I wanted to write a post to let you know how things are going, and perhaps even show a photo of the “puffier” me.
It may be a bit more info than you want, but I want to give a general overview of the whole procedure, and also let you know where we are at currently. Plus, I don’t want you to be shocked when you see me over the next week or so, since I’ll still look a bit like I got beat up and then got stung in the face by a swarm of hornets.
I also want to thank you for your prayers–we really appreciate them!
Why did you do this?
About 4 years ago, my dentist first suggested I consider orthognathic surgery. Although I’d had braces as a kid, my teeth were not straight, did not meet in the front and would all begin falling out sooner rather than later. I first looked into the process, but the cost of braces and the surgery were prohibitive, to say the least. About 2 years ago, the issue came up again, and after meeting with a local oral surgeon who actually no longer performs this procedure, we decided to move forward. So last February (2011) I had my first appointment with an oral/maxillofacial surgeon (actually the chief surgeon) up at Strong Memorial Hospital in Rochester, and in May of last year I got my braces.
(note on cost, while we have had to pay for the braces in full, our insurance did cover the surgery as medically necessary)
Why not just braces?
While braces can move your teeth around, the problem was that my upper jaw had not grown properly, so even if the teeth were straightened, the top and bottom jaws would not meet, and we would be at the same place we are now. When your teeth don’t align, certain teeth end up bearing much of the burden when chewing which wears down the top of the tooth as well as the root. So even if I wanted to do just braces, the orthodontist told me we could perhaps make a 10-20% improvement on my bite, which he estimated to be not worth the cost of braces.
The day of the surgery:
So last Friday, after about 11 months in braces, I checked into the Strong Surgical unit, got hooked up to an IV, dressed into a hospital gown and started the process of waiting. Our check in was at 11:45 am, and the surgery began around 3:30 pm. During that time I spoke with several nurses, anesthesiologists, attendings, and residents, all wanting to know what I was allergic to (Penicillin & Erythromycin…at least I was when when I was a kid, although surgery seemed to clear up all of my other allergies), what medications I take (none), and when I had last eaten anything (a chocolate chip cookie at the Country Inn & Suites near the hospital the previous night).
The other common thing they wanted to know, other than my date of birth, was “describe in your own words what we are doing today.” The simple answer was “moving my jaws around.” The more detailed answer was that they were rotating my lower jaw to align with the upper jaw. this would involve a severing my mandible on each side, rotating the jaw, and reattaching with screws. The work on my upper jaw was a bit more intensive. They would slice it into two or three sections. This would allow them to widen the upper jaw so it would fit my lower jaw properly. They would also remove parts of the jawbone in the back so that it had the effect of raising my back upper teeth. And finally, they would move my upper jaw forward by 6 mm.
Afterwards, everything would be put back together with plates and screws. I think I have 18 screws in the upper jaw and 6 in the lower. The new x-ray of my head look pretty cyborgish, though.
Shortly before we headed to the operating room, they gave me something to relax me…although I was already pretty relaxed. They they put a hairnet on me, wheel me down the hall to the operating room, and begin putting monitors on me…and that is the last thing I remember prior to the surgery.
The surgery itself:
Once I was out they did a bit more prep. They stitched my eyelids together (since they are moving your face around, they use the eyes to make their measurements–plus, it protects your corneas). Since they are working in your mouth, you tend to swallow a lot of blood, so they stick a tube down your nose so you can breathe. Thankfully, I have no memory of that. Before they remove the tube, they use it to drain your stomach so that you are less nauseous when you wake up. They also pump you full of steroids during the surgery to help with the swelling that comes afterwards (although I’m not sure how my face could have swelled any more than it did). Everything went well, and it took between 3 and 3.5 hours for the surgery.
The initial recovery:
I’m told my recovery was a bit extended because I was nauseous when they first woke me up, and the medication they gave me for it knocked me out. Since I was nauseous for the next 3 days, that doesn’t seem too unbelievable. I remember being woken up by a nurse several times for water, or vitals, but the first time I think I was actually aware of what was going on around me was 11:30 that night. Although Liz had seen me that night, I had no recollection of her being in the room. By 3:30 am when they woke me up for x-rays, I was actually feeling pretty good. The thing that seemed funniest at that time is that my whole lower face was numb, and my mouth was banded shut, yet the x-ray tech kept trying to have a conversation and seemed surprised that I couldn’t talk. All of the nurses were much better at reading my sign language (I got pretty good at communicating, “I think I’m going to throw up.”)
