Jaw Surgery: The Experience and Aftermath (7 Days Post-Op)

Today I am one week post-op, so I thought I would talk a bit about my experience of jaw surgery and the last few days. Speaking continues to be difficult, so it is nice to have a writing outlet. Beyond that, it’s been very helpful for me to read the blogs of other people who have had the surgery, so I’d like to return the favour a bit.

First:

WHY: People keep asking me why I had surgery, and I find this question so curious and slightly uncomfortable, because the answer seems so obvious. I had jaw joint noise and pain, as well as a compressed airway, and was grinding my teeth… but those are just symptoms. The problem was that my skeleton didn’t form in the normal way, so I had surgery to fix what was broken: my face. The official diagnosis: dentofacial deformity; Class II division I malocclusion, 9 mm overjet, maxillary buccal segments forward and retrognathic mandible, excessive lip curl, lip incompetence.

TREATMENT: Lower jaw and chin advancement (SCIENCE: mandibular sagittal split osteotomy and genioplasty. Here’s an animation.)

WHERE: Victoria General Hospital, Halifax.

I started down this road a year ago, when I had my first orthodontist appointment and got set up with Invisalign and referred to a surgeon. Braces are a necessary step on the road to surgery: tooth placement is a key part of bite placement (otherwise, I may not have bothered getting braces at all). The treatment is a year of braces, followed by surgery and approximately 6 more months of braces. (My experience with braces has been largely not-interesting, but if you need braces and not surgery, I would definitely recommend Invisalign.) I had pre-op appointments in Halifax twice prior to surgery: to get x-rays, molds, and photographs to allow the surgeons to plan the surgery.

Before & after x-rays, complete with swelling!

SURGERY: Tuesday, February 26 2013

I felt in good spirits Tuesday: not overly nervous and satisfied that I’d done as much work as humanly possible beforehand to ensure a relaxed recovery. I went to the hospital at 10:30 am to do paperwork, put on my hospital duds, and take some pre-emptive anti-swelling medications. By 12:30 I was on a gurney outside the OR, and at 1 pm I was in the OR, strapped to the table with a warm blanket, an IV in one arm and a woman telling me to to take deep breaths of the oxygen mask. The next thing I remember is waking up to a nurse saying my name in the recovery room two hours later.

The funny thing about surgery is that, of any part of the process, it was probably the one I visualized the most… and the only part of which I had no experience at all. Drugs are awesome.

I was told afterwards that the surgery went well, I “did great” (at being unconscious?), and I (only?) lost about 100 ccs of blood. I didn’t experience any nausea, or post-op bleeding, even when they removed my nasal tube. After some time spent under the watchful eye of nurses in the recovery room, I was moved to my own room by 4pm. It was in a ward devoted entirely to facial surgery patients, so needless to say it was quiet in there!

AG showed up, and between semi-intelligible speaking and typing on my ipod I relayed to him my experience of the last few hours, had my first meal (bland broth, orange pekoe tea, water, vanilla Ensure, all taken by syringe) and then we watched TV together until visiting hours ended.

The pain was not too bad. I had an IV drip with steroids for anti-swelling and antibiotics to prevent infection; an ice pack; an oxygen/misting mask; children’s Tylenol for pain; Naproxen for swelling; and the occasional morphine shot. Unfortunately I was woken up every hour to have my temperature and blood pressure taken, until 7:30 am when the team of surgical residents gathered around my bed to give me the good news: discharged! I slept all the way home.


POST-OP: Wednesday, February 27 2013 and beyond

Now that I’m home, things are well in hand. My lower face continues to be numb, but the feeling is slowly coming back (I have flashes of warmth and tingling where nerves are being regenerated). My mouth is banded shut with thick elastics bands – a cast for my face – which makes verbal communication a challenge, but I’m getting along well with charades. I am already thankfully past the peak swelling and bruising days… it was truly hideous there around day 2-3 where my face was easily twice its normal size. I’m glad that’s over, because it was a bit hard on the psyche. Looking in the mirror, I hope to see big changes day to day, but the changes are gradual. I practice my smile and it looks creepy and awful, but I know I just have to be patient and wait for the rest of the swelling to go away.

EATING: I haven’t eaten a solid thing since my food tour of Halifax ended with a Supreme Burger and fries (with chili mayo. *cough*) at Henry House on February 25… and I won’t be eating any solid things for 2-3 weeks yet. I need to eat 3-6 times per day. The first four days were very difficult, since I could only eat the thinnest of things – juice, milk, broth, Boost – through a syringe (contrary to popular thought, I can NOT use a straw right now); my stomach went absolutely crazy. Luckily I had done a big grocery before the surgery to ensure that I’d have something to eat, no matter how unsatisfying. Now I am able to drink from a cup, and eating slightly more elaborate things put through the blender: roasted tomato & pepper soup, baked beans, chili, a cream-of-chicken-milk-havarti-garlic-cream-cheese concoction… this diet is incredibly NOT appetizing (and I have a bunch of food aversions to make it worse!), but you’ll eat just about anything when hungry enough, no matter how gross it looks in puréed form.

Pro-tip: with a numb face, I found my success rate for actually getting food in my mouth rose dramatically when I started watching myself eat in a mirror.

ENERGY: Food – the getting, preparing, and consuming of it – takes up most of my brain space. It is difficult to get enough calories from any given meal to truly feel satisfied. You can only drink so much in one sitting! I have little bursts of energy, but overall I’d say I’m on the lethargic side, and have a bit of brain fog: I find it hard to concentrate on anything for long. There’s also the hanger… it’s real, and it’s spectacular. That said, overall I’ve been in good spirits this whole process, and I’ve already started going for walks outside, which feels great. I haven’t really lost a significant amount of weight at this point, just 5 pounds.

ORAL HYGIENE: The worst. Brushing the outside of my teeth is a delicate operation (I’ve already snapped one of my elastics; there are stitches everywhere), and brushing the inside is impossible. I use a baby toothbrush to brush often; rinse with salt water multiple times per day; and I also have a prescription mouthwash to use twice per day. I’m already daydreaming about reintroducing my toothbrush to my tongue.

SLEEPING: Sleeping is difficult since I am a stomach sleeper who is being forced to sleep on her back. However, I have a wedge to keep me elevated at night and this has been great for drainage and keeping the swelling down. I also use ice packs at night to help with the swelling.

PAIN: The pain continues to be manageable: as I mentioned, my lower face was completely numb for days afterwards, and I was sent home with children’s Tylenol and Naproxen, which I take a couple of times a day to take care of what I can feel. I also take a very small dose of Dilaudid before bed to help me sleep through the night. Fortunately, these drugs have left me a lot more clear-headed than I expected. I do feel pain when tilting my head back or leaning forward, and sudden sharp pain when accidentally yawning or sneezing, so… I try not to do those things.

Jaw Surgery Swelling: day 0, 2, 5, 7

The Progression of Swelling! A “before” image from two weeks pre-surgery (pink shirt), the worst swelling of 2 days post-op (ACK!), the somewhat reduced swelling of 5 days post-op, and finally today (7 days post-op, green shirt). Let’s hope it’s all gone sooner than later!

WHAT’S NEXT: I’m going to carry on with my DVDs and my liquid diet for the next two weeks, at which point I’ll finally have my first post-op appointment with the orthodontist, who may or may not loosen my elastics and open up a whole new world of food for me. The majority of swelling should be gone within this next week, which will be great, and I have little exercises to do with my face to wake up the muscles and practice smiling. Hopefully having my chin and nerves start to wake up won’t result in too much pain. My next visit with the surgeon is at the end of the month… fingers crossed for a great recovery!