Jaw opening: how far, how soon?

[Bullfighter]

Just found this very helpful board today, after having had BSSO and genioplasty on Feb 1.

The "structural" part of the surgery went very well, and I'm back to eating a fairly normal diet (other than the usual restrictions that come with having braces/wires on my teeth). Zero pain from chewing. I wear elastics only at night now. The improvement to my bite is incredible, and I've started the last phase of orthodontia to fine tune everything.

But, the opening between my top and bottom front teeth is only 25mm, maybe 26/27mm if I really try. I have noticeable stiffness and tightness in my jaw muscles, probably from spending a month in elastics. It feels like they want to be permanently shut.

For those have been through it, does this sound normal at the 7 week mark? I had expected the numbness in my chin/lower lip, but I hadn't expected it to be so difficult to open my mouth.

Jon

[DRG]

I am not speaking from personal experience yet, give me a few more days and I'll be in the same boat as you, Bullfighter. My OS had told me that a primary issue with range of motion is scar tissue. I can't entirely understand it myself, as in just how the scar tissue restricts movement. I need to see a diagram or an animation to fully comprehend just why, where, and how that happens.

[I love my teeth]

I had BSSO on Jan 17th. just banded shut for 1 day post op, then no bands, elastics or wires. At 2 weeks I could open 22mm, at 7.5 weeks I could open 36mm, now at 9 weeks, I'm not sure I have any more than 36, just maybe a bit less stretchy feeling and a bit more comfortable. OS told me I need to get at least 40mm, which is "normal". I can tell you 36 is not normal, as I still poke myself in the upper lip with food because I couldn't get it in my mouth.

I have crazy pain in my TMJ muscles, occassional spasms, which are lessening. I just started trying to move my jaw side to side--and oh man stiff and painful!!

I am no longer restricted with my diet, so I am trying foods that require more chewing to strengthen my muscles--last night we had Chinese and I ate the broccolli and carrots- which were only lightly steamed, and quite hard.

I have been going to acupuncture since 3 weeks post op to help with the numbness, but the bigger benefit for me has been the relaxation in my muscles--the day after my treatment I can usually open a few mm wider with less discomfort.

It sounds like everything you are feeling so far is normal!! Or at least like me, so if that makes 2 of us its normal right?

good luck!
Christine

[Bullfighter]

[quote="DRG"]I am not speaking from personal experience yet, give me a few more days and I'll be in the same boat as you, Bullfighter. My OS had told me that a primary issue with range of motion is scar tissue. I can't entirely understand it myself, as in just how the scar tissue restricts movement. I need to see a diagram or an animation to fully comprehend just why, where, and how that happens.[/quote]

Maybe because the mouth is held very open during the surgery -- stretches the muscles -- and then effectively held shut afterward.

[Bullfighter]

I had BSSO on Jan 17th. just banded shut for 1 day post op, then no bands, elastics or wires. At 2 weeks I could open 22mm, at 7.5 weeks I could open 36mm, now at 9 weeks, I'm not sure I have any more than 36, just maybe a bit less stretchy feeling and a bit more comfortable. OS told me I need to get at least 40mm, which is "normal". I can tell you 36 is not normal, as I still poke myself in the upper lip with food because I couldn't get it in my mouth...

At least you're getting close. I don't think I'm going to get from 26 to 36mm this week.

I've also tried to make myself chew more -- maybe that's part of the answer. Will be asking my OS today...

[I love my teeth]

good luck at your appointment. At 2 weeks post op he told me some stretching exercises to do, which I did religiously until my 7.5 week appt. I think that really helped. I am still doing them and using the muscles more, but can't seem to get the last bit of opening.

keep me updated after your appointment. Where in SD are you? We almost relocated there about 10years ago--loved it!! We were looking out in Rancho Bernardo area!!

[Bullfighter]

good luck at your appointment. At 2 weeks post op he told me some stretching exercises to do, which I did religiously until my 7.5 week appt. I think that really helped. I am still doing them and using the muscles more, but can't seem to get the last bit of opening.

keep me updated after your appointment. Where in SD are you? We almost relocated there about 10years ago--loved it!! We were looking out in Rancho Bernardo area!!

I'm in Scripps Ranch, just south of RB.

[Bullfighter]

Update: spoke with the doctor today and apparently the ~25mm opening after 7 weeks is "about where you should be".

