17 days - some before/after photos

Still lots of swelling, readers, especially in the right cheek, upper lip, and under and around my nose. Plus that funny little sneer which kind of lifts my top right lip, fortunately also temporary. But it's already clear that my surgeon's chopped out a fair bit of my top jaw and brought my chin forward. I like it.

I have had an interesting range of reactions. Lots of people just say how swollen I am. Only couple of people have said I look quite different. One said my chin looked good, the other just said "Does that take a bit of getting used to?". And today the orthodontist's receptionist said "I wouldn't have recognised you walking down the street, I can't believe how different you look". I think that's a bit extreme. I guess she just gets used to recognising people by their mouths, perhaps it's an occupational hazard.

I just feel I look like I should - more like I used to when I was younger. After my extra jaw growth happened I used to look at photos and couldn't believe it was me. So it's a return to normal, really.

In a month or so I will be meeting up with someone who has only seen me once since I was in my early twenties. It will be interesting to see if she notices any difference - I doubt she will.

Today was good. I slept all night, and had no rests today, I felt fine. My son was home from school with a runny nose so I kind of had to keep going, but it didn't bother me.

My divine children sat quietly while the orthodontist bent over me today. Apparently after I saw him last (on Monday) my surgeon rang him and told him that the reason my jaw is over to the side is because of my jaw joint misbehaving. I surmise that after I told the surgeon how the orthodontist had made a slightly disparaging comment about the bite - that it may never be perfect - he thought a phonecall was in order to stop the man scaring me like that!

So today the clear message was that he thinks my jaw will gradually drift back over to the centre position. He put a looser arrangement of bands on me which has actually allowed it to drift more over to the SIDE which I hate, but I must have faith.

Basically he was very very nice to me and told me he was giving me preferential treatment because "you're special". Basically he got rid of all my upper surgical hooks apart from the required ones. This is a new approach, I wonder if he felt bad about worrying me.

I still don't sound that good. I think it's mainly because of the fat upper lip.

I'm off to put heat on my face and massage in my anti-flam ointment (which is kind of like Deep Heat, if you know that cream). I did it last night and it felt divine. I swear my bite got temporarily more centred afterwards, for a while.

Two weeks and two days

Here's my rating of the first two weeks: not too bad! Compared to having a baby, the pain is nothing. I have had two babies with no pain relief. Then you really get to know what 'bearable' means (or that in fact it means nothing because you can bear what you previously thought was unbearable, and retain your sanity (just)). Also, there's no one waking you during the night and other people do most of the work around the house for you. And you get to have heavy drugs when you need them. The emotional angst is minimal, whereas with a new baby I found there were emotional extremes never otherwise experienced. And I have NO regrets about the babies. Or the surgery.

Also three years ago I got a really bad flu type virus and slipped a disc in my back at the same time. Coughing and sneezing were agony. I'm finding this much easier than that.

That said I'm up and down. Not feeling so good today - tired, sore back, headaches at night. But I sleep in a bed again and it is bliss!

I saw my surgeon yesterday. He is really happy with my progress and amazed at how good I am for this early on. He pressed various muscles all over my face and expected them to be sore and tender, but they aren't.

I am almost off pain killers - the only two problems are headaches (which he said are common and a result of everything being in a different position and various feedbacks to the brain being very overstimulating, or something to that effect) and my teeth moving. The rubber bands the orthodontist put on my back teeth on Monday are already doing a great job of pulling them down out of their sockets so that they touch, but it HURTS! The same kind of pain as a regular braces tightening.

He said my sneering top right lip is definitely temporary, a result of things being tight, swelling, nerves etc, and he's seen it lots of times before. He still feels really confident that my lower jaw will move over when the swelling in the joint subsides but that it will take "quite some time". Until then I have a cross bite.

I can eat any soft food I want, but I can't chew for another 4 weeks. This is still very restrictive I am getting skinny. My hip bones stick out. I have to try to get more in.

I can brush my teeth. Excitedly, I removed my rubber bands and brushed the front and sides. Then I went to open my mouth to brush the surface of my molars and.... nothing. My mouth wouldn't open. It's like the joints have fused and there isn't enough of an opening to get a toothbrush in there. I will try a child's brush. I did a rough job with the little interdental brush I have.

