Surgical patient's guide
Frequently asked questions (FAQs)
Here are the most frequently asked questions. The frequently asked questions section that follows could be useful to those who would like to get information fast while waiting for me to answer them. I still invite people who wish to do so to contact me if they have specific questions or want to know more.
Contents:
General questions
Surgical procedure
Recovery
After the surgery - Medications
After the surgery - Diet
Consequences - Repercussions and complications
Consequences - Swelling
Consequences - Sensitivity and pain
General questions
How long did your orthodontic treatments last?
28 months (from October 2006 to February 2009).
How long did you wear your braces before your surgery?
17 months (March 2008).
How long did you wear your braces after the surgery?
After my surgery in March 2008, I had to have another surgery in April 2008 and I wore my braces until February 2009. Therefore, I wore them for 10 months after my second surgery. My orthodontist told me that I would wear my braces after the surgery for a time period varying from 6 to 12 months, so the 10-month time period was totally normal.
How old were you during your orthodontic treatments and your surgeries?
I was 26 years old when I started my orthodontic treatments and I was almost 28 years old when I had my surgeries.
What is the minimum/maximum age to have this surgery?
In reality, most surgeons will suggest to their patients to wait for their growing period to be over before having a jaw surgery. The optimal age to have this kind of surgery is between 20 and 30 years, because at this age, people recuperate faster than when they are older. However, there is not really a maximum age to go through such surgery; it all depends on the case. I invite you to consult with an oral and maxillofacial surgeon near you to learn more.
Who were your orthodontist and your oral and maxillofacial surgeon?
My orthodontist is called Dre BN and my surgeon is called Dr AD. I recommend both of them to anybody who is thinking of having orthodontic treatments and/or an orthognathic surgery.
Which hospital did you go to for your surgeries?
The Charles LeMoyne Hospital (HCLM) on the South Shore of Montreal in Quebec.
What was the delay to have your first surgery?
After getting confirmation from my orthodontist and my surgeon that I was ready to go through my first surgery, the delay was 3 months. It is important to know that this delay was normal for a hospital located on the South Shore of Montreal in 2008; the situation could be very different from one region to another in Quebec, from one province to another and from one country to another.
Were you afraid of going through your surgeries?
I was more afraid of the unknown than the surgery. I had a total confidence in my surgeon and I knew that my only role in all this was to be put to sleep in the hospital, wake up after the surgery and recover. I wasn't afraid at all at my second surgery; I even accepted to go through it very quickly and I was very calm in the hospital!
How did you prepare yourself to undergo your first surgery?
I went through a complex psychological process before my surgery for which a summary is described below:
- Denial and fear: The first time my orthodontist talked to me about a surgery, I didn't want to have the surgery at all; I was nauseated in her office! I was so afraid of getting a surgery!
- Initial curiosity: Before meeting with my surgeon for the first time, I had done a few searches on the internet to get details on jaw surgery... I should not have done that, because it scared me even more!
- Acceptance: The first time I met with my surgeon, I thought I would faint while he explained to me what needed to be done with my jaws! He also told me that I didn't have to know how he would proceed (he was right!) and after accepting that, I was able to accept the surgery as an essential step of my dental treatments.
- Well-thought-through curiosity: Before my workup appointment in preparation for the surgery, I continued gathering information about the surgery a little bit by avoiding websites that showed explicit details and by focusing on websites that generalized the different surgical procedures.
- Comprehension: To accept a surgery of such magnitude, I had to know and understand what would happen to me to be less scared; I then asked a lot of questions to my surgeon to leave nothing in the dark.
- Voicing the fears: Did I still fear the surgery? Yes. But I also spent time with my loved ones talking about my fears to be able to feel less alone in all that. This step was very important in my psychological process. Fortunately, I'm surrounded by people who were always behind me in my decision.
- Resignation and serenity: On the day of my first surgery, I was psychologically ready, as if time had done wonders. I felt hectic, nervous, but also less scared and very calm about what would happen to me.
