Q&A

(Note there are other pages linked a couple lines above this one, it’s easy to miss)

Q: Why make a website?

Dr. Behrman has an out-dated treatment philosophy which needs to be called out. In the operating room he improvised and performed an over-zealous 4mm+ mandibular setback which left me with sleep apnea. Additionally he didn’t use any titanium plates or screws in my lower jaw which caused a joint-destroying over-rotation. It’ll be selfish for me to remain silent instead of warning future patients.

Q: What operation did you originally have?

Lefort I with maxillary impaction and a BSSO to fix an anterior open bite.

Q: Concisely state your claims.

  • Dr. Behrman setback my mandible and shrunk my airway, advancement of the maxilla was obviously needed. My minimum cross-sectional airway size is under 60 mm^2. I have all the usual complications from a narrow airway including sleep apnea and difficulty breathing during physical activity.
  • Dr. Behrman did not use rigid fixation (titanium plates or screws) in my lower jaw. This caused my proximal segment to over-rotate.
  • The over-rotation has caused complications in one of my condyles, destroying one of my joints.
  • Dr. Behrman left my impacted molars in-place and due to the proximal segment over-rotation no local oral surgeon is willing to touch them.
  • My medical insurance, a third party you could argue has a strong financial bias against me, will cover a revision.
  • He did not inform he that he has been sued over fifteen times, I asked him what can go wrong in surgery and withholding this information violated informed consent rules. See here: Lawsuits

Q: What exactly was wrong with Dr. Behrman’s plan?

Airway management is a key component of any orthognathic surgery but in my case Dr. Behrman planned to keep my maxilla fixed and then setback my mandible. Instead maxillary advancement was obviously needed.

See here for a paper on the consequences of setbacks: https://pubmed.ncbi.nlm.nih.gov/31451303/

Q: Was the plan followed?

Unlikely. They openly admitted, paraphrasing: “the bite guides the surgery, the plan is merely a guide to obtain occlusion in the operating room and not directly followed” and refused to discuss any of these details afterwards.

My suspicion is that Dr. Behrman from the start intended to perform an over-zealous setback since he’s not talented enough to mange both occlusion and airway in open-bite cases.

Q: Why would a surgeon ignore the airway?

Because they can usually get away with this.

My best guess is that airways were first reliably measured with CBCT’s in the late nineties so anyone stuck on older methods could dismiss the new evidence as unproven. Typically narrow airways lead to problems when you’re older so the connection to the offending surgeon is harder to make. Setting back the mandible was regularly done several decades ago before medicine had discovered titanium was biocompatible. It was a reliable way to fix bites, albeit at the cost of airway, when the tools available to surgeons were limited. Today there’s no excuse for it.

Q: Why did he skip rigid fixation?

There is absolutely nothing wrong with my bone. My best guess is that it’s a deliberate technique Dr. Behrman regularly uses to achieve occlusion in the operating room. I’m told that at first he attempted to use plates but then decided to abandon them since he couldn’t get the bite to line up due to poor planning. His residents told me they skip rigid fixation all the time and it’s not a complication I should worry about.

This has several drawbacks. See here for a paper on fixation and stability: https://head-face-med.biomedcentral.com/articles/10.1186/1746-160X-3-21:

“For Class II patients [like myself], rigid fixation is needed for stability when both jaws are operated: the single jaw procedures are stable without rigid fixation but not when the procedures are combined… Clinically, an excellent result is obtained in 90% of the patients with rigid fixation, but in only 60% without it”

Dr. Harvey Rosen writing in Aesthetic Perspectives in Jaw Surgery in 1999:

“Correct positioning of the proximal segment during bilateral sagittal split ramus osteotomy is aesthetically important… Provided that rigid fixation is correctly utilized, overrotation of the proximal segment is now rarely seen“

Evidently Dr. Rosen was unaware of Behrman’s practice, some 100 miles away, when he made this comment.

Q: What happened after surgery?

Dr. Behrman simply refused to see me and had residents handle my complications.

Q: What is Behrman’s background?

Nepotism. He followed his uncle’s footsteps and graduated the same University of Pittsburgh dental program and then followed his uncle to New York Presbyterian, joining when the his uncle was in charge of the department. One can’t help but wonder was he properly qualified for most of his significant career moves?

Q: New York Presbyterian has a high hospital rank, does that matter?

It’s irrelevant here since individual departments will vary in quality. Look at the lawsuits for the other orthognathic surgeon in Behrman’s department and you tell me.