Wired shut and worried about relapse. So nervous that I picked the wrong doctor!

[SamBracingForIt]

Hi everybody!

I was just wondering if anybody has any experience with being both wired shut and rigid fixation at the same time? Do surgeons ever use both? I've been using archwired for years in anticipation of my double jaw surgery for an overbite/gummy smile/receded chin, and I never realized that there was a difference in the fixation techniques with wiring a jaw shut vs. using elastic bands. I met with two different jaw surgeons before my surgery, one who is the head of the oral/maxillofacial surgery department at a big university, and then another with a pretty impressive resume who I ended up choosing after I moved cities. Upon meeting with both of these surgeons, they both said I'd need to be wired shut for a minimum of 2 weeks. I never got so far with the first surgeon to see if by "wired" he meant banded, but he did in fact say "wired shut" at our consultations. So, when the surgeon closer to where I had just moved said the same thing, I didn't think too much beyond, "Well, it sucks that these surgeons want to wire me shut instead of use rubber bands, but oh well." I honestly just thought that the inner workings of the surgery were the same, and that wires vs. bands was just a preference thing to wrap it all up. I really liked the surgeon I chose. He was very nice and patient, and talked about how he does this surgery all the time and teaches residents at one of the university medical schools in town. Let me also say, I went about things backwards when I moved because I met with him first and then went to see an orthodontist he recommended. I was one of those rare cases that really could've done the surgery first and then fine tuned with orthodontics afterwards, but the surgeon recommended, for optimal results, if I had the time and money, to do some ortho beforehand. Because my bite wasn't terrible, I'd probably only need braces for about 6 months before surgery. The orthodontist he sent me to, I liked probably even more than the surgeon himself. OMG he is a hoot. So funny and so nice, and he and his staff had nothing but nice things to say about my oral surgeon. Even when I was having a panicked moment before my surgery, I asked my orthodontist if I had made a mistake by only consulting with one oral surgeon, and he said, "no, you're in good hands. I only send my patients to 3 oral surgeons in the area, and your doctor has lots of experience with Invisalign." Oh, yeah, I had Invisalign instead of traditional braces and then got surgical hooks put on 4 days before my surgery. So, yeah, I thought everything was just dandy and never questioned the whole begin wired shut thing.

So, I had my surgery this past Tuesday. I got to the hospital at 5am, surgery scheduled for 8am. I was super nervous, but my surgeon put me at ease. I had the NICEST nurse anesthestist who really helped calm me down. Thank goodness because the anesthesiologist was an absolute sweetheart. Actually, all my nurses were amazing. I woke up, what seemed like 2 minutes later being wheeled into the room where my mom and friend were waiting on me. I felt fine. No nausea, no pain. I wasn't that swollen...yet haha. I was drinking water, I was able to get up and use the bathroom. I even tried to drink a smoothie right out of the gate. My surgeon came in later that afternoon and said things couldn't have gone any better and that he was happy with the outcome. Yay! I was in good spirits despite my mouth being completely wired shut. I was in good spirits when I left the hospital the next day. My main complaints were the occasional jaw spasms that I was having and am still terrified will send my bite completely off of the splint.

BUT it's been a few days now. I've reached my peak swollen face. I've had those couple of nights where it felt like I was breathing out of one tiny coffee stirrer. I've had drainage and tickles in my throat that warrant a cough that cannot happen. Yawning, forget about it. Sometimes, I truly cannot tell whether or not I'm clenching my jaw or if I'm actually wired into my splint that tightly. I'm swollen and have yellow bruising under my eyes and all down my neck and chest. My mouth tastes absolutely awful, and my gums feel very irritated. I know it's because I can't brush my teeth. I want to brush and floss my teeth more badly than anything else right now, even more than eating. I'm currently 100.3 lbs. Down 8 lbs. So it's pretty miserable over here.

