Damages awarded in complex maxillofacial surgery case

We have recently settled a complex case for a Swedish client who received maxillofacial treatment in England on a private basis.

As a child, our client was involved in an accident and suffered a mandibular fracture and the loss of her upper incisors. This was treated with a plate and dental implants, though as she grew older, she developed a retrognathic (set-back) maxilla (upper jaw), anterior open bite and bilateral cross bite. She had concerns over her appearance: she felt her midface was too flat, her lower jaw was too strong, and she disliked her profile. She also suffered from difficulties chewing food due to malocclusion (issues with her bite).

Following research into potential treatment options, she booked a consultation with a maxillofacial surgeon in London. Plans for maxillofacial surgery were put in place, involving a Le Fort II osteotomy – a complex procedure involving re-positioning of the maxilla in order to achieve better occlusion and an improved aesthetic result. A genioplasty (chin surgery) was also suggested to improve the aesthetic outcome.

Our client was clear throughout the planning process that she was reluctant to undergo any procedure which would change the look and shape of her chin; however, she was reassured that her chin would look the same following the genioplasty. Specific measurements for the movement of the maxilla were discussed and agreed upon prior to the surgery.

Following the operation, our client was distressed to notice that her chin was a different shape to before and set at a different angle, pointing downwards. She no longer showed her upper teeth when smiling or talking, and had ptosis (drooping) of her lower lip which caused significant difficulty when eating. Her occlusion was worse than prior to surgery. She also began to notice an unpleasant dry sensation inside her nose which caused her difficulties with breathing.

She voiced her concerns to the defendant surgeon, who agreed to perform a revision genioplasty. However, he was unable to make her chin look as it had done before surgery. Our client was devastated by the outcome. She felt that her face was unrecognisable and as a result avoided socialising and felt unable to work in a public-facing role. She became withdrawn and depressed. She struggled to find a surgeon with the appropriate expertise to carry out the complex revision surgery required.

We investigated our client’s claim by obtaining expert evidence from a maxillofacial surgeon before sending a letter of claim to the defendant. Our allegations were that there was a negligent failure to obtain informed consent for the genioplasty, as our client was not advised that it was not necessary and could be undertaken as a secondary procedure after the osteotomy if desired. We also alleged that there was a failure to conform to the agreed surgical plans both for the genioplasty and the osteotomy, with inappropriate movements of the maxilla and chin bone.

Liability was denied at the pre-action stage, and so we started court proceedings. A settlement offer was made by the defendant prior to exchange of expert evidence on liability, which our client accepted. Her compensation will allow her to undergo the reconstruction surgery she now requires to rectify the issues.

Rosie Nelson, associate in the clinical negligence team, has commented: “Our client has gone through significant distress following these events, having placed a great amount of trust in her surgeon. The expert evidence we obtained during the course of our investigations confirmed clear breaches of duty which caused such a poor aesthetic outcome for our client. We are really pleased that our client has now been awarded the compensation due to her for the avoidable errors, so that she can have the surgery she now needs to move on with her life and put this chapter behind her.”

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