March 2016 surgery buds

[jawa]

Roll call!

[finnan13]

Me! 1st March. Double jaw surgery to correct underbite!!

[jawa]

Yahoo! Bi-max and genio for sleep apnea!

[finnan13]

What's your operation date??

[jawa]

The 10th!


Good luck! Your number is up in a week!
How are you doing?

[cbrfoltz]

I'm wondering how both of y'all are doing?

I'm scheduled for MMA and Genioplasty (?) April 21st, 2016.


Claire

[jawa]

Hey! I am two weeks post op and things are healing wonderfully. The swelling has decreased drastically. No major complications. I can breath through my nose! My sleep has improved. My profile has improved. I actually think that my tmjs are in a more harmonious position. They feel better, and although I am not opening my mouth too wide, they don't seem to be popping or slipping out of the socket at all.

I went for a mile walk on day 6. I couldn't ask for a better recovery.

At a followup I was told that I look like someone a 5 weeks post-op, and I'm only at two.

I will say in all honesty. The first 24 hours are bad. Like really bad. There is nothing you can do to prepare for it. Just let the nurses take care of you and the first day will be over before you know it. But know that once you get through the first day things get a lot better and time flies. You will be sent home with some potent drugs and you just kind of drift in and out of sleep.

I do have a concern that I am dealing with but I am not really letting it get me down. It has nothing to do with pain. I will not dwell on it here. I will probably make a post about it in the next few days.

I will say some words of advice: Don't over think the liquid diet. I went overboard and had ziplock bags of cooked potato, carrot, beets, squash, sweet potato, kale, spinach, etc etc etc. I even had small cooked portions of chicken and salmon ready. You will not have an appetite and you will want to keep it simple. Greek yogurt and honey. Greek yogurt and honey is your best friend. Ice cream. And if you plan on taking vitamins, invest in some liquid vitamins. I bought a pill crusher and a ton of supplements in pill form. squirting a disgusting mix of crushed vitamins in water into your mouth is not something you will have the gumption to do more than once during the recovery process.

Hot showers were a great way to loosen up dried blood, and moisten the sinuses.

Any questions ask away!

[cbrfoltz]

Thanks for the update! Sounds like you're doing great. I'm proud of you.

I am going to take your advice on not overthinking the liquid diet. My main concern is all the things that I'm sensitive to, like yogurt, dairy, eggs, oats, corn, tomatoes, yeast, wheat and gluten to name a few.

We were planning on cooking some soups up in advance and pureeing them to liquid. I'm from the south, but we'll be staying in a hotel in New Jersey with a suite and kitchen for 28-35 days, 8 of those are pre-op. My mom is 83, and although she's in great health, I was thinking that just caring for me by herself for the first couple of weeks is going to be taxing enough without having to cook and puree everything. I'm hoping that by 2 weeks, and maybe even before, I'll feel like doing some of the cooking myself. The idea of going for a walk at 6 days post-op sounds heavenly!

I LOVE the idea of liquid vitamins! I had been told to purchase a pill crusher, and was not wild about having to use it. From my understanding, because of how far they're moving me, Im going to be very tightly banded and for longer than is typical. For at least the first 4 weeks, I'm going to be totally on liquids through the syringe thing, then through 60 days on no chewing.

Thanks for posting an update, and if we're allowed to say that we're praying on this board, I'll be praying for you.

If that was not allowed, I sincerely apologize, and I will not do it again. Can't remember anything from the guidelines, and don't want to offend you or anyone.

Claire

[jawa]

Hey

How much are they moving your jaws? Can you give a little background on your situation? That seems like such a long time to be in a hotel? Why are you traveling so far? etc, etc

Let me tell you, I stayed with my parents, and I was worried that I would be a lot of work to take care of. Honestly by day 4 you will be up and moving around. If you do a little prep before surgery you should be able to care for yourself by day 4. Hopefully the shower is large enough to fit a plastic chair. Find yourself a plastic chair that fits in the shower and chill out under some soothing warm water. If its a tub, then bring your rubber ducky.

Make a little time table when you have to take pain meds, and when you have to take antibiotic etc, and stick to it. Have enough ice packs so you can refresh them every 2 hours or so. Make a plan so everything runs like clockwork. Like a hospital. You will be fine.

Who cares if prayers are allowed or not. Thank you for well wishes! I wish the same to you!

Oh and buy a lot of plastic squeezable restaurant condiment bottles.

[MagnoliaMama]

I'm two weeks post op from a segmental LeFort I and BSSO (sx on 3/11). The first week was pretty hard, but now that I've put some more miles between me and the bone saw things are looking up!

I initially had very severe nausea, even with the help of nausea meds through the patch and my IV. My stomach is sensitive to both anesthesia and swallowed blood so the first week was a blur of puking and pain. Once that settled down I was able to get into the groove of real recovery. Showering, getting dressed, and putting some effort into my appearance all helped a lot.