In my misery, I decided to look up "jaw surgery relapse" ya know, to really hit it home. When I first started reading, mostly scholarly articles, the research showed certain jaw surgeries are more prone to relapse than others. Class II malocclusions being one of those prone to relapse. Great. I then learned that within class II malocclusions, the fixation technique used by the surgeon has a lot to do with the long term stability of the bite. I kept reading that there wasn't nearly as much occurrence of relapse with rigid fixation, and I thought, well good, don't we all have that though?! I mean how on earth could a bite just move back after being screwed and bolted into place?!... well, turns out, when you're wired shut, you AREN'T fixated with bolts and plates aka rigid fixation... I mean. I am having a meltdown. I know it probably sounds so stupid that I was unaware of this, or that I didn't even ask about it at consultations, but out of the two oral surgeons I met with, BOTH talked about wiring me shut. So, I figured it couldn't be that uncommon. Well, my research the past couple of days has proven me wrong, and it seems to be VERY uncommon. Heck, I texted my friend who had jaw surgery done by our local oral surgeon, aka the guy does wisdom teeth and extractions most of the time and is by no means a jaw surgery specialist, and even he used bands not wires on her! That was over 10 years ago!! AND the thing is, my surgeon here is pretty young. Like, he's not some dinosaur living in the dark ages where wiring patients after jaw surgery is the gold standard. During one of our initial consultations I asked him if jaw surgeries were a regular part of his repertoire, and he said that he did 72 last year... That's more than one a week, unless he lied to me. He's board certified. He's got a great resume. So, I am FREAKING out that he did in fact lie to me, and this must not be a surgery he performs often because he decided to wire me shut instead of using rigid fixation and then band me shut. The only saving grace that I can possibly think of is that maybe he did a combination of both, but I haven't found any accounts of that anywhere. My first post op is Wednesday, and I'm nervous I'm going to just go into his office and have a full on panic attack/meltdown. Of course, I'm going to address this with him. Does anybody have any experience where a doctor used both rigid fixation and wiring the jaw shut? Literally any insight/words of wisdom/similar experiences would be so appreciated. I've almost made it 1 week, with 3 more to go wired shut.

[PierreDeFermat]

You're confusing internal fixation at the osteotomy site with "external" occlusal fixation.

You maxilla, mandible, and chin were all internally fixated with plates/screws, but your teeth are being kept shut with wires instead of elastic bands (most likely because you had a lot of surgical advancement and you're in the middle of orthodontic treatment).

It sounds like your procedure went very well-- your surgeon is very experienced and board certified.

[SamBracingForIt]

[quote=PierreDeFermat post_id=501275 time=1522635306 user_id=31191]
You're confusing internal fixation at the [i]osteotomy site[/i] with "external" [i]occlusal[/i] fixation.

You maxilla, mandible, and chin were all internally fixated with plates/screws, but your teeth are being kept shut with wires instead of elastic bands (most likely because you had a lot of surgical advancement and you're in the middle of orthodontic treatment).

It sounds like your procedure went very well-- your surgeon is very experienced and board certified.
[/quote]

So, PierreDeFermat, (thanks for your words of comfort btw) people who are wired shut have rigid internal fixation as well? I just couldn't find any posts or articles where that seemed to be the case. People on here talk about it in an either/or fashion... "it's either you're wired shut" aka intermaxillary fixation (external occlusal fixation) or you're banded shut with rigid fixation (internal fixation at the osteotomy site), with the latter being the more modern and more stable approach.That's not to say I don't realize something must be holding my jaw together where they made cuts, but it made me think that whatever is used for internal fixation in a wired shut case must be different and less stable than the rigid fixation they use with people who just get banded. Maybe I'm overthinking. It just has me freaked out that I didn't know something so important. So mad at myself for not being aware of this beforehand.

[PierreDeFermat]

This is internal wire vs. internal plate fixation (rigid fixation):

Wire Vs Plate.jpg

This is you with internal plates and external occlusal wire fixation (and possibly a splint, shown in blue)

IRF.gif

[SamBracingForIt]

[quote=PierreDeFermat post_id=501283 time=1522645727 user_id=31191]
This is internal wire vs. internal plate fixation (rigid fixation):

Wire Vs Plate.jpg



This is you with internal plates and external [i]occlusal[/i] wire fixation (and possibly a splint, shown in blue)

IRF.gif
[/quote]

Unfortunately, I can't see the images you attached! Not sure why?! Anyway, still freaking out a bit, just because I can't find anything on the vast internet that talk about having both rigid internal fixation and being wired shut, but instead how wiring people shut is just very, very rarely done anymore. So, I'm just mad at myself for not knowing this before the surgery, so I could ask why my surgeon was choosing this seemingly antiquated approach. I know, it probably seems stupid that I only realized there were different fixation techniques after the surgery, but I literally just thought that "of course, you have to be held together by plates and screws to heal!" Now, from the few cases I find of people being wired shut (and usually those are just old studies because, again, it's hard to find people with actual experience being wired shut these days) there is either no internal fixation or some sort of internal wire thing... all the studies talk about how it's so much less stable and much more relapse prone than internal rigid fixation. Ugh. I feel so stupid.

