picture progression: from braces to jaw surgery

I guess I should take a step back here and share some pictures of the journey my mouth has been on in the last year.

My dental fiasco didn’t start last October, actually. It started when I was 11 and I was told I needed braces. I got an expander (and then another) at 13 and braces on at 14. I got them off the summer before I turned 17, open bite and all. I made the terrible decision at 26 to stop wearing my retainers and see what happened and BAD THINGS HAPPENED. I jammed my top retainer back on, but it was never to fit very well again. The bottom was a lost cause. So that’s where these pictures are starting out, from day 1 of getting braces for the second time on October 21st, 2015, until right before the mandibular osteotomy/genioplasty in September of 2016.

Day 1, October 21st, 2015

These pictures are in time-order. I would take pictures every time I had an orthodontist appointment (every 4-12 weeks). In these four pictures I had bite turbos on my back molars in order to allow my cross bite to be corrected with elastics. This was not a good time for talking or eating.

Bite turbos out, yay! Things are coming together. These were my last four appointments before surgery, and with the Damon system of braces (which I have) your wires get thicker and thicker which each appointment, so my mouth was getting its shit together fast. During the time the last two pictures were taken was the first time I could touch my front top teeth to my front bottom teeth in 16 years. That really was a special moment and a huge relief.

My previous couple posts depict the uglier side of recovery, so here’s one taken on day 16 post-surgery to shine a little ray of hope into all this metal and misery. I can only mean mug right now and pretend like I’m trying to be sexy because of this goddamn occlusal splint, bane of my being, torturer of my soul. I get it taken out in two hours, giddy-up!

12

Green bruises and all.

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12 days post-op

Have I mentioned how annoying this splint is? It’s like a retainer times 10 and makes it difficult to speak and eat. I negotiated with my surgeon when I last saw him on Monday to take my splint out a week and a half early, and he conceded, so that’s something to look forward to. I feel bad for anyone who has to have this thing in for the whole six weeks.

I thought I’d upload some pictures commemorating my first non-doctor’s appointment outing since surgery. I went out to a bar to play trivia with my boyfriend, and drove my car for the first time since surgery too. My mouth is open because because it’s still difficult and awkward-looking to close it fully because of the splint. Don’t be fooled by my mad makeup skillz–I still have green and purple bruises along the sides of my face and neck.

 

I stopped taking hydrocodone this week and my mind feels so much clearer. I have more intense jaw owies and twinges, but nothing so bad I wish I was back on narcotics. I’m still sleeping a lot, but have been trying to get out in the sun at least a little bit every day.

Tonight I was feeling really sick of cold protein shakes for dinner, so I bought some broccoli cheddar soup and orzo pasta. I combined them to make the soup a little bit more substantial, and have been swallowing the mixture whole, and it’s making my night. This is way better than when I tried to put macaroni and cheese in the blender (pretty gross, but I did it twice out of desperation). I have a feeling my surgeon’s going to find some icky pickles when he removes this splint next week.

Other than that, I’m still swollen, though a lot of that has dissipated. I’m still not chewing, though I have nightmares that I catch myself doing it on accident. The left side of my jaw and chin hurt a little where the screws are, and I’m also gaining feeling back faster on that side. My bottom lip down to where my neck starts (plus some cheek out to each side) is all still completely numb. I’m still scared to look at my stitches or explore too much in my mouth. I’m still sleeping with my ┬áhead elevated and putting hot compresses on my face to help get rid of the bruising. I still drool and have food on my face unbeknownst to me. It still kind of hurts to yawn or cough. But time is passing, and I feel so relieved to be through the worst of it.

jaw surgery–before

In two days I will have a Mandibular Bilateral Sagittal Split Osteotomy and Genioplasty Advancement. In other words, jaw surgery. When I originally found out I would need this surgery three years ago, the orthodontist thought I would also have to have my top jaw surgically corrected and possibly segmented into three pieces to widen my bite. Thank God my orthodontist here is a miracle-worker and has resolved my open bite and cross bite without surgical intervention. So the problems I have left are my lower jaw and chin.

