Break My Jaw

Journey to double Jaw Surgery

February 14, 2013
Elle
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Communication breakdown.

Long time, no post. There’s been a huge communication breakdown between my surgeon/TMJ people/dentist, and it’s been absolutely awful.

On January 5th I went in to see my surgeon to have a more serious look at my case and to get a surgical plan sorted out. We were supposed to take measurements, look at my scans (1 MRI, 8 cone CT scans, and 15+ xrays) and look into a timeline. Absolutely none of that was done during this meeting. Why was nothing accomplished? Well it’s a combination of a few things:

My surgeon had very obviously not looked at my scans. After sitting in his office for 2 hours, he finally comes in to see me and spends another 30 minutes silently reading over the file. Finally, he slammed the folder shut and announced my medical history was “confusing” to him and that too many people were now involved in my case – what?? The only people involved have been the ones HE has sent me to! He suggested that my dentist’s involvement in my case was “inappropriate”, even though she has done more diagnostic testing than anyone combined at this point.

On top of everything, he brought up the idea of a total jaw joint replacement, but qualified the remark by saying “oh but you probably won’t need one”. Why would you even bring up the idea if my case doesn’t suggest I’ll need one? All in all he was a complete arse to me during the visit, causing me unnecessary worry these last few weeks. The meeting was concluded by him making me get *another* CT scan ($600) in a higher resolution (supposedly) so he could send it to a diagnostic radiologist in the United States. I was told my results would be in within 2 weeks.

Five weeks later, I finally got a call from my surgeon’s office saying that they have my results. However, the call came with a request that I go have another MRI done…. because my surgeon didn’t know that I already had one done. What is happening here! Is this guy not reading my file at ALL? At this point I’m getting scared to trust him. I understand he’s human, and that time is all relative but… this is my face.

And nobody is going to screw up my face.

/rant over/

Ellen

December 28, 2012
Elle
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Christmas Gums

I’m currently 9 days post-op and doing great! This surgery went way smoother than I could have ever dreamed. I saw my periodontist again today and I’ve been given the green light to eat slightly harder foods and start brushing with the special toothbrush. The soft food diet has been good to me and thankfully I haven’t starved, but I’m excited to venture out into the world of firmer foods again. No jawbreakers any time soon, but eating a cookie sure sounds great!

The stitches from the donor site are beginning to come loose and fall out. This is the first point in my process that the donor site has actually started to bug me; no pain, but it is irritating. It’s like having a scab that’s halfway off and keeps catching (yuck). Hopefully they’ll be totally gone within the next 2-3 days.

My actual graft site (where the gum and bone was put in) is pinking up and the doctor assures me it looks great, but it still looks pretty gross to me. The area is noticeably thicker than the rest of my gums and the area around the sutures is white (totally normal). Apparently the area will remain thicker until my new bone smooths out, which should be in about four weeks from now.

My lingual frenulum (the piece of skin that connects your lip and gums) was cut during the procedure. I’m not completely sure if it was re-attached or not, but it hasn’t really given me any grief so I can’t complain since it will have to be cut later on for the genioplasty.

The most painful aspect of this procedure was the bone graft. Because I had a fair amount of allograft (cadaver bone) implanted, it made my jaw bone quite tender for a few days. It wasn’t actual pain, per say, but more of the feeling after you’ve been chewing gum for hours. Its more of an ache than pain, but it radiated up my jaw bone towards my ear for a few days which was the most discomfort I felt thankfully. However, even 9 days post-op I still feel my jaw tiring out after eating a meal, but I assume that’s because it hasn’t had much exercise in awhile.

I’m going to try getting back into my exercise routine in the next few days. The surgery has left me feeling pretty sluggish. But maybe all the Christmas dinner I’ve had over the last few days has contributed, too…

Merry Christmas!

Elle

December 20, 2012
Elle
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One surgery down! Two to go…

The gum and bone graft is over! Can’t even begin to tell you how relieved I am.  The surgery itself went a lot better than I was anticipating. My periodontist was absolutely fantastic and I didn’t feel a thing (not even the needles, wow!). What a relief. The entire surgery took about an hour and a half and was painless – the weirdest thing was feeling the pressure of the dentist pushing against my jaw bone (literally the bone itself) with his instruments to get the allograft material in. Didn’t hurt, just an absolutely bizarre feeling.

