Welcome back everyone!
The process underwent months prior to surgery
It's been a while since my last post. Apologies it's been a hectic two months. FINALLY I am pleased to say I had double jaw surgery on the 12th of December 2017. I got my original surgery date when I attended joint clinic in August; this was supposed to have been November the 21st a week after my 21st birthday. However unfortunately it was cancelled because not enough appointments had been made prior to surgery to get everything in place for the life changing day. Therefore Leading up to surgery day I had a few appointments scheduled. This consisted of a dietics appointment on the 31st of October . This appointment only lasted roughly fifteen minutes. I was advised I would be on a liquid diet and we disused foods I could have and couldn't have. I was also given leaflets with ideas on what I could have as a guideline. This was a mandatory appointment which would be crucial in recovery post op. Secondly was a pre-op assessment on the 7th of November which went though lots of questions and checked my BMI and height amongst discussing the process if what was going to happen. This wasn't with the surgeon but was with a nurse from the head and neck department. Following this appointment I was asked if I would have a ECG (which monitors your heart to detect any abnormalities or underlying heart conditions) this wasn't anything that caused me worry because it was a routine check in which I had prior to my wisdom teeth extraction also. Friday 17th of November I had an orthodontic appointment to have my splint moulded. A splint has a similar appearance to a retainer usually worn after braces and orthodontic treatment. This was done using soft wax in which you bite into and a face bow pictured below which gathers the dimensions of the face in order for the orthodontic team in charge of the moulds to create a model of the face to work on. They then once all the moulds are taken for the splint and of the mouth will move the moulded jaws to the desired position requested by the surgeon. This in a sense is a trial and error process in which can determine if the movements are too much or to little and need to be altered. Its quite amazing really what goes on behind the scenes.
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| Face Bow
(Picture from Jensen Dental- http://jensendental.com/products/artex-facebow/)
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| An example of a splint (Picture from Accutech Orthodontic lab, inc. (2018) https://www.accutechortho.com/orthodontic-laboratory-products/splints/goldilocks-splint |
Lastly on the 6th of December I had my final appointment with my surgeon before surgery day the following week. This consisted of him talking through exactly what he was going to do and by how much he was going to move each jaws by. They increased how much they was moving the jaws, I believe it was 7 or 8 mm forward for the top jaw and the same for the bottom jaw but moving it back. I had my splints fitted once again to make sure they fitted correctly before surgery and all was fine.
I signed all the consent forms and put down contacts for the hospital staff to contact, we shook hands and all was underway for the following week!
More information about this part of the process can be found on the following article ` Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning' accessed on the following link- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350313/ .
Surgery day - 12th December 2017!!!
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| All dressed ready to go! |
I was instructed to arrive at the hospital by 7:30 on surgery day and went bare faced as it was easier. I scoffed my face the previous evening with as much as I could as I knew it would be my last proper physical meal for a while. I had to have my blood pressure taken which was high even though I felt calm and had to get into these glamorous sexy gowns and Ted stockings. I hate those things but they prevent DVT (Deep vein Thrombosis which is a clot usually behind the knee or calf due to lack of movement) so they are a godsend,
My Surgeon came to see me at around 8.00am and said that I was first on the list and should be going to theatre at around 9ish. He asked how I was feeling and wished me luck. He also explained It can take up to 5 hours to correct my underbite and that I would go straight to ICU following surgery and then to 2b after one day (if I could get a bed). As it was snowy one of the anaesthetist team was stuck in traffic so we had to wait until the whole surgical team was present before i was whisked down for surgery.
At around 9:30 I had to do a couple of check lists to make sure everything was correct and was asked what nostril I breath out of better as they would pop my breathing tube in the not so good side. I was told my nose would be sore and tender to the touch afterwards and to expect my nose to bleed. I was then transferred to theatre. I was greeted by everyone and they made sure I was comfy whilst inserting a cannula (which I absolutely hate-it makes me feel sick) and then injecting me with anaesthetic through my cannula. It took me longer to dose off and I remember drifting off and walking up and feeling like the world was spinning round. A mask was put over my mouth and I was instructed to take deep breaths and then I dosed off.
