Biz Vision

I had my visit with my surgeon Jun 12 and I finally got to see what he did with my jaw. The procedure is called a "Lefort I Multi-Piece Osteotomy". The Lefort I can be 1-piece, 2-piece or 3-piece. I believe I got the 2-piece since they had to expand my upper jaw. In layman's terms:

2-Piece Lefort I Osteotomy:

• makes an incision under the upper lip
• fractures the upper jaw
• completely separates the upper jaw
• removes a wedge of bone
• splits the jaw down the middle
• re-positions the jaw
• re-attaches the upper jaw with titanium screws and plates
• sutures the incision

• Step by step photos displaying incisions, blood and bones:
• Lefort I (WARNING: Not for the faint of heart)

Diagrams showing the 1-piece Lefort I:



Diagrams showing the 2-piece Lefort I:



Diagrams showing the difference between a Lefort I, Lefort II and Lefort III:



Upcoming milestones:
4 weeks post-op - start soft chewing
5 weeks post-op - visit surgeon
6 weeks post-op - one week until the splint comes off
7 weeks post-op - splint comes off!!!
8 weeks post-op - resume regular diet
4 months post-op - braces come off (hopefully...)

I'm way behind on blogging about my recovery from surgery. When I hit the 2 week mark (Jun 5th), I was plenty excited. I was back to work, my elastics were going to come off, I was going to start up on mashed foods and my splint was due out in just 2 more weeks!

And then I had my visit with my surgeon and orthodontist.

The Bite: My surgeon thought my bite on my jaw was lining up very well. No concerns. He put one of the x-rays up but I couldn't see the screws on it. I asked him to explain the exact procedure I went through but he didn't have the time for that either. He promised he would show me on the models next time around.

The Elastics: I thought finally, the elastics come off and he disappointed me, well, only partially. He said I had to continue wearing the elastics at night but I could take them off during the day. I can live with that.

The Splint: Here's the one I was most anxious to hear about. "When does the dreaded splint come off?" He thoroughly disappointed me on this one. "5 more weeks", he said. I have my appointment on July 10th. Hmmff...

The Bone Graft: I asked him about the stitch in my lower cheek and I was right. He took a bone graft from there. I guess that solves that mystery. He used it to fill in bone when he separated my upper jaw.

Nose Blowing: Leading up to the 2 week milestone, I was starting to look forward to blowing my nose. It was really starting to feel grungy and yet again, I was disappointed. He said, it was best if I waited another week. I guess there was something to look forward to at the 3 week milestone now.

Cleanliness: Both my orthodontist and my surgeon thought I was doing an excellent job keeping my teeth clean. Hooray! I'm not so concerned about cavities and gum disease now.

Braces: I had to ask my orthodontist when he thought the braces will come off. He said he couldn't really comment until the splint came out but he has to leave them in for at least 4 months to support my upper jaw while it completely heals. There could be some tweaking he has to do which may push it past 4 months but I won't know more until July 10th.

Upcoming milestones:
3 weeks post-op - visit surgeon, start blowing my nose
4 weeks post-op - start soft chewing
5 weeks post-op - visit surgeon
6 weeks post-op - one week until the splint comes off
7 weeks post-op - splint comes off!!!
8 weeks post-op - resume regular diet
4 months post-op - braces come off (hopefully...)

I use Google Desktop to auto-update my favourite RSS feeds but every once in a while something gets messed up and I have to re-configure it. And then I go into the big wide world we call the Internet to find how to do it again...

It always takes me forever to find this site so here it is, once and for all, for my handy retrieval: Using Google Desktop as a Google Reader Notifier

--
Edit:
It turns out the website creator has sneakily gone and changed his post and it no longer meets my needs. That procedure adds all your Google Reader feeds to Google Desktop instead of just specific ones. To add specific ones you need to do the following:

1. Log into Google Reader
2. Right click the feed you want to add and select "Copy Link Location"
3. Go into the Google Desktop Web Clips Options
4. Paste the address. It should look something like: http://www.google.com/reader/view/feed/http%3A%2F%2F...
5. Change "view" in the address to "atom"
6. Keep your Internet Explorer logged into Google Reader
   

Wow, what a great day. So, I went back to work today and almost everyone commented about my changed face. Mostly positive comments too! I had to stumble and mumble through a couple of conversations but eventually got the message across. I think all the extra talking and smiling did me really good. My mouth feels relaxed and I can move my lips around a lot more freely. Dare I say it, but I'm kind of getting used to the splint too.

I also broke an elastic yawning today. I had a spare elastic so I replaced it but I visit my surgeon tomorrow to get them taken off anyway. I probably could have just removed the other one but it's only one more day so I might as well go the distance. Mashed foods here I come!

I woke up this morning with a terrible tummy ache. I knew I couldn't afford to throw up with my jaws bound together with elastics. Yuck, what a mess that would make! Fortunately I didn't have to but I did spent the better part of the morning writhing around in pain. It took 2 large gulps of Pepto-Bismol to finally clear up the ache.

The rest of the day wasn't terribly exciting. I spent a good portion of the day playing this addictive game - Shuffle.

I also geared up for my first day back at work. It feels like I'm going camping with the all foods, meds and other gear I'm taking with me. I guess it's better to be safe than sorry. I'm somewhat anxious about returning. I wonder how my co-workers will react with my inability to speak! Ok, it's not that bad. I've got the same feeling you get before a big speech or presentation - anxious until it begins.

Finally I got a good night's sleep! I slept like a baby last night. I must have finally tired myself out. It feels good to be refreshed and recharged.