When I see my surgeon again at the six weeks mark he will give me jaw exercises to do. In the meantime my job is to put heat on my face and massage it.

Today I am going to take my daughter to her gymnastics class. I won't be able to do all the skipping, hopping etc that the parents do with their children at the beginning, but I want her to go. I'll probably doze all afternoon again!

Two weeks today

I planted trees, dug and weeded in the garden for many hours in the weekend and generally felt great - but today all I could do is lay in the sun and dozed most of the day! My little girl just kept clicking 'Play' on the DVD.

My friends are being so great and I am not having to get my son to school and back again, he is picked up and delivered. I might do it myself later in the week.

I rang my orthodontist this morning because although I'm seeing the surgeon tomorrow, I was so concerned about the hook digging into my top lip. Also, with droopy hooks, there was nothing left for the surgeon to work on anyway. And the pain of the rubbed mouth was starting to break through the numbness. I went in and he took off the very tight bands, fixed the hook and put some elastics in on the sides instead.

My bite is still well over to one side. At first he said things like "I'm not too concerned... once the swelling goes down these things tend to come right...." And then at the end he said "We might not be able to get your bite right, but at least you'll be able to incise and chew". OHHHHHHHHHHHh. I haven't done all this for 'at least'.

My sleeping is quite light and I am DITCHING the reclining chair tonight and moving into a bed. I'll just use lots of pillows. I am very sick of sleeping in a chair.

I can tell that hunger could get to be a bad problem as I feel better. Making a new soup each day gets to be a drag and there are only so many bowls you can swallow. My appetite is growing. My bands are a bit looser now but I know it will still be about 4 weeks before I can actually chew. I already have lots of recipes lined up for when I can. In the meantime, I cook for my family then sit down to gruel.

Swelling going down - day 12

I can't figure out why my top right lip does that - is it because of the saggy surgical hook and power chain underneath it? They do jut out. My lip is numb, that hook might be eating away at my lip and I can't feel it.

What a day! I am totally exhausted and shaky cold tonight but today I did two loads of washing, took the children to the library (and even SPOKE to the librarian with my clamped-shut mouth, it is embarrassing), gardened for about 3 hours and had a bath with my daughter. A good day.

I did have a horrible headache all day which is becoming pretty normal for me. Not the headache I used to get, in my right temple, more of an all-over one.

The swelling is WAY less. There is still lots under and around my nose though, even if the more obvious cheek swelling is on the way out.

Still waking up at night with the joint pain, darn it.

There was an interesting article in today's newspaper concerning my surgeon. I knew part of this story but not all of it. A month or two ago a man was in town and saw what seemed to be a woman getting beaten up. He went to help her and the woman and her friends turned on him and beat him up very badly. One of his eye sockets was broken and his eye dropped 2cm. Unbelievable. My surgeon, Brian Whitley, operated on him and had to put titanium mesh under his eyes. The man spoke of how wonderful Brian is. Then, five days after he got out of hospital, he got swine flu which led to him being in the intensive care unit, unconscious..... The man is training to be a police officer and will continue his training when he's better.

SO basically I have NOTHING TO COMPLAIN ABOUT. I am absolutely fine.

The power of drinking water!

My new pain med strategy worked pretty well, and last night I had a great sleep from 10pm until about 3.45am, when my pain broke through into my dream. 'Ouch, my jaw is really sore,' I said to my friend's brother (who was magically unaged since I last saw him 15 years ago), surprised and puzzled as to why that might be. Then I woke up and reality hit. I took just one more tramadol. Then straight back to sleep until nearly 7am. I must say that the feeling of tramadol descending upon me and knocking me into a deep deep sleep is a hazy, lazy, seductive feeling.

This morning I read on the orthognathic surgery support website that someone's surgeon told her that drinking plenty of water is important for reducing swelling. It seems it gets the body out of 'hold on to fluid' mode.

So I finally admitted it to myself: I have been drinking hardly anything! I just didn't feel like it and because all my meals are liquid I had been telling myself that was enough (even though I knew my bladder wasn't filling often enough). Usually I drink lots of water.

