My report: I underwent BiMax surgery on May 27, 19 (10 weeks now), due to a diagnosis of severe degree sleep apnea (around 60 events per hour). The surgery was in the city where I live, Porto Alegre (Brazil), with a reference surgeon (Dr. E.dela P.uricelli)
Preoperative: just under 2 years with fixed dental braces.
Surgery: I was admitted to hospital the day before for planning and preoperative and anesthetic procedures. The next morning, about 11 hours on the operating table, a little longer than expected, but nothing serious. Both upper and lower jaws have been advanced to increase throat airflow and sublingual brake correction. Unfortunately I do not have here how much (in millimeters) of the advance made.
Hospital recovery: I was hospitalized for another 4 days. Despite having my mom accompanying me (my wife had to keep an eye on our toddler & pet ...), it was critical to hire a nursing technician for intensive care in the early days, in addition to standard hospital care. It was an additional expense, but worth every penny. If you are doing a complex procedure like a BiMax and can afford it, I strongly recommend it! In the early days it is very important to have constant hygiene work, perhaps even airway aspiration, applying ointments - lots of bruises on the nose and lips, and dozens of sutures. Professional work at this point makes a difference (such as covering mirrors and practically forbidding family members to photograph me or show me pictures, LOL). I have never been a difficult patient, as I am very tolerant of pain and discomfort, but the first days are terrible. I did not need to take additional painkiller than originally prescribed (although I was allowed to morphinoid if I asked) because the pain was not unbearable. The problem really is the multiple discomforts: not being able to speak, not being able to open the mouth, bloating, difficulty swallowing saliva and liquid food, hunger generated by low caloric intake and the stomach is not used to liquid diet and consequent difficulty sleeping in an elevated position, etc.
Home Recovery: After the first few days, I went home. In the first week there, it was also extremely difficult, mainly due to the almost permanent feeling of hunger and the difficulty of sleeping always in the elevated position - almost sitting - and supine. My luck is that my wife's grandmother left us a single hospital bed at home, the kind with automated elevation. It helped minimize discomfort as it is far better than a pile of pillows. The difficulty of swallowing saliva remained until then.
Then, little by little I got used to it ... swelling decreased, the body got used to the liquid diet, I was having more mobility, etc. Revisions every 3 or 4 days, hygiene several times a day, lots of healthy blended food, juices, coconut water, whey protein, soups and broths, and so on. With each revision, the staff slightly reduced the elastics that prevented the opening of the mouth (both in quantity and resistance). I don't remember which week they took them all so I could brush the inside of my teeth and tongue, then put the 'locks' back on. At this point the opening of the teeth was a few millimeters, almost insufficient for the head of the infant toothbrush to pass through the space. It's a desperate feeling, because in my head it seemed to be making a big effort and 'opening a big mouth', but when I look in the mirror, my teeth hardly part. With each new revision, this opening increased by 1 or 2 mm.
I was about four weeks away from work (many late series and movies checked in this period
), still coming back with the rubber band on my braces.Today, 10 weeks later, I still have two elastic bands (one in each canine, approx) and are expected to wear the fixed braces for at least 1 year - I'm lobbying my orthodontist to shorten that time, though.
A big parenthesis: since I regained consciousness after surgery, I noticed that my left hand (not sure if the whole arm) was numb. I immediately recalled that, just before anesthesia was applied, a medical staff member "missed a vein" by installing venous access and needed more experienced help. So I thought it might have something to do with the tingling or maybe my left arm was in the same position around 11 hours of the surgery, damaging some nerve. The medical staff reassured me that this numbness would pass over time, but it was several weeks and I saw very little improvement, perhaps a slight return of the pinky and ring. In some periods of cold or exertion, the pain even increased, any touch to the arm already throbbing. An orthopedist I consulted asked me for an echo Doppler, which eliminated the possibility of arterial damage. Electroneuromyography, however, showed damage to the median nerve - carpal tunnel. Today, 10 weeks, the numbness has decreased (hopefully not due to accommodation or placebo effect) and the pain has ceased. I hope some more time will be enough for the hand to return to normal.
Well, sorry for the prolixity, but at least for me, reading reports of other operatives helped me a lot in the recovery period, I regret not having read in the previous phase. It is still early for me to draw conclusions (facial muscles have not yet become accustomed to the new bone disposition), but I already notice breathing and sleep improvement. I certainly don't regret opting for surgery and I know the postoperative hell is a price worth paying.
In addition to the width of the mouth opening not returning to normal, I also still have partial insensitivity in the lower lip, chin, tongue and gums. My smile is still a little awkward because of this slight 'paralysis' of the lip and chin muscles.
Now, my questions to the community:
1) Any tips to accelerate the return of facial and lip sensitivity? I don't believe in alternative medicine, like acupuncture, but suggestions are welcome ...
2) those who like me had plates, screws and grafts: my surgeon recommends that I remove the lower plates - the upper ones would be lifelong - because she has studies that indicate that the absorption of molecules from such components can in the long run cause any liver dysfunction (or any other organ). What is the most common recommendation? Only remove the plates when there is an infection or exposure event?
3) My surgeon is extremely careful that I do not expose myself to heat and high temperatures due to infections that would be more conducive in this environment. Just yesterday he presented me a case of a patient who operated on in January (2019) and last week had a serious infection, with great chances of having to undergo a new procedure. Do you have that kind of care in the summer? I live in subtropical latitude, but in two weeks I will go to the Mediterranean summer, so I'm terrified! She prescripted me cefalexin, in any case. What will be the rate of infections and how much can be treated with oral antibiotics? And will this risk accompany me for the rest of my life? Should I worry about the temperature of the bath?
4) How long have you been away from contact sports (soccer, basketball)? Should I be very afraid of exposing myself to a hit or injury?
Ah, any consideration to take a flight? could it affect recovering at this point of pos op?
Well, sorry for my poor English too, it's not my native language ...
