lower jaw surgery (BSSO) and experience of recovery

[annafaith]

Hi,

I'm set to have lower jaw surgery and genioplasty on the 15th of July, and was wandering what people's experiences were of recovery, particulalry for this type of jaw surgery (BSSO). My surgeon is great, but pretty blase about it all, and I get the impression from him that the recovery period will be minimal - he has suggested at least 2 weeks off work. This surprised me a little as googling through pages of other people's experiences, I got the impression recovery took a lot longer. I know it's important to take into account individual differences. My surgeon has said that some people have massive swelling with a lot of bruising, and some people have minimal swelling and bruising, and that it depends on individual differences.

Still, it would be good to hear from anyone who's had this done. I feel a bit in the dark about what to expect after the surgery has taken place.

[Bullfighter]

Hi,

I'm set to have lower jaw surgery and genioplasty on the 15th of July, and was wandering what people's experiences were of recovery, particulalry for this type of jaw surgery (BSSO). My surgeon is great, but pretty blase about it all, and I get the impression from him that the recovery period will be minimal - he has suggested at least 2 weeks off work. This surprised me a little as googling through pages of other people's experiences, I got the impression recovery took a lot longer. I know it's important to take into account individual differences. My surgeon has said that some people have massive swelling with a lot of bruising, and some people have minimal swelling and bruising, and that it depends on individual differences.

Still, it would be good to hear from anyone who's had this done. I feel a bit in the dark about what to expect after the surgery has taken place.

I had both done in February. My surgeon was also pretty "casual" about it, but this was because he has done several thousand of these procedures over the past decades. Both are common surgical procedures at this point, and the complications of lower jaw surgery aren't quite as bad as with upper.

Overall, the first few days will be hell, with a lot of swelling, and "drinking" through a syringe/tube. You will look all puffed up, so don't even think about trying to judge the results of the surgery. I had a pressure bandage around my head to control the swelling, so you will look like a bruised mummy. After the first week you should see rapid improvement, although you still can't get an adult-sized toothbrush in your mouth -- get a child-sized toothbrush and be gentle. I bought a WaterPik (adjustable to soft stream) for use after my incisions had healed -- very useful once you get the approval to start eating soft foods again (~3 weeks, if I recall).

After 2 weeks, the visible swelling will probably be gone, so you'll be able to go out in public without looking like someone who has lost a boxing match. Actually I was much better after 1 week -- I still knew I had swelling, but the compression bandage was off. One thing I recall was that the compression bandage caused a lot of bruising around my neck, which was ugly. The bruising then moved down to my chest, which was also ugly, but could at least be covered up by a shirt. I wouldn't plan on any plunging neckline type outfits for maybe 3-4 weeks, depending on how quickly it clears up.

I took 2 weeks off work, but have the option to work from home -- which I did, for another few weeks. You'll still be on a liquid diet, which means frequent trips to the blender to keep your energy levels up. You won't be able to open your mouth very much, or clean your teeth as well as you can pre-surgery. You will be sleeping on your back, head elevated, which may or may not affect the quality/quantity of your sleep.

The whole process involved basically zero pain, but you will get bored of the liquid diet pretty quickly. You will experience numbness around your lower jaw, chin and lower lip, which makes it hard to drink without dripping. I'm 5 months post-op, and the numbness is going away -- still partially numb on the left side of my chin, but it doesn't affect the way I look or how I eat/drink.

In hindsight, I probably worried too much about the pain and not enough about coming up with enough variety in the liquid diet -- I was incredibly bored with the same 3-4 recipes. Just expect to be really swollen and miserable the first few days, and you'll be prepared for the worst part.

The results are worth it, though -- great bite, vastly better profile, more balanced face. Now I wish I'd done it 10 years earlier.

[annafaith]

Thanks for such a detailed reply. You bought up some points I hadn't really thought about, like not being able to use a normal sized toothbrush. Your experiences seem to tally in with the kind of blogs i've been reading about this kind of operation. I'm surprised though that you weren't on blended food until 3 weeks post op - could you only manage liquified food until then? When I asked my surgeon about eating afterwards, he said that basically I would be okay to go on to soft food from the word go, let alone waiting 3 weeks? My lower jaw is being moved forward about 1 cm so it's not a small advancement either.

I'd be interested to know whether you had yours done with the NHS or privately? I've been reading about people using syringes and jaw bras etc. and was wandering what the NHS gives you to go home with, and what they provide while you're in hospital?

