Well folks; another orthodontic appointment and therefore another update. Quite a lot went on today and not just from my orthodontist either.
I was actually quite surprised today because my hospital appointment started with my maxillofacial surgeon! Normally the orthodontic assistants bob their head round the door and call people in, but today Mr. Loukota came out of the treatment area and greeted me before asking me to follow him into the orthodontic area.
Once I was in the chair he asked how things were going, and how the numbness and loss of sensation was changing. I explained that overall things appeared to be going very well and showed him the areas of my face where sensation was returning or improving. My surgeon, obviously quite pleased with what he was hearing, went out of the room and started calling other members of the team in to see the result of their work. I was even seen by the technical assistant; the person who is responsible for making the impression casts, splints, and facebow representations.
At this point I mentioned to my surgeon about the strange painful lump that I had found on the left of my soft palate. He asked me to show him where it was with my tongue and he promptly went in with a mirror to take a look. After some quiet mutterings of "Hmmm..." and "Very interesting", he started to explain what the lump was.
The lump is actually a section of the skull which would normally be well out of the way in someone who had not undergone major jaw surgery. The bone is known as the pterygoid lamina (pronounced 'terry-goid'), and is basically a conduit through which the medial pterygoid nerves pass. The nerve is responsible for receiving sensory information from the rear parts of the mouth, and transmitting movement information to the muscles in that area. The bone itself can be seen in the diagram below (item 14).
When the maxilla is moved a considerable amount, as was the case in my bimax operation, apparently a condition can be encountered where the pterygoid lamina bone protrudes lower than the roof of the maxilla itself. When this happens the bone manifests itself as a lump in the soft palate area, just behind the rear molars. He explained that it was difficult to notice and rectify during the surgery, and in the immediate aftermath because of the lack of sensation in the area.
As the bone is causing me some mild pain my surgeon told me there were a number of things that could be done. Basically they are going to leave things as they are until February 2008 at which time my surgeon will see me again to see if things have improved. If not he has offered me the following options.
* Grin and put up with the discomfort and irritation
* Surgery to gain access through the soft-palate, and remove a length of the pterygoid bone to shorten it
It was made clear that the bone CAN sometimes dissolve away by natural processes in the body, once the body realises that it is surplus to requirement. He said this might happen in this case eliminating the need for either of the two options. I was a bit confused at this because surely if the pterygoids are surplus to requirement, why haven't they dissolved a long time ago? Either way at least I know what the problem is now, but it still leaves a follow-up surgery cloud over my head. I doubt I could grin and bear it! The discomfort is mild/moderate to say the least, but it's more the annoyance than anything else.
Anyway at that point my orthdontist Jag took the helm and my consultation started. Strangely enough one of the first things I noticed as Jag was talking to me was that he was wearing invis-align braces!! Apparently he explained that he has had buck-teeth for a number of years, and finally decided to get something done about it. However he conceded that he didn't practice what he preached, and had gone private to get the invis-align! Typical!
Jag removed my old pre-op lower arch wire which appeared to be a task in itself. I'd forgotten about all the hooks that he had crimped to the wire before my bimax, and it never occurred to me that these would stop the wire from sliding through the securing clamps at the back. In the end Jag had to cut the arch wire into pieces in order to get the thing off! He then proceeded to break off all my lower brackets using some special tool. I thought it was going to be a lot worse than it was, but having zero sensation in my lower gums meant that all I could feel was the 'force' of what he was doing. After a bit of drilling to remove the old bracket adhesive he set about fitting the new brackets, which are positioned higher on my front teeth, and even higher on my lower canines. This is supposedly to allow them to exert more leverage on these teeth as they need to move back considerably more than the other lower front teeth.
When it came to refitting the arch wire, Jag used something new that I hadn't come across before. Due to the fact that my canine brackets are now higher than the others, I've been fitted with a braided stainless steel wire which apparently allows considerable up and down movement which solid wires don't. This was fitted with a LOT of force which made me think I'd end up with a broken jaw again at one point. However Jag explained that he needed to get as much tension on the wire as possible initially to get the teeth moving. Even though my appointment was only at lunchtime today at it is now 18:40, I can already feel the discomfort starting to creep in from the highly tensioned wire. I get the feeling tomorrow will be an uncomfortable day, but I can't think where the pain is coming from. I know my bottom gums are numb from when I brush my teeth, but something is hurting a bit.
To finish the job off Jag fitted me with red ligs in the double-twist configuration, as opposed to the steel quick-clips that I had been wearing since pre-op. Jag then explained that for the next 3 weeks, I'm elastic free because of the nature of the braided wire. He said that with the amount of force on the wire, the added tension of elastics, and the possibility of things 'moving' too much and knocking my centreline off balance, he didn't want me to use the elastics for the time being.
Then came the news I wanted to hear. I've been given the orders to start chewing again! He said that provided I didn't try to 'run before I can walk', there is no reason why I shouldn't recommence chewing (or mastication as he called it). He said that I shouldn't have any problems but I should avoid things like crusty or wholemeal bread (wholemeal contains hard seeds), tough meats (like gammon and steaks), very hard foods, and things which required extensive biting like burgers. Other than that I can eat pretty much what I want although he said I should oscillate my meals (one hard - one soft/liquid) for the next could of weeks. I can certainly say so far that chewing feels SOOOOOO weird!! I've got teeth which are still numb which makes it impossible to feel how much pressure I'm exerting when chewing. I also seem to have a tendency at the moment to 'eat' my bottom lip. If it wasn't devoid of sensation I think I'd be jumping all the time through biting it!
So really that is it for this update. My next appointment is scheduled for the 17th of October when Jag says he will be replacing the braided wire with a mono-filament wire, but again this will be under high tension. All I've got to do in the meantime is hope that my pterygoid structures sort themselves out, or it looks like I might be in line for another operation!
Next update will be coming ASAP.
), and they would see if a bed was free. She said there was absolutely no chance that I would get onto the ward on the Tuesday.
