Surgery Consent Form (WOW)

[Elaine]

I never signed a consent form like this, nor was I advised of all this. I do remember signing one saying the doctor was not responsible for the outcome. I guess that should have told me something.

The proposed surgery has been outlined for me in laymen's terms and possible complications and side effects have been discussed including ( but not limited to ):


___A.Objectionable scarring of the incision line, possibly requiring later revision.


___B.Postoperative swelling, discomfort, bruising of the area, bleeding, hematoma (blood clot) formation, and wound infection.


___C.Adverse or allergic reactions to medications oranesthesia causing multiple side effects, some of which may be serious.


___D.Foreign body reaction and (if used) rejection of implant materials.


___E.Malocclusion (change in bite) after surgery.


___F.Postoperative development of adhesions (scarring) within the joint space which may cause continued jaw dysfunction and decreased range of jaw movement or chewing difficulty.


___G.Facial muscle weakness, particularly of the forehead and eyelid, or inability to close the affected eye tightly, which is caused by injury to
motor nerves in the immediate surgical area. This weakness may be partial or total and is usually temporary, but may be permanent.


___H.Sensory nerve damage, numbness, or other sensory alterations which may be temporary or permanent.


___I.Ear problems, including infection of external, middle or inner ear, ringing in the ear, hearing loss or equilibrium problems.


___J.Freys Syndrome


___5.I understand that additional treatment may be necessary post operatively, including physical therapy, splint therapy, reconstructive dentistry,
orthodontics, jaw repositioning surgery, removal of certain fixation devices, or further TMJ surgery including total joint replacement, bone grafts, and
arthroscopy.


___6.I understand that this is complex surgery, and there can be no guarantee of complete resolution of my present symptoms or jaw dysfunction. Occasionally
there may be increased symptoms post operatively.


___7.I have been told of my option of a second opinion regarding this procedure from a qualified professional.
___8.Recognizing that during surgery some unforeseen condition may be discovered that might necessitate a change in approach or different procedure from those
explained above, I authorize Dr. ****o perform such
procedures as are necessary and advisable in the exercise of his professional
judgment.


___9.I understand that general anesthesia will be used for my surgery and that there is risk of serious bodily injury inherent in such anesthesia, including
death. I have been told not to have any food or drink for 8 hours prior to my anesthetic and that CONSUMING FOOD OR DRINK BEFORE INTRAVENOUS GENERAL ANESTHESIA MAY CAUSE SERIOUS COMPLICATIONS OR DEATH!


___10.I have discussed my past medical history with my doctor and have disclosed all diseases and medications, including alcohol and drug use (past or
present).


___11.I agree to cooperate with the recommendations of Dr. ****,
realizing that lack of cooperation may result in a less than optimal result. I have not been given any warranty or guarantee as to the result of the
proposed procedure.


___12.I certify that I have had an opportunity to read and fully understand the terms within the and that all the above blanks were filled in prior to my
signing this form. All my questions have been answered to my satisfaction and I am willing to undergo the proposed surgery.


I also state that I speak, read and write English.

[Cymy Sue]

Bump for Janis

[This message has been edited by Cymy Sue (edited 08-26-2003).]

[Cymy Sue]

This is a brief form of consent. The ones you have to sign now are more indepth in regard to possible complications.

[ALuv4Labs]

No need to worry. I don't know what kind of surgery you are having, but considering it's on a TMJ board, I'm sure it's one I have had. I have had several different jaw surgeries all beginning with a bad overbite and TMJ. The first one was to break and re-allign my jaw. I had this when I was only 14 and everything went VERY well! I will not go into details about what all I had done unless you see this and ask me to. I had to sign for all of these things that you listed, and none of those serious things happened to me. There was a great deal of swelling, a bit of numbness in some areas, and a good deal of pain. I am actually now a "patient counselor" type of person for my Oral Surgeon's office. If patients have questions about the surgery and want to talk about it with someone who has had it rather than just the doctor, my doctor gives them my number. I have never heard of anyone, out of at least hundreds of patients, having any of those serious complications. It is just there for everyone's protection because technically, it COULD happen...It's just that the chances are very, very slim. If you would like to discuss this further, feel free to post a reply to me. I am very open to talking about all of this and would love to help. Good luck!

[Elaine]

I am "one" of those patients with serious complications. Your statement of "no need to worry" definitely would not apply to me. After having three surgeries, puking headaches to the point of vomiting for six hours at a time. Excessive weight loss(30lbs) due to not being able to chew. Hearing loss in the right ear, a bite that is so far off, not to mention an opening of 10mm. An implant that needs to be removed due to the fact the jaw joint put to much stress on it and the screws have come loose. My condyle is down to a stub from the wear & tear of the implant, plus the development of osteo-arthritis. Next step is total joint replacement, like I would agree to that after having been through this nightmare. Once I get this implant out, I hope I never have to let a oral surgeon get his hands on me again.
Elaine


This is one point that should be stressed before undergoing this surgery!!! Uggh!!
I understand that additional treatment may be necessary post operatively, including physical therapy, splint therapy, reconstructive dentistry,
orthodontics, jaw repositioning surgery, removal of certain fixation devices, or further TMJ surgery including total joint replacement, bone grafts, and
arthroscopy. One surgery "usually" leads to another and on and on it goes....


[This message has been edited by Elaine (edited 09-10-2003).]