Smile's Recovery: "Did you just say TPA?"

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#61 Post by **smile** » Mon Jul 31, 2006 10:57 pm

Today is day 17 post surgery. I can't believe the time's gone by so fast! So what's new with me.. My lower lip is slowly regaining sensation. I'd say a good 30-40% is back to normal. My chin is still missing sensation although I get a weird tingy-pins-and-needle sensation when I try to fall asleep. The stitches are still in but less bothersome than before. I still can't smile/laugh fully because it hurts.. but not as much as before. Talking got much better from day 14. A lot of the mouth-motions came back that day. I'm still not 100%-talking-wise though. But much more understandable than before.

As for opening my mouth, I'm at 2.5 fingers.. Unfortunately, I'm only good at going sideways one way and not the other. Weird. I haven't hit the wall with this recovery - something I'm surprised by. I'm very drama-queen-y, as all teenage girls can be. =) In retrospect, I thought the recovery was easier than I anticipated.

I've been able to floss lately although it feels weird because I can't feel my gums. I also have a hard time getting to the back molars.

Still on advil - surgeon said until the end of this week.

As for swelling, I have my good days and bad days. Some days my face seems to puff up for no reason at all. I look mostly normal I'd say. I'd give it another week or so. Bruising went away around day 11 I believe.

I started exercising again from this Saturday - I was pretty dizzied by it the first time around. Some light cardio and strength training. It's much better now. I'm not going too strenous (light 5-10lb weights and short 30 min cardio stuff, etc) since my surgeon advised no strenous sports until week 4. I feel 'blah' without some exercise so I feel it's okay to be doing it.

I'm sorta on a normal diet now.. I had toast today and managed well. I had some lasagna the other day and did fine as well. I'm not going to have any steak anytime soon though I'll tell ya that much.

The stitches on my neck left a bit of a mark. I'm applying stuff to it daily. It's not that bad though.

Today my teeth hurt - I don't know why. The ones that have the elastics on them.. I suppose the pulling and such is making them angry.

My next ortho appointment is in a week. I'm excited to see him although I'm not sure if he's cleared to do any orthowork yet..

I've watched SO many movies during this recovery. I mean, I might have set a record.. lol

I'm saddened by the fact it's July 31 - the beginning of the end of summer. Ah.. It's a tragedy.. but all good things must come to an end.

Hope everyone's doing well!

#62 Post by **nvcarissa** » Tue Aug 01, 2006 7:22 am

Thanks for the update. It sounds like things are going smoothly and your recovery is well underway.

#63 Post by **smile** » Tue Aug 08, 2006 10:55 pm

Today was my 2nd ortho appointment post-surgery. Hmm. I had a bit of a shocker today. As for the appointment itself, he didn't do much but look and compliment. The stitches are still in (and it hurts when you tug on my mouth!) and I can only open 30mm so that's not a shocker he didn't do any ortho work. Ortho work resumes in 3 weeks (total of 6 weeks post-surgery.) This is when he dropped the bomb: "Next appointment we'll get you a new wire and give you a TPA". My jaw fell, my smile wiped clean, eyes bulging.

"Did you just say TPA? As in.. a wire on the roof of my mouth?!" I'm.. shocked! I wasn't expecting this - no one ever told me of this possibility. I thought the surgery widened my upper palate - I thought I could see the light at the end of this long orthodontic journey. I thought I could just straighten my upper teeth (which haven't been straight ever since surgery) and make my molars meet and be done! But noooooo, I have one more lovely step in this journey. Sigh. I wouldn't be so.. tramatized if someone mentioned this, even the possibility, long time ago. Hopefully, this doesn't add any more time to the 4-6 in braces post-surgery. Anddd that the TPA won't be in for too long.

As for other news 3.5 weeks post-surgery, gums still numb, stitches still in, 50% of lower lip has good sensation, the other 50% has shallow sensation. The same side of the chin as the good side of the lip has better sensation than the other side of the chin. Range of facial motion has reached 90% normal. (Still hurts to laugh and smile a lot) Slight residual swelling still left in my cheeks which I find annoying, but expected.

...I still can't believe I'm getting a TPA. Then again, it's nothing compared to an RPE I suppose.

#64 Post by **chrisk** » Wed Aug 09, 2006 6:52 am

Smile,

Sorry to hear about your setback - when something is thrown at you like that it is a bit of a shock. I'm sure with your attitude you'll be fine - its just one more stage in this long saga - and you'll soon be through it. Think how far you've come - and the end is approaching.

Chrisk

#65 Post by **smile2006** » Wed Aug 09, 2006 9:58 am

Hello-

I had the same surgery (upper, lower and genioplasty) as you on July 13th. I wanted to ask if you have had a plastic splint in your mouth since surgery? My upper jaw was widened and I've had a splint attached to my my top braces since then with a palatal arch bar. I am concerned about my upper arch holding the width when it finally comes out on August 16th. I was wondering if my orthodontist would do something orthodontically to maintain the width once the splint if out. At this point I do not know.

