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6 Month Update: Decisive Victory!!!


Yesterday I had my 6-month post-operative appointment with my surgeon, Dr. Kupferman.  He received the results of the sleep lab results, and I’m happy to report that my AHI (Apnea-Hypopnea Index) went from seventeen (mild-moderate) to post-operative score of  three !!!!  Since anything below a score of 5 is considered “normal”, I can finally say that the MMA surgery has relieved me of my sleep apnea!

SIX MONTH UPDATE (well, actually 6 months, three weeks):

Sleep Quality: Three words: Very much improved!  My eyes pop open between 7-8 hours after falling asleep.  My sleep inertia is still around 15 minutes (vs 45-60 minutes pre-surgery), and I’m generally in a good mood and rested.  I have far more energy throughout the day, and the sporadic heart arrhythmias (skipping heartbeat) I was feeling last year have completely disappeared. Truth is, I’ve been feeling this good for many weeks, and frankly I’m beginning to take it for granted already! The big story about sleep quality is really about my wife.  She has been significantly impacted by the apnea as well, and is also noticing feeling more refreshed in the mornings.

windtunnelAirway Efficiency: Some more numbers from the surgeon;  One of the functions of the software they use allows them to compare the airway volume increase  by comparing the cone-beam scans they do pre-surgery and post-surgery.  According to the measurements, my airway increased in volume by 40% !!!  Not only does this prevent my airway from collapsing completely while sleeping, but it allows me a much improved air uptake while exercising. I’m hoping NASA accepts my proposal to give them access to my mouth to conduct wind tunnel tests.  So far, they haven’t returned my calls….

Numbness: As I mentioned before, My facial numbness has completely disappeared.  As far as mouth numbness is concerned, it’s mostly gone, but not completely. The sensations in the roof of my mouth and upper gums has have increased significantly, starting from the back of my mouth (near the molars) and progressing forward. At this point, I have sensation (pokes, temperature) as far up as my canine teeth.  The canines and incisors on the top are still fairly numb, as is the front edge of the roof of my mouth just behind these teeth. These teeth also feel “spongy”, although this sensation has mostly disappeared from the teeth farther back. Other MMA patients have reported this sensation for many months after surgery, so I’m not too worried about it. My surgeon has told me that nerve regeneration can take up to a year. After that, there’s a good chance that whatever hasn’t regenerated probably won’t.

I’ll say this last thing about numbness:  permanent nerve damage is a real possibility with this surgery.  The good news is that even if you have some, it’s not something you’ll probably be distracted by.  The single biggest factor in avoiding it, however, is the skill of your surgeon.  PICK YOUR SURGEON WISELY!

giantBurger Jaw Flexibility: 
Oddly, my jaw now opens wider than pre-surgery. Before, the distance between my upper & lower incisors with my mouth fully open was about 45-50 mm.  Now, I can open about 60 mm. Since I’m not a mechanical genius, it took me a while to arrive at the obvious reason: My mouth open wider because my jaws are longer!  Duh!

So, if you’re a giant hamburger, be afraid. Be very afraid…


Sleep: There’s an App for that…


No, this isn’t a picture of me uploading the iPhone OS directly into my brain (I learned the hard way that’s more difficult that it seems).  This is my 6-month post-operative sleep study, which will measure my currently sleep quality to my baseline pre-operative sleep study.  Hopefully this study will provide some empirical data which validates what I’ve been subjectively feeling for the past few months: that I am more rested than I can remember, and my snoring has all but vanished.

I wonder if I should tell the technician that I’m picking up KLOS on one of my fillings…..

3 Month Update: Steady Progress

day90_front day90_side

I think it was mid-April when I made the decision to do surgery and scheduled it for mid-May. At the time, I remember thinking that it meant my summer was shot, as I’d be consumed with recovering, etc. But the truth is, I’ve had a great summer!  The surgery (and most of the recovery) seem like very distant memories now, and I’ve gone days without thinking about it for a while now.

When the soft food restriction was lifted around week 8, it only took a couple of weeks to get my jaw strengthened (and stretched) enough to eat like I did before surgery. At this point, the only things I still avoid chewing are ice cubes and really hard nuts like whole almonds.

