Metal Mouth Message Board

Hi all,
I posted here about 2 years ago when I was starting out on the journey with braces and surgery.
I found archwired to be an incredibly useful resource when finding out about this surgery so it only seems fair
to share my story also, in case it is of interest or useful to other people.

I am a 34 year old male and was having surgery to address a class II profile, narrow upper jaw and retrognathic or receeded lower jaw with
an overbite. I also had very poor nasal breathing and issues with sleep apnea.

On January 8th I had a bi-max or 2 jaw surgery. The upper jaw was impacted 3 mm and moved forward 5 mm. The lower jaw was advanced to the new best bite - as my surgeon phrased it.
I have rigid fixation or plates to hold everything in place.

However the first operation wasn't a success. Immediately after the operation the lower jaw relapsed leaving me with a substantial gap between the upper and lower teeth. My surgeon said he has been performing these surgeries since 1985 and this is the first time he ever had this happen. He mentioned that the complication may have related to condyle repositioning (i think ?) but wasn't sure about this.

Anyway I ended up having a second surgery on the lower jaw to advance it again. This second surgery took place on January 14th and appears to have been successful and Im happy with the results.

However as a result of the complications with my surgery, my OS wants me tightly banded for 4 weeks. I've just started into week 3 now but these are heavy elastics and I cannot open my teeth at all.
Im on a liquid only diet and am losing weight despite my best attempts to drink shakes, soups etc.

Im going to try to summarise the issues Ive had and what Ive learned from this experience.

Aesthetics or appearance changes.
There is a noticeable difference in how I look now. It is a positive change but it takes a lot of getting used to. Prior to the surgery I had a long narrow face. Now my face is noticeable shorter and wider. The 3mm impaction has made a big difference.
I was told that as a result of the impaction the upper jaw movement of 5mm resulted in an actual net advancement of 3mm of the upper jaw.

Even though these are small movements they had a big impact on my face. One side effect of the advancement is that my teeth are further forward in my mouth. So my braces are way more visible now than
they were prior to surgery. But this is a positive change as I never showed much teeth before when I smiled and now I will.

However I wouldnt say that my profile is absolutely correct. The jawline is definitely stronger as a result of moving the lower jaw forward.
I was told that due to the impaction, the lower jaw now meets the upper jaw a little higher and rotates forward sligtly. So this has also
contributed to a better profile and a more pronounced jaw line.

My OS told me that he would wait for a year and see if I wanted to do a genioplasty then. It would have seemed better to have done it all together but he said he always waits for a year to see how everything settles down and see if the patient wants it then. To be honest Im not sure if I would go through the discomfort and numbness etc again for it.

The change that everyone comments on the most though is my nose. My OS didn't use any sitches to stop it from widening and it is now
substantially wider than before. This is exactly what I wanted and I have been breathing through my nose for the past 3 weeks. I could
never do this before and I am delighted with it. It also looks more proportional given the advancement of the upper jaw.

Functional Improvements
Breathing. It seems amazing to me to be able to breathe through my nose. The surgery may have been worth it for this alone.

It's too soon to say if my apnea is cured as I am not sleeping so well at the moment due to swelling and nerves jumping. But when I sleep I can
breathe through my nose and I hope that cures it.

My bite was ok prior to surgery but seems better now. I had a crossbite on my right side and it has almost vanished and my front teeth meet much better now. It still feels weird that my teeth on the right side almost sit fully on top of each other now. I saw my orthodontist and he seems very pleased with the new bite.

Recovery.
So far its been pretty tough. I ended up in hospital for 8 days rather than 3 and needed 2 surgeries, anasthetics, etc. People say its extremely rare for this to happen but if you search archwired you will find a few stories like this. My OS said that this initial complication does not mean that I am more likely to relapse, so I will wait and see.

My swelling is very slow to go. I had 2 surgeries so I guess I have to be more patient. But the slow pace is frustrating.
But the worst thing has been the heavy bands. My jaws are completely immobilised. I am sick of liquids at this stage. My orthodontist told me that being banded shut like this delays the swelling healing.

Numbness. My lower lip and chin are numb. The right tip of my nose is numb as is an area on the right of my top lip. My upper and lower gums are also numb. From time to time I get very intense pins and needles in my chin. It also feels like my lower face is jumping around.
So I take these as positive signs. But the nerve pain is uncomfortable and I underestimated this aspect of the surgery.

Mental Issues.
I was very naive about this surgery in advance. I thought I would take a few weeks off and be fine and I was very relaxed about it all.
I expected to be out and about in 2-3 weeks. The reality was very different! I was traumatised after the first surgery. I lost a lot of blood and was the weakest physically and emotionally that I can remember. The morphine and anasthesia made me very emotional and incapable of thinking rationally.

I ended up in hospital for 8 days and had the uncertainty of not knowing if the second operation would work. When I saw myself the morning
after the first surgery I didn't recognise myself in the mirror. It was all very scary and I bitterly regretted having the surgery.