Good luck with your recovery. I'm in the same boat as you with numbness. It is getting better, nearly 100% in the top lip but the bottom lip and chin area are coming along slowly!

#66 Post by **Brandyleigh35** » Wed Aug 09, 2006 11:46 am

Smile2006, I would guess the splint and the TPA is very similar in nature to having the SARPE done with the RPE. Your palate was still surgically expanded just in one fail swoop as opposed to the SARPE process IT takes about 4-6 months to heal, but the beauty of the surgery is that the space fills in with new bone growth. Once healed there is usually pretty minimal relapse. Usually less than 1mm. I'm only 5 months post op. My ortho took my TPA about 2 weeks ago as I'm a bit over expanded and he intentionally wants to relapse me a bit. From what I can see in pictures nothing has change at all yet. I would think that once the bone heals you should be pretty ok and that you won't have any worries when it comes to collapse etc. Surgical palate expansions are supposed to be more stable over time then those done with just an appliance. Hope this helps!

Smile, having lived with the TPA for a couple of months recently I have to tell you it is really not that bad. I truthfully could forget that it was in my mouth most of the time. It is a little aggravating when eating but other than that it is a piece of cake. You can do it!

Brandy

#67 Post by **smile2006** » Wed Aug 09, 2006 3:03 pm

Thanks Brandy-

I'm still trying to figure out what the difference is between doing SARPE and having the palate widened during upper jaw surgery? I posted this somewhere else and it wasn't ever resolved. Are you suggesting they are the same procedures? If so why would the SARPE people keep the expander in so long? I want to ask my OS about this when I last saw him but totally forgot

#68 Post by **Brandyleigh35** » Wed Aug 09, 2006 4:13 pm

I think as I understand it that they are very similar procedures in what they are accomplishing. When a person is required to have upper jaw surgery anyway, I think many doctors think it is just as easy to do the expansion while they are already in there doing the jaw surgery. The bones are already separated so expansion is easy during that procedure and it means doing all of it at once rather than a person going through two separaqe surgeries. In the case of a SARPE this is usually done on individuals that do not require upper jaw surgery such as a Lefort. The bones are fractured but not completely released as in upper jaw surgery. SARPE people then expand for a week or two and the appliance is left in place to allow the bones to fuse and fill in the palatal suture (the seam down the middle of your palate that is released.) Ortho's vary as to how long they make their patients wear the RPE, but it only takes roughly 4-6 months for the bones to heal so anything longer than that is strictly precautionary and usually not necessary. Like I said, mine came out 2.5 months after surgery and was replaced with the TPA for another 8 weeks. Now I have nothing, and I'm fine. The bones have healed and filled in the space with new bone growth, so it won't collapse because there is new bone there to support it.

From what you are reporting they did the adjustments to your upper and lower jaw, and expanded your palate all in one procedure. Much less invasive for you, but achieves the same goal. The only real difference is the expansion is done all at once, then held in place for the bone to fill in. SARPE is done gradually over time where the bones fills in as you go. That is why it is recommended that expansion not be more then 1/2mm a day as much more than that and the bone growth cannot keep up. So...same outcomes just different approaches. The splint holds your palate in place, whereas in SARPE the RPE holds it where it needs to be.

Does that make sense? Some people have to have a SARPE before upper and lower is done, as the teeth cannot be aligned the way they need to be for surgery to take place. Others do not have to do this. Personally I think one surgery verses two is the way to go if it can be done that way. As I understand it the end result is basically the same, its just the approach that varies a bit.

It is my guess that the same exact thing has been achieved with your mouth, only they did the full expansion while they were in there moving your jaw around, and now you are splinted for the time being while the bones heal. The TPA is strictly to continue to provide support in case the bones are still healing and filling in. As I understand it, the SARPE is just a little less invasive then a Lefort. A more minor type surgery or approach to expanding a small palate. It is still a "rapid palate expansion" just without the total release of the jaw connections as in upper jaw surgery.

Brandy

#69 Post by **smile2006** » Thu Aug 10, 2006 6:43 am

Brandy-

Thanks so much for putting all that information into words. Everything you said is what I suspected, specially that with the LeFort it is a total "cut" of the bone. I was also told that if the expansion needed is really large than it is typically done prior to the upper jaw surgery because (like you said) the teeth can not be aligned without it. My expansion was not huge and was not needed prior to the rest of my surgeries (looks like I have about a 4-5 mm gap). Plus, I teach at the university level so two bouts of surgery would have very disruptive to work. So everything you said makes sense. Thanks for taking the time to write all that. It is much appreciated. Hopefully my width that was gained and held in place by the splint will hold even if there isn't a TPA or anything placed when the splint is removed. I really should have asked the ortho more about this but it also seems he would have said something at this point (however, SMILE's didn't). Such a process! I'm happy to be on the back side of it now though

#70 Post by **Brandyleigh35** » Thu Aug 10, 2006 2:58 pm

Oh your welcome! Glad I could explain if for you! Hope you are feeling back to your old self soon!

Brandy