So, aside from the annoyances that come with orthodontics, my summer has been pretty awesome since mid July, which in Southern California is really the beginning of the hot season.  And I’ve got most of August and September to go before things start getting ugly (high temps will plummet into the low ’70’s).

There are a few things I can report:

Jaw Opening: My jaw is making great progress in flexibility.  At this point, I can open it about 3 fingers width (around 45 mm).  I feel like I’m very close to my pre-surgery opening range.  I’m pretty sure that the switch to a normal diet has challenged the jaw more, and accounts for these results.

Numbness: I’ve hit a few milestones on numbness since my last report.  Currently, I’ve gotten back ALL the sensation on my face – no numb, tingly, or itchy spots!  Since this isn’t a guarantee for MMA patients, I’m very pleased to have this outcome.

As far as inside my mouth, I’ve noticed that I’m getting some sensation in the top jaw toward the back in the molar area (both sides).  Perhaps the sensation will return from back to front.  Pain on biting chewier food is subsiding a lot, which has helped me return to a normal diet.

Sleep Quality: I’m really feeling the long-term benefits of improved sleep quality.  Morning time is much easier in terms of waking up getting started, I have much more energy during the day.

BOTTOM LINE: t the three-month mark, my life is 95% normal.  I go days without even thinking of the surgery or any recovery issues.  The improvement in sleep quality feels amazing.  There is no question that this surgery was the right decision for me!

Week 8: Let the Chewing Begin!

With eight weeks behind me as of Monday, it’s time to ditch the bland, carbohydrate-rich soft-food diet I’ve been on for a month and a half, and start taking this new jaw out for a spin!

Of course, I can’t exactly start off gnawing on raw carrots at first, so I’ve spent the last couple of days trying new things to see how well I could chew them. So far I’ve managed to have a sandwich (up until now, crust has been impossible to swallow without chewing), a tuna salad on a bed of lettuce (but I couldn’t bite through the raw bell peppers), a turkey burger with lettuce and a tomato, some chunky chicken salad sandwich, and some chicken strips from Carl’s Jr. (hey, it was a tough afternoon).

For the most part, the biggest difficulty is cutting through stuff with my incisors. Pressure (from biting) makes them hurt. In addition, all my teeth feel “spongy”, as if they aren’t locked down in the gums. This makes me nervous about tearing off a big bite of steak or chomping down on a handful of almonds. For now, I’ll stick to slightly squishier game.

The only other difficulty is that my mouth still doesn’t open up as wide as it used to. Before surgery, I measured my jaw opening, and was able to open up between 45-50mm (just over three fingers width). At this point, I’m up to just over two fingers, or between 30-35mm. So, a giant double-bacon-burger is out for the moment. Probably a good thing too, since despite all my best intentions, I’ve managed to gain all my pre-surgery weight back.

Well played mac & cheese. Well played…

Week 6: No More Rain in Thpain!


Last week I hit the best milestone so far: Dr. Chang removed the splint that was wired to my lower teeth since the surgery! Here’s a picture of the @&^%#! thing.  The removal was simple – just a couple of snips with the wire cutters, and it no more lisp!

Orthodontics: Once the business of splint removal was over, it was time for Dr. Chang to have his first really good look into my mouth since getting my new jaws. He was pretty happy with how my bit turned out, at least with regard to where my incisors were meeting.  He noticed I had a “tripod bite”, which means I only have contact at my incisors and very back molars.  All the teeth in-between don’t touch at the moment, which will be something of an impediment in a couple weeks when I’m allowed to begin chewing.  Oh well, one step at a time.  For now, I’m getting rubber bands on the sides which I need to wear when I’m not eating, cleaning, or using my teeth to remove bottle caps.


Photos: Here’s the six-week set.  For whatever reason that front-facing pic makes me look like The Incredible Mr. Limpit.  Nevertheless, I’m definitely into the slow-change phase, where you can see differences over weeks, not days. After the 8th week, I’ll move to monthly photographs.  See all of the photos together on Mug Shots page.

