In words by webmeister Bud

20140526 - x-rays

I’m not a medical professional. Heck, I’m not even a medical amateur. I had neither the marks nor the looks, only the handwriting. Thus, this is in no way to be construed as medical advice.

This is simply a list of pointers from Future Me, who has gone through jaw surgery, to Past Me, who has not. However, if it happens to help even one person going through this experience, it’ll make Future Me very happy.

Hello, Past Me. =)

20140604 - prePre-op

You’re in for quite a ride but, as you know, it’s all for the better. You have a class III malocclusion, requiring orthognathic (the ‘g’ is silent) surgery to fix your underbite and crowded teeth.

Right now, it’s difficult to get your teeth properly clean through brushing and flossing, your jaw clicks when you open wide, and you’ve been told that you could have headaches for the rest of your life if you don’t address this. So, good on ya for going for it.

Your surgeon’ll be moving your top jaw forward about a centimeter and separating it into three places to expand your top teeth over your bottom teeth. Because that empty space ain’t gonna fill itself, he’s gonna borrow some bone from your hip (it’ll grow back, too!) and graft it on to your jaw.

And, while you’re out, he’s gonna take some more hip bone to augment your chin ’cause, apparently, it’s deficient.

After checking in to the hospital at 7:00 am for paperwork, pre-flight questions, and prep (you’ll get to wear this really stylin’ shower cap), the procedure itself’ll take from about 9:00 am–2:00 pm.

Whoa, what happened?

About 30 seconds after you konk out (or so your brain will calculate), you’ll wake up feeling pretty funky in a bright, noisy room, presumably filled with lots of other people coming to. A nice nurse beside you will reorient you to the world (you’re gonna ask a lot of the same questions) and, after that, you’ll be wheeled into your recovery room.

If you feel up to it, you’ll bum-shuffle yourself from the gurney to your recovery bed, and it’s about then that you may notice a few things attached to you which weren’t there before.

There’s an IV in your left hand. This is to keep you nourished while you readjust to eating, and give you medicine to keep you comfortable. There’s a tube going up your nose, down your throat, and into your lungs to keep ’em fluid-free.

And there’s a tube going, um . . . well, let’s just say that, for the first day and night, when you won’t be moving around at all, you won’t have to worry about getting up to pee.

You’ll also have an oxygen mask for that mountain-fresh air feeling.

20140604 - in the hospitalKiiinda out of it

What’s up with my face?

Weird, huh? Frankly, nothing below your eyes are going to feel normal for a while. Your face will be numb from your cheeks to your chin, and that lack-of-feeling will be compounded by the ice packs you’ll be sticking to your face for the foreseeable future.

At home, you may have the fancy-dancy reusable no-drip ice packs, but at the hospital, they put ice in Ziploc™-like bags, and then (here’s the secret to not having a dripping wet face) they zip the first bag into a second bag. Keep this ice on your face as much as possible. It’s gonna help you become less spherical.

Know this: you got out lucky. Most folks who have this procedure wake up with their jaws wired together or, if not wired, shut with high-tension elastics.

Maybe it’s that your skull is that thick, or maybe it’s that your surgeon is just that good, but your mouth is free to open as you see fit (not that you’ll be able to for a while).

As for opening your mouth: don’t. Just don’t. Keep your trap shut, and don’t try to talk. Just keep writing things down on that handy-dandy little notepad you brought into the hospital with you.

There’s an acrylic splint on the roof of your mouth, which is wire-tied around a number of your teeth. This is here to keep things steady while your jaw solidifies back on to your skull. It’s weird. It’s thick. It’s claustrophobic. But, it needs to be there, so grin (actually, don’t; you couldn’t right now if you tried) and bear it.

It may, in fact, cause gagging episodes, but these will do you absolutely no good. Try to calm down, center yourself, and muscle past any thoughts of gagging. Close your eyes, breathe slowly through your nose, keep your tongue down in your mouth, and grip onto something until the feeling passes. Gagging will make your hip very unhappy.

Ow! My hip!

This is typical. Most folks who have this procedure say that their hip — from where the hip bone was borrowed for the graft — hurts more than their mouth. Indeed, your mouth may be uncomfortable, but it probably won’t hurt with all the freezing. Where you’ll feel pain is your hip.