I'm having to remind myself to take it easy. I went out with my mom and daughter to get the latter some new shoes for Easter today and I found myself out of steam after only two hours of being out and about. I'm typically very energetic and active so being a lump is foreign to me. I do need to be more consistent with taking my liquid vitamins. I find myself avoiding them because they taste so gross. My range of motion when I take off my rubber bands is exceptional so I can probably fit my normal tablet vitamins without a problem so I may try that tomorrow.

I see my surgeon again in about a week for another check up, then not again until the end of April when he'll be taking out my splint (fingers crossed!).

Claire, I'm celiac and not a big dairy eater so if I can help you with food planning in any way just let me know!

[Luciangreuceanu]

Hello,

Also I had double jaw surgery on 1st of March for a huge class 2 overbite. (previously I had also SARPE last year)
Indeed, the first week is the hardest one. I was lucky that I have a missing tooth so I could eat through this hole more. But the swelling, the sleep, the breathing, these are things people should be prepared for for the surgery.
I wasn't...

Yesterday I had my elastics off and I will meet my surgeon next week and he will take off my splint.

My biggest fear is the relapse... I still feel I have to force myself in order to have the correct bite.

I will keep you posted.

All the best to all,
Lucian.

[Jfl232]

Hi Guys/Gals,

I just had a SARPE on March 15. I spent the night at the hospital. Then started expanding 6 days after surgery. I'll be doing 2 turns a day for 20 days. I am a bit worried however as I was playing with the gap in the front teeth and heard a little crack.

Is it normal for one side (right side) of the palate to move or "click" up when I bite with a little pressure on my right side? I'm emailing my OS tonight and have a follow up with my orthodontist on Wednesday. Hopefully this is normal. I pretty much stopped messing with my teeth now.


After this heals, I'll get braces on and should be doing double jaw surgery December 2016 or January 2017.

[cbrfoltz]

Hi Y'all,

This is Claire. OK, background. I'm 55 years old, and married to a dentist with a lot of advanced training in restorations, occlusion/bite, TMJ. I was in Ortho once as a child, and 4 or 5 more times since I got married. I can never remember which.

There are several theories of how to approach OSA, even within the realm of Orthognathic Surgery. So, what I'm going to describe about my case is based on my husband, and his colleagues' beliefs and theories about the subject. One of the Oral Surgeons I saw for a consult explained it this way, that although Orthognathic Surgery has been around for decades, there's still a lack of consensus when using it to treat OSA as to what "normal" is, how small of an airway is "necessary," and how and where to move people. The approach to which my husband et al subscribe is that the number one goal is to get as much airway as possible, but that a stable bite/occlusion and proper placement of the TMJs are crucial so that after surgery, the bite will not break down. There are theories all over the map on all of this, and the Oral Surgeon I'm referring to described it as the "Wild, Wild West Phase of learning about all of this," mostly anecdotal and not a lot of empirical research available.

I'm definitely NOT saying that the approach we're taking is "right" or the only approach to take. It's just the one we're taking.

In my 30's I would wake up at night mildly panicked and felt like I couldn't get a full breath in through my nose. When I was 48, after Menopause, I had my ovaries removed, and subsequently had full blown panic attacks because I couldn't breathe. I had a sleep study done within 96 hours post-op. This was early December, 2008. Back then, they didn't do AHI, but they did say that I had severe sleep apnea, 400+ Episodes in 6 hours sleep. I was unable to tolerate the CPAP, so the only other option which we knew of at the time was going the ENT route. December 30, 2008, I had a UPPP, Tonsils and Adenoids removed, and a sinus surgery. ENT wanted to split this up into 3 separate surgeries due to pain, but I talked him into it. It was somewhat painful, but the results were miraculous for about a year or two. No snoring, I lost weight. All was good. They did put me an an anti-anxiety/depressant "for a short time" which has morphed into going on 6 1/2 years. Back then, we were quoted a 70-90% success rate for the UPPP, but now, I believe that even the ENT's have dropped that rate down to around 40%.

In 2015, I wanted to find out the real state of my health. I had a complete physical, and I'm not diabetic. Yet. I went to see another general dentist in our area who is part of a group of dentists from around the country that my husband mentors. He does a lot of TMJ and Sleep Apnea treatment. He had told me a couple of years after my UPPP that the renowned Orthodontist he works with on his more complex cases said that for some people, because of the anatomy of a their skull, the only real solution to OSA was Orthognathic Surgery, and that from studying my face and skull, he thought that I fit that scenario. He was correct.

