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.

Menu
Salmon
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

video
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. 

Second Post-op Checkup


No big news at this appointment, given that I am eating pretty well and maintaining my weight, the surgeon felt confident in keeping me banded shut for another week.  My swelling is pretty much completely gone.  The bruising is almost all gone too.  I can open my lips to see my teeth. 




This is what the splint looks like inside my mouth. You can see the wires attaching them to the canines.
 

Recovery Day 8-13

Now that I’m feeling like I have more energy and that I can breathe better, I decided to do something every day that gets me out of the house as a way to build up my stamina and energy.  Menu has stayed pretty constant.  Just waiting and healing.

Day 8
 
 
Day 9
 



Day 11


Day 13







First Post-op Checkup


This day I turned the corner in terms of energy.  I had a doctor’s appointment around noon and was prepping all morning to put on real clothes, make myself look presentable and eat so I wouldn’t get hungry.  I took a small can of apricot juice (100 cal) along with me in case I get hungry.  Doctor took an x-ray and then looked in my mouth.  Inspected the stitches and made sure I couldn’t open my mouth and that the elastics were doing their thing.  He said 1-2 more weeks with the splint.  He was really pleased and I told him things were going well.  He was concerned about nutrition and I told him I only lost about 3 lbs which made him feel good.  We stopped at my house on the way home and picked up some extra food that I wanted to bring to my parent’s house.  This is a good sign that I have this much energy. 



 

Recovery Day 6


Sleep still comes in 4 hour increments, mainly because I have trouble breathing after a few hours.  I have a sink setup so I can run hot water on a washcloth and put the washcloth up to my nose to make it open up.  The shower doesn’t steam as well at my parent’s house and it’s a lot of energy to go upstairs to get to the shower.   Took a shower to alleviate the stuffy nose and could feel like I had something in there but wouldn’t dare blow.  Stuck a tissue rolled up in my nose and pulled out something hideous.  But it suddenly made it easy to breathe. 
 
Menu (sippy cup)

Cream of chicken soup

French onion soup (minus the onion slices)

Mashed potatoes

Baby oatmeal

Tortilla soup

Jello (syringe)


 

Recovery Day 5


My husband left on a business trip at 4 am, so my Dad came over to be with me in case of emergency (clearly I can’t call 911, or at least nobody would understand me).  My mom came over at a more humane time of the morning.  They collected a bunch of essential items and took me over to their house for the next few days.  My stuffy nose is still problematic, but I haven’t had any attacks like on day 2.  The humidifier continues to be my best friend.


I'm green like the grinch!

Lots of bruising
 

Recovery Day 4


Sleep is still difficult when I can’t breathe well.  I am keeping up with the maximum Afrin dose I can do and supplementing with shower time.  My husband is leaving on a business trip tomorrow, so I need to pack to go live with my parents for the week.  This is a slow and tiring process, given that I have no energy.  Packing some clothes in a bag tired me for the next 30-45 minutes.  Then I’d pack something else.  Just don’t have the ability to breathe and do these physical tasks. Tried to eat Chicken and Stars soup by blending the “stars” part but turned out again to be too thick and wouldn’t go through my teeth.  Disappointing.  My mom bought me some baby oatmeal that is ground very fine.  With lots of milk it fits through my teeth and is a bit more filling on the belly than just juice and broth. 

Menu
beef or chicken broth

baby oatmeal

egg nog

Jello

tomato soup with cream cheese melted in

banana shake

fruit juices from juicer (apple, watermelon, pineapple, tangerine, melon)

Swelling starting to improve significantly.

Bruising has begun.
 