Now I am 18 days post the second operation and I feel a lot better about everything. I drank lots of water to flush the meds from my system and now only take Panadol for pain from time to time. I now like the changes I see in the mirror. As I said I still have considerable swelling so its hard to judge the final result. But everyone I meet tells me that I look very well and that its a positive change.

It's hard to stop from obsessing about this surgery. I suppose a lot of us do this surgery because we aren't happy with a combination of functional/aesthetic issues.

On reflection I was more interested in aesthetics than function and so when it all seemed to have gone wrong I felt very stupid and guilty for having had such a serious elective surgery.

I have to try to stop myself from looking in the mirror every hour or so. Not becasue Im admiring myself but because I keep wondering
if my jaws are moving and how stable everything is. I have been getting some jaw spasms and this worries me. However from reading archwired it seems that this is common enough.

Ok so thats it!
If anyone read this far could I ask two questions?
1) Did you have jaw spasms where your jaws seem to actually jump? I have had 2 big ones. Last night I swear I heard a pop and a felt a
jumping sensation in my jaws underneath my ears. I have felt a pressure in my ears since last night. If it still there tomororow I might ring my OS.

2) Has anyone had some relapse due to bone movement? If so how much and how long post surgery was it?

Any information will be gratefully received. Ok so that's my story todate. Good luck to everyone on this site who has had or will be having surgery.

Tony

Tony,

Thanks so much for sharing your detailed story. I am sorry to hear that you had such severe relapse, but at least it got fixed and fixed quickly. For 4 weeks post-op and having 2 surgeries you sound like you are doing very well, all things considered!

8 days in the hospital had to be terrible. Were you in so long because of the relapse, or did you have other complications?

As for your question on spasms, I think this is TOTALLY normal and it happens to us all to some degree. Some of us notice them more than others. If it causes pain I'd inquire about some muscle relaxers, but if it isn't causing pain I'd just keep an eye on it and it will likely get better as things settle down.

Best of luck as you continue your recovery...

-Chicago29

Hello Tony,
Sorry you have had such a tough recovery. I, too, went into this surgery quite niavely and was quite surprised at the difficulties one could face or the time it takes to heal. I had upper, lower and genio 6 months ago. Had a host of pos-op difficulties and my third surgery to remove lower jaw screws is next week. That all being said, like Ozzy's Mom always says, give it a year! The swelling seemed to take forever, but like you said, when you have multiple surgeries it delays the progress. I couldn't keep out of the mirror as well to watch my progress. I thought I would be out of work 3 weeks and went back after 5. Even at 5 weeks, it was difficult. I work in a restaurant so customers would always have something to say or ask about my appearance or surgery. I will say, even with all of my post-op bumps, I probablly would do it again. Even if I was fully aware of possible complications I always think it doesn't pertain to me. I, do wish, however, i had found this site sooner. I discovered 8 weeks post op. I definately would have helped my recovery as it has provided a great deal of comfort and support post-op. Try to find the silver linings in your recovery-I know it seems tough. Your in my prayers

Chicago29,
I could have gone home a few days after the first surgery but they kept me in because they were waiting for theatre time to become available and did not think it would take so long. There were a few false starts before I finally had the second surgery 6 days later.

Re muscle spasms - its good to read that other people have them also and that they are normal but they do feel very weird and uncomfortable.
Thanks for the good wishes.
I'm dreaming of a burger and chips and that must be a good sign
Tony

trish222,
Thanks for your reply. I have been reading your posts also and am sorry to hear about the complications you have had. I hope your surgery on Feb 9th goes very well.
I have taken 4 weeks off work and am glad I did so. I would find it very difficult to be in work when I cant talk and am still swollen. A liquid diet also reduces your energy levels. Each day I go for a walk but a days work would be too much at this stage.
I wish you the best of luck in your continued recovery also.
At this stage, if everything settles down and stays stable I will also be very glad that I had the surgery.
Tony

I'm not quite sure of the exact definition of a relapse but at the one week mark post-op for manibular advancement I went in for an appt with the surgeon and after removing the elastics and splint it was discovered that I had a severe open-bite.

As the surgeon explained it, the screws didn't hold. So he literally forced lower jaw movement until the bite was again correct and then wired me shut. I'm now 2 weeks into a total 5 week sentence. Fun stuff.

@theKurp:

What do you mean "he literally forced lower jaw movement"? Are you saying he moved stuff right there in the office with his hands? I can't imagine that is what you mean, but I read and re-read your post and I cannot tell if you had this done surgically, or "manually"

Man, I would have FREAKED OUT if they would have moved my jaw like that.

chicago29 wrote:@theKurp:

What do you mean "he literally forced lower jaw movement"? Are you saying he moved stuff right there in the office with his hands? I can't imagine that is what you mean, but I read and re-read your post and I cannot tell if you had this done surgically, or "manually"

Yep, with his hands he pushed and pressed my lower jaw until my bite returned to where it was immediately following surgery. Painful, yes, but not excruciatingly so.

Tony,

I am sorry about your complications, but it will get better.

