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Thursday, May 15, 2008

Jaw Surgery

Well, Tuesday I had a mandibular sagittal split osteotomy with rigid fixation and, while I was having work done, had my wisdom teeth (teeth 1, 16, 17, and 32) extracted (so that they didn’t cause issues at a later date).

In preparation for the surgery, I’ve had braces on for around a year. These were used to straighten my teeth and line them up so that, once the surgery ws performed, my jaw would close properly. Hopefully, at the end of the summer, once everything is firmly in place, I’ll be able to have then taken off.

The problem I was having with my jaw was that the top and bottom jaws didn’t line up properly. The first attempt at correcting this was through upper jaw expansion when I was in my early teens. While this helped, it wasn’t a permanent solution as many of my teeth were still misaligned and the jaws themselves didn’t match. One way to think about the problem is to think of each jaw as a curve (something between a “C” and a “U”). Ideally, the jaws line up on top of each other but, in my case, they were slightly skewed and my bottom jaw was out further (so my molars on each side met off-center, the center teeth on the top and bottom didn’t line up, and I had an under bite).

The picture below illustrates one of the problems with my jaw. The blue line is between the two center teeth on my lower jaw while the red line is between the two center teeth on my upper jaw. The problem was an issue with my lower jaw (and not my upper jaw) because the center-line of my upper jaw matches the center of my face (notice the position of my nose).

A photo showing that my upper and lower jaws did not line up

Here’s a top-down view that (crudely) illustrates some of the other issues. The center of the lower jaw (blue) was shifted from the center of the upper jaw (red), the molars weren’t aligned properly in the back (the upper molars were on the outside on the right, but but lower molars were on the outside on the left), and the lower front teeth stuck out farther than the upper ones.

The surgery was done on the lower jaw in order to move it backward, straightening it out in the process. The bulk of the work was performed between the back teeth and the beginning of the joint. The jaw was cut in such a way that allows for bony contact to be maintained (apparently this is something that distinguishes it from other surgeries, and what eliminates the need for the jaw to be wired shut, but, not being an orthodontic surgeon, I don’t quite understand what this means). Once the cuts were made, the jaw was fixed in the new position with three screws on each side, which involved a small incision into the cheek on each side. (Well, that’s how it was supposed to work. Apparently there were some issues that resulted in the surgeon removing the first set of screws on the left side, changing the alignment slightly, and re-attaching them in the new position.)

The picture below is from a scan taken of my jaw following the surgery. The dots on each side of my jaw are the screws now holding things together, and the red line is running through the center of my nose and between the center teeth on the top and bottom jaws.

The recovery for the surgery will last 4-6 weeks. Currently I’m on quite the collection of medications (I’ll probably revise this post once I’m not on them any more as I imagine they effect my writing) including Roxicet (for pain), Promethazine (for nausea), Methylprednisolone (for swelling), and Cephalexin (to prevent infection). For at least 4 weeks I’m on a “no chew” diet. After that it’s “soft foods” only for a few more weeks. I’m definitely interested in any suggestions for foods anyone has.

What I’ve tried so far (in roughly chronological order):
(I’ll add to this list as time goes on)

  • Sprite/Ginger Ale/Sierra Mist (helps a lot with “phlegm”)
  • Boost
  • Ensure
  • Yogurt
  • Pudding (The first attempt didn’t go well; it was too sticky. I might try this again at some point)
  • Apple Sauce (Various flavors)
  • Powdered Instant Breakfast Mix
  • (Pureed) Chicken Noodle Soup
  • (Pureed) Cream of Potato Soup
  • Ice Cream or Sherbet (Soft-serve or with chocolate/fudge/frosting)
  • Cream of Cheddar Soup
  • Yogurt smoothie things
  • (Pureed) Cream of Chicken Soup
  • (Pureed) Curried Cream of Potato and Carrot Soup
  • Fruit Smoothies
  • Cashew-Carrot-Garlic Soup
  • French Onion Soup
  • Mashed Potatoes (with garlic and/or shredded cheese)
  • Pasta Salad (cut into swallow-able pieces)
  • Rhubarb Pie (minus some of the crust; cut into swallow-able pieces)
  • Couscous (mash the vegetables with a fork)
  • Spaghetti Os (swallow whole)
  • Beef Taco (minus the taco shell)
  • Spanish Rice
  • Pancakes (just barely cooked through with lots of syrup cut into swallow-able pieces)
  • Chicken and Stars Soup

A note to anyone looking for no-chew foods to eat: Get creative! Really, you can find something that has whatever flavor you happen to be craving, and there are lots of options that let you eat basically the same thing as friends/family if you’re a fan of meals as a social thing.

Everything (except the swelling) seems to be under control (I’ll be sure to update if anything changes).

Zach with a very swollen face

posted by Zach at 6:59 pm  

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