I had a terrible headache from this morning and for most of the day. But I started drinking frequently. By the end of this afternoon I was feeling WAY better. I really think this will help me a lot. I feel my best tonight since the surgery. I even danced to some music! (In the jungle, the mighty jungle, the lion sleeps.....I love that African beat.) So my spirit is strong.

So: to water!

Day 11 - driving and sleeping

I drove for the first time today - into town to look at a homewares shop with my mother. No problemo! But then I got home, had lunch and slept for nearly 3 hours. And I'm still tired. Phew.

I saw my pharmacist Isaac today and he has a great strategy to fix the pain at night: take 4 hourly paracetamol during the day even though I feel fine without it during the day, and then the tramadol before bed. He thinks that will keep the pain low enough for me to sleep all night.

He said tramadol is basically as strong as morphine but doesn't have its addictive qualities. It doesn't seem that strong to me. I would hate to have very severe pain long-term if that's all modern science can offer! And I also take anti-inflammatories twice a day.

It worries me how long my pain will last - how long can I keep taking these strong drugs for? When will this jaw joint settle down?

Isaac then went on to sell me more than $50 of liquid paracetamol for $25 because he had stock that expires in October. It's still only enough to last for a few days, but I see the surgeon next Tuesday, after which point I'll hopefully be more loosely banded so I can swallow pills again.

I got a great response from the orthognathic surgery support website regarding my overheating/cold shivers - someone's surgeon told her it's normal in the first 2 weeks after surgery and it's to do with the liver getting rid of the anaesthetic or something like that. Good to know it's normal and won't last.

It really is starting to sink in how long it could take me to get over this.

Day 10 I think - up and down

Nice chipmunk cheek on the right still.

(I hope that little pouch under my chin is swelling, I think it is)

After 2 1/2 days in powerchains, the bite is definitely better. Teeth touch on both sides at the same time when I close my mouth, this seems like a small miracle to me.

Oh dear, my top right lip has a sneer. It doesn't work properly. Obviously some injury to the motor nerve as well as the sensory nerve. All is expected to pass as the swelling goes down though, thank goodness. But it's pretty neat that my lips touch on the left when I close my teeth together!

Had a bad day. Felt like death after going with my mother to take my 2 year old to her gymnastic class (although grandma went in with her while I slept in the car). Got hot and then cold chills, as has been happening pretty much since the surgery. Bad temperature regulation. Came home, ate (slowly) then slept another 2 hours (or was that go unconscious).

Last night had only paracetamol for pain relief because my clamped-closed jaw joint feels so much better. But, I discovered, not at night. Back to the hard stuff tonight.

I must mention Bepanthen cream. (Not the ointment version). It is SUCH a good healer, my surgeon gave me some for my ravaged lips (which must have been turned inside out during the surgery) have had skin falling off in sheets and now there is healthy pink stuff there instead. I have tried every lip balm known to man and this beats them all.

My online friend Cece who had this surgery 1 day after me near Chicago somewhere has been going for two 20 minute walks a day since day 3. I just read this on her blog. I am nowhere near that point!

Must go to bed (chair, I mean). This is the 2nd time I wrote this, lost it the first time GRRRRR.

Day 9 - getting better

Things are definitely improving. I even went for a short walk yesterday! And went the whole day without pain relief.

I just had paracetamol last night, and got an 'okay' sleep, but there was still too much pain. I'll go back to something stronger tonight.

It's still the left jaw joint that's causing the pain. And my bite hasn't improved further, it's still about the same as when I got back from the surgeon. But that wasn't even 48 hours ago yet, so I must be a patient patient. If all goes according to plan, when the joint recovers then so will my bite.

My liquid diet went well yesterday! I found smoothies I liked, and made a wonderful tomato and capsicum soup for lunch and drank about 5 cups of it. Then I had a smoothie: vanilla ensure, vanilla icecream, milk, banana and flax oil. About 3 cups of that. I felt full! But about half an hour later got some very bad upper tummy cramps. Too much volume, I think.

Last night I pureed up some beef curry my husband made for the family. It needed quite a lot of water added to make it runny enough. I drank 3 cups of it. Then I made real hot chocolate - about a small bar's worth of dark chocolate melted with milk and cream. One big mug was enough, it was rich and delicious. I went to bed with a very happy tummy.