I now have 2CCs of bone (allograft) along the front right side of my lowerjaw, gum tissue grafted from the roof of my mouth onto my front right three teeth, all tied together with 10 tidy stitches (6 on the donor site, 4 on the graft site). I was given Apo-Naproxen 250mg and Tylenol 3′s to take for pain, and a prescribed mouthwash to keep the surgical sites clean.

I tried to play tough guy by taking the weaker of the two painkillers I was given (the Naproxen) as the freezing wore off. This was a mammoth of a mistake. I don’t have a very high pain tolerance to begin with, and once the anesthetic was gone it felt like a horrendous toothache – right to the bone and radiating up my jaw. I took a T3 which took care of the pain within about 15 minutes. Today I’ve been able to space out the medications a little more by taking a Naproxen between my T3s, which has kept my pain down. I’ve had two T3s today and the pain is very manageable.

I do have a lot of swelling, and they said this was expected because of the bone graft. I’m not allowed to put ice or heat on my face, as it will prevent the soft tissue graft from taking. The swelling is more of a discomfort and annoyance than actual pain – I can’t really open that side of my mouth so I sound like I’m talking with a mouth full of quarters. I’m on a soft food diet for 2 weeks as chewing is pretty much out of the question with the bone graft.

The periodontist emphasized I must not brush or floss any of my lower my teeth for at least two weeks – hence the super-cleaning mouthwash, which surprisingly does a pretty good job of cleaning. I brushed the outside of my upper teeth with water this morning, making sure to steer clear of the donor site.

So far so good. If the other two surgeries are anything like this, it should be smooth sailing. I’m nursing my wounds maliciously because lets be honest… I really don’t need any more procedures to be added to the list!

Elle

December 18, 2012
Elle
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Surgery’s Eve #1

Tomorrow is the first surgery! I feel both sick to my stomach with nerves and excited to finally get some of these things knocked off the list. As a recap, I’ll be having a gum graft on my lower right canine (potentially the lower right incisor next to it as well) and a bone graft to an area just below the incisor. They’ll be using local anesthetic so unfortunately I’ve got to keep my cool during the hour long procedure.

The bone graft will be coming from a very generous cadaver that donated their organs and bones. A big thank you.

I’ve been told I’ll be on a soft food diet for about a week, so I stocked up on smoothie materials, pudding, macaroni and cheese, soup and jello. I was also instructed no exercise for 3-5 days, so I took a few days off of work as well – it’s going to be my drugged movie catch-up time!

I think reading up on the procedure is what’s rattling my nerves at this point… Since I’ll be awake, its probably not something that I should have read up on too much. I think I “nope’ed” right off the internet when I got to how they prepare the gums for the graft. The needles will obviously be the worst part (oh lord, the needle in the palate is hurting me already).

I’ve probably said this before, but this is the hardest and simplest of the procedures I’ll be having done. Hardest in the sense that its tough on my body emotionally (and physically by extension). I have such bad dental anxiety from the earlier years that I just turn into a mess whenever I go to any sort of dentist… being awake during a procedure like this is not cake walk for somebody like me. However, these grafts will probably also be the easiest things I’ll go through (in comparison to the 6 extractions and the jaw surgery/genioplasty/septoplasty) so I’m counting my blessings that we’re starting out small. I can’t help but feel a tiny bit lousy for the position I’m in… Still trying to keep everything in perspective though and take the hurtin’ one day at a time.

All aboard the surgery train? First stop grafting, next stop posture therapy. Choo choooo …

Elle

November 30, 2012
Elle
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Almost at the First Cut.

T minus 20 days until my first surgery. The nerves are starting to get worked up again but I’m feeling a little bit more cool and collected the more I talk it out with my doctors/dentists.

I saw my general doctor just to give her the low down on what was happening and where I was going with all this surgery stuff. This stuff is starting to get frustrating more than anything because its hard to communicate the jaw issues to a doctor that really has no idea how to treat these problems. Hell, I feel like I know more about it than she does. She has all the letters from the five other specialists, but wanted me to go in for a (third) sleep study because she thinks that I might have sleep apnea. Its already been found that I do have mild obstructive sleep apnea and this has been attributed to – surprise! – my set back jaw. It would be a waste of my time to have another test done that would essentially confirm for the umpteenth time that I do in fact need jaw surgery.