HOW: The surgeon will make two diagonal cuts through my jaw on both sides in order to pull it forward 12 millimeters and screw it in place. That may not sound like a lot, but it is when you’re dealing with facial proportions and jaw placement. Secondly, he’ll cut through the tip of my chin and move that forward too, screwing it in place to give my face better proportion after the movement of my lower jaw.

jaw

The places marked in red will be cut and moved.

WHY: I’ve addressed this in previous posts, but I’ve had a cross bite, open bite, and significant overbite since puberty (for about 17 years now). I had two expanders and braces as a high schooler, but none of my bite issues were corrected. At first, just the open bite bothered me, but I was pain-free. As time passed, I started having increased muscle tension and discomfort, especially on the left side of my jaw and down my neck. I also chew farther back on my teeth than I should, meaning my molars are wearing down faster than they should. My open bite and overbite also affect how I speak, giving me a little lisp and making me thrust my jaw forward to enunciate, which is exhausting, especially when I’m teaching linguistics, when accuracy and being able to talk at length is vital.

I’m adding some before pictures to show some of the issues I’ve mentioned and to be able to compare them to after (assuming I make it).

Left to right: the day I got braces for the second time, teeth 10 months later right before surgery, profile from both sides before surgery

Did I mention I’m extremely nervous? Current list of worries:

  1. Being aware but paralyzed during surgery
  2. Throwing up after just getting my jaw broken
  3. Getting a blood clot
  4. Having to wear a splint in my mouth when I go back to work and not being able to talk
  5. Not having my jaw rubberbanded or wired shut, so my freshly-detached jaw is just flying free
  6. Waking up with an incredibly swollen, different face than I went to sleep with
  7. Having to swallow medication immediately after surgery (not a pill swallower to begin with)
  8. falling into a deep depression
  9. crying immediately after surgery and having difficulty breathing

Obviously some of these fears are more justified than others, but in my anxiety-ridden mind, they’re all equally devastating prospects. I picked up a journal I’ve dubbed my jaw journal, and on the front it says “It’s Gonna Be Okay” with inspirational quotes sprinkled throughout the pages. I thought this would be a good, uplifting exercise, focusing on positivity, but I just don’t think I’m cut out for it. Most quotes have my cross-outs or scribbles on them, like “fuck optimists” or “bullshit,” then my own version of uplifting quotes written in place of the originals. For instance,”If we had no winter, the spring would not be so pleasant.” Seeing as I live in Phoenix, I obviously don’t agree with that pithy sentiment. I replaced it with, “It’s the same sort of cold comfort when we look up into a clear sky and see that we are mere specks in the enormous universe. Our actions here on earth contribute, no doubt, to the evolution of civilization, but in such a minor and minuscule way that there is freedom in knowing that what you do doesn’t really matter, can’t matter, in the scheme of things.” That’s from Enchanted Islands by Allison Amend, which you should read, by the way.

So I guess, in a way, my journal idea is working, just not the way this journal intended. I’ve been brainstorming ways to wrap my mind around this, deal with the fear and pain, and with not eating food for six weeks. I think good books, journaling, sunshine, and watching good shows will go a long way. Everyone says watching comedies improves your mood, but I’ve found that watching the most fucked-up things I can find (stories about kidnappings, murders, the deep web, torture, craniofacial surgery way more severe than mine, stalkers etc.) helps me put things in perspective and take my mind off my comparatively-petty problems. Whatever works, right?

So, with my fridge stocked with liquids and my credit card charged with any and all things from Target I thought might make this process more comfortable, away we go.

just when I thought I couldn’t get any sexier: adult braces and double jaw surgery

I had braces like any normal, American teen. After an especially painful three years filled with three expanders, chains, and a minor gum surgery, I told my orthodontist to take them off, because I was dismayed by the slow progress and wanted nice senior pictures. He acquiesced, and I was dazzled by my new smile, the first time in high school that I’d seen my teeth brace-free. My dazzlement was quickly dampened when I realized that my teeth didn’t touch in the front. By a lot.

BLTs from Subway, my sandwich of choice, had become a pain in the ass to eat. My misaligned teeth ripped them apart like a butter knife cutting a loaf of soft bread. My teeth were great pizza de-cheesers. One time, while eating dinner with a good friend, he told me there’s something different about the way I talk. Not quite a lisp, but like I’m trying harder to say the same sounds everyone else does. I lived like this for six years, then I went to a dentist in Rhode Island to get some cavities filled. She was the first person to tell me I needed to get braces put back on in preparation for eventual jaw surgery.