My body is wasting away a bit. I've probably lost 2kg (which is what I put on in preparation for the surgery) but I really notice the muscle loss. I'm going to try to do a few exercises to slow it down, but really don't feel up to doing much yet.

I have more soup plans for today. I woke up at 6am and got on the computer to write this. I was just too sore to try to go back to sleep.

I'll try to get some new photos up for tonight.

In general I am feeling happy and good about the surgery. It is such a fast and magic change after the slow haul of braces. I love the way my teeth overlap and my lips touch at rest, and the few cosmetic things that are really an added bonus. I would not have had the surgery done just for the cosmetic reasons but it was great to be able to have them added in. I don't know if anyone else will even notice them but it doesn't matter to me.

It is great having my mother staying to help. I'm doing quite a bit around the house still but having plenty of time to sit around reading, which is nice.

1 week on, and encouraging news

Went to the surgeon today. He says all is GREAT - wounds are healing very well, I'm keeping them really clean (I squirt warm salty water and savacol mouthwash around) and the x-ray looks great.

But I have a bulged disk on my left TMJ. And of course my bite wasn't lining up that well. So I am back to torture of a different sort: super tight bands. I have power chains so thick and tight that I am effectively wired shut for the next 8 days. Not only is this expected to improve my bite, but it will rest my poor sore joint. Apparently the disk will 'definitely' go back to normal.

I need it - last night was full of terrible pain. The drugs aren't strong enough for it. I did have a muscle relaxant that causes drowsiness, but didn't take it last night because it was giving me these bizarre jerky rigors which were pretty unpleasant. Apparently it's a rare side effect.

My mother drove me, and on the way home we stopped to buy a few things (I stayed in the car, cowering at my freakish appearance and the hideous pain in my jaw joint, which had got even worse). By the time we got home, some teeth on my left hand side were touching! Awesome. I felt terrible - really hot and nauseous with a terrible headache - but more positive, somehow. It is easier to endure things if you feel sure it will work out well in the end.

Then I tried to eat lunch... oh my goodness. I am going to be a bag of bones after 8 days. I even resorted to the foul Ensure plus.

My family had roast chicken and vegetables for dinner and for the first time since the surgery I felt HUNGRY. I pureed it all up and it was very disappointing.

The other thing is the medications - I have tablets because I could get them in with the looser bands - but now I can't and I have to grind them up and put them in water and swallow them. And the taste is unbelievably bad. Never have I had to ingest something so foul. I'm going to ask for liquids tomorrow.

I should add that this sore joint/off bite thing is 'more common than not', in the words of my surgeon. That's one thing I hadn't picked up on from all my research, so I was unprepared for it and it really knocked me.

Day 6 or 7

Is this day 6 or 7? Surgery was last Monday, this is the following Sunday.



I rang the surgeon today because a lump by my right ear, under my cheekbone, was worrying me. He said it sounds like a displaced disk from my tmj joint. Great.

If only my tight band hadn't snapped.

Anyway I see him tomorrow so all will be revealed. I just hate feeling only my canines touching.

Check out my neck bruising.

I want to add more photos but for some reason I can't.

Managed to last all night last night without taking more pain relief halfway through. Slept for 2 hours this afternoon. Had a nasty slip on some cloth on the floor which made me jerk my jaw back somehow. It HURT.

My husband goes back to work tomorrow, but my mother's here to help now. The school term starts tomorrow so not only does Jack have to be taken to school and picked up, but there's after-school activities 3 days a week. I am feeling better though, I think we'll cope.

Day 6 after surgery

I have been feeling really down today because of the pain in my right jaw joint. It gets very bad at night. It's made worse by the face that my lower jaw falls open when I sleep. I use the 'jaw bra' I was given at the hospital to hold ice, and put it tightly around my head and jaw to hold my jaw closed. Of course then I have the uncomfortable sensation of just my right-hand canines touching. So I let off the tightness slightly to keep the teeth just slightly apart.

I am wondering if the joint has become dislocated. It feels wrong - there is a bony-feeling bump below my cheekbone just in front of my ear, where there should just be a hollow.