Also, you mentioned you had quite a bit of swelling and bruising. Did you find anything useful for helping with that, like hot or cold packs?

I'm glad yours went well and you're happy with the results, which is the actual aim of putting ourselves through all this in the first place!

[annafaith]

Bullfighter - scrap my query about getting it done privately or NHS - just realised you're from the US!

[Bullfighter]

Thanks for such a detailed reply. You bought up some points I hadn't really thought about, like not being able to use a normal sized toothbrush. Your experiences seem to tally in with the kind of blogs i've been reading about this kind of operation. I'm surprised though that you weren't on blended food until 3 weeks post op - could you only manage liquified food until then? When I asked my surgeon about eating afterwards, he said that basically I would be okay to go on to soft food from the word go, let alone waiting 3 weeks? My lower jaw is being moved forward about 1 cm so it's not a small advancement either.

I'd be interested to know whether you had yours done with the NHS or privately? I've been reading about people using syringes and jaw bras etc. and was wandering what the NHS gives you to go home with, and what they provide while you're in hospital?

Also, you mentioned you had quite a bit of swelling and bruising. Did you find anything useful for helping with that, like hot or cold packs?

I'm glad yours went well and you're happy with the results, which is the actual aim of putting ourselves through all this in the first place!

With regard to liquified food: I was in the hospital for the first two days, and had only water, apple juice and broth. At that point the bone is completely broken, held together only by screws and/or plates and your incisions are still very susceptible to infection. Definitely listen to your doctor (I'm not one), but for the initial healing you want to avoid any kind of chewing. You will probably have elastic bands holding your jaws in position anyway.

When I was discharged after two days, I had apple juice (no orange juice yet due to the acidic content) and started blending shakes using ice cream, Ensure supplements and soda for flavoring. Also later that first week I started having a lot of yogurt. I was allowed to start on soft foods -- e.g., small pasta -- after ~2 1/2 weeks, but because I couldn't open my mouth very far I wasn't comfortable even trying it. I think it was during the third week that I started having fish and other things that kind of fall apart on the fork.

Smoking and alcohol impair bone healing, so while I don't smoke I did give up alchohol for 5-6 weeks.

I had big cold packs for the swelling in the hospital, with a strap that encircled my head so there was a big bag over each side of my face. But the entire lower part of my face was swollen, and the packs were hard to keep positioned. I believe they gave me some IV meds to control swelling. By day 3, when I was home, the swelling had already happened and it was mostly about keeping my head elevated at all times. Walking and staying on your feet helps.

For the bruising, there are remedies that are supposed to work, but I didn't have access to them while hospitalized. Maybe someone else here can be more helpful on this ....

I went home with prescriptions for antibiotics (finished the course) and pain (didn't need it). Also a tube of cortisone cream for my lower lip -- you'll find that you can't keep it moist the normal way and it will be numb, dry and cracked due to the surgery. I used the cream for at least a month.

Good luck. As I said, I think the results are absolutely worth it.

[annafaith]

Thanks again, stuff for the lips is another good one i hadn't thought of.

[Minerva]

Hi,

the complications of lower jaw surgery aren't quite as bad as with upper.

.

Hi,

Does that include Sarpe?

[suzyscientist]

Hi Anna,

I was BSSO & genioplasty on the NHS. Opposite direction to you - I had 7mm taken out!

From what I've seen on these boards, the NHS experience varies according to health board. My experience was absolutely faultless, I could not be happier. I was sent home with a jumbo pack of straws, syringes, and a lot of painkillers (which I actually hardly used). I also had a month's supply of meal replacement drinks - they even gave me options for flavours! I also got a few recipe booklets from the nutritionist who came up to see me. All brilliant!

For food - I was on liquids for about 4 weeks, then was allowed more soft things like pasta etc, but I actually preferred to stick with stuff like potato, because chewing is HARD. Don't underestimate how frustrating it will be! I was all set to just chomp away on some macaroni cheese but I ended up putting it in a blender because I got too annoyed with my lack of muscle function! Patience definitely required

Each patient will have different eating/ chewing regimes so your surgeon will give you more advice nearer the time.

Bruising wise - I had a lot. I used arnica cream and it seemed to work really well. All my bruising was gone in about 9 days. Swelling lingered, but like others have said, after about 2 weeks its only you that notices it.

I loved my cold packs - they were great. I've heard they're not that useful after day 3, but I used them anyway because it felt nice!

