Having 3-Piece Lefort 1 6/8/16

[tylerjwilson]

Hello All! I stumbled across this site about 6 months ago as I was pursuing orthognathic surgery to correct an underbite. Long story short, I had braces to correct a lot of spacing back in 2008/2009 for about 8-10 months. I was absolutely not interested at all in any type of surgery. Fast forward to 2015, I got engaged to my lovely fiancee and set our wedding date to 2 years (May 2017) and began tossing around the idea of getting my jaw corrected. I don't know the measurements, just that I had an underbite that I could clearly see present in every picture I took. When I smile, my bottom teeth show, rather than my top for the most part. My dentist keeps reminding me how ground down my back teeth are getting and that he highly encouraged me to get the surgery. I went to the University of Pittsburgh School of Dental Medicine to get evaluated as I saw a previous orthodontist who wanted an arm and a leg for just the orthodontic portion. The SDM was a much more reasonable price, but then I got to thinking that if I'm going all in, I want it done by a professional for the most part. I ended up finding a 3rd opinion who spent well over an hour at the initial consult talking to me about my options, showing me photos of previous patients who had a similar issue and the end result. He even showed me xrays of his jaw surgery he had. I ended up biting the bullet and committing to getting braces again to correct any pre-surgical issues and meeting with an oral surgeon that he was in the military with and good friends with.

My initial referral letter states that I have a concave profile and malar deficiency, a class 3 malocclusion, maxillary a-p and transverse deficient. It also mentions I have a bilateral posterior crossbite and have minimal crowding/spacing.

In September 2015 I started orthodontic work and up until April 2016, navigated all the way through the necessary wires to the pre-surgical square ones. I've since had several appointments with the oral surgeon for records and an overview of what I should expect. My last appointment, he mentioned a 3-piece Lefort 1 on my upper jaw to widen the sides a little and bring the front forward. I then scheduled a date of 6/8/16 for the surgery at the local hospital that my fiancee works at. I was told that the surgery would be in the afternoon and due to that, I would be staying overnight. If it was in the morning, he said I would likely go home. As far as time off, I'm scheduled a week and a half off work. The surgeon told me he did the same procedure back in January on a Wednesday and the guy went back to work the following Monday...that just seems too quick to be true and would probably seem uncomfortable, depending on the nature of the job.

I go this Friday 6/3 to get some pre-op testing done, I already had a CT scan, but have to get a Chest X-Ray, Blood Work and an EKG on Friday in preparation for surgery next week.

I've scouted out which flavor of Boost I like as I imagine I will be drinking that for a good bit, I got a soft tooth brush for brushing. He said the hospital would give me some type of face bra for ice packs and prescriptions for pain and mouth wash. I've read other posts of items to get, but I feel somewhat unprepared as the surgery date was picked and scheduled in a matter of 2 or 3 weeks since I wanted to be good to go for my wedding next May, he had full availability for whenever I was ready.

I'm not sure how to post pictures, but I took a few shots of my current mouth situation. Currently, I'm scared half to death, but who wouldn't be? Any questions or advice, throw it to me!

[snapdresser]

Only a week and a half off? You may want to consider taking off at least another week or two if you can. You'll still have a fair bit of swelling 1.5 weeks post-op. Though maybe that doesn't matter for your job and you don't have to do much talking anyways.

It's normal to be nervous about it. Just wait until the day before your surgery: you'll feel like you're losing your mind I'm sure everything will go fine though. Good luck and keep us posted!

[tylerjwilson]

I guess I forgot to add the other detail, I am working from home the remainder of June, as I anticipated swelling.

[snapdresser]

Ah, ok. That'll make a big difference lol. Another word of advice: I wouldn't spend the time reading 3-piece LeFort horror stories. I'm sure yours will be fine!

[tylerjwilson]

I've been posting on the June Surgery Buddies topic, but I'll update mine on here.