Coming Round
I don't originally remember coming round as apparently my surgeon and surgical team paid me a
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| After coming round- I was out of it! |
visit and told me it went really well. I remember being woke up in ICU by the ward sister that evening though and they told me surgery was a success and Mr K was happy with how it went. In total it took 7 hours, longer than expected because they had trouble aligning the top jaw to the bottom jaw as they were pretty big movements. The gap between my teeth before surgery was about 11mm (I believe) as a result of being worsened by braces. I felt awful. I was so drowsy I found it hard to stay awake, but after a while of being conscious I kept being woken up by blood. I had a forever ending nose bleed that would go on for slightly over a week! As well as the blood from my nose I had a great deal dribbling out of my mouth. Yes dribbling is a regular occurrence, it took me over a week to stop drooling. Dribbling was very annoying. This was because I couldn't close my mouth due to the swelling and the drains in my mouth which drain the blood away from the wound site (usually a long tube attached to the wound site with a bottle attached to collect the blood). However i had four small tubes attached into my gums, two at the top jaw and two at the bottom, which contributed to the swelling. As a result I had a lot of blood build up in my mouth so every couple of minutes I had to use the suction tube to clear it away. The blood tricking down kept me up the whole night as it was uncomfortable so I didn't sleep much because of it. My parents visited me but I was out of it and couldn't stay awake very long. Unfortunately I was in no state to see my boyfriend either which made me upset as I wanted too but he understood. However at the same time I was happy because I didn't want him to see me like that.
After mum and dad went (they didn't stay long) I felt really sick. I vomited lots of blood up and was so scared. This happened a lot and I was petrified I was going to damage my jaw. I felt bad for the nurses because of how often they had to change the bed and change my gown. They bleeped the doctors at one point because I was violently being sick and it was now black in colour. Thank fully it was all okay. Its normal apparently to sick up blood as all the blood runs into the stomach. I has some anti-sickness and it eased it. The pain wasn't too bad because I was on Oramorph and Co-Codamol. I was written up for Morphine and Tramadol also but both makes me sick. The nurses were fantastic and looked after me so well that evening and the ward sister even platted my hair for me and made it all nice. bless her.
*Picture containing blood below*
Hilotherapy mask
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| Hilotherapy mask pictured above on myself 2nd day post op |
From the moment I woke up I had this Hilotherapy mask (cooling mask) on my face. Its attached to a machine which pumps hot or cold water into the tiny filaments in the mask to sooth the face and reduce swelling and pain. It was honestly amazing and I believe this contributed to my swelling going down quite quickly as I had full use of it throughout the four days in hospital. The first two days I wore this mask non stop as when I removed it I could feel my face getting increasingly warm and uncomfortable. However once re-applied there was a sigh of relief because it was so soothing. Day 3-4 I didn't use it continuously as it hurt slightly but I had it on for 15-20 minutes at a time and I found that really helped. It's something I recommend asking your surgeon about if you are going to have double jaw surgery or any jaw related surgery. My surgeon Mr Knepil did studies on this mask and found it to be highly effective. Here's what he had to say about this incredible device;
"We have been using Hilotherapy masks for over two years at Sheffield Teaching Hospitals. Some of the drive for introducing Hilotherapy masks was by our nursing staff on our head and neck ward who have found the machines easy to use, excellent patient compliance and an overall feeling that they do
help to improve pain control and reduce post operative swelling.
Over a 12-month period we used 80 Hilotherapy masks for patients following maxillofacial surgery.
We have recently carried out a retrospective patient satisfaction questionnaire, designed to answer
specific questions regarding the use of Hilotherapy face masks, comfort, do they facilitate faster
healing, pain control, degree of post operative swelling and recommendations of overall experience.
We used {Hilotherapy’s} patient satisfaction questionnaire using five point Likert rating scales.
Analysis of the replies from patients who had used the masks showed that more than 80% of the
samples strongly believe that the Hilotherapy facemasks helped them heal quicker. 86% were very
satisfied or satisfied with the overall experience of the mask and 61% were very satisfied with the
overall experience of the mask.
As a group of surgeons, we have found them very effective in reducing pain in our osteotomy patients
and subjectively also seem to reduce the degree of postoperative swelling.