Recovery Day 3


My current sleeping arrangement is on the couch with my head propped by two extra pillows.  I also am keeping the ice on all night long.  Every few hours I need new ice.  It is convenient that my husband has decided to sleep on the neighboring couch so I can easily get him if I need something. We probably fell asleep around 10 pm with the TV on.  At 1 am, I woke to the feeling of not being able to breathe.  I woke my husband and he watched me as I lay on the couch laboring to breathe. Then of course, I began to panic and my heart was racing.  I wasn’t due for any more Afrin so there was really nothing to do, and then he remembered the instruction that patients often take multiple showers per day.  He turned on the shower and sat me down in the bathroom. After 10 minutes I started to breathe much easier.  I stayed in the bathroom with the shower on for over an hour until the water went cold and the steam went away.  I went back to bed for a while.  Woke up at about 6 am to the same problem and headed to the shower. I guess this was going to be the routine.  I need to breathe, so this is it.  My parents came over to watch me and my husband mentioned to them that I can’t go out walking if I can’t breathe and explained the incident from the night before.  He then went out and got a humidifier to help me breathe 24/7.  They setup the humidifier so it would put the steam right at my nose level as I lay on the pillow.  Wonderful!

 

Uneven swelling.  Look at that nose!

Recovery Day 2


Today I decided to take a shower (supervised of course). I lightly touched my face with mild soap to try to clear the surface.  It was tender to the touch.  I have very little energy but am dealing pretty well being a couch potato. I still have not taken any painkillers including Advil or aspirin.  I take the antibiotic 3 times a day using a baby syringe.  Thankfully, it’s the bubble gum/berry flavored amoxicillin which is tolerable. My husband came up with a tasty banana shake for me to eat.  It’s a calorie monster but it’s heavenly and filling. Because it’s banana, it easily blends to fit between my teeth.  I also ate sloppy jello, jello which has been slightly melted after setting and whisked so it’s not clumpy. I tried the Ensure clear and it was disgusting.  That went right out in the trash.  See the rest of my menu items below. Everything required a syringe at this point. My parents came over to take care of me for a while.  My mom heard that people recover faster if they are physically active, so she bundled me up and insisted on taking a walk around the apartment complex. We made it to the other side of the building and back very slowly.  This was broad daylight so I had sunglasses on but was still squinting. Because my nose is stuffy and my mouth is banded shut, by the time I reached the couch, I was wheezing.  I spent the next 10 minutes laying on the couch taking long breaths trying to catch up.  I continue to take Afrin as often as possible but my nose is feeling worse as the day goes on. 

Banana shake

½ cup heavy cream

2 bananas

3 large scoops of ice cream

Hint of vanilla extract


Swelling and fat lips.

Look at that big fat upper lip!

 

Discharged


Just as my family arrived around 12 pm, the nurse came with my paperwork so I could leave.  I then tried to explain to them about how I had to go to the doctor’s office and I started crying because all I wanted to do was go home and lay around. I had been doing so well, I didn’t want to have any emergencies especially on the road. They then were trying to figure out how to get to the doctor’s since it was a different location than normal.  I was loaded up with a fresh pack of ice on my face and was wheeled out to the car.  The sun hurt my eyes a lot since I could not squint to block out the sun.  We arrived at the doctor’s office and they sent me back pretty quickly.  I think I was scaring the other people in the waiting room. I told them that my nose was stuffing up so the nurse came over with some rubbing alcohol to clean out the blood and gunk.  It felt a bit better. It was painful for them to pull on my lip to gain access to the molar than needed a new bracket.  It didn’t take as long as I thought but it was overall unpleasant.  Then they put extra elastics on and now I couldn’t be understood when I talked. 

Waiting in the doctor's office


Got home around 3 pm and was thirsty.  I lay on the couch the rest of the day and watched tv.  Started eating water and juice with the syringe.  I also started using the Afrin to try to open up my nose.  My husband made lamb with tsziki sauce and blended some up for me.  It smelled so good.  I squirted some in my mouth, hit my teeth and bounced right back out.  I was shocked!  Turns out with the splint which molds perfectly to the shape of the teeth, not all “liquids” can fit through.  Basically everything needed to be strained with a fine strainer. Defeated, I returned to juices and broth.