[SamBracingForIt]

Update: I talked to my oral surgeon. He said he did both! I just have too much free time, and gave myself a panic attack. Probably doesn't help that I'm hungry and naturally a worry wart hahaha

[PierreDeFermat]

Because you probably do not have sufficient privileges to view attachments.

See the link:

https://imgur.com/a/4vSPg

[snapdresser]

Maybe I missed where you said this, but did you have BSSO or IVRO? Usually they use elastics for BSSO and wire for IVRO.

[ObsidianGT]

OP:

You definitely worked yourself into an unnecessary tizzy. I read cases here and it's not uncommon to have internal rigid fixation and wires plus splint.

A user here has an excellent blog detailing his experience. He had internal rigid fixation and wires plus splint.

Here's his site and the specific page that shows some details:

http://doublejawsurgery.samansari.info/ ... 9.html?m=1

[SamBracingForIt]

[quote=ObsidianGT post_id=501367 time=1522927413 user_id=31566]
OP:

You definitely worked yourself into an unnecessary tizzy. I read cases here and it's not uncommon to have internal rigid fixation and wires plus splint.

A user here has an excellent blog detailing his experience. He had internal rigid fixation and wires plus splint.

Here's his site and the specific page that shows some details:

http://doublejawsurgery.samansari.info/ ... 9.html?m=1
[/quote]

Haha I TOTALLY worked myself into a tizzy! In my defence, I was only a few days post op, and I had way too much time on my hands to google things, not to mention I was SO miserably swollen, anything and everything was sending me into a downward spiral. I sent a crazy email to my surgeon's office, and he called me on the phone within an hour to calm me down. He's so great, and I knew I picked him for a reason. Thank you for the link to the blog! I like reading about similar experiences. Definitely not freaking out as much anymore, or at least, not about my internal fixation. Now, I've moved onto obsessing over my nose and lips hahaha

[SamBracingForIt]

Now, I've moved on to freaking out about yawning too many times (I try to stifle them) and loosening a screw/plate in my maxilla and clenching/maybe grinding my teeth and am convince I'm going to have a fibrous union as a result. My next appointment is in 18 days, and I'm getting ready to send my surgeon my second crazy panicked email.

[kim1224567]

I've just gone 4 weeks post op so I know what you mean re having too much time on your hands - Google has a lot to answer for

I'm actually really glad to be going back to work tomorrow so I can get back into my routine and stop obsessing about which parts of my face are/aren't numb!

Not sure if you're aware or already part of this other group on Facebook but they're also a really good place to share your concerns and use as a sounding board - they'll help you stay on track and not overly obsess

Just look up "We Need/Got Jaw Surgery"

[SamBracingForIt]

Thanks Kim! I'm just obsessing over literally everything that could go wrong and am convinced I'm going to do or have already done something to mess up my healing. It's maddening to obsess over it so much. Have you had a post op appointment every week since your surgery? I went into my OS's office the day after my surgery, when I was released from the hospital, to get x-rays done, and just had my one week post op this past Wednesday, and then he told me he doesn't need to see me for 3 weeks. It makes me nervous to go that long, I literally want to go in once a week haha

[kim1224567]

My surgeon appointments post op were 1 week, 2 week and 4 week. The 4 week one was the best because he told me I could move to a soft chew diet and said at 6 weeks I can eat whatever I want

My next appointment is at the 8 week mark.

Hope you're recovering well!!

[SamBracingForIt]

My surgeon appointments post op were 1 week, 2 week and 4 week. The 4 week one was the best because he told me I could move to a soft chew diet and said at 6 weeks I can eat whatever I want

My next appointment is at the 8 week mark.

Hope you're recovering well!!

How has your recovery been coming along?! I saw my surgeon at 1 week, 4 weeks, and at 6 weeks and he said everything looked great and that I didn't need to see him anymore (unless of course, a problem arises) and that I could start seeing my orthodontist again