Mouth Stuff: Once the splint was out, I could fully appreciate how much grime had accumulated on the backs of my bottom teeth. Dr. Chang handed me a toothbrush, which I gratefully accepted and rushed over to his sink. I was disappointed that one brushing didn’t remove the gritty feeling. I also found that after a couple of days it was still there. That’s when I realized it was time to 1) get rid of the kid-sized toothbrush I’d been using, and 2) ditch my gentle Sensodyne toothpaste for some good-old-fashioned Colgate to increase the abrasion. That did the trick! After a couple of brushings, the backs of my teeth were smooth, and I also noticed the fronts of my teeth (at least between my brackets) were much less yellow.

Airway To Heaven!

Today the surgeon’s office emailed me the post-surgical cephalogram showing my new airway. I’m happy to report that it seems that my airway is significantly larger!

To demonstrate, I’ve made a quick movie comparing the pre-surgical and post-surgical pictures. I’ve highlighted the airway in yellow.

Click “play” on the Vimeo movie below, and witness the beginning of a glorious career as a balloon animal artist…

Week 4: One Month Update!

Pre-Surgery                                 One Month Post Surgery

I read a lot of MMA recovery blogs while I was researching this surgery. And on most of them, this is the point during recovery where the blogger would say some thing like “Wow! it went by so fast!”. But being the skeptic that I am, I didn’t believe I would feel this way. And during the first couple of weeks after surgery, I still remained skeptical.

But now, I have to admit that at this point life does seem pretty normal, and surgery day does in-fact seem like a distant memory!

MMA Bloggers: 1, Idiotic Skeptics: 0.

Since the one-month mark is such a significant milestone, it’s time to write an exhaustive status update on all the issues I’ve been tracking so far.

Another Great Checkup: Today I had my final weekly checkup with the surgeons. As before, they indicated I am ahead of schedule with healing. Dr. Kupferman looked into my mouth and verified that all incision sites are healed. He decided to release me to the orthodontist.  From here on in, I’ll be checking in with the surgeons monthly. Now that the swelling is mostly gone, they took more x-rays to get an idea of airway size improvement. The technician promised to send me the images, and I’ll post them when I get them.

Still Splinting: I was hoping to get my splint removed at this appointment, but Dr. Kupferman felt that it was better for the orthodontist to do this. Why? In my case, I did not have the luxury of doing a year of pre-surgical orthodontics to prepare my teeth in advance (which is the usual treatment plan for MMA surgery). All my orthodontics are happening post-surgery, so as you can imagine, my bite is way off at the moment. Most notably, my rear molars do not currently touch together when my jaw is closed. The purpose of the splint is to give my molars something to “rest” on while the ligaments, muscles and tendons of the jaw get used to their new positions. So, Dr. Chang (orthodontist) will hopefully remove the splint next week when he puts arch wires on, and will figure out a way to temporarily fill the gaps between my molars (perhaps with bonding material) while my teeth are moving into position. And so the lisp continues…

Off The Hook(s): The good news is that Dr. Kupferman did remove the screws and hooks which were attached to my gums above and below my front incisors. The hooks were used as rubber band anchors for the front of my jaw. Now that I no longer need rubber band traction (for healing anyway), it was time get that pesky hardware out of there.

And it’s not a minute too soon; over the last month the head of the top screw had begun to embed itself into the inside of my upper-lip. This was causing some discomfort when smiling, because my upper lip would stretch and pull on the screw head. Also, the hooks (which were fashioned by the surgeon from twisted wire) were growing into the soft tissue of my gums, and were a constant source of low-level irritation.  Finally, the screw head located on the bottom jaw was grown-over with gum tissue (a normal occurance), which was being irritated when I brushed my teeth.

The process of screw removal was pretty simple: The surgeon simply unscrewed the screws with a phillips screwdriver. For the top screw, he didn’t need to numb me up because my upper gums and palate are still 100% dead. He did give me a shot in my lower gum line to get the lower screw. In 5 minutes it was done, and I’m now able to smile BIG again!

Comfortably Numb: Speaking of numbness, I realize I haven’t talked about post-surgical numbness in a while. Every MMA patient knows (or should know) that the surgery will most likely result in facial numbness to some degree. In a majority of cases, this numbness is temporary, but will last for many months. In a few cases some of the numbness can wind up being permanent. It’s one of the risks of this surgery that all patients (and potential patients) need to come to grips with.