On my surgery day, my mother came down to take me in as she lives about 150 miles north of me. Once we got to the hospital, I went up to see my fiancee who also works there as a social worker and I could see some of her coworkers knew I wasn't taking this very well as I don't frequently have surgery, so I was very scared. She took her lunch break and then some time to spend it with me while I had to go register on the surgery floor. This part caught me off guard because I didn't think we were going to be separated so fast, but once I checked in, another lady said alright, lets go, and led me behind the doors to the room to put on the gown and brush my teeth one last time. The 29 year old baby that I am, basically started crying while this lady sat down with me to sign one or two more forms, but reassured me that I would see my family again before surgery. Once I got settled into a gown, another lady came in to put the IV in my hand, I didn't take this lightly, the tears were flowing. The time was around 11:45 AM now and my surgery was scheduled for 1:30, apparently the last one of the day. The surgeon only comes in for his surgeries, so I knew it probably wasn't going to happen until 1:30 at the earliest, they refer to it has having rights to do surgery there. Around 1:15 PM, they finally let my mom and fiancee come back and sit with me as I stared at a wall for the past hour and a half. I could hear frequent talk about my oral surgeon not being there yet and they couldn't get a hold of him. I figured this was my chance to back out if he doesn't show up for some reason, I'd probably just suck it up and live with the underbite...sometimes the nerves are just too much for one. After while, the anesthesiologist and two others came in to tell me that they are there to make sure I'm completely comfortable during the whole procedure, to monitor my vitals before, during and make sure I wake up comfortably when it's all done. They said they are waiting for the doctor before they do anything further, so I had some more time to think about backing out. Eventually, I heard the oral surgeon nonchalontly walk by and say "I'm Here"...I was more thinking he was going to say "I've been here, I thought I was meeting down at the other end of the hall"...needless to say, he stopped in to say hi to my family and explain what he would be doing, then he said he had to go change into his superman outfit.

1:45ish - The anesthesiologist team stopped back in and I knew it was getting to be go-time here any minute. They said they were going to give me something to calm me down through my IV...I've had surgeries before and this happens each time...they put something in, and seconds later I started laughing hysterically. I don't know what it is, i'm sure whatever it is, is normal for it to cause that. My mom and fiancee started laughing as well, maybe they wished they had some of this too. Needless to say, they started wheeling me down the hall and that I just had my last night with an underbite. The odd sense of going down a hall and into what felt like a freezer room, didn't seem to bother me at all at that point. Once we got into place, I could see blankets and foam padding on the butcher table for me to go and they asked if I needed assistance or not. I was able to roll myself over and be in position. Things were getting a little blurry at this time, I'm sure they were doping me up while I was laying there. I remember them strapping me in so I didn't roll off and then they stuck a mask on me. The head anesthesiologist told me that I'm breathing in the purest form of oxygen, so I continued to talk to him about this pure fresh oxygen asking if it was as pure as being in the middle of a field in Nebraska, in which he said...not quite, but our tanks were freshly filled up this morning! After that, he said you can probably start counting down from 10 if you want...at this point, I was staring up at the ceiling and everything was starting to get really blurry, fuzzy, etc. Next thing I know, I could hear others talking saying "his vitals are starting to show hes waking up, but were only halfway done with the procedure"....just kidding. The next thing I know, I hear people talking about "OK, this patient can go up to room 6015 at 9, and this one can go up at 9:10...I was very confused, but, once I woke up, they took an oxygen mask off me and I started to look around and drift back asleep again, but once I did come to it, it was after 9 PM. I think it was around 9:45 that they wheeled me up to my room for the night, which I felt terrible, because my mother had to call in sick for work (govt job) and she had a 2 hour drive home. I figured I'd wake up at maybe 5:30 or 6 in recovery and then she could see me and head home. Nope, it was almost 10 PM. Thankfully she was still there, I guess she took my fiancee out to Dinner and they did some shopping after while.