One more day to wait until I know for sure whether something like that has happened. But it is hard to keep my spirits up. If it has happened I dread what might happen next: could the surgeon put it into place on the spot and how much would that hurt.... or would I need more surgery.... would it cost more, this has cost so much already.

I am trying to appreciate the good things obvious from the surgery so far: my open bite is gone and the top teeth overlap the bottom ones; the slants of both my top and bottom jaws have gone and they seem to be level, and so does my chin. My airway is good. The surgeon told me he was cutting so much bone out of my top jaw anyway that he removed some bone in there to give me a wider breathing passage (the inferior something bones, he said). So that's got to be good. And he also straightened the septum of my nose (the bit that I'd have a ring through if I was a bull!). Plus my lips close naturally - or nearly, if my jaws weren't held apart by the contact of my canines they would easily close. They're still quite swollen though.

Hard to keep my spirits up. I hope it's temporary.

Also I haven't mentioned the stitch between my eyebrows. The surgeon drilled into the bone there and put a screw in as a non-moving reference point during the surgery. It doesn't hurt. Apparently it won't scar.

Day 5 post op

I can only sleep with narcotics. Also last night had to have a muscle relaxant cos the pain in my jaw was bad. Mostly at the top left. Very bad, in fact.

I did sleep, however (in a reclining lazyboy chair) then woke up and rang my surgeon straight away. Because only my canine teeth can touch and that's on the right hand side only! Check out the terrible bite in this photo. (see luscious bruising also)

He was very reassuring. He said that because my bands are loose ones now and because there is a lot of swelling in the joint, he would expect my bite to be like this. If only I could shut up my worry-head and just have faith! He has moved my appointment with him from next Friday to this Monday, when he will do an Xray so he can see everything, thank goodness. I suspect I am a needy patient.

I am managing nice food - carrot and coriander soup from the freezer for lunch, yum. Scrambled eggs pureed with milk: not so good. A friend brought more soup for my dinner and I added some poached salmon and broccoli and pureed it all up into the right consistency with water. It was great. Banana smoothie for dessert.

My $60 or so worth of Ensure plus will go unused, I suspect. It's horrible compared to the other things I can make.

Out of Hospital

Just got home today after 3 nights post-op. I woke up, that's the main thing! It has been better than I expected. I am really delighted about lots of things: the amount of feeling i have in my lips and chin, I have no splint (plastic wafer between teeth), I can breathe through my nose.

These photos are day 3 post op (yesterday) . I haven't got the hang of how to place the photos properly yet! The other photo is of me trying to bite my front teeth together, it was taken the night before I went to the hospital.

My face feels symmetrical (although doesn't look it cos of the swelling) and shorter and my chin is probably a better shape. The open bite is well gone with my front teeth overlapping nicely.

BUT yesterday afternoon one of the rubber bands holding my jaws tightly together broke and the midlines of my teeth are no longer lined up with each other. I am so sad about it! But my surgeon insists it means nothing at this stage, it's just my muscles spasming and moving my jaw around, not being used to my new bite. Quite likely too. I have no choice but to believe him. He took off both the bands last night and put on some looser ones.

My surgeon is delighted with my progress and the nurses also seemed to think I was doing really well. The hospital I stayed at was fanstastic.

I am only having panadol and an anti-inflammatory for pain relief. I had fentanyl (a morphine derivative) until yesterday, it made me sleep lots but I got some horrible hallucinations.

My wonderful husband has been doing a great job with the children but is a bit shocked about how much work it is!

Day before surgery

The day before
Tomorrow I have orthognathic surgery on my upper and lower jaws. My surgeon will cut and reposition both jaws. I have been really relaxed about this but today I am pretty scared!

What's wrong with my jaw at the moment

This photo was taken two years ago, pre-braces.

Why am I having it? I look normal but things aren’t great on the inside of my mouth. My teeth have a terrible fit.

The main problem is my open bite: so, only my very back teeth touch due to the tilt of my bottom jaw.

Secondly, my bottom jaw is pushed over to the left, and there is a ‘cant’ to it, so in fact only my back left teeth touch. However I can make the back right ones touch with a bit of a muscular squeeze on one side.

In the words of my surgeon: ‘It’s amazing you can chew anything at all’. Actually I can chew anything I want, but I’m a slow eater.