Despite the little bout of frustration I’m going through right now, the doc was able to give me a little relief. She suggest I not see the cervical spinal chiropractor (who I was told wasn’t really a chiropractor) because the MRI scan didn’t have enough detail to show if my C1 Atlas was actually impinging on my spinal cord or not. Doc’s suggestion was don’t fix it if it ain’t broke. And since I’m exhibiting no symptoms, I should just carry on with a less risky form of treatment, which would be the TENS therapy and the splint, maybe throwing some physio in there. Let’s be honest thought, if this quasi-chiropractor person messes up even the slightest or if, by chance, my C1 actually is poking the spinal canal… I’m going to be a quadriplegic in an instant.

And I don’t need any more problems.

Elle

November 15, 2012
Elle
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The C1 Conundrum

I finally went in to see the dentist who was harassing me with 7am phone calls (only after she phoned at 7am yet again and demanded I see her immediately). As it turns out her “emergency exam” , which cost me an extra $150 mind you, was essentially telling me much of the same information that my other dentist had told me; your posture is screwed and we need to fix that before we put on the braces. The the usual “your joints are degenerating bla bla bla”. Heard it 100 times, no need to make me pee my pants over it by calling me every morning telling me there is something “seriously wrong”. Seriously lady, you made me think I was about to die or something.

The only thing she had to tell me which was of a fair bit of a surprise was that the C1 disc in my back is angling inwards towards my spinal column. The disc is pointed in such a direction because of my head posture (and extension, my jaw). Because my jaw is set so far back, my airway is obstructed and thus I’ve compensated by essentially sticking my head out and my butt out to a) breathe and b)stay balanced while breathing. Now since my head is at a funny angle, so is my spine, and so this silly little disc at the very top of my spine has bent inwards as well and begun to “impinge on my spinal column”.

Now this would be a much bigger problem in a few scenarios; a) if I were still growing, which would mean I would still be trying to adapt, b) if I weren’t having surgery to correct it and c) if I got into some form of accident that caused a neck injury. Obviously 1 and 2 are off the table so that’s fine. Its just the 3rd one I need to worry about… but that’s why they call them accidents I guess, so no sense actually worrying. I went back to my “quarterback” dentist (general dentist that’s orchestrating all this madness) with the news and she just kind of looked at me and said “Yeah… I know?”. Even less reason to worry. Treatment plan? See a spinal alignment doctor + 6 months of a splint/TENS therapy to loosen up the muscles in my jaw and neck and help move the posture and jaw into a more natural and stable position.
Today I made the appointment for the spinal specialists, general doctor, and a second consult with my surgeon. Looks like I’ll be seeing a medical professional every week until Christmas.  All I want for Christmas is…. a straight spine and a properly set jaw?

Elle

November 8, 2012
Elle
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5 Dentists and too many choices.

I went back to my general dentist today to talk things over again after her seminar on my case. She had a few good things to tell me, a few recommendations and a whole other round of people for me to see.

So the general dentist, who is also a specialist in neuromuscular dentistry, told me she’s my quarterback; she’s going to make sure my other specialists actually communicate (which is yet another worry of mine!. Even though I already have a treatment plan, she pulled the reigns back on it and suggested something I hadn’t really thought of before:

We need to figure out your diagnosis before we fix the problem.

Huh. Makes sense I guess! So a couple possible diagnoses were made; thyroid/pituitary gland disorders, spinal alignment, and some sort of airway disorder. So I’m being sent to an endocrinologist to test my hormones, a spinal quasi-chiropractor guy, and pulmonologist to look at my airway and breathing. On top of this I STILL have to see my surgeon again to get his take on all this jazz.

Her biggest suggestion was a 6 month diagnosis project that involves TENS (stimulating and relaxing the facial muscles with electricity to find the optimal place of rest where the jaw muscles are the most stable). It involves 2-3 months of weekly TENS stimulation while wearing a splint full time (to keep your jaws and muscles in that position) followed by 3 months continuing to wear the splint, without TENS. Following that diagnosis and realizing where my jaw is best suited, they’ll put the braces on, holding teeth in the same position as the splint, and then get started with the rest of that orthodontics jazz.

The main benefits of this slower road would be that they will be able to find the best possible position for my jaw to sit in, minimizing the risk of relapse or other problems after the jaw surgery (such as teeth grinding or discomfort). The surgeon will know exactly the place my jaw needs to sit to feel comfortable and will likely reduce the risk of ever having to have the surgery done again. And that’s a lovely thought.

However.. its another six months tacked on to an already brutal treatment period. I seriously just want to get this business over with ASAP. It’s been years and I’m just ready to go go go. It’s tough when people are constantly reminding you to slow down to get the best results. Its even harder when you know they’re right.

Elle