The surgeon came out and told them all went well, that's about all I remember of that conversation, is that everything went according to plan. He even showed them my molds and how I look with the splint and what not...I'm not sure how he showed them this...maybe he took pictures, maybe an xray, not too sure. I was having a tough time trying to stay awake while my visitors. To my surprise, I could talk, barely. Once everyone went home, it was pretty much a sleepless night, the entire night. Nurses came in at various hours to check my vitals, check my water and sponge thing to wet my tongue and lips since they were dryer than the desert. I kept telling the RN that I had a headache, not much pain, but just a headache...it took a while, but he gave me something through my IV and I was eventually able to doze off. Next thing I know, my lights come on in my room at 5:45 AM and it was the surgeon, dressed and ready for work that day...asking how I was...told me how he was hammering away at me for a good while. He had something to open my mouth to peek in, not sure if it was a popsicle stick or not, but he couldn't really see above my upper lip, he said it was stuck to my brackets. He saw what he needed apparently though, he said its a good pink color in there. At this time, he dropped off some prescriptions... (800 mg ibuprofen, amoxicillin, antibacterial mouthwash, liquid oxycodone, and decongestants). At this point, I went back to bed once he left, only to be woken up again about 20 minutes later for vitals to be taken. I'll skip some of the other stuff, but let it be known, I can't urinate while laying in bed...not sure who can. So it's even more odd to stand up, while another guy holds your arm so you don't fall, and waits for you to go. I told him to turn around..he understood, but still had to hold on to me.

Fast forward a few days, I am 4 days post-op, with a followup appointment scheduled for this Wednesday, 7 days after. It's been a really rough past few days, I won't sugarcoat that at all. I was unprepared for how crummy I was going to feel and the nasal bleeding, it never ends. Today however, I am getting not clear drainage, but a very light tint of red...compared to pure red. I would say I'm at the crest of the worst and it's going to be all right from here. I've been breathing through my nose all day, having to use some kleenex to wipe the drip every 3 minutes. I really can't talk...my voice is so hoarse, so it's easier to text my fiancee. She's been such an angel the past few days, tending to whatever I needed...picked up all my medications, made sure I had cold water, changed out my ice packs. The swelling has gone down a significant amount, still a ways to go, but my nose has definitely shrunk from what it was post-op! It looked like I had rhinoplasty. She goes back to work tomorrow, meanwhile, I'm off all week...and tentatively start working from home next Monday...which can be extended out if I need more time off doing nothing. I think this week will drive me absolutely nuts, so I'll be ready to start working again, remotely. There is no way I will ever learn to talk right with this splint in my mouth. About the splint, it is clear, doesnt cover my teeth...from what I can see, it goes up to my brackets and stops...I assume it's tied in with elastics or metal somewhere, but my lips don't open that far currently to check. My bottom teeth are free flowing, I can open my lower jaw a decent amount to drink.

Food wise, I've just been having water and Boost drinks...not the worst thing in the world, I have other things like chicken broth, shakeology drink mixes, etc...but I'm going to wait until after this appointment to see where I stand, and if I'm allowed to brush my teeth at all...I'm certainly not brushing anything that potentially would move, despite the oral surgeon saying nothing will move, since it's bone to bone contact where the surgery was done. I just don't want to come near the incision and potentially rip it. I don't know exactly where it is, but I'd assume since I can only feel one side of my nose...its up along there somewhere.

Would I do it again? Probably not. However, I'm extremely thankful that it's done and over with and that things will get better over the next several weeks/months.

[Nozzelnut]

The next couple days are going to be rough! Stay hydrated, keep up with your meds and mouthwash; things will work out. After day 3, things will start getting a lot better.

[UnevenJAG]

I found your post really interesting to read, I panicked a bit when I read the part about you 'waking up mid surgery' and then laughed when I read it was a joke although it is a slight fear of mine to wake up during surgery and also to then feel the pain but can't move. Hopefully the recovery gets easier from here, I've read a lot of blogs about the recovery process etc, it's seems the first 4-5 days are the worst!

I myself am due to be ready for double jaw surgery in approximately 3 months according to my orthodontist, hopefully from there it won't be a long wait until the hospital can actually schedule me in for surgery!!

[snapdresser]

I continued to talk to him about this pure fresh oxygen asking if it was as pure as being in the middle of a field in Nebraska, in which he said...not quite

Excellent surgery-day write-up! Thanks for posting this!!