In conclusion, an orthognathic surgery is planned physically by orthodontic treatments, but the person who will undergo the surgery also has to prepare himself/herself mentally. Fortunately, most of the steps were done naturally and effortlessly in my case. I wish the same thing to whoever will go through that!
If it all needed to be redone, would you do it again? Why?
Yes, absolutely! I liked the orthodontic part of my dental treatments the least, because it spread over several months. Numerous sacrifices were necessary during this time period, such as a drastic change in the way to eat to avoid crunchy or sticky foods and to have an exceptional oral hygiene. As far as the surgery is concerned, I would go through one again tomorrow morning if my surgeon told me that I had to have another surgery for any reason. When I think about what I looked like before my treatments and what I am today, physically and emotionally, I really wonder why I didn't fix my dental and jaw problems much sooner! I would never go back!
Do you have regrets regarding your dental treatments (orthodontics and jaw surgery)?
Not really, no. My only regret is not being courageous enough to go through them sooner! However, I couldn't have asked for better dental health professionals who followed me throughout my treatments and I would probably not have had the chance to know them if I had gone through my treatments much sooner.
Surgical procedure
How did the surgeon hold your jaws together?
A few days prior to my surgery, my orthodontist installed "surgical posts" (little metal rods) on my orthodontic wire at several places in my mouth. The surgeon used these posts to hook elastics which held my jaws together.
How did the surgeon attach your facial bones at the right place?
He placed 4 titanium fixation plates on my upper jaw, 4 titanium screws on my lower jaw (2 on each side) and a titanium fixation plate on my chin bone after repositioning it.
Will your plates and screws stay there indefinitely?
Yes. The only reason why I would need to have them removed is if they caused me pain or if they got infected. My surgeon would then have to remove them. For the moment, they don't cause me any pain or discomfort. However, I can feel my plates on each side of my nose if I press my fingers there.
Were stitches used and if so, how long did they stay in place?
Yes, my surgeon used absorbable (dissolving) sutures in my mouth to close the wounds after both my surgeries and non-absorbable sutures to close incisions made on my cheeks during my second surgery. My dissolving stitches did not cause me any discomfort. My surgeon had told me that usually, the dissolving sutures that he uses disappear after about one to two weeks. My surgeon removed the non-absorbable sutures put on my cheeks one week after my second surgery during my post-operative follow-up appointment.
Recovery
How long did you stay in the hospital?
Two nights at the time of my first surgery, one night at the time of my second surgery. As my surgeon said, one night per jaw affected during the surgery!
How long did your recovery last?
My initial recovery period was planned for a duration of 3 to 4 weeks. My surgeon had given me an additional week during my follow-up appointment at the end of my third week of recovery, so it would have lasted 5 weeks in all. However, I had another surgery 4 weeks after the first one. The second surgery's recovery was shorter, that is 2 weeks. Therefore, I was home 7 weeks for 2 surgeries. Let's not forget that each case is different; some people take less or more time than others to recover.
Were you alone during your recovery from your surgeries?
My surgeon advised me to have someone with me or who could come check up on me regularly for the time period during which my jaws were held together. So, my spouse stayed with me for a few days at the time of both my surgeries.
How long did you have you jaws held together after each surgery?
One week at each surgery.
Note: This time period depends on the surgeon and the techniques used. I have talked to people who had their jaws held together for a period varying from 1 to 3 weeks, but sometimes, surgeons don't tighten the jaws as much and some people can eat soft foods a few days after their surgery even with the elastics.
What is the sensation of having the jaws held together?
The sensation is weird when waking up after the surgery. To get an idea, tighten your upper and lower teeth together and try to speak; you will be able to do it easily. Unfortunately, it is a little harder to drink and almost impossible to eat solid foods, mostly if the elastics used to hold the jaws together are very tight as in my case. My jaws could simply not move.
How long did you have to wait before resuming your normal activities?
