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.