Tuesday, March 26, 2013

Final Thoughts

The surgery and recovery was tough, but I would definitely do it all again.  Actually, I felt that many of my fears were unfounded and knowing what I know now, I recommend anyone thinking about it to go for it!  The results will last a lifetime; the pain and the discomfort are only a small part of it all.

Summary of changes: My maxilla (upper jaw) was impacted 7 mm and advanced 1 mm.  Four plates were installed in my upper jaw.  This eliminated my gummy smile, lip incompetance and stopped the mentalis strain when my lips were together. I now keep my mouth closed at rest. I sleep with my mouth closed reducing the likelihood of sleep apnea. The upper jaw impaction allowed my lower jaw to swing up and forward, giving me a nice chin.  It is a bit softer but is more femine than having a chin advancement.  The upper jaw advancement gave more support to my upper lip (I have a visible upper lip now!)  No botox for me. Dental/bite related, my open bite and class II were corrected.  My front teeth now can bite into things like lettuce! 

Side Profile (Before and After)
Front view lips at rest (Before and After)

Big smile (Before and After)

Feel free to leave feedback/comments.  I am always open to helping others through the decision to undergo orthognathic surgery and their recovery. 

Cost of Surgery/Insurance

Just to give everyone an idea about costs:

Before Insurance:
Surgeon: $10,000 (includes consultations, models, x-rays, and surgeon)
Anesthesiologist: $4,750
Hospital: $20,000

For insurance to cover a procedure, medical necessity must first be established.  The surgeon takes measurements, pictures, x-rays and models of your teeth and submits a letter to your insurance company stating that this is not being done for cosmetic reasons, rather that the condition is abnormal enough that orthodontics alone cannot fix the bite and/or that you have other underlying conditions that are made worse by the poorly positioned jaws. 

I had the benefit of submitting a letter from my ENT stating that my sleep apnea would improve with correct positioning of the jaws.

Some insurance companies will deny you outright because they do not cover jaw surgery (cost savings).  Other insurance companies will have a review board, where your case goes before a group of medical specialists on behalf of the insurance company and they either accept or deny you on a case-by-case basis. Other insurance companies just require certain proof (the x-rays, measurements, photos and models) and automatically approve you. 

You do have the option to file a petition if for some reason they deny the surgery. 

Speaking at 6 weeks post-op

At 6 weeks after surgery, my workplace filmed me for a video segment to be used on the website.  You can see how well I'm able to speak and how I look at this time of my recovery.

You Tube Video

Final Post-op Checkup

At the six week mark, I was given the OK to eat whatever I wanted and go completely back to the orthodontist for final tooth movements.  The surgeon wanted to see me again at the 3 month mark and 1 year, just to make sure everything continues to be OK. 

Fourth Post-op Checkup

At this checkup, the surgeon declared that I could go to see the orthodontist to continue with my treatment. He wants me to continue to wear the loose elastics until I see him at the six week mark when he will do final photos etc.  I was able to open my mouth about 2 inches which is a great improvement over the previous week. 

Third Post-op Checkup

At this checkup, they took the splint out and gave me looser elastics.  First they removed all the tight bands and asked me to open and close a few times to make sure my bite is stable.  With about 4 snips on the wires holding the splint in, it came out pretty easy.  No pain, no worries.  There was a lot of food stuck between my splint and my teeth, especially behind the front teeth, which I was allowed to brush to clean it out.  Part of the gums felt weird from not being exposed to air for 3 weeks and the gums between my last two molars were inflamed from being behind the splint.  The gum issues cleared up in a few days.  I was given loose rubber bands to wear from upper canine to lower molar to keep guiding my bite and preventing any sudden jerking of the jaw.  I thought that I would instantly be able to open my mouth after being unbanded, but I was surprised to find that I really couldn’t open at all.  This is because the jaw muscles haven’t been used and were tense from clenching for 3 weeks. 

Every day was an improvement in my ability to open my mouth.  It especially got better after sleeping, which I believe relaxed the muscles, allowing me to open wider and with less pain each day.  I used the heating pad often to try to relax the muscles during the day.  The pain was very similar to a pulled muscle. 

With the splint out, I was able to eat anything that could fit into my mouth without chewing.

Meatball blended in sauce
Mac and cheese lightly blended (basically like a pre-chewed consistency)
Alfredo noodles extra saucy
Mashed potatoes and gravy
Flan and Chocolate Mousse (made with whole milk)

Minus the splint


Speaking at 3 weeks with a splint

This is a video of how I looked and sounded 3 weeks into recovery still wearing the splint.  This is greatly improved from the first few days where the swelling made it almost impossible to move my lips.