the loss of adjacent bone and/or teeth and which may require additional treatment for a long period of time (less than one per cent).
*Change in the position of the jaw joints, which may cause post-operative discomfort, bite change or chewing difficulties. If the jaw joint symptoms existed before surgery, there is no guarantee that there will be an improvement, and in rare cases, there may be a worsening of the symptoms after surgery.
*Stretching of the corners of the mouth, which may result in discomfort, cracking and slow healing.
*Inflammation of the veins that are used for IV fluids and medications, sometimes resulting in pain, swelling, discolouration and restriction of arm or hand movements for some time after surgery.
5. General anesthesia will be used for this surgery, and I have been advised of the risks of general anesthesia, including bronchitis, pneumonia, hoarseness or voice changes, cardiac irregularities, heart attack or death. We encourage you to discuss this with your surgeon or anesthesiologist. I am aware of the importance of not having anything by mouth, including clear liquids, unless specifically authorized by my surgeon or anesthesiologist (for eight hours prior to my anesthetic.) General anesthesia without a totally empty stomach may be life-threatening!
6. I realize the importance of providing true and accurate information about my health, especially concerning possible pregnancy, allergies, medications and the history of drug or alcohol use. If I misinform my surgeon or anesthesiologist, I understand the consequences may be life-threatening or otherwise adversely affect the results of my surgery.
7. If my teeth are wired together after this surgery, I understand there are certain associated risks and complications: oral hygiene will be diminished, there may be resultant gum disease, my teeth will feel slightly loose for some time after the wiring, and there is always some concern about airway obstruction. I agree to carry wire cutters with me at all times when my jaws are wired and to avoid the use of alcohol and other activities that may cause nausea or airway problems.
Information for Female Patients
I have informed my surgeon about the use of oral contraceptive or birth control pills. I have been advised that certain antibiotics and other medications may neutralized the preventative effect of birth control pills, allowing for conception and pregnancy. I agree to consult with my personal physician to initiate additional forms of contraception during the period of my treatment.
The fee for services has been explained to me and is satisfactory, and I understand that there is no warranty or guarantee as to the result and/or cure and that my condition may return or become worse.
By signing this consent form, I acknowledge that I have read it completely and understand the procedure to be performed, the risks and the alternatives to surgery (if any). I have had all of my questions answered to my satisfaction. I was under no pressure to sign this form and have had sufficient time to fully review this form and consider my choices. I have made a voluntary choice to proceed with surgery. I certify that I speak, read and write English.