Post-Surgery Treatment

After my jaw was unwired, it was time to get back to my orthodontic treatment. There were just a few minor adjustments (lots of bands treatment to pull my right molars together, push down and move around my left cuspids so they wouldn’t hit prematurely, etc), but one issue that popped up again was my teeth splitting apart on the left side. Dr. G. had thought that having my jaw wired shut and having my teeth start out touching after surgery would prevent my tongue thrust from wreaking havoc on my bite, but that proved to be too optimistic. So I wore an array of bands on that side to help pull everything back together, and I also started looking into speech therapy. Finding someone who could treat me was more difficult than I anticipated, because several different practices were listed in the provider directory but then they would only provide treatment at one facility (which of course had a 3-month waitlist), and I also didn’t realize that tongue thrust is considered a pediatric condition so several therapists wouldn’t work on that issue with me since I am an adult. I ended up finding a great therapist, though, and speech therapy ended up helping me more than I even expected. Dr. J. taught me how to chew properly by alternating evenly on both sides, starting on the left since that’s the side I never used to use (amazing how something so seemingly intuitive as chewing needs to be a learned behavior when you’ve been doing it incorrectly for 20some years), and even more importantly, she taught me how to keep my tongue from between my teeth. Although it sounded impossible at first, the rest position for my tongue is now with the tip lightly touching the roof of my mouth just behind the alveolar ridge - which also keeps my tongue neatly in the middle of my mouth rather than pushing between my teeth.

I finally had my braces removed in February, 2005, and now face wearing retainers at night indefinitely - it could definitely be worse, though (hello, jaw wiring). It turns out that the porcelain brackets do not come off very nicely at all. A lot of them broke apart during removal and basically had to be dremelled off - not a pleasant experience, but I came to realize that having quite a bit of remaining numbness actually came in handy ;) . When I spoke to my oral surgeon about the numbness at my 6-month post-surgery checkup, he said that the numbness in my gums, chin and lower lip is probably permanent at this point, unless the undamaged nerve from the left side of my chin starts growing over to the right side to pick up some of the slack. The numbness is tolerable, at any rate - it’s not like a permanent shot of novacain, and I can feel some sensation but just not very much.

I had also spoken to Dr. G. about the fact that my face still appears crooked. I was afraid that something had gone wrong, since I thought the crookedness would be addressed by the surgeries, but I had apparently misunderstood that part of my treatment. Dr. G. told me that the surgery didn’t change the fact that my face is physically longer on one side, and had I gotten the chin implant, that would’ve evened out my appearance (I thought it was just to give me more of a chin…whoops). It’s still not that noticeable unless I point it out, so I can certainly live with that. Another lingering problem that I never even thought about before starting all the treatment is the psychological aftermath. I still panic when I first go to the dentist since there’s some inherent nervousness with people working in there now, after the trauma of having my jaw wired shut and then having the wires forcibly removed. I am happy with how my jaw no longer locks up while I’m at the dentist, though - it used to be quite painful during cleanings, and then would hurt for hours afterwards, but I haven’t had those problems since surgery, and while I had to do some massage to loosen up my jaw muscles enough to even open my mouth, my jaw actually felt better after my last cleaning than before it.

Even though it took 5 months (just from when I realized there was a problem, which was 5 months after the surgery), I did finally get my insurance company to pay for all of my treatment. They had paid for my second surgery right away, but then denied my initial surgery until they had descriptions of my treatment instead of just codes… too bad they couldn’t seem to articulate that to the hospital, since all they did was ask the hospital for a certain form (which didn’t show the descriptions), which no matter how many times the hospital supplied it, the insurance company would then claim that they still hadn’t received the proper information. Argh. Very frustrating situation, but it eventually got cleared up. I did get to see the bill from the hospital, though, which was an eye-opening experience - no wonder they pushed three different wire cutters and soaps and lotions on me when they cost an arm and a leg each. I’m also not sure if I made the insurance situation worse, since I disputed one of the diagnoses with my doctor. I noticed that nestled between “mandibular hyperplasia” and “maxillary hypoplasia” is “tobacco use disorder”… Interesting, seeing as how I don’t even smoke. So I had Dr. G. send in a form to the hospital to remove that diagnosis from my record, but who knows if the insurance company was upset at having two different versions of the coded bill.

What will hopefully be the last issue with my jaw to be treated (in the foreseeable future, at least) is dealing with scar retraction. About 7 months after my first surgery, I slowly realized that I had lost a lot of range of motion in my jaw. I could only open it about an inch and a half, and then the left side of my jaw would start feeling really tight and I physically would not be able to open my jaw any wider. My dentist told me to get it looked at right away (it was quite obvious to him something was going on - there was barely enough room in there for the little mirror to fit in), but my orthodontist didn’t think it was too much to be concerned about. I ended up seeing my oral surgeon anyway to fit in one more visit before I switched to an insurance company that he didn’t accept, and while he agreed that scar retraction can happen during the year following surgery, he also thought it was a bit strange that it was happening so long afterwards. He gave me an exercise to try to break through the scarring, so we’ll see how well that works out in gaining back some motion.