Remember the no-gagging rule? In fact, coughing, laughing, or any amount of exertion is gonna send many unhappy signals from your hip, so take it easy for a while. It’s recovery time. Recover.

Post-op, day one (night one)

Try to just “be” for the first night. You won’t be moving much except to get comfortable. The nurses’ll be in to check on you quite regularly for blood pressure checks, to give you anti-nausea meds (through your IV) or pain meds (separate shot, but well worth it), and just to see how you’re doing.

Using your little notepad, be ready to ask them for what you need to stay comfortable. Have sheets pre-written to ask for fresh ice packs, a cold cloth for your forehead, vaseline for your lips, or those impossibly-warm blankets you can only get at the hospital or by sleeping inside your dryer.

Sleep may be difficult. You’ll have to do it mostly sitting up, you’re full of tubes, your hip’s not letting you forget it’s there, and the hospital’s still a workplace, so it’ll be brighter and noisier than home. Just grab pockets of Zzzs when you can.

Your swollen face, the numbness, and the fact that your upper jaw is now closer to your lips than it ever has been is all going to mean that you’re not going to be a champion mouth-closer for a while. In fact, you’re gonna be a drooling machine.

Thankfully, the hospital will provide you with a suckytube which suctions away all your charming spit. Keep it to the side of your mouth and, for the love of Pete, don’t close your mouth over of it. That’ll create a suction inside your mouth, putting the integrity of your sutures at risk.

Post-op, day two

20140605 - in the hospitalHello, ladies . . .

After your morning blood pressure check, you’ll go through the two weirdest experiences of your life, mark my words. Those tubes (excepting the IV) are coming out. The nurse’ll talk you through what’s happening, and it’ll be quick, but it’ll still be extra heapin’ helpings of weird. At least you only have to do ’em once each, right?

Once the tube’s out of your nose, you’ll find it quite drippy. Tinged with blood before it clears up, it’ll just drip without warning, and this’ll go on for a week or so. The nurse’ll bring you a little box of tissues, but if there’s ever a contraband item I can recommend getting someone to sneak in to the hospital for you, it’ll be good-quality Kleenex™ or similar. You’ll go through a lot, so they’d best be kind to your nose, rather than rough and scratchy.

Keep the Kleenex™ and suction machine close, droolyface; you’re going to start swallowing liquids today. Water and apple juice to start, and then other juices, milk, coffee, tea, or soup stock. You’ll get thicker stuff too, like tomato soup and pudding. Start slow and keep at it. You gotta eat.

“Eating food through a straw” after a procedure like this is a misnomer. Just like you shouldn’t create a suction in your mouth with the suckytube, you shouldn’t be sucking on anything through a straw or anything similar; it’s just bad news for healing. You don’t smoke, but if you did, you wouldn’t be able to do that, either.

Instead, you’ll get large safety syringes you’ll suction liquids in to, then “inject” ’em into the side of your mouth for swallowing. Again, go slow, but keep at it, and you’ll be a pro eater in no time.

You’re gonna start getting up to start rebuilding your energy, so you’ll be getting up for little walks, to go to the bathroom, etc. Your IV tower on wheels will have to be unplugged and follow you around for the complete hospital experience. Remember that “go slow/keep at it” mantra? Here it is again.

Once you’ve got the hang of swallowing, they’ll cap your IV (the needle in your hand stays, but you don’t even notice it unless you stare at it and overthink your life), and you’ll be free of the wheeled tower companion.

Homeward bound!

20140606 - postPost-op day 2; just home

You’ll be in the hospital for two nights before they discharge you. After your final blood pressure check, your nurse’ll remove the IV needle, and you can get ready to go home. Then, you may just experience one of the greatest feelings of post-op recovery time: your first shower. Enjoy every moment of it. Be sure to pat dry your hip site, rather than rubbing a towel along it.

Make sure you have someone taking care of you. Ideally an adult. Your five-year-old is going to be easier to look after than you.

Kit out the couch (which is where you’ll want to be for the first week; you’ll be up a lot) with Kleenex™, a cold cloth, lip balm, blankets, pillows, remote controls, charging cables, and game controllers.