Days 2 – 3:
On Saturday Liz brought me home. The girls were a bit freaked out by the size of my face,but I think they enjoyed my inability to talk a bit too much.
During the first couple days there were some difficult things, and one amazingly great thing.
1) I tried to eat, but was so stressed that I mightn’t keep it down, that I ate very little. This meant I lost 10 pounds the first 2 days…supposedly weight loss levels off after 2 weeks. (& by eating, I mean with a syringe)
2) My face and lips were extremely swollen and numb. I don’t think I’ll post the worst, but here are a couple examples. While having your face numb is a bit strange, it seems a much better alternative than actually feeling the after effects of everything that was done to you.
3) Teeth banded shut. It wasn’t as bad as I’d imagined, but talking was difficult, and even drinking was a bit of a challenge. And I’m not sure why, but my tongue seems convinced that there is a hair back there…now that I can open my mouth (although only slightly) shine a light in and see that there is no hair, my tongue refuses to believe.
I can breathe! Okay, I’ve always been able to breathe, but never through my nose. I mean I could breathe through it a bit, but every so often I’d need a deep breathe through my mouth to feel like I was getting enough air. I was pretty self-conscious about my breathing in public. It also made exercising in the cold difficult (breathe through your nose and the cold air is filtered before it hits your lungs…breathe through your mouth and your lungs are pretty sore for a long time afterwards.
One of the other benefits is that I won’t hear people tell me I look like Jay Leno any more.
The other issue with my upper jaw not forming properly was that it blocked my nasal passage. Move it to the right spot (and, as the doctor said “scrape out any other crud in your nasal cavity while we are in there”), and breathing is majorly improved. Obviously, I don’t know how eating solid food is going to be yet, but as rough as the procedure was, just being able to breathe has made it worthwhile.
The first follow up:
On Tuesday I had my first follow up with the surgeon (one/week for 6 weeks). My bands were loosened, which was great, but even without them I could not even open my mouth wide enough to get a tooth brush through. Still a lot of healing for my muscles to go through. We got to see my new x-ray, they checked how much feeling has come back in my face, and went through a few other odds & ends–the big one being that I no longer needed take the antibiotic. There is a 1% risk of infection from the surgery, so they give you antibiotics before, during, and after the procedure. Worst tasting medicine ever. The doctor also warned us that the steroids would be working themselves out over the next couple days so that I would likely have a pretty down period of time as they left my system…I think that accounts for how I felt Wednesday.
Where we are now:
- First off the pictures. As you can see the swelling is down a lot, but still there. My face is still pretty swollen and bruised, though not quite so freakish as just 3-4 days ago.
- While I feel much better than I did last weekend, the overall recovery will likely take up to a year or so, I should be back to work next week.
- Everything from my nose to my chin is numb to varying degrees. Almost like I got a huge a shot of Novocain. Most feeling is back in my cheeks. My nose and upper lip is still a bit numb, but feeling is almost fully returned to them.
- My chin is still quite numb but the space between it and my lower lip, as well as my lower lip, have basically no feeling at this point. So I do tend to drool a lot, but I’m getting better at drinking from a cup (even had coffee today!). While I wish the feeling were coming back faster to this area, it can take up to a year. In fact, one of the risks of this surgery is that you never recover the feeling in that space between your lip and chin (thankfully it doesn’t impact speech, or eating/drinking in anyway).
- I have a plastic splint attached to my upper teeth, and several tight rubber bands that allow me to open my mouth less than 1/2 an inch. So between that and my lower lip not working, speech is still a bit of a challenge.
- I’m also congested. They warn you ahead of time, that for much of the first week it feels like you have a head cold. But even with that, I can still breathe through my nose better than before…although there was a point on Sunday where the words “emergency tracheotomy” popped into my head more than once. On top of that, due to all the work they’ve done, you need to wait 2 weeks before you can blow your nose.
- The unshaven look is simply that the doctor suggested I wait to shave until I can actually feel my face.
I guess that’s about it. If you have any questions about the surgery, or anything else, please use the comment space below and I’ll update you. Thanks again for all of the prayers!