I was in total denial. Flabbergasted by her extreme suggestion, I took her warnings of tooth decay and jaw pain with an enormous grain of salt. It was upsetting to hear, but I thought she just wanted the money another round of braces would provide her.

Then my jaw started to hurt. It’s been a gradual process, but the way my jaw and teeth are aligned means my mouth is never properly closed, meaning it feels as if I’m constantly holding my jaw open. The joints ache, the pain creeping down my neck translating into constant severe muscle tension. The roundness to my teen face narrowed out, defining my cheek bones and the decided lack of a chin. That something was skeletally wrong with the way my jaw was set became more obvious.

I let how much all this bothered me build and build, until I went to an orthodontic consultation the other day, five years after seeing that dentist in Rhode Island and still thinking something as benign as Invisalign could fix it all. The orthodontist started by saying that I’m a beautiful girl and that there’s nothing wrong with the way I look, BUT. He said the moment he looked at the pictures the technician had taken of my teeth, he could tell I was a surgery referral. He explained that I not only had an open bite, but also an overbite and a cross bite. He pulled up the picture of my profile, something I normally die a little looking at, and pointed out in glaring detail the skeletal malformation of the lower half of my face. It’s strange to have someone talk about your face as if it’s a work of art, something to be critiqued and molded, scrapped and conjectured about.

I walked out of the orthodontist’s office, determined to carry out the professional persona I had cultivated while in there. I was crying before I hit my car, the loud, racking, dramatic sobs of a rom com protagonist when she gets dumped. It takes the news that I have to have my face pulled apart to get me in that many pieces. I called my very oldest friend and one of the only people I’ll cry around. Her sympathetic murmurs were comforting, but it’s a very lonely feeling to know that you have to pass through something that you alone can do, and that no one around you can help you shoulder the burden.

When I was 13, I loved watching graphic videos of surgeries. I was interested in anatomy, and wondered how they put people back together when they were broken. I could normally watch any surgery with a steely gaze, but a few turned my stomach, namely anything involving the face. One day I tuned in mid-surgery and had to waffle my fingers over my eyes. I watched as the surgeons completely disconnected the upper jaw from the rest of the patient’s face with a bone saw, then plucked the patient’s wisdom teeth out FROM ABOVE, something that still chills me to think about. They joked about how that’s not how it’s normally done, in case any viewers were scheduled for the following week. I remember thinking she must have been in some horribly disfiguring car accident that they would have to deconstruct her face so severely. It looked like it had been flipped inside out, then run through a meat grinder. Turns out, they were doing the exact surgery I would find out I needed 14 years later. I could throw up.

I have options: I could do nothing, live with this increasing pain and tension for the rest of my life and just deal with the consequences. I could get adult braces, an enormous blow to my nearing-30-year-old vanity, in an attempt to improve my bite. But the only thing that would fix it completely is surgery. That brings up questions of where and when and insurance. I leave for Brazil in four days, so none of this would proceed before that. But after that? It’s hard to plan for something this involved and long-term when my life, by choice, is so ephemeral in its certainty. I have no idea where I’ll be in a year, but it most certainly won’t be anywhere near my parents. Who will take care of me when the time eventually comes? Maybe I’ll try to snag a husband just to drive me to appointments and blend my food and pick the dried blood out of my nose. I’m worried I’ll throw up with my teeth banded shut. I’m worried the swelling will be so severe that I won’t be able to breathe. I’m worried the screws will fail and that my top jaw will come undone and fall out. This is a very unfortunate thing to happen to a hypochondriacal wuss with anxiety issues.

I’ll try my best to not ruminate on this as I embark for Brazil. I’ll enjoy my year as my jaw pain intensifies. When I look in the mirror, I’ll see a work of art that still needs a lot of work, a future surgical palate (no pun intended). I’ll cry, I’ll be at peace with it, I’ll cry some more. I’ll imagine kissing no one while in braces. I’ll wallow and be strong, hoping the cycle spends more time at the latter.