I would have no hesitation in recommending the use of Hilotherapy in the management of
postoperative pain and swelling following orthognathic surgery."
(Knepil. G , Hilotherapy UK LTD. (2014)
I definitely think without this mask my swelling would have been a lot worse and the pain would have been more intense. From looking at peoples recovery who hadn't used the mask due to it not being offered I believe that their swelling looked worse than those who had benefit of the mask. If you are interested in the mask, especially if you Will be undergoing surgery the following website has numerous studies from surgeons who use the mask and believe it to be beneficial. Please visit http://www.hilotherapyuk.com/oral-maxillofacial for more information. It also offers a rental option for those who haven't had access to this mask or simply want to rent it for after their hospital admission.
The day after
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| 2nd day post op- my new profile |
The day after surgery I felt a lot better than the evening as I no longer was being sick thanks to regular anti-sickness medication. I was still using the suction but not as much but there was still a lot of blood. I wasn't able to suck from a straw or sip a cup because I was still so swollen and I was so frustrated because I really wanted to go home. I had to have a few bags of fluid as a result, to stop me from getting dehydrated. I didn't actually want to leave ICU because everyone was so caring and lovely. I spent most of the day waiting for a bed. My parents come to see me at lunch time and went then came back at around 4/5ish. I then got the news I was going to 2b. Before going to 2b I had to have my dreaded drains removed. The Doctor did this with this strange sharp hook. As they were embedded into my gums it was unbearable. I clung onto my mums hand so hard I actually hurt her and I am usually good with pain. That however brought me to tears. It was so traumatic and made my parents cry. Afterwards I was so traumatised and in lots of
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| 2nd day post op-my new profile |
pain. They gave me Tramadol because the pain was at about a 10 out of 10. This is when I realised it makes me sick. A few seconds of having it through my canular my heart started to race and beat so fast, I started to sweat and feel really dizzy and ill and I was sick. Anti-sickness kicked in fast and saved the day though! After the Tramadol kicked in I was on my way to 2b. On the way out of ICU I spotted my boyfriend. I hadn't been looking at my phone and he had come to see me. I tried to talk but I couldn't as I was swollen so was waving like a loon. He actually didn't recognise me at first and was so apologetic.
*Beware gruesome picture below*
Below are two pictures of drains for comparison. One is a normal drain used on the body and the second picture shows the type of drains i had in situ:
Picture above is a regular drain used in other surgical procedures.
(picture from iStock- https://www.istockphoto.com/gb/photos/surgical-drain?excludenudity=true&mediatype=photography&phrase=surgical%20drain&sort=mostpopular)
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| My elastics |
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| Picture shows a drain being inserted to drain an abscess- This isn't me but was the only picture I could find that was suitable. This is the type of drain I had placed into my gums in four locations (OUCH!!!). (picture from Dentistry.co.uk-http://www.dentistry.co.uk/2014/11/11/dct-oral-maxillofacial-post/)
Moving forward to the evening I had my parents visit me as well as my Boyfriend;his cousin but also one of my good friends Lauran turned up and surprised me. It really made me smile because I wasn't expecting her to come. It was lovely spending the evening with them both and I really appreciated all the support and company! As my speech was incoherent due to having the splint and swelling playing a major part (my mouth wouldn't shut because of it) in all of it I was confined to writing on paper in order to communicate. *note- I highly recommend getting a whiteboard*. Lauran had a good idea of creating me some emoji cards to use in a means of communication. That was her task for the previous day. Unfortunately visiting time was up and they had to go sadly. Seeing people I loved really made my day though.
I still couldn't drink because I was too swollen but I was given a syringe with a canular end on it to get fluids into me for the mean time by a very lovely HCA. This enabled me to squirt the fluid to the back of my throat. This still wasn't enough and I was told I needed to drink more. It was so hard as it was really exhausting and draining. The doctor eventually found me a curved syringe which was so much easier and after I had this I was able to drink more.