Hope this helps and sorry if I repeated some stuff Bullfighter already told you

Suzy

[annafaith]

Thanks suzy, all your info is really useful as I haven't actually spoken to anyone having the same operation on the NHS. I didn't realise they gave out all that free stuff, although I think this probably depends on the hospital you're at too. You sound very lucky with your experience which is great

Well... I'm going into hospital tommorow and surgery on Saturday. I still haven't actually been given ANY advice on eating and drinking post op and what I can expect. The surgeon said 'soft food' when I saw him about a month ago, which i think is quite vague, and he seemed to think this would be okay almost immediately afterwards!? Well, from what I've read on here I will be on liquids for at least a few days - I somehow doubt I will be chewing straight afterwards???

When were you given all of your advice about recovery, like eating and drinking etc? Was it at your pre-op assessment or at the actual time of the surgery? When I had my pre op done the specialist maxfac one was closed because of staff illness, so to make do i was sent to general surgery instead, where I had to tell THEM what surgery I was having. The nurse knew nothing about jaw surgery at all, let alone what issues I should be expecting in recovery! So that was very useful I'm just hoping it will all fall into place tommorow...

[suzyscientist]

To be honest, I didn't get a lot of pre-op advice, because I got a cancellation and it was a case of "if you can get yourself to the hospital by 2pm, we'll operate tomorrow morning..."

When I got there I was in plastic surgery ward, so they weren't hugely familiar with maxfac but they knew what it was at least One of the junior doctors took all my obs and then I was left on my own til the following morning, when all the maxfac crew got in, then I got visited by the anaesthetist, my surgeon, two other surgeons (I think they were students?) and got a good 15 mins to ask all my questions. After surgery they were quite attentive, came up to see me twice a day and answered any questions I had... In terms of eating in the hospital, the nurses actually took care of that, making me drink constantly and ordering liquid food for me.

The evening before I was discharged the surgeon and his team came and gave me all the info about eating and looking after my mouth (lots of rinsing for me! But every surgeon gives different instructions so you might not be told to rinse...). I had my jaws stuck together with elastics, and was told not to chew for the first few weeks, but I know others had different experiences.

I guess my advice is: as soon as he says any questions, ask as many as possible, and write the answers down... I forgot lots of what they said! If you have someone looking after you then it's useful to have them there at the same time. My hospital was quite strict about visiting hours and I was lucky my surgeon came round when my mum was there... so DEFINITELY take a notebook and pen with you!!

Other things to take: a fan (general anaesthetic can make you feel really warm), a laptop, if you have one, with DVDs (I took books but was far too wiped out to read!), a neck pillow (you know the ones you see at airports? Not the inflatable kind, the soft squishy kind!), ipod/ something to listen to music plus earphones, slippers & comfy PJs (hospital gowns are scratchy polyester...). EAR PLUGS - some people snore

I really hope this helps.

Best of luck with your operation - ask any questions if you need more info & I'll try to help... I'm at work pretending to be busy

Suzy

[annafaith]

Ok cool so it sounds as though they tell you everything when you go in, and not beforehand. I'm happy with that, as long as I get all the info. Will defnately be taking a notebook and thinking of some questions today.

Thanks for the info!

[smithie]

I had a BSSO with about a 1cm advancement (no genioplasty) in March. It was not bad. Sent home about 4 hours after coming up from anesthesia, and was completely exhausted: I could not consistently keep my eyes open for another 12 hours or so. By the second day, though, I was fine to walk the dog, drive to the store, etc, and I probably could have returned to work by the 3rd or 4th day out (though I took a week off). I ate whatever I could mash with my tongue, with meatloaf, muffins, yogurt, and milkshakes being the staples, until 4 weeks out when my surgeon said I could chew again. You have to work at it initially, and you may not have the desire to eat an appropriate amount of calories for the first couple days. I had the mindset that I was just going to eat as much as possible, even if I wasn't hungry, and I think this was helpful. Eating a lot is the best thing you can do for your energy level initially.

Had no pain whatsoever, took the prescribed Vicodin only once (even that was probably unnecessary) and then switched to high dose ibuprofen at doctor's suggestion. By the time I returned to work (7 days out), had normal energy levels, walked 4 miles the night before just to make sure I'd be able to go all day. Worst part of recovery was the splint, which makes you talk with a moderate lisp and makes it even harder to fit food into your mouth. Very unpleasant, but temporary (2 weeks for me), and it's hardly debilitating --- I even taught 2 classes while wearing mine.

It's not a minor undertaking by any means, but if you have a skilled surgeon and you force yourself to eat a lot of calories, you'll be fine. Good luck!