In my case, I experienced a small amount of facial numbness on my lower-left lip & chin when I woke up the day after surgery. Dr. Relle did a quick sensitivity test at that time and was pleased with how little numbness I had. He told me that I would probably experience an increase in numbness over the next few days, but that it was a good sign that I had good sensitivity just after surgery. He also let me know that during my surgery, the nerve in question was very accessible and pliable, and so they were able to minimize the nerve trauma as much as possible during the procedure.

Over the next few days, I did notice an increase in facial numbness. The areas affected were the left half of my lower and upper lips, a patch on my left cheek which extended to the edge of the lower eyelid, and (surprisingly) a patch on right side of my nose. Incidentally, these numb patches seem to somehow respect the vertical meridian of my face; by which I mean that numb patches near this border one one side never seem to cross that border. Oh the wonders of anatomy!

Over the last few weeks, I’ve experienced both “odd sensations” in these numb patches, as well as “itching” sensations. The latter is especially cruel, since “scratching” these numb spots is predictably useless. The good news is that during the last week, I’ve noticed more general sensation retiring to these areas (scratching those “itches” now works a little better), as well as some shrinking of the perimeters of the numb patches. While I expect that I will be living with these numb patches for many months to come (usually takes 6-12 months for full resolution), I’m encouraged by these positive early signs.

Regarding numbness inside the mouth, it’s pretty much limited to my upper gums and palate, which have been completely, 100% dead since surgery. My upper teeth feel “wooden”, and I have to use the mirror to visually orient my toothbrush when I brush the uppers. In addition, I have to rely on my tongue to tell me if my food is too hot. Otherwise, I would burn the roof of my mouth without even knowing it. Fortunately this is normal, and I expect that at some point I’ll have inner-mouth sensations return.

Pain: I no longer experience any surgery-related pain. I do have bouts of “pressure” every couple of days, which may cross the threshold of an “ache”, but usually this is transitory. I have taken maybe two doses of regular Tylenol over the last week. In short, pain management is no longer a factor of my recovery.

Swelling: I’ve experienced a drastic reduction in swelling since surgery. The doctors say I’m ahead of schedule on this. For the most part, my face doesn’t look swollen to the casual observer. I can recognize some swelling, but that’s only because I know my face. This minor swelling is located at the points where my bones are fastened together; in the left & right mid-points of my lower jaw, between my cheekbones and nose on the left and right side, and behind my upper lip. I’ve also noticed that the swelling in these areas ebbs and flows; some days there’s more, and some days there’s hardly any. I expect that over the next few months I’ll see this same pattern, with a general trend of reduction until finally resolved.

Energy: Energy has been relatively normal for over a week now. I returned to work this week (I chose to recover for 4 weeks before returning), and have had no issues performing my duties, which consist of sitting in a chair in front of a computer. I can tell you that before surgery, I had a daily ritual of fighting off the urge for a nap around 3pm. This week, however, I haven’t experienced a single “nap attack”. I take this as a good sign that perhaps I’m sleeping better!

Sleep: While I won’t have a corroborating sleep study until 6 months after surgery, I continue to see objective improvements in my sleep quality and daily energy:

For starters, I’ve had several nights now where I’ve slept all night, after which I’m feeling refreshed and ready to start the day. Another indicator is that my period of morning sleep inertia has gone from from a pre-surgical 45-60 minutes down to a post-surgical time of 15 minutes.

I’ve been sleeping on my back since shaking the dizziness, and in general I’d say I’m back to a normal sleep life, aside from feeling more refreshed than before. Finally, my wife continues to report that my snoring has completely disappeared!

Mouth Stuff: The stitches are all gone. The incisions in my cheeks feel tough and sinewy, but I’m betting that  they’ll soften up over time, as mouth tissues seem to be very elastic and pliable. Sometimes my teeth and gums feel “mushy”, as if my teeth are mounted in soft rubber. I’ve been told that the ligaments holding the teeth can cause this feelings when they’ve been disturbed, and that these sensations should eventually disappear. Finally, I’ve now gotten to the point where I can stretch my jaw open about 3 centimeters (two fingers or so between upper & lower incisors). I remember pre-surgery I could open 3 and a half fingers wide, so I still have some work to do with my jaw stretching exercises.

Weight: During the first week after surgery, I lost 12lