Day -6: The Poop is Officially Getting Real

Two days ago, the prospect of my surgery was akin to that of a vacation that is very very far away; no need to worry about planning just yet, I’ve got all the time in the world.

Then yesterday happened.

It started with me pre-registering at the hospital, which included getting relieving confirmation of many of the facets of my surgery (that I will be staying in the hospital two days as originally told, that I will be knocked out for all of it, that it’s a six hour procedure). Those were good things. I also got my blood tested and just about everything came out in the middle. According to Ash, everything came out EXACTLY in the middle, which I find statistically improbably. I’m so average it doesn’t even seem possible!

Then we met with the surgeon, and that’s when things started to take shape. We spent about 90 minutes in his office learning, asking, listening, viewing, and so forth. One of the major things that’s changed in orthognathic surgery in the past few years is the use of computers to take the guesswork out of it. Years ago (not really all that many) it was mainly “look in the mouth, take Xrays, guess how far things needed to move.” Now, with my CT Scans and X-rays being processed by computers smarter than the average bear, he can know within a hundreth of a mm how far to move stuff. (He pointed out that the most the human eye can really work with is 1/2 mms, but it’s nice to know that science is far more exacting than human reflexes).

WHAT THE PROCEDURE WILL ACTUALLY ENTAIL

I’m going to show a few different pictures. I got more in my possession than I’m putting on my blog (including shots which show EXACTLY where the nerves are that he’s going to go out of his way NOT to sever), but I’m going to stick with just a few. Oh, and if the severing of a major nerve got you a little squeamish, I should point out that this is probably not a blog you want to read any further on, and I recommend you go back and look at this lovely Dirty Dozen list made by Jay and I.

Planning1

This is what my mug looks like currently. You’ll see that I still have an open bite, and you’ll also see (looking at either of the outside shots) that of all my teeth, really only my back ones touch. This is the major problem, and the thing I’m trying to get fixed. What you CAN’T see is my posterior airway. Most people’s posterior airways are 10-12mms. Mine is currently 4. So yeah, that’s apparently bad, as air is supposedly good for you. So more than my teeth not touching, being able to breathe is the real reason I’m doing this. Anyway, the braces have done wonders in getting my teeth to even look like this, but I’ve got a LONG way to go.

After sedating me, putting in a catheter (which freaks me out FAR more than the actual surgery), nose tubes, throat tubes, and just about everything else, they’re going to begin by working on the top jaw. What they’re going to do is… well, I’ll let the picture show you.

Planning2

They begin by a palette expansion. When you just listen to the term and don’t think about things, that sounds almost pleasant. Like, if I were an artist, I’d probably want a palette expansion because it would free up my creativity. Here, though, it means they take a chisel (yes, he used the word chisel) and basically fracture the top of my mouth into two separate parts. If I’m not mistaken, they end up putting some metal in there to hold it there. Also, while they’re separating it vertically, they’re also pulling it out a little (which seems odd as I have an overbite as it is). As you can see on the left, after they’ve expanded the palette, they put in this splint (off-white) that will ultimately be the indicator as to where the lower jaw is supposed to go to meet it (red). Dr. M explained that even after I’m done, not all of my teeth will touch, and that means I’ll have longer ortho still to go (he estimated 6-9 more months, but I’m still thinking a year).

Finally, after having done that, the real fun begins. I know what you’re thinking: “but isn’t getting your face smashed by a chisel the real fun part?” I know, you’re all jealous. Then they work on the lower jaw.

Planning3

See in the this picture the teal looking part, and how in the 2nd picture that part seemed to be fully connected to the chin part? Yeah, that doesn’t happen anymore. He will basically cleave the jaw in half width-wise, kinda like cutting apart one thick piece of bread into two. Then they move the chin part forward, and they will later attach it back to the jaw part with 3 screws (on each side). Here’s the really eye-opening part about this. He explained that the most you could/should ever move this jaw forward is 9mm. A typical procedure moves it anywhere from 5-6mm.

Do yourself a favor and get a ruler or something and look at how much 5-6mm is. When you’re talking about a face, it’s pretty significant.

Now here’s the kicker. He’s going to be moving mine forward 9mm. But that’s not all! With having moved the top forward a bit, they will have to rotate the jaw forward and upward to meet the angle of the top jaw. Between the sliding out and the rotation up, I will probably be moving my low jaw close to 12mm when all is said and done. That’s nothing to shake a stick at, because… WHY ARE YOU SHAKING STICKS AT MY MANGLED FACE?

As you can see by that final image, my teeth will more or less line up with each other, and I’ll eventually be able to chew food using all of my teeth, and not just my molars/wisdoms as I’ve done my whole life. (Note: I haven’t had wisdom teeth since February, and, come to think of it, I’m also missing some molars too). Next is a photo as to what my top will look like when I’m done. Note the large gaps that weren’t there before. I’m assuming those will be filled with highly-concentrated morphine, or so I’m hoping.

Top

WHAT TO EXPECT AFTERWARDS

Dr. M didn’t tell me a whole lot I didn’t already know, but that’s due mainly to me having researched this pretty extensively over the last 18 months. As I’ve linked here before, this handy timeline gives a pretty good idea of what a general person can expect from this procedure. I’m not going to expound too much on that. I’ll go over the specifics my surgeon’s told me about.

– I’ll be in the hospital for 2 days. This is good for a # of things. It will give Ash a chance to get my medicines, pick up last-minute stuff, and learn more while at the hospital in how to care for me. Also, as my throat/mouth/nose will all be filled with blood and other unpleasantries, they’ll have nice suction machines that will expel much of that without me having to worry about it. (I WILL have to worry about it when I get home, and from what I’ve read, it’s not happyfuntimes.)

– Any chance of nausea from the meds will almost certainly take place within the first day or so, so having people prepared to deal with that (and cut my bands if need be) is one less thing for me to stress out about.

– For the first week, the bands they have in place will be extremely rigid. I shouldn’t even TRY to talk/open my mouth. I’ve been teaching signs to the boys, I’ll have a whiteboard, and I also have the aforementioned Steven Hawking technology. But not only will I be on a syringe diet, I won’t be doing much of anything else for some time. This includes brushing my teeth. My first real brush won’t happen for a week. Just like I’m uncharacteristically hyperfocused on the catheter rather than the surgery, Ash is looking forward to my breath less than just about anything else (my one-day morning breath can be pretty killer).

– At one week, I get those bands off for a bit, get to open my mouth about 1 finger’s height, brush with a baby toothbrush, then get new bands on. The new bands will get replaced daily (during which time I can baby-toothbrush-brush and eat puree with a baby spoon), but the rest of the time it’s syringe and liquid diet. He wasn’t the first person to suggest that I’ll soon be asking Ashley to blend tons of atrocious sound drinks (lasagna puree? Yes please!)

– At six weeks or so, I’ll get the bands off, and from there the world of not only liquids begins! I also should get the splint out around then. Life in general will just be better. I’ll be able to talk more clearly (hopefully totally clearly), and I’ll be able to blow my nose by then. Before that, any blowing risks rupturing things in your sinus cavity, so yeah, there will be no blowing of the ole’ honker before then.

– Swelling starts around day three, lasts anywhere from 10 days to a month. Numbness will initially be basically everywhere below my eyes, and will slowly start to come back patchwork over the following months. Numbness can last anywhere from 3-9 months, but there’s a possibility parts of my face may stay numb forever. Ought to make shaving fun!

THE RISKS

Dr. M did much to ease our  minds with the consult. He assured me that, even though I’m his very last patient (he unofficially retired a couple of months ago, and just did his second-to-last patient yesterday), he’s not trying to beat out the clock. “I won’t be rushing off to make a tee-time. I don’t even like golf.” If he’s able to do the procedure in 5 hours, wonderful, but if it’s as long as he thinks (6 hrs) or even if he hits some complications tying and untying binding wires (7+ hours) he’s there for the long haul. Also, he is staying onboard with me specifically for all my follow-up appointments. He’s done this for 29 years, and the few people I have spoken to who had this same procedure, and with him as surgeon, had nothing but glowing things to say about him. That being said, something like this carries risks.

  • Death. Not because of this procedure itself, but because of the nature of surgery, basically. A non-factor.
  • Excessive bleeding. He was the surgeon who extracted my 8 teeth in Feb, and noticed nothing unusual then, but still, it’s something that could happen. You never really know how good a bleeder someone is until you’re in there, hackin’ away. Also of note, 3 weeks ago I was supposed to donate one unit of my own blood to myself to use in an emergency. This didn’t happen because I was ill (they wouldn’t have taken my blood even if I went in). He doesn’t imagine it will be a problem, and will go to a blood bank if he needs to. It’s at times like this that I really wish I knew which blood type I was.
  • Numbness as described above.
  • Incompleteness and relapse. No matter how perfect the surgery goes, it’s unlikely that I’ll have a 12mm windpipe after this. I may only go up to 6 or 7 (though hopefully higher). That’s not a fault, it’s just how people’s bodies differ with the procedure. Also, no matter how good he does, and no matter how good I am about maintenance going forward, it’s still likely I’ll relapse some. My teeth and jaws will want to naturally go back to the way things were for 37 years. If I take good care of everything, that should be at a minimum.
  • My facial structure will change, but probably not massively. I *could* opt for a chin implant if I really did want a chin. I was going to link a picture of me in profile, but I realized I never posted one on my blog b/c I dislike my profile so much. That being said, I’m not doing this for cosmetic reasons, so I’ll take whatever change I get and move on. I *may* end up bleaching my teeth when the braces come off. We’ll see. Okay fine, here’s my profile:
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    From January 2015

    And I’ll also post a picture of how my mouth looked right after the extractions (before the braces worked their magic)_1090206

  • As I’ve said a few times, I’ve packed on quite a few pounds this year (mostly bad weight, unfortunately) because I will have some weight loss. Dr. M pegged me at 10 pounds, but I’ve read anywhere from 10-50 pounds. The 50 was for a linebacker, but I’m anticipating being in the 20-25 pound range. I’ll also not have much energy until around week 4 (when I hope to be going back to work).

That’s enough for now. I’ll post more as it gets closer, and hope to blog every day, at least for the first few weeks.

p.s. Just felt a pretty significant earthquake while editing this. Apparently within the last 30 minutes we’ve had 4 hit, and this (what was the fifth) was the first one I’ve felt, and the most shaking I’ve ever felt. Probably over a 4.0.

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