I've been looking through my pictures and I'm not noticing much of a difference over the last couple of days. I guess the rest of the swelling will gradually go away. I did notice my droopy right eyelid though!

I developed it about a year ago. I was taking a nap in the sunlight and my left eye was cuddled on the pillow while my right eye was exposed to the sun. Anyway, I woke up with a puffy right eye - it looked like I'd just come out of a 12 round fight. Ever since then my right eye lid has always drooped a little. I expected it to recover over time but it sure looks like it hasn't. In any case, I looked up some exercises to strengthen up the muscles on the right side of my face. Here they are:

You need to be patient, and work the muscles gently. The idea is not only to regain motion, but for the motion to be balanced with the good side. Don't force things to the point that the two sides pull against each other. If you see a motion pulling other muscles that shouldn't be moving, back off a little, and freeze it at that point, and relax the muscles that shouldn't be moving. Keep your eyes on those eager-beaver muscles in the cheek area as you work your eye or mouth. And check the muscle that runs down your neck to make sure it doesn't "pop out". Keep the muscle movements appropriately isolated. Use a mirror - the feeling of motion you get while exercising can be very deceptive, so this is important. The mirror will also help you avoid letting the good side overcompensate by moving in an exaggerated way.

Remember not to push it - better to hold a position at the point it can go without inappropriate muscles jumping in to help than to try too hard to do things your face isn't ready for. Movements will elongate with time.

Exercise in short sessions, but repeat the routine 2-3 times a day, more if you can. Quantity is not as important as quality, so don't do your exercises when you're tired.

1. Sniffle. Wrinkle nose. Flare nostrils.
2. Curl upper lip up and raise and protrude upper lip.
3. Compress lips together. Pucker lips & attempt to whistle.
4. Smile without showing teeth; then smile showing teeth.
5. Try moving your lips into a small smile slowly. Then gently pucker slowly using equal strength from both sides.
6. Draw angle of mouth upward so as to deepen furrow from side of nose to side of mouth.
7. Harden (wrinkle) the chin; "stick out" the chin (like a boxer).
8. Using your index finger and thumb pull the corners of your lips in toward the center. Slowly and smoothly push out and up into a smile. Continue the movement up to the cheekbone. Use a firm pressure.
9. Placing 4 fingertips on the eyebrow rub using a firm stroke up to the hairline. Return downward to the eyebrow. Do the same type of massage in a circular motion on your cheeks and chin, and outward to your ear.
10. Try to close the eye slowly and gently, without letting your mouth pull up or your eyebrow move downward.
11. Raise eyebrows and hold for 10 -15 seconds (watch out for synkinesis - hold the brow at a point before the corner of your mouth starts to move or your cheek tries to help). Wrinkle forehead.
12. Frown and draw eyebrows downward.
13. Gently wink with one eye and then the other to the best of your ability. Don't push it.
14. Open eyes widely, but without involving your eyebrow. Stop if you see any inappropriate muscle actions.
    

And here's a set of exercises specifically for droopy eyelids:

1. Gently tone the muscles of the eyes by pressing two fingers on each side of your head, at the temples, while opening and closing your eyes rapidly. Repeat 5 times.
2. Sit upright with your eyes closed and relaxed. While keeping your eyes closed the whole time, first look down and then look up as far as possible. Repeat the facial exercise 10 times.
3. Sit upright with your eyes closed and relaxed. Keep your eyes closed while lifting your eyebrows and stretching your eyelids down as far as possible. Keep in this position for 5 counts, relax and repeat 5 times.
4. Sit upright with your eyes relaxed and open. Lift your eyebrows while closing your top eyelids until about halfway closed, then open your eyelid wide open until the white of your eye shows over your iris.
5. Sit upright looking straight ahead with your eyes open. Look up then down, while keeping your head still. Repeat 10 times. Then look left and right - repeat 10 times.

Oh, I just made a discovery! I was brushing my teeth after dinner and there was something bothering me on the left side of my bottom teeth. I thought I had some leftover food stuck there so I slithered my finger in to get it out and BAM... I just felt a stitch! A stitch on my lower jaw? How could this be?

I think my surgeon slit open a spot under my left gum to get a bone graft! That would also explain why that area was swollen when I came out of surgery. In any case, my poking opened up the wound a little and a gush of blood came out. I'll have to ask my surgeon on Tuesday about that since he never mentioned it.

And I almost forgot to mention, the oat is gone! I don't know if it got unwedged or if it dissolved away from my saliva but it's not longer there. Alas, it feels much better not having a wedged oat in my mouth.

Today's been a really good day for me. My second day of working from home and I didn't get tired at all. My energy level is starting to feel almost as good as normal now.

I'm still having sleep issues though. I didn't get to sleep until a little past 2:00 AM last night. Not sure what's keeping me awake but perhaps I'm not tiring myself enough through the day. I didn't nap today so we'll see how I sleep tonight.

The other thing I noticed while in bed last night was my tongue is starting to get scaly. I think it's because of the plastic splint which is starting to feel waxy now. Can't wait to get my elastics off so I can give my tongue a good scrub.

I tried taking a peek at my stitches this morning but couldn't get a glimpse. I also had some bleeding in my mouth today. It was from the inside of my lower left cheek so either I cut myself on my braces or I have a bit of an infection due to inferior brushing capabilities. The tightness around my upper lip and nose seems to have reduced so maybe I lost a stitch this morning. Finally!

I'm making more and more discoveries of people in the Ortho-blogosphere. Check this out - Brandy had her surgery just 2 days after mine. It's kind of comforting to know that I'm not the only one going through this massive inconvenience.