Menu (syringe only)

Fruit juice

Water

Chicken broth

Egg Nog

Hospital: Surgery Day


I was not allowed to eat or drink anything after midnight.  My surgery was scheduled for 12:30 pm but I was told to arrive at 10:30 am. We headed to the outpatient check-in where they took my co-pay and checked that my address and insurance information was correct.  I was then handed a buzzer thing like they have in the restaurants that lights up when your table is ready.  When it goes off, they were ready for me to come back to prep.  I have to do a urine test and then change into a hospital gown.  Then I was shown to a prep bay where I got to lay down in a bed and they started a long checklist of things.  A whiteboard next to me listed all of the people I needed to see before they could wheel me back.  They started me on an IV and gave me nice warm blankets.  They attached pressure cuffs to my legs to keep circulation and prevent blood clots.  Those were nice and felt like a leg massage. I was very nervous and my blood pressure and pulse were high but I could not be given anything to relax me until I had signed all my consent forms. The anesthesiologist and assistant came by and discussed that they were going to put the anesthesia directly into my lungs through a tube in my nose.  In the other side of my nose, I would have a tube going down to my stomach to suck out blood and gunk.  This tube would be staying in for a few hours post surgery until I stopped bleeding.  They didn’t want me throwing up.  They then gave me a super powerful Afrin to sniff in my nose to keep the swelling down. Then the surgeon and the assistant surgeon came by to confirm a final time what we were going to do.  The anesthesiologist came by with a shot of some kind of relaxing drug.  The world started getting kind of fuzzy.  I said it was making me feel weird and that I was going to close my eyes.  That was the last thing I remembered.

 

The next memory I have is that I could hear the nurses and my family talking.  It was about 5:30 pm, I was in my hospital room and everyone was commenting on the nice flowers my work had sent me.  My eyes were very heavy and I could only open for a few seconds at a time.  At some time, the nurse gave me a remote to control my pain meds and explained that I should click it when I needed.  I didn’t really want to click it because I was worried about nausea and dizziness and so I decided to wait until I had “3” pain. So I just went back to sleep.  At around 10 pm, I started getting braver and waking up a bit, so I could move a bit.  At this time, I still had the tube down my throat going to my stomach.  I kinda felt around in my mouth and could feel the tube with my tongue.  Best not to start gagging so I stopped exploring. I could tell I still have the splint wired to my top teeth and could feel some elastics, but not as many as I expected. I overheard a nurse saying that they’d take the tube on in an hour or so, so that was exciting. The best way to describe how I felt was mostly numb.  My cheeks felt as if someone had put masking tape on certain parts to both stretch it and make it difficult to flex.  My face was swollen all the way from the bottom of my eyelids down.  I could not squint. Inside my mouth, originally I thought the tube was making my throat feel tight and sore (like a typical sore throat) but in fact, the soft part of the roof of my mouth was swollen and sore and felt like a really bad cold with drainage.  I could not move my lips, they were so swollen, it was like they were attached to the front of my teeth.  Around 11 pm they took out the tube.  It wasn’t as bad as I thought, it was like a 1-2-3 and you feel something moving up through your nose, the worst part was a giant wad of snot/blood that came out with it.  Then they came with water, salt water, apple juice and cranberry juice with a syringe.  They had me rinse to get the blood out of my mouth (which wasn’t very much) and then I started using the syringe to drink.  It wasn’t too bad, but I could actually open my mouth a bit, which worried me because I thought I shouldn’t be able to.  I wondered why I hadn’t needed to go to the bathroom despite all the fluids.  Turns out they had a catheter in.  This was no big deal.  They took it out somewhere around 6 am.  It felt weird for like a second but nothing to fear, trust me.  Then I was going to the bathroom every hour because they had been giving me so many fluids. They walked me to the door the first time but then let me walk by myself after that. My lips were so swollen and dry that they spontaneously bleed and as I looked in the bathroom mirror, I saw blood coming out of my mouth and freaked out grabbing toilet paper to blot it up.  I thought it was something serious but the nurse reassured me it was just a dry cracked lip.  She was right. Once I was getting up and around, they stopped the leg massages (darn!).  At around 9:30 am, the surgeon stopped by to check in on me.  He had mixed news.  Good news is that the surgery went really well and he was really impressed with my recovery.  The nurses told him that I never touched the pain button. Bad news is that some of my brackets had broken during the surgery, one he needed to attach an elastic to in order to keep my mouth shut, and that was why I could open my mouth a bit.  He needed me to stop by his office (an hour from the hospital) and get a new one glued on so he could band me shut for healing.  I agreed but was very upset inside. I was worried I wasn’t going to be able to handle the car ride from the hospital to home and now I had to take this extra trip and be around people.  What if I started to not feel well.  I won’t have access to any drugs and I can’t just lie down.  And then of course my nose started to stuff up.  I asked the nurse if they could do anything and they said, no, and especially don’t blow your nose.  I thought it was strange that they couldn’t give me Sudafed or something.  They told me to use Afrin when I got home, but I wasn’t going straight home and that was even more frustrating.

