I saw my surgeon on Monday and got the answers to my many questions. I was really impressed that he took the time to answer each of my questions and then some. I deal with many surgeons in my job and can say that most are not this patient and willing to take the time necessary to make you feel comfortable. I also had to fill out the hospital intake forms which really made things more real!
Here are the answers he gave to my questions:
What do you recommend? BSSO and genioplasty, upper jaw surgery not required.
Do you think my teeth (gaps) will be ready by March 28th? As long as OD feels teeth are in suitable position.
How much overjet do I have now(measurement)? He does not measure, moves teeth into best position for bite. From what I have measured myself I would say 8-10mm.
Asymmetry? Yes, there is some but will not be changed with this procedure.
How much movement (and what kind) do you expect? Again no measurement but will move forward lower jaw as much as able and angle slightly if needed to ensure best bite position.
Will BSSO be sufficient to correct bite? Yes, ortho to finish positioning postop.
Does amount of movement increase risk of permanent numbness? Yes Age? Can't change it so doesn't matter.
Discuss hardware used to stabilize. Titanium plates and screws.
Any long term risks? Hardware... 5% of patients need hardware to be removed at some point can be done in office with freezing if necessary.
Previously mentioned open bite...front/back? No open bite now so will not be open postop.
Can I expect a perfect bite post-op/post-braces? Will move mandible forward to align jaws, ortho to finish aligning teeth/bite.
Any incisions to face or intraoral only? Oral incisions only.
Bleeding? Always a risk for bleeding but should be minimal.
About how long will the surgery take? 1.5 to 2 hours. Be there at 6:45, surgery at 8:45.
Will it be you or a resident performing the surgery? Surgeon with resident assisting, follow ups will be with resident.
Will I be banded or wired? Not wired, elastics only.
Splint? No.
Surgical hooks? Yes, ortho to apply.
Swellling...Ice good or bad? Ice x 24 hours then heat after that.
Manual lymphatic drainage (massage)? I didn't ask about this but have training in this area and plan to do self-massage to promote drainage, very light massage technique will not cause any harm.
What changes can I expect in my face? Cannot be predicted accurately, even if twins had the same surgery they would likely look different.
Do you have software that can show me potential profile and front view pictures? No.
How will surgery effect lip competence? Should improve with genioplasty, without genio lip competence will not dramatically improve.
How will surgery effect mouth breathing? Should improve.
Does genioplasty increase chance of permanent numbness with increased traction on the nerve? Yes, anything that involves the nerve can cause numbness
Opinion re: need for genioplasty? Recommended but not mandatory. I was previously strongly leaning towards no genio as I like the shape of my chin viewed from the front, I just don't want to end up with a 'big' chin. He said surgeons usually prefer bigger chin, maybe I can negotiate a medium sized chin??? This is worrying me the most at the moment. As of right now I won't see him again until the surgery date but I may call about this.
Can I expect to be free of jaw related headaches after? May not resolve if related to clenching. I honestly think at the moment my jaw pain is more muscular and related to my worsened bite from the braces/extractions as I don't really recall having this pain in the past.
What are my chances of relapse? Up to 25% experience some relapse. 1-3 mm not usually noticeable, if 4mm or more further surgery may be recommended.
Supply list? I think I will follow my fellow bloggers suggestions on this front.
Diet info? Will see dietician in hospital postop. I plan to stock up on liquids, soups, puddings etc
Vitamins (Calcium, D, B)? Protein powders? I plan to take vitamins and high protein shakes.
Postoperative meds? Pain medication and prophylactic antibiotics.
Chronic nasal inflammation...post-nasal drip, swelling, breathing, prior injury to nose? Not much will change in this regard...if ongoing problems could see ENT.
Preoperative physical? Yes, need forms returned 1 month prior to surgery.
Should I stay in the city overnight? Inpatient? YAY! He will arrange for me to stay in hospital overnight since I live 2 hours away.
Sleep positions postop? Whatever is comfortable. I'm planning to sleep in a recliner downstairs.
When is first follow up office visit? Timing of other visits to plan for travel/work. One week, two weeks, fpur weeks, three months, six months, one year.
Time off work? 1-2 weeks. I'm planning for 3 weeks just in case as my job involves ALOT of talking with patients and other hospital staff. If feeling ok I may go back sooner but don't want to feel rushed.
Cosmetic suggestions re: bonding canines post-braces, who to see?He can give me a list if my ortho doesn't have a local recommendation.
What if I get hit by baby/dogs? Avoid for 6 weeks....hmmmmm. Again this one worries me, seems to happen on a daily basis. Here's hoping I can avoid this :S
Yikes, that's a lot of questions (and answers) but I'm sure he's used to it. Sorry for the gigantic post, it will also help me remember all of the answers too. His last piece of advice was to try to think about the surgery as little as possible from now until then, not sure if that will happen. Though I do think my two week Mexican vacation will help with that (16 more sleeps!)...can't wait!!!
That's all for now. Will post about my adjustment and new pics later :D
Wow, lots of info. Thanks! I'm curious about MLD. I just ready a little bit about it after googling it. I've been making a mental list of ways to prep my body for surgery (which really won't be for another 5/6 months), and massage was on there. But of course, MLD is more specific. I'd love to hear more about what you do!
ReplyDeleteHey Bracedmom! Glad to hear you were able to get the answers to your questions. I remember being in your shoes just a couple of months ago and having so many questions even though I was following others and knew the answers to most. I still wanted the reassurance of my surgeon. It's good you won't need upper jaw and won't have a splint. That does add to the recovery and the post op discomfort. I was unfortunate in that I needed both but with each passing day the memories of the first week is slowly fading.
ReplyDeleteI wanted to comment on two things you mentioned here. One - the chance of having the metal removed later. My surgeon told me 10% but I still thought it sounded small I wasn't too worried. Well I might be one of the statistics on this one. I'll know more next week but I have started to form an abscess over one of the screws. It could be from the stitches so I've been put on antibiotics but if it is the screw, it will have to come out. Some of the others are bothering me too but I'm going to give it time to see if it gets better first.
On the genioplasty, I think if you're happy from the front view, you should wait to see how you like the outcome. I had my lower jaw moved a whopping centimeter (10 mm!)and it made a huge improvement on the profile and chin appearance. My lip incompetence was greatly improved because I no longer have a 12 mm overjet (it's perfect now at 2 mm). I am honestly glad I didn't do the genio and the reason is because the surgeon wanted to move my chin 5-7 mm which I would have hated and would have looked like a totally different person. You can always do it later if you choose. I just wanted to share my personal experience because I remember feeling overwhelmed and like I had to make a decision quickly but that's not the case with the genio since you can do it later with little downtime if you think you still need it. Some surgeons wont do it until after the jaw recovery is over anyway because it's impossible to predict soft tissue changes and how they will settle once the recovery is complete. Good luck whatever you decide!
@Amanda - MLD would be mainly used for postop swelling in this situation. It is a very light massage, stretching the skin in specific sequences to promote drainage of the lymph (fluid between cells) which decreases swelling, bruising and helps the body to remove debris.. If you want to find a certified therapist near you check out www.vodderschool.com. It really does reduce swelling and I plan to treat myself postop (not as effective as being treated by someone else) but should help. It also feels fabulous and is very relaxing. If you have any more questions just ask, this was a very brief summary of MLD :)
ReplyDelete@Braced Blogger - That sucks that you might have to have some hardware removed, hopefully things improve for you and you won't have to go through that. I'm feeling the same way about the genioplasty. I think your results were great because you still look like you but your profile is improved. I'm still deciding but will likely calling to discuss further with the surgeon to see what the various options are...I still want my chin to look feminine. Right now the whole procedure is covered through our provincial health care however if I wait the genio would not likely be covered and I don't think I would want to pay out of pocket or go through a second surgery. Do you think if you weren't happy with your chin you would have a second surgery?
Bracedmom - sorry it took a few days to get back with you. To answer your question, I honestly don't know if I would go through with another surgery later if I felt that I still didn't like my chin or profile after jaw surgery. Amazingly, the thing I didn't realize that I would feel after jaw surgery is how relieved I would feel not having gone through with the genio. It was such a sense of relief because although I know my chin is still small, I feel happy knowing that I still recognize the old me when I look in the mirror (someone that disappeared the first 2 wks post op when there was much swelling and I was quite depressed about that) and most importantly, I think the amount of chin my surgeon wanted to give me would have just been way more than I would have been pleased with. I like my profile now and honestly my chin is almost flat so far from perfect. I also realize that there will always be little flaws that we can pick at, and each of us are our own worst critic. I feel more accepting of myself now, and I don't feel the need to change anything else, now that I've gone through with this surgery.
ReplyDeleteNow that the swelling has gone down quite a bit, I can tell you that my surgeon was spot on when he said the best way to predict your outcome without the genio is to slide your lower jaw forward and then look in the mirror. Your chin won't look differently, it will just be in a new place. When I compare my "self-predictions" pre-surgery to the actual results, they look almost identical minus the slight swelling I still have. I was impacted 3 mm but the rotation of my lower jaw is not that noticeable with such minimal movement. My lower jaw came forward 10 mm. Perhaps you could try that and see if you like it. Whatever you decide, good luck with your decision. I know it's a personal choice, and it was one that I weighed heavily pre-op. Whatever you decide, it will be the right decision for you.
All the best,
Tara
Thanks for the reply. I'm with you in that I can't imagine myself wanting to go through a second surgery. Thanks for the idea about self-predicting. I'll have to take a couple photos to compare. I'm definitely still undecided and considering my options. Glad to hear you're happy with your outcome because that is what truly matters in the end.
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