Your caretaker will bring you some amazingly blended meals and drinks to build your strength back up and try to get back some of those 5.5 kgs (12 lbs) you lost at the hospital.

20140606 - foodOM NOM SLURP.

There are no dieticians in this house, and you don’t have any food sensitivities, so your basic food lineup is going to be:

  • Breakfast: oatmeal, applesauce, yogurt, homogenized milk or cream, banana, peanut butter
  • Lunch/dinner: meat, rice or potatoes, sauce, beef or chicken stock
  • Smoothie: Carnation instant breakfast powder, homogenized milk, yogurt, berries (see “Avoidances”), ice cream
  • Add-ins: powdered skim milk, protein powder
  • Avoidances: anything with seeds (strawberries, etc) which, even when blended, might slip past the sutures and cause problems

After every meal, begin your bathroom ritual of a warm salt water rinse (or two) from a safety syringe, braces brushing (with a toddler toothbrush, and don’t brush your gums for the first week), chlorhexidine (Perio-Plus) rinse from a safety syringe (after breakfast and dinner; no more than twice a day), and Vaseline on your lips. Then, back to the couch with you.

You’ll look like a prizefighter who took a few too many to the neck, based on the bruising. Plus, your hip site will be all sorts of colours, but don’t worry; both will fade in the coming weeks.

Possible TMI warning: the next paragraph deals with nose debris. Skip it if you’re squeamish. I’ll even dim it down.

Still here? Okay, you were warned. You may find it hard to breathe through your nose. There’s a bunch of dried blood which keeps crusting up in there, and it hurts to outright blow, so here’s a tip. After your post-meal rinses, get a paper towel, quickly run it under some hot water, then stuff it up your nose. Leave it there for a minute or so. The warm water will start to break down the crusty bits, and they should be easier to remove (manual extraction, I’m afraid). Repeat as nostril-y necessary.

Okay, gross bits overwith. Welcome back.

Post-op, week one

20140612 - week 1

Here are some things you can expect . . . at some point, some of the freezing is going to start wearing off around your lips. When it does, you’ll feel your nerves checking in, one by one. This is not the most pleasant feeling you’ll experience in your life, unless you enjoy being stabbed by needles.

Prepare yourself: some parts of your face, like your cheeks, your chin, and the roof of your mouth — numb not from freezing, but from nerve disconnection during the surgery — may not regain their full feeling for, so I’ve been told, TWO TO SIX MONTHS. But, at least, I’ve been assured that the feeling will indeed come back. Six months is much better than never.

The strangest thing you’ll have to do in your day-to-day life? Wash and shave a numb face. It’s like you’ve got prosthetic bits on your face. You feel the tugging of the razor, but your face doesn’t provide the expected feedback.

You’ll get better at not drooling, and you’ll start easing in to regular, gentle activity. Wander the house, sit outside, wash a dish or two. You’ll still tire out after rigorous activity like brushing your teeth or folding a couple of shirts, and the more you push yourself, the more your hip will hurt again. Go slow/keep at it.

Your sleep may not improve this week, but at least you’ll have all the comforts (and quiet) of home. YouTube Epic Rap Battles of History and Graham Norton in between powerdiscing TV shows.

Next will be a followup appointment with your surgeon, so you’ll have to, y’know, get dressed.

You’ll also find, after spending your time in sweatpants or just your housecoat, that proper pants . . . kinda hurt. That’ll get better by next week. Just keep the belt loose and/or don’t button up. Hang those pants off your right hip like the homey Gs.

Your followup will be kind and gentle. Your surgeon has this fascinating curved metal thingy to move your lips around smoothly without feeling like he’s ripping your face off. He’ll send you home with some elastics to wear six hours a day. Headaches will abound.

Finally, because writing everything down has pretty much lost its lustre, you’re gonna try some intelligible conversation this week beyond grunts and wild gesticulation. Remember that your mouth hasn’t really done this for a bit, so (can ya guess?) go slow/keep at it.

Post-op, week two

20140614 - week 2

Here’s where things’ll really start to improve for you.

This week, you’ll find the energy to put together and blend your own meal, AND you’ll find you’ll be able to slurp it out of a cup through the front of your mouth, rather than safety syringe-ing it into the side of your mouth. Good thing, too; those syringes are starting to fall apart from wear.