First, I went to see a local Oral Surgeon for a Cone Beam CT Scan which is a 3-D X-ray kind of thing. It showed that just above the area where I'd had my UPPP, which was still looking great, my airway was 36 mm, the worst he'd ever seen. He has not done any really complex cases yet. He told me that the current theory is that 300 mm is a normal airway, and you can get by with 150mm. But remember, one of the Oral Surgeons I saw regarding actually doing my case said that he thought those numbers could be right, but he absolutely could not definitively tell me what "normal" is. Back to the Oral Surgeon down here who did the CBCT. He referred me to an ENT who looked inside my mouth and said that there was nothing more he could do for me because the UPPP still looked great, and if they took away any more of my soft palate, basically, everything would collapse, and I wouldn't be able to talk. Public Speaking is what I currently do for a living, so that wasn't appealing.

The ENT ordered a seep study. I had 80 events per hour, and my breathing cessation lasted up to 69 seconds. Somehow, between newer CPAP's, anti-anxiety meds, and Rem ZZ Mask Liners, I have tolerated the CPAP very well, and have used it all night long, every night since I got it. He and the pulmonologist basically told me that it's great that I tolerate the CPAP and "Good luck with it for the rest of your life." They don't have any other suggestions.

In the meantime, June 1, 2015, I went back to the other general Dentist, and he started me in MAGO therapy. This is based on one of the schools of thought out in the dental community right now. A MAGO looks like a clear bite splint, but, my layman's understanding of what it does is put your TMJ exactly where it's supposed to be and stable. Then, they look at you and your airway, and see what kind of treatment is or isn't necessary from there. A lot of people are in Ortho at this point and getting their bite/occlusion stable, but mine already was, so I just had to do MAGO therapy/diagnosis. When both TMJs were in place, it was about Thanksgiving, 2015.

Mom and I drove from Georgia to Pennsylvania to see the highly regarded Orthodontist who manages my kind of case. It was not a big surprise to learn that getting my TMJ stable had decreased my airway, and it was now 15mm. I could really tell the difference. I'm not able to do much, and there are certain activities which completely close off my airway, like bending down to take a load of clothes out the the dryer. The Orthodontist said that there were only a handful of Oral Surgeons in the world who could do my case, move me as far as I need to be moved without ruining me aesthetically, and most importantly, maintain my very perfect occlusion/bite and TMJ position.

The first one I saw wasn't on that list, but she, the Orthodontist, suggested that I see him anyway because he was local. He flat out refused my case because he said that my occlusion/biteTMJ location was perfect, and he couldn't begin to guarantee that he could keep them that way post-op. His suggestion was the same as the ENT''s "good luck with the CPAP the rest of your life." I picked another one of the surgeons that the Orthodontist uses for cases like mine, the one who does 90% of her cases including hers personally and her son's. However, there were 3 that I just loved, and would have been thrilled with either of the other two. Surgery is April 21st. They are going to move my upper jaw forward about 10mm, and my lower jaw down and forward 12-14mm. To do the upper jaw, they have to lift your sinuses up off your jaw and set them back down on top of it. That's why you have a lot of the side effects of Sinus surgery, but can't use a Netti Pot. Because they're moving me that far forward, and doing the genioplasty, whatever that is, my jaw is going to be in a more fragile state than someone who had their jaw moved forward 3-5mm. So, in order to have the best bony healing and maintain my TMJ position and bite, my jaws will be banded more tightly shut, and I'll be on a strictly liquid diet longer than some other patients.

It was my choice to stay up there for up to 26 days post-op. Some patients fly home 5 or 12 days post-op and have a local Oral Surgeon do most of the follow-up care. I didn't want to put the very slight G-force pressure of takeoff and landing on those newly healing bones. Plus, there's not a surgeon in this area who does a case this involved, and I felt like I'd rather stay up there longer, and have my surgeon make the call on when to step back on the bands. When I told the surgical coordinator this, she was thrilled. She said that patients who fly home at 5 or 12 days post-op routinely have more complications, and when they do, they aren't 10 minutes from the surgeon's office, and that while my case wasn't the most complicated one they'd ever done, it was still pretty complex, and the surgeon would much rather have me in town for that length of time if I could do it.

I hope that explains why I'm going to be on a liquid diet longer, and my logic in staying up there so long. It is pretty much picking the philosophy which my husband and his colleagues agree with, and which makes sense to me, and doing what it takes to stick to it.


Glad to hear everyone's stories! They're encouraging.

[jawa]

Very interesting! My advancement was 4mm maxilla, 9mandible, and 7 genio. I honestly think I need more advancement.

Thanks again for sharing. I think your decimal point is off one place on your measurements. No? 300mm? 150mm? you mean 30 and 15 right?

[snapdresser]

I also got the LeFort I/BSSO/genio for sleep apnea. Maxilla advanced 5mm, mandible advanced 4.5mm, and genio for another 4mm advancement. I'm very happy with my results and wouldn't want more advancement than that. I've been able to acclimate well to the changes and I think it might not have been so easy with larger movements.