It depends on the nature of the activity. The first times I vacuumed about 10 days after my first surgery, my nose started bleeding, so I stopped. However, I was able to start taking walks outside after 2 weeks of recovery, slowly increasing the distance and the speed.
Note: It's always better to start with light activities, such as walking, and ask for advice to your surgeon for the other activities. The surgeon could give you recommendations depending on what you went through during the surgical procedure. For instance, a person who loses an important amount of blood during the surgery could not have as much energy as another person who loses less.
After the surgery - Medications
Did you have to take medications after your surgeries? If so, which ones?
Yes, at both my surgeries, my surgeon prescribed me two types of analgesics (painkillers) that I was taking if needed depending on my pain. He also prescribed me antibiotics that I had to take during a week to avoid any infection setting in the wounds.
With your jaws held together, how were you able to take your antibiotics and painkillers?
My antibiotics were liquid, so very easy to ingest. (However, it was another story for the taste... simply disgusting!) My strong painkillers were in caplets, but I could crush them easily and ingest them after mixing them in a glass of water or juice. When the pain subsided, I took Children's Motrin suspension (liquid).
After the surgery - Diet
When were you able to eat for the first time after your surgeries?
My first surgery was done in the morning and the second one, in late afternoon. In both cases, I was allowed to drink a little bit of water and take my medications on the evening of the surgery, but I was allowed to eat only the next morning following the surgical procedure. The hospital staff knew when it was safe for me to eat again after the general anesthesia. The first thing I ate was liquefied foods so I could eat without much difficulty.
What did you eat while you had your jaws held together?
Since my jaws were held together very tightly, I could not eat anything, but I could drink fluids. Therefore, I fed myself with juice and Boost for a week at the time of both my surgeries.
Consequences - Repercussions and complications
Were you nauseated after your surgeries? If so, what did you do?
I wasn't nauseated when I woke up from my surgeries. If I had been nauseated in the hospital, they would have given me medication against nausea in my saline solution to get a relief. Back home, I was nauseated from being tired, but with rest, everything went back to normal quite quickly. My surgeon allowed me to take a Gravol caplet if I were nauseated.
Note: It's always safer to verify with the surgeon before taking any medication.
Is it dangerous to throw up with jaws held together? How is it possible to throw up?
It's not as dangerous as we can imagine. When waking up after a surgery done under general anesthesia, the stomach is empty. If we had to throw up at this moment, what would come out wouldn't be solid, so it is not really dangerous to choke. In the same manner, when the jaws are held together, we must be on a liquid only diet, so if we needed to throw up, it would be nothing but liquid. An evening after drinking Boost, I started being very nauseated and I asked my spouse to call my surgeon, because I was panicking. My surgeon wasn't worried about the fact that I was nauseated, because if I had thrown up, it would have all been liquid, so little danger of choking.
Did you lose weight after your surgeries?
Yes. I lost 11 pounds in a week after my first surgery. I then gained 5 pounds back in 3 weeks. I lost these 5 pounds again in a week after my second surgery. After my second surgery, I made the informed decision of maintaining my total weight loss (11 pounds), because I felt better like that.
Note: It's possible and it's easy to gain the weight lost because of the liquid only diet after the surgery.
Do you have scars? Are they still visible?
The majority of the scars resulting from an orthognathic surgery are inside the mouth, so they are not visible. After my first surgery, 100% of my scars were inside my mouth. However, during my second surgery, my surgeon had to make small incisions approximately 1 cm in diameter on each cheek to insert the fixation screws on my lower jaw. These are my only external scars. Fortunately, they are no longer visible, except when I pull on my skin at this spot; we then see that the skin is not totally normal.
Note: The important thing to do to minimize the appearance of scars is ensure to protect them from the sun with sunscreen during at least the first 12 months following the surgery. Massaging the scars with an over-the-counter cream enriched with vitamin E sold in drugstores starting a few weeks after the surgery can also help heal them correctly. The best is always to ask for advice to your surgeon.