[tylerjwilson]

Had my one week follow-up today, went by pretty quick. I managed to get my lip unstuck yesterday and get a good child sized toothbrush up there to clean my teeth and gumline, without going too far up. Seems like the area above my lip was stick on some wire-ties, which was somewhat painful to get off. Alas, all went well today, he said the incision looks good, had me hold my lower jaw against the splint for a bit, then gave me some pretty thick elastics to use for the next week, the animal on the bag is walrus, which it says 5/16" 14oz. It basically feels like i'm wired shut now, as I'm afraid to try to open my mouth with the elastics (why would I want to pull on bone that is trying to heal?) In my prior orthodontic work several years ago, I never had elastics, as it was purely fixing spacing issues. So this is the first time ever that I've used elastics. He said the more I can wear these, the sooner my splint can come off. I'm using 2 elastics in the form of a square. He put them on and showed me in a mirror what it looks like, he said, whatever you have to do, just make it a square on your front section of teeth. Easier said than done, I got home to do it myself and I saw that the wire is snipped and one of the surgical hooks was removed since surgery, so this will have to be best effort in my square making ability. He was originally talking about removing the splint at 4 weeks. He also reaffirmed my diet as a non-chewing, as long as I can swallow it and mentioned pastas as something I can do. With that, I had a bowl of wedding soup earlier, where the vegetables were pretty mushy and I cut up the small meatballs into swallow size pieces. Basically ended the appointment with saying by my next appointment (next wednesday) I should feel pretty back to normal and will be begging to get the splint off. Also gave me a copy of the xray from today. Looks like I have a big bicycle chain running along my upper jaw.

[tylerjwilson]

Couple pre-op images to share and my current x-ray post-op. I'll share bite pictures once the splint is out!

http://s613.photobucket.com/user/tylerw ... 9.jpg.html
http://s613.photobucket.com/user/tylerw ... u.jpg.html
http://s613.photobucket.com/user/tylerw ... m.jpg.html
http://s613.photobucket.com/user/tylerw ... s.jpg.html

[tylerjwilson]

Turns out that I'm not feeling very comfortable with the elastics I was given, they are very thick and hold my jaws together very tightly, where I can't open it and am terrified to cough or sneeze in fear that it will tug on my upper jaw. After a few hours of wearing them, the muscles in my lower jaw become so firm that I can't tilt my head around because my lower jaw wants to stay in the position it was in (sleeping, looking down at a puzzle or book). My oral surgeon mentioned prescribing me muscle relaxers to help with this, but instead he is going to give me a lighter elastic for now, I have to stop in tomorrow to pick it up.

[sirwired]

I am SO GLAD my post-surgical elastics were light. (They were, in fact, the lightest elastics I was ever in over my treatment.) They were just enough to "remind" my jaw to rest in the splint's slots at rest. But I had to wear that wired-in splint for nine weeks, which was awful.

If you do take the muscle relaxants, well, I've taken them before for my back, and they work great. But you will feel like a useless limp sack of meat. Don't plan on getting any work (or anything, really) done while on those things.

[tylerjwilson]

Doesn't look like I'll need the muscle relaxants, the new elastics have a giraffe on them and say medium. I've been wearing them at night, due to my best friend going into cardiac arrest Friday while he was at work, alas, he was saved by a stranger/customer at his work who promptly administered cpr and saved his life. So due to needing to somewhat talk to family all weekend, the evening is the only time I could wear them. I think they are essentially to help my jaw rest in the grooves, however, I can't line mine up to even find them anyway. It seems like I really need to extend my lower jaw forward than it normally goes to get the ideal position, but once I start to tilt my head upward, the pressure up around my nose gets so tight, that I can't move it any further. I believe that's part of why he lowered me to a lighter elastic. The right side of my jaw doesn't even touch the splint, but I was told prior to surgery that it may not align perfectly, I'd need lower jaw surgery to fix that, and I opted not to as it wasn't my end goal, just fixing my underbite was my ideal goal.

[Nellyfizzle]

Hi! I almost cried when I read what you said because I have almost the exact same issue as you have. I too have a concave face and a low lip line. It's been hell and my face drops as I get older (now 26). Finally getting bracers and fix all of this! Would you please pretty please give us an update on how you feel, look and maybe some before and after pictures? You'd be helping me so so much!!