Problems this causes: I clench my teeth at night and they are badly worn at the back. There’s no guarantee that this surgery will stop my clenching but, to me, it feels like I do it because the tooth fit is so uncomfortable. The one or two teeth that do touch feel like they’re sticking up and in the way, and if I could only gnaw the damn things away…..(actually I have, the lower left back molar is a gold crown now). Of course I have no idea I’m clenching, I’m sound asleep.

Second problem: headaches. In my right temple. Bad, frequent ones, which often come on during the night. Could these be due to that extra squeeze I have to do to get the right back molars together, and/or the clenching? No one knows for sure. I went to a neurologist and he thought ‘maybe’.

Causes
1. ‘unilateral (i.e. one-sided) condylar hyperplasia’: the condyle on the right side of my jaw grew a bigger than the other and pushed my lower jaw over to the left. I think it's genetic: photos of my grandmother reveal her at about 40 with a jaw WAY over to the left. And my daughter I suspect has the same thing (she's only two). Mine appeared in my mid twenties, I've read that this growth can happen until then.

2. The open bite appeared a couple of months after I started wearing an ‘NTI’ splint, which goes just between the front teeth, and is meant to stop clenching and grinding because the feeling of biting down on the front teeth tells the brain to stop biting hard. The NTI failed: I’d kept clenching and now I could clench on the thing between my front teeth AND get my back teeth together. According to the NTI website this happens to about 5% of people who use it. It has been a disaster for me.

That was about six years ago. Soon after that I had my first baby, and then three years later another, so I have been busy. But now it’s time to have it fixed.

Preparation
I’ve been in braces for nine months, and before that I had three wisdom teeth out in preparation for this. One was nastily stuck in my jaw. I was out of action for five days or so. It was my first general anaesthetic and the anaesthetic bit was actually really pleasant!

The braces are fairly foul, they cut the inside of my mouth at times, trap food and look pretty ugly. But they are temporary so I put up with them.

This photo was taken 4 weeks ago.

The surgery
So what will the surgeon do: first he will work on my upper jaw. It gets a slice taken out of it way above my teeth so that it is becomes tilted up at the back. This way my lower jaw will be able to close all the way along my teeth. Also, the my clever skull has grown the top jaw a bit longer on the right to try to meet my lower jaw which is sloped down on that side. So the surgeon will cut more out of the right side to straighten it up.

He’s also going to cut out a bit more up there overall to get rid of what he calls my ‘long face’: I am keen on the idea because for the first time in my life my lips will touch at rest. This means I hopefully won’t constantly have dry peeling lips due to sleeping with my mouth open (although I breathe through my nose always). I am the world’s biggest lip balm addict. Once I tried to ‘quit’ and within 24 hours my lips were bleeding.

Also I have dreadful tooth enamel on my front teeth which is apparently exacerbated by the wetting/drying the teeth get from being uncovered a lot: enamel is meant to be kept wet with saliva. I have fillings coating my two top front teeth.

So although I’d never have the surgery for those problems, I am happy to have them fixed at the same time, it doesn’t cost more or cause extra risk.

The top jaw gets held in its new place with plates and screws.

Then the surgeon will do a ‘saggital split’ on my lower jaw which basically leaves it free to be moved wherever he chooses. He’ll match it up to my newly positioned top jaw so my teeth all meet perfectly (bliss) and screw it in place.

This website shows the general bone cuts this surgery uses: http://jawsurgeryuk.webs.com/surgeryprocedures.htm I'll be having the mandibular saggital split osteotomy (without the genioplasty) and the LeFort 1 osteotomy. Until a week ago I thought I was having the genioplasty but my surgeon decided it wasn't needed - yay!

This is expected to take about 4 1/2 hours at a private hospital. I have to pay for it myself and it will be horribly expensive.

I go in tonight ready for surgery at 7am and stay another three nights afterwards.

The main risk is permanent numbness in my lips or chin. But just a patch, the surgeon said, not the whole lot! Five percent of his patients experience this. But I will have the full return of feeling.

I have been doing lots of positive thinking and I’m sure I’ll be pleased in the long run. But right now I am just dreading how I’ll feel for the next few weeks. I will try to roll with it.

I should get home on Thurs 16 July, will try to post again then.