You might even discover that little plastic taste spoon from the frozen yogurt plate and decide to spoon yourself a few millimeters of pudding left over from your smoothie.

Still take it easy, though, both with food and activity. Keep your pace light, and work up to some semblance of routine slowly. Y’know all those grunts old/tired/hurt people make when they’re moving around? You’ll be makin’ those noises.

You’ll have another followup with your surgeon, just to see how things are going. He’ll let you know that your jaw is solidifying well to your skull (“I can hardly wiggle it around at all now!” . . . I hope he was joking), and that things are generally chugging along.

Keep on keepin’ on with the brushing and elastics, but you can drop the salt water/chlorhexidine rinses.

You’ll be talking more, though it’s gonna sound like you’ve got a mouth full of acrylic ’cause, well . . . you do.

A massive triumph will take place this week: YOU’LL GET A FULL NIGHT OF SLEEP. Break down that couch camp and get on back to your comfy bed for MORE SLEEP.

As a grand finalé to the week, you might even try driving, do a little grocery shopping, or go to see a movie.

Don’t. Any or all of these activities will knock you flat.

But you’re probably gonna do ’em anyway, aren’t you? You’re so me that way.

Post-op, week three

20140618 - week 3

Oh, you’ll just be on fire this week. A tiny, candle-like fire, but a fire nonetheless.

That horrid splint? The one keeping you from talking properly, swallowing pills, or feeling normal? It kinda feels like it’s been wearing away, doesn’t it? That may be the case, or you may just be getting used to it, but the fact is, this week (after a few failed attempts), you’ll be able to swallow a pill; those dependable Advil liquid gelcaps you’ve been using sporadically for braces pain may now come to your rescue once again.

It might have something with the fact that you can now open your mouth “a finger” (it seems that post-op mouth opening is measured by how many fingers you can fit between your teeth).

Wanna be brave? Wanna be a tough guy? Go ahead, look at yourself in the bathroom mirror, open up, stick another small mirror into your mouth, and have a good look at that splint.

Happy you did that? I didn’t think so. Ignorance is indeed bliss sometimes.

That’s okay, though. The greatest day of your post-op life is coming this week. And, keep in mind that, in general, you’ve been cutting your forecasts in half. You were supposed to have that forsaken splint stuck to the roof of your mouth for six weeks.

However, your surgeon has called you in to have it removed THIS WEEK. That’s right, during WEEK THREE, YOU LUCKY SOD.

Don’t mind the freezing needle you’ll see on the tray when you go in. Your surgeon’ll tell you that it’s optional, ’cause some folks have sore gums when they pull the wires out from between your teeth, but you’re doing okay, so a natural removal it is.

Clip, clip, clip go the wires, from both your splint and around your teeth. Then, it’s just a matter of pulling the remaining pieces out and DISPENSING WITH THAT DAMNED SPLINT. BEGONE, FOUL FALSE ROOF-OF-MY-MOUTH! GUM ALL THE PUDDING!

20140623 - SPLINT BEGONE!

Are colours really brighter, smells really sweeter, and rainbows really following you around everywhere? Maybe. Or, maybe it’s just that the splint is gone.

You can talk like a normal person again! Woo hoo!

Keep in mind that, while there’ll be parts of extreme ticklish sensitivity to the roof of your mouth, owing to the fact that nothing’s touched it for almost a month, there’ll also be parts which are still numb (you won’t even realize you’re brushing the roof of your mouth along the sides).

You’re now done with your jaw surgeon until after you get your braces off. No more elastics, either! Wearing ice is now optional too, though you’ll find yourself icing in the mornings for a few days yet.

Speaking of which, you’ll go to your orthodontist’s office for the first time since your surgery. They’re gonna re-cement a band which came loose during the surgery, and replace the top wire which the surgeon snipped when he split your jaw.

Oh, and you’ll get . . . more elastics (you thought it was over, didn’t you?) to wear six hours a day, but these’ll be in a triangle, rather than a trapezoid, so less headaches!

Post-op, week 4

20140701 - week 4

This is where I’ll leave you for now. As of this posting, it’s July 2, exactly four weeks since your surgery. But, I’ll come back and update things as needs must.