The reason is apparently that very significant internal swelling is still present, and that affects the flexion of those muscles. The insides of my mouth still feel puffy, so the explanation makes sense.

Maybe the takeaway from all of this is that there is a massive amount of healing that takes place in the months after the surgery, and external bruising/swelling/incisions heal long before the internal -- so the improvement on the outside isn't a good guide to how far someone is in terms of total recovery.

[sarahorsomeone]

I think I must have been very lucky with my surgery (Le Fort I and BSSO), I never really experienced any restriction in jaw opening. A little bit of a stiffness for the first few days, but only the kind of stiffness you'd get in your limbs if you'd over-exercised, I could still open wide.

It's interesting you mention scarring since I have very little visible scarring in my mouth, the marks where my incisions were made are pretty much invisible now (my surgeon was amazed when he looked in my mouth, he said that's not what he'd have expected at all). Since my surgeon tidied up my scars from a previous operation to remove cysts from my jaw, the inside of my mouth is actually a lot neater post-op than it was pre-op.

I was also never banded or wired shut, which I know helps prevent muscle-atrophy as much as possible, so that might be another factor.

[I love my teeth]

You know Sarah-I have often wondered why very few on this board have mentioned trouble opening, or TMJ muscular issues? but my theory is it's age related. many, many on here who have had this surgery are "younger" (20's)....jaw has "recently" stopped growing. Maybe the trauma to the joints and muscles isn't that bad. BUT!! for those of us that are older-I am just about to turn 40, which means my joints and muscles have been in their shorted (as I had lower jaw moved forward) position for 20+years. So, in theory, I wonder if this makes it harder for those muscles/joints to adapt as quickly to their new position?
I don't know, but I am a physical therapist and I have worked with post surgical patients for many, many years--and the same theory holds true to total knee replacements, ect. The longer those muscles are in the wrong position, the longer it takes to get sorted out.

take care all!
Christine

[Bullfighter]

You know Sarah-I have often wondered why very few on this board have mentioned trouble opening, or TMJ muscular issues? but my theory is it's age related. many, many on here who have had this surgery are "younger" (20's)....jaw has "recently" stopped growing. Maybe the trauma to the joints and muscles isn't that bad. BUT!! for those of us that are older-I am just about to turn 40, which means my joints and muscles have been in their shorted (as I had lower jaw moved forward) position for 20+years. So, in theory, I wonder if this makes it harder for those muscles/joints to adapt as quickly to their new position?
I don't know, but I am a physical therapist and I have worked with post surgical patients for many, many years--and the same theory holds true to total knee replacements, ect. The longer those muscles are in the wrong position, the longer it takes to get sorted out.

take care all!
Christine

I'm ancient, over 40, so maybe it's true.

[Bullfighter]

8 weeks after BSSO -- opening to 30 mm now.

31 mm if I stretch and cheat...

[I love my teeth]

see Bullfighter--you did it--!!

I am still not fully open yet at almost 11weeks, but I can get to my 36mm easier and more consistently....I think I can get further at times as well. I still have tightness (probably from swelling) on the insides of my cheeks--when I open the skin in there feels really tight still, so I guess I am progressing along normally. I have lost more swelling around the jaw bone (the angle of the jaw is more well defined and I can feel the bone much better through the skin this week)....my chewing function is improving as well, especially on the right (bite is not quite right yet on the left)....so the strength in the muscles must be improving too!

good luck!
Christine

[Bullfighter]

see Bullfighter--you did it--!!

I am still not fully open yet at almost 11weeks, but I can get to my 36mm easier and more consistently....I think I can get further at times as well. I still have tightness (probably from swelling) on the insides of my cheeks--when I open the skin in there feels really tight still, so I guess I am progressing along normally. I have lost more swelling around the jaw bone (the angle of the jaw is more well defined and I can feel the bone much better through the skin this week)....my chewing function is improving as well, especially on the right (bite is not quite right yet on the left)....so the strength in the muscles must be improving too!

good luck!
Christine

That "tightness on the insides of my cheeks" is exactly what I'm feeling.

I haven't been critiquing my chewing prowess yet. I am happy to report that food can enter my mouth, be crushed and softened between my teeth and eventually goes down my throat. This is all very exciting.

36mm is very close to normal, IIRC. Sounds like you're on track!

[Bullfighter]

40mm!!! 40mm!!!

3 months post op...

I'm going to go bite a utility pole to celebrate.