I am 48 years olds and had double jaw surgery with Mytec anchors on the TMJ's and turboectomies on Dec 28th, 2009. I am 5 weeks post-op. I too was naive about the healing time. I thought I would be eating steak by 8 weeks! I am not sure where I got the misinformation. My OS is Dr. W. in Dallas from Baylor. He says I am doing very good. I am not sure if he is just saying that for encouragement or not. I have not had any set backs. I still have swelling a more pain then I think I can handle on some days. I started back to college on Jan 19th, and I have more pain on the busy days and when I don't eat well. I too had the surgery for sleep apnea, class II malloclusion and an over bite. I considered the surgery for over 7 years. I still talk funny and I am not sure I like my profile yet. My breathing is definetly better and my husband says I don't snore any more. I am tired of a soft food diet too, but it looks like it will be any 12 weeks for that steak. I pretty much am just taking one day at a time and I have accepted the fact that I am in for the long haul.

Good luck,

Robin O

Today I had a checkup with my OS. He told me that there are discs in the jaw that can slip after the surgery - especially if the jaws are banded together like mine. He said its entirely normal for jaw spasms (even painful ones!) and that the only concern is if the pain persists after them.

theKurp - moving the jaw like that does sound painful! The liquid diet is a real pain. Im sick of soup and my weight has dropped from 73 to 65 kgs in the last 3 weeks and I still have 2 weeks of a liquid diet left
I can mumble through my teeth but it gets tiring very fast and is frustrating. Do you have to work with your jaws wired ?

roposzen,
I think the doctors always say we are doing well. Today they looked at my teeth , asked me a few questions and said everything is fine. But unless they do x-rays each time we visit, I doubt they can really determine that much information. Still it is a relief just to see them again and be told its all fine. Good luck with your continued recovery. I find the swelling very slow to go down. In the second week I could see progress every day but this week nothing seems to have changed. I think these tight bands mess up the soft tissue recovery so I hope when they come out in 2 weeks that things start to pick up then.

dosTfy5 wrote: theKurp - moving the jaw like that does sound painful! The liquid diet is a real pain. Im sick of soup and my weight has dropped from 73 to 65 kgs in the last 3 weeks and I still have 2 weeks of a liquid diet left
I can mumble through my teeth but it gets tiring very fast and is frustrating. Do you have to work with your jaws wired ?

For more years than I can count I've been somewhat of a fitness and nutrition fanatic, so my priority has always been to eat what's good for me rather than what tastes good. So I'm used to eating food even if I don't like the taste.

First week out I dropped almost 15 lbs after weighing 170 lbs pre-surgery. I've been able to put about 6 lbs back on since then. I simply look at the calories of everything that I'm eating and try to get somewhere between 2000 and 2500 calories per day. I think it's important to get adaquate nutrition if one wants to recover as quickly as possible.

I returned to work 2 days after surgery. Now, before you give me props you should know that I'm a software engineer and I work from home. Part of my job does require spending time on the phone but I've limited it to participating in rather than conducting meetings - at least until I'm free of these wires. The people I work with understand and have been very accommodating in terms of not asking me talk alot.

You're one week ahead of me. I track time with little milestones. For instance, this Friday will be the halfway mark for me. I have a party I'm attending a week from this Saturday and I'll have 10 days to go. My next OS appt will be with 1 week to go. Some days go by quickly and some days seem like they can't end quick enough. February 23rd can't get here too soon as far as I'm concerned.

Today I had an appointment with my orthodontist. He put on lighter class II elastics.
So now my teeth can open a millimetre or 2. This feels very weird after being tightly banded shut for 3 1/2 weeks. I asked if I could brush my teeth before he put the new elastics on but found that I couldn't open my teeth wide enough to fit the tootbrush in behind my front teeth
Still I think it is some progress. Slowly but slowly...

Hi Tony,

Great read on the story thanks for sharing everything. I am currently on day 5 post op and so far they have been extremely tough. I knew going into this surgery it wasn't going to be a walk in the park with recovery but there are a lot of things happening that I wasn't aware of. For instance I have the jumping in my lower jaw also whenever I go to fall asleep my lower jaw jumps hurts and therefore wakes me up. because of this I haven't slept in two days now. I am calling my OS tomorrow to see what he can give me for this I was hoping there would be some other remembdies but it's comforting seeing that it happens to the majority. Also the difference in breathing through my nose in incredible also it almost burns with the amount of air I take in now which is my other question. With the numbness that I have I also have a major cold sensitivity where even the air I breath in freezes my mouth. I was wondering if anyone else has an input on this. Also extremely sorry to hear about the multiple operations it seems the more I read the more people have to have this done so I will keep everyone updated on my end as well. If anyone has anymore information on the jaw jumping that is my biggest issue since it is obviously painful and keeps me awake I also don't want to mess up anything post op.
Thank you all,
Dave

I just wanted to compliment the OP on a very well organized post! It's great to have the info divided into sections for easy accessibility. So, thank you.