Did you sneeze and/or did you choke on food with your jaws held together? If so, what did you do?
I didn't sneeze, but my surgeon had told me that it wasn't serious if it happened to me. I choked a few times while drinking. The important thing is not to panic and take the time to catch our breath correctly!
Why did you have to go through 2 orthognathic surgeries?
During my first surgery, my lower jaw was moved forward, but unfortunately, after the swelling on my jaw subsided, my surgeon noticed that my lower jaw was still too far back. To avoid a final malocclusion and/or additional orthodontic treatments to improve the occlusion a little bit, I agreed to go through another surgery to reposition my lower jaw once again.
Are your fixation plates and screws cold or more painful in the winter?
No, they are not cold in the winter and they are not painful at all.
Consequences - Swelling
Did you swell a lot after your surgeries?
Yes, enormously, mostly after my first surgery since both my jaws and my chin bone were touched. I was under the impression of having gained 200 pounds in the face and I was also under the impression that my face would split open!
Note: Swelling is normal after jaw surgery. Let's not forget that each person is different and the level of swelling depends on the type of surgery performed, but also on several other factors.
Are there any tricks to prevent swelling?
During the first 48 to 72 hours following the surgery, bags of ice applied to the face can help prevent swelling. Therefore, I put a lot of ice during my hospital stay and a little bit after I got back home after both my surgeries.
How did you decrease the swelling after it appeared?
I constantly applied moist heat to my face; most of the swelling subsided quite quickly (within a few days).
How long did you stay with your swollen face after your surgeries?
Most of my swelling was gone after a few weeks (about 3 weeks after my first surgery and 2 weeks after my second one). However, I am under the impression that my face still stayed a little swollen, meaning that I could feel the swelling by touching my face, during several months.
Consequences - Sensitivity and pain
Did you lose sensibility in your face after your surgeries?
Yes. Immediately after my first surgery, the part of my face comprised between my cheeks and my chin was completely numb; I could feel absolutely nothing in that area. This loss of sensibility was temporary for the whole upper part of my face. After my second surgery, I didn't really lose sensibility in my lower jaw and I didn't feel an increase in the remaining discomfort of my face or my jaws.
Note: During an orthognathic surgery, facial nerves are cut to reposition the jaws, cutting the sensibility in the areas where the affected nerves provide feeling. Post-operative loss of sensibility is very similar to the numbness felt during procedures at the dentist's office involving local anesthesia. Usually, this loss of sensibility subsides slowly as the nervous connections are re-established during healing. Nerves can sometimes not heal correctly and the loss of sensibility can be permanent. Again, this behavior is unpredictable and is part of the risks associated with jaw surgery. Let's also not forget that the level of numbness varies a lot from one person to another.
How long did you have numbness in parts of your face?
My face was really uncomfortable by the numbness during about two weeks after my first surgery. Then, the numbness subsided progressively and I regained sensibility in the face bit by bit within a few weeks. To this day, I still have a light numbness, or rather a light loss of sensibility, on my chin. This loss of sensibility is more discomfort than numbness; I feel my saliva or food running down my chin and things that touch my chin. I still notice improvements more than two and a half years after my surgeries, so I don't lose faith in recovering my total sensibility on the chin. I also have little areas here and there on my gums and on my lips which are more sensitive than anywhere else. These sensitive areas give me the same feeling as when the numbness subsides after appointments to the dentist for minor procedures that require local anesthesia.
Were you in a lot of pain after your surgeries?
After my first surgery, I had enough pain to ask for morphine every 4 hours in the hospital. Back home, I could control my pain quite well with medications containing narcotics which were prescribed by my surgeon. One week after this surgery, Children's Motrin suspension (liquid) was sufficient to soothe my pain. After my second surgery, I was hardly in any pain. I only took Children's Motrin suspension in prevention to avoid being in pain during the night.