You can talk, your mouth opens two fingers, you’ve gained a couple of pounds back and, in general, you’re feeling pretty darn skippy.

The great thing about week 4? You can count the bits of normality you’re still missing on one hand. They are:

  • The ability to chew. Your surgeon has advised that you stay on liquids for another two weeks while the glue sets, as it were.
  • Feeling in your cheeks, lips, chin, and the roof of your mouth. Again, could be a month more, could be five months more.
  • To have the energy of someone your age, not the energy of a 193-year-old. That’s been improving, so keep it up!

Thanks for reading, and I hope your jaw surgery experience has been nothing short of educational. The worst is over. Eyes on the prize now. HEALTHY YOU: GO!

20140623 - x-rays

UPDATE #1: Six months down the road, you may notice that you FINALLY have complete feeling back in your face.

It took a while, to be sure, with patches of weird numbness, especially along your top jawline, but it looks like all the nerves found their way home or, at the very least, took it easy while they took the bus.

True, there are still large swaths of both oversensitive areas and numb areas on the roof of your mouth, but those have been evening out over time. Here’s hoping that continues until you can claim 100% normality.

UPDATE #2: Happy nine months post-op! This is about the time you can concede that the feeling you have on the roof of your mouth is how it’ll be. Maybe not 100% normality, but a solid 90%.

Everything will be back to normal by this time except at the very front. That first centimeter or so right behind your teeth? Not quite back with the program with regards to the feels, but it’s not something you’ll notice unless you’re rooting around, looking for numb spots.

Remember: you came out of this pretty dang lucky, chum. 90% normal is something to treasure.

UPDATE #3: Don’t panic, but somewhere along the path of braces, one of the many micrometer-sized movements your teeth make while under the influence of wires and brackets will allow an itty-bitty li’l amount of bacteria to slip past your gums, and right up to the root of one of your teeth. This’ll cause an abscess.

Remember that “don’t panic” bit above? Once you feel it, THEN will be the time to panic. Get your dentist on the phone ASAFP for an emergency appointment before the pain really sets in ’cause, if you don’t, you gon’ regret it. He’ll take an x-ray, freeze your mouth so you can actually sleep that night, then book you in for a proper root canal (they’re done in TWO PARTS now . . . yay!) with his full crew the next day.

Just get that sucker taken care of. Stat.

UPDATE #4: Well, you did it. One day shy of your post-op one-year anniversary, BYE BYE BRACES! Oh, what a wonderful (slimy) feeling!

Now, that thin plastic retainer you’ve got to wear over your top teeth (in concert with the hotglued back-of-your-bottom-four-teeth wire) for two months 24/7 except when eating or brushing? WEAR IT.

It keeps your teeth in the same condition as they were when your braces came off, which is pretty much perfect, right? Right.

Most folks only have to wear their retainer at night (and, keep in mind, this is for the rest of their natural lives) but, since you still have an implant and crown to put in, you’re all-day retainer star!

Only thing about that retainer is that it’s made from a mold taken of your teeth the same minute your braces came off. That means your molars are going to be held in place . . . a bit spaced out from the rest of your teeth, owing to the bands around them. That may be a bit food trappy.

UPDATE #4.5: Yup. Definitely a bit food trappy. =/

UPDATE #5: One thousand and seventy two days. Two years, 11 months, and 8 days. One million, 543 thousand, 680 minutes later AND YOU’RE DONE.

Whole again. One again. Oh. What a feeling.

That crazy robot charging plate which was installed into your head three months ago? It’s all healed up and ready to (pretend to) be “a real tooth!” (said in Pinocchio’s voice, please).

Now, after the best week your mouth will have had in all this time, you have a week of COMPLETE RETAINER FREEDOM while your amazing dentist makes you a new retainer.

BUT NOT JUST ANY RETAINER. A retainer which, after the mold was taken, has molars which are DIGITALLY MOVED FORWARD to touch the teeth in front, just like it should be!

And this retainer is smaller, stronger, and generally the awesomest thing you could ever be required to put in your mouth at bedtime every night.

Congratulations, son. You did it. You now get to fade into the crowd like everyone else with healthy teeth, and nobody shall know the path you took to get there.

Unless, of course, they read this.