Around 6 pm. I still have the tube in my nose.
 

Pre-op Physical


Less than 7 days before surgery I did my pre-op physical and bloodwork.  They are just checking to make sure I’m healthy enough for surgery and no underlying problems need to be addressed.  I can’t have surgery if I have an active infection (especially UTI).  Everything checked out.

Hospital Consultation


About a week before surgery, a nurse from the hospital calls to go over health history and any special considerations.  I filled out a health history form beforehand so the conversation was pretty quick.  She asked questions about allergies and negative reactions to anesthesia and then gave some advice about my time in the hospital.  She said that they are very concerned about the body focusing all its energy on recovering, so if I ever feel pain above a 3 on a 0-10 scale, I should use the painkillers.  She also mentioned that to help clear the anesthesia from my system to do 5 minutes of deep breathing in and out every hour.  This will clear it out of my lungs and help me be less drowsy.  And that I should keep this up for a few days post-op as well.

Comprehensive pre-surgical consultation


About a week before surgery, the orthodontist placed the surgical hooks on the teeth.  Since I have lingual braces, she placed clear brackets on the outside of each tooth for the surgeon to use. 


I returned to the surgeon for final models.  At this appointment, they took another set of molds, cephlometric x-ray and panoramic x-rays, profile pictures including pictures with mouth closed, mouth at rest, mouth in full smile, to help the doctor determine how much he needs to impact the upper jaw. Then they used something called a face bow to replicate how the jaw opens and closes.  They stick one part in your ears, align another part with your eyes and bridge of nose and then you bite on a wax form on a plate to determine the “hinge” of your jaw joint so they know how your jaw moves.  From there, the doctor will make plaster molds and do a mock surgery to determine exactly what he will do during the surgery.  From this, he also builds a splint, basically a plastic retainer that represents the bite he wants to achieve.  During the surgery, he wires your teeth to the splint via the surgical hooks and then can properly adjust the upper and lower jaws to achieve a good skeletal relationship.  After performing the mock surgery, the surgeon decided that he would only need to do the upper jaw surgery which will reduce healing time and risk while still getting me a good bite relationship.  He told me that he was going to move the upper jaw forward 1 mm and up 6-7 mm.  The lower jaw would auto-rotate into a good bite without having the BSSO.

Surgical models


Surgical splint aka wafer


Facebow setup
http://practicon.com/5020-Easy-Bow-Set/p/70-19143/

 

Six-weeks pre-surgery checkup


A checkup consultation with the surgeon was scheduled about 6 weeks before my teeth were in their final position at the orthodontist.  They took molds of the teeth and did some additional pictures and measurements.  At this point, once they determined the jaws and teeth would fit together correctly, they scheduled a surgery date with the hospital.

Initial Consultation


During the initial consultation, the doctor takes pictures and makes some visual measurements of the jaws, teeth and face to identify the potential surgery options. This is the time to ask what kind of hardware and recovery process is involved with treatment.  I was originally quoted with both upper (lefort 1) and lower (BSSO) surgeries.  The surgeon’s assistant had a model of a skull which showed the procedure and demonstrated how the jaws would be moved along with sample screws/plates.  For the upper jaw I would be getting four plates with multiple screws for each plate.  For the lower jaw I would only have 3 screws per side, but that they would have to make some external cuts to put those screws in, meaning I would have some minor scars under my chin.  The typical treatment involved being banded shut for 6 weeks (most commonly without the splint in) and the bands would get progressively looser.  I would have to be on a liquid diet for 6 weeks.  Typically people lose 5-10 lbs but should not try to lose more as that’s not a healthy way to lose weight.  They also explained it was a day surgery (23 hour stay) and that with upper jaw surgery, after the surgery is complete, I will have a tube down my nose into my stomach to keep blood out and prevent me from throwing anything up.  They also mentioned that if I do have to throw up sometime, its fine, I won’t choke because liquid in = liquid out.  I would also get a pair of safety scissors to cut open the bands in case I am choking for some reason.

 
The surgeon said I would not return until the orthodontist was done aligning the teeth within the jaws.  At this time, they sent a preauthorization to the insurance company proving medical necessity for surgery approval.  They submit copies of the molds of your teeth, x-rays, and a description of the problem along with a letter from the doctor.  In my case, I also had a letter from my ENT stating that correcting my rethnogenic mandible would improve breathing and reduce my sleep disturbances (apnea).  I received a letter about 6 weeks later stating that all aspects of the surgery had been approved.
Long list of questions for the surgeon

Diagnosis


TMJ

Moderate jaw joint degeneration

Open bite

Overjet

Mild crowding

Class II molar relationship

Smaller than normal airway

Sleep apnea

Mouth breather

Long face syndrome

Maxillary hyperplasia

Mandibular rethnogenia

Mentalis strain




 




My decison to have jaw surgery

I realize from the backstory post it makes it seem like the decision to have surgery was an easy one.  It was not and I felt it was worth adding a post addressing this.

I hated having braces as a kid.  I did everything I was told just so I could be done fast.  I was the only kid in my class who had permanent teeth pulled.  I never understood why.  I hated how I looked when I had the big gaps in my teeth during treatment.  Truthfully, I never understood why I needed braces because I thought my top teeth looked pretty good and my smile was "pretty." I never liked the way my smile looked after getting braces off even though the teeth were straight.  There were actually a few black gaps between the top and bottom teeth but I figured that must be normal (later found out that was my open bite).  I felt there was something about the missing teeth that made my smile look less attractive.  Or maybe I was just being harsh on myself because my face was changing during those awkward teen years.  I was always bitter about the loss of those teeth, there was nothing wrong with them and now I'm already starting out adult life with less teeth than 95% of my peers.

Turns out what I didn't like all those years was actually my skeletal problems. The "mile high gums" were what made my smile look less attractive.  The front teeth were tipped back, making my face look sunken.  The black gaps in my teeth was my openbite.  The frowny looking face with dimples on my chin when I held my mouth closed was the long face with lip incompetance.  And for being 100 lbs, I thought I always looked like I had no chin line, that was my rethnogenia.

When I went to the dentist 3 years ago (moved to a new city), and they diagnosed me with all of these problems plus an overjet and class II molar relationship, I was honestly devastated. I couldn't believe that after all the unhappiness of going through treatment as a kid, NONE of these problems were fixed.  And now that I was an adult, they gave me the even worse news that the only way to fix it was with surgery.  Hell NO!  I HATE hospitals.  I outright refused.  But then it started to eat at me...

Sometimes I think it's psychological, once someone points out a "blemish" you can't help but obsess over it. 

I did a lot of research and decided to schedule consultations with at least 3 different orthodontists to see if my situation could be fixed WITHOUT surgery.  I heard about these things called TADS/miniscrews that could be drilled in your jaw and attached to braces, could push all your teeth into your gums, making the openbite and gummy smile a bit better.  I was so desperate to do this without surgery, I was looking into doctors in neighboring states (3-5 hours away) just because they might help me.  I ended up picking 3 different local orthodontists to consult first. 

At my first consultation, the orthodontist said that my teeth looked "fine" and he wouldn't want to fix them.  He also poo-pooed my TMJ and joint damage.  He suggested I get veneers if I didn't like the openbite.  WOW.  Nice. 

At my second consultation, the orthodontist said I absolutely needed surgery or my underlying conditions would get worse.  They really pointed out the extent to which my skeletal problem was a detriment to my health.  I came off very combative and listed about 10 reasons I didn't want to do surgery.  They were impressed with how much research I had done.  They offered the TAD option, but explained it wouldn't fix all my concerns and had a high chance of relapse since the true underlying problem isn't actually getting fixed.  Before I left the room, the doctor looked me in the eyes and said, "After spending this hour with you, I think I know the kind of person you are, and you won't be happy unless you get the real problem fixed... think about the surgery." 

At my third consutation, the orthodontist gave me two options: she said I really needed surgery to fix everything.  I immediately barked back NO way!  Then she moved onto the TAD/miniscrew option.  She was going to pull up the back teeth, reducing the gummy smile somewhat.  I agreed to this treatment.  She sent me to an oral surgeon for a consult about the TADs.  Turns out they weren't going to do just screws, but whole plates with hooks.  The surgeon would cut into my gums and screw "temporary" plates into the upper jaw bone around my nose and then a metal hook would hang down into my mouth area.  They explained this was surgery and that I would have to spend the rest of the day at home resting and gave me prescriptions for narcotics and told me that I would need to ice the area because it would cause swelling.  The total cost just for installation was a couple thousand and this was without anesthesia.  Yikes!  Sounds like a lot of money, a surgery situation, and still only half results.  And insurance wasn't going to cover any of this. 

In the middle of this, I had started seeing an ENT (Ear, nose, and throat) doctor because the second orthodontist suggested I might have sleep apnea tendencies due to my face structure.  I explained the situation to the ENT and he agreed, saying that all the factors I listed placed me at a high risk for sleep apnea without even having to run a sleep test.  I had a smaller than normal airway and a deviated septum.  He said patients like me as they get older tend to bend forward as they try to get better breath and end up more hunched over and wheeze because their airway starts to collapse.  He left it up to me, but said I would definitely benefit from the surgery. 

I realized, being a pretty stubborn person, sometimes I'm willing to do anything BUT what I really should do, just because I'm hellbent on not doing it. 

After sitting on this information for a while, I called the orthodontist I had chosen and told her that I wanted to seriously look into the jaw surgery thing, not the TADs.  She gave me a reccomendation of a great oral surgeon (makes the Top Doctors list in DC) and I went to my consult with a list of combative questions in an effort to shoot down the idea of surgery because of the risk of numbness... or fear of surgery in general.... or that I might lose weight during recovery... any stupid excuse my stupid brain could come up with.  I went to see the surgeon, showed him my list of questions, he answered each one.  I think he gave me a dose of reality... it's not that bad of a surgery, the possible side effects are minor and nuisances, nothing life altering or life threatening.  He said I need to get over my fear of hospitals and surgery, you could always have an emergency situation and need surgery, then you don't have a choice.  I walked in ready for World War III, I walked out confident that I was going to do the surgery....  And that's where this blog truly begins.  

Backstory


I had braces as the age of 12 to correct a bad overbite due to genetics and a thumb sucking habit. My top teeth were crooked but not really crowded and my bottom teeth were very crowded.  I had two upper and one lower pre-molar extracted and two years of braces.  I thought my teeth had been fixed. I moved at the age of 25 and the new dentist found a laundry list of problems with my teeth.  After getting opinions from 4 other dentists and orthodontists, they all basically said I had a jaw discrepancy that no braces would ever fix and that if I wanted to have healthy teeth and jaws for life, I needed this fixed.  So I began my final round of treatment.
 
Two weeks before treatment began at age 12
After treatment ended at age 14 (staged smile)

Today: Look at those mile high gums when I'm smiling big!