Third Day Post Op  My lips are still very swollen here. From being swollen they were chapped and had blisters in the corners. My skin was splitting and my lips were extremely sore. This was partly to do with the dried up blood that wouldn't come off since surgery. I had a wash in the morning and managed to wash lots off gently with a flannel but it was so painful. I then applied some blistex and some E45 to my lips continuously (apparently vaseline can be drying after a while) and this helped enormously. I definitely recommend washing your face as soon as you can and getting all that dried blood off your lips as it makes it sore. My skin was so dry and flaky after surgery and the E45 was a godsend! Looking after your skin and lips is a must.  but not that much. I was still using the hilotherapy mask 
in was still difficult as my lips ballooned.
Fourth Day in Hospital
The fourth day I was told that if I continued to drink as well as I did over night then I would be going home. I therefore drank as much as I could before my orthodontic appointment at 2.00. I was feeling happier in myself today as I was able to drink more. I think it was because the swelling had reduced and the curved syringe definitely helped. I was dreading getting my elastics on because I was worried it was going to be so painful! I could just about close my mouth but it took a lot of force and was uncomfortable so it naturally sat open (due to the swelling). I had three elastics put on by my orthodontist over the surgical hooks on the left and right side going all the way to my back molars as well as a band at the front. This was to close the gap and to make sure everything heals well and correctly. I was told not to talk and I wasn't allowed to take the bands off to eat or to brush my teeth. They will stay on until they decide otherwise (hopefully will have lighter ones on the 10th of Jan). I was finally able to see my new bite now and was so happy with it. It's hard to understand if you don't have an underbite or overbite at how satisfying it is. I will now be able to eat properly without struggle and smile with my teeth as well as being proud of my smile. It has definitely given me a new lease of self esteem and confidence. I had to wait for a porter to wheel me to imaging 2 to have an x-ray on my jaw. However waiting there with people in the waiting room was so embarrassing with my keep drooling, my nose keep pouring with blood, dried up blood around my nose and looking like a hamster. I kept getting strange looks and it was horrible.
Seeing the x-ray was amazing. My teeth finally touched and there was no more underbite it was
weird though because you could see the screws and plates. I was waiting to be taken back to the ward and I spotted my Grandma, she had come to see me. She was told I'd be down there and finally found me. She popped down to the shop and got me two massive boxes of tissues as the ones Nan had brought a day previously had all gone in one day! I then got to go ahead I was allowed home YAYYY! I was given my medication, some disposable Neurofen (as I am not able to swallow tablets as I cant open my mouth) and codeine. I was also prescribed ibuprofen and paracetamol but I had these at home so weren't required. I finally got to sleep in my own bed that night!
Here to the left is a photo of my elastics in place. These have to stay on and I cant take them off even to brush my teeth. You cant see the splint here but its between the top and bottom teeth, a little like a retainer in a sense.
After Discharge
The first night at home wasn't as great as I had hoped. I was able to have a nice bath which was absolutely lovely but I got too hot and dizzy. I had a temperature but that soon went. When the pain relief wore off the pain was quite bad and I couldn't sleep. Due to not having the hilotherapy mask my face appeared more swollen and felt extremely hot. My parents had ordered some freezable face masks from Amazon and they were due to arrive the next day. In the meantime we used a bandeau bra and inserted some ice packs we had brought from Tesco into the slots where the padding would go. This helped a lot and it brought the swelling and warmness down in my face. It gave me some comfort whilst I slept too. The first week at home I made sure I stayed on top of pain relief even if I had no pain. I made the mistake of not keeping on top of it because I was okay and then the pain hit hard and it took ages for the pain relief to actually kick in. At around two weeks I was gradually taking less and less pain relief and eventually took it occasionally at three weeks post op. Sleeping was difficult for the first few days as you are advised to sleep propped up at a angle I soon got used to it and managed to sleep well once the pain was controlled but then woke up with pain after 4 hours when it had wore off. It does get better though.
Eating- One Week Post Op
Eating was very difficult. I wasn't offered any liquid food at the hospital so I had my first liquid meal of soup at 4 days post op. I has to use the syringe still because I couldn't suck from a straw or sip yet from a cup. However at about day 7 or 8 I thought I would try and sip a straw and drink from a cup and succeeded. This made life so much more easier. I am able to eat soup with a baby spoon and slurp it into my mouth. It is a struggle but its way better than using a syringe. I was advised I would be on a liquid diet for at least 6 weeks so things like soups, yogurt, milkshakes, hot chocolate (more like lukewarm) and smoothies. You will loose weight and have lost a lot of weight already. It will make you emotional and so frustrated not being able to eat and you will feel constantly tired and hungry. I have had non stop hunger pains since coming out of surgery.
Two Weeks Post Op
At two weeks post op the swelling had reduced quite a lot and so had the pain. Occasionally pain relief was still needed. I have no numbness in my face and haven't since surgery. My gums are the only place in which are numb. Eating had become easier but it is still messy. I had to try and drink at least 3 forisips each day, which is a nutritional drink which is prescribed. Upon brushing my teeth one evening and using the mouthwash as directed something burst in my mouth and I was so scared it was an infection. Grandma took me to the hospital the next day to get it checked and I thought it was an infection or a wound site from where the drain had been. The doctor on call got to me really quickly and confirmed it wasn't an infection and it was in fact a wound from the drain being removed. He advised me it shouldn't get infected as long as I keep my mouth clean with the mouthwash. I then started to use salt water solution which I made and took this along with the mouthwash each morning and evening and this reduced the wound site and it eventually closed within a week.
 Picture on the left shows the make shift ice pack face caddy as mentioned above previously. I found this helpful once home to reduce the swelling and pain. To the right shows the cooling masks brought from Amazon. These go in the freezer and only last about 20 minutes before it starts to get cold. You can also warm these up. These were very helpful and recommend purchasing some of these if you wont have access to a Hilotherapy mask. 
Three - Four Weeks Post Op
There isn't much to update at three weeks post op. I am still continuing to loose weight and plodding on with the liquid diet. Christmas was so difficult this year as I couldn't eat anything and all the smells of Christmas dinner and all the chocolates and goodies I was unable to eat was driving me insane. I felt very low and upset that I wasn't able to eat anything yummy. We had a early xmas dinner a week before so I was thankful for that and there was even snow! My band snapped at the front of my mouth on Christmas day but thankfully my orthodontist gave me a packet of bands and I was able to put some back on straight away. At the end of week three all my stitches had fallen out which was such a good feeling as it meant I was healing well. The swelling has started to slow down and isn't going down as quickly as the first two weeks. There is still some around my cheeks, jaw line and in my gums and lip area. My nose also finally stopped bleeding, HORRAY!! Week four again, not much to update about really apart from skin problems after surgery. I have noticed I have developed quite a few spots and have developed bad dandruff. My skin is so dry and flaky on my face and I am continuously applying blistex and E45 to my lips and am moisturising my face. I found face masks definitely helped with the spots, especially the peel off ones. My mood has been horrible lately, I think not being able to eat and seeing people eat and being able to smell the delicious smells male you upset and frustrated you cant eat. The same with not talking also. This journey is bound to make you feel low one minute and high the next. My surgeon described it as "an emotional roller coaster".
EndNote
I am now on week four but there isn't much to update on. I will do another blog post on the 10th of January when I have my first appointment since getting my elastics on. I hope to get this splint out so it will make life easier. Hopefully I will get the go ahead to eat soft foods after the 10th. This liquid diet is getting unbearable now and really makes your mood low. I also plan to write two other blog posts on the process of the double jaw surgery for those who wonder what they actually do in theatre and a blog post on the things I found useful to have for recovery to those of you who may be awaiting your jaw surgery.
I hope you all enjoyed this blog post. If any of you have any queries reliant to jaw surgery please comment or drop me a message on hollysjawsurgeryjourney2017@gmail.com or message me on my Instagram page @hollys_jawsurgeryjourney2017 (https://www.instagram.com/hollys_jawsurgeryjourney2017/) Please feel free to subscribe and share and any comments on the blog post it's self I will answer. Below is a little gallery I have put together of my jaw surgery journey so far.
Gallery- Day 1- Day 18
 
Before and Afters
   
Thank you for reading!
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I'm going to be a surgical doctor in my orthodontist but I'm scare, probably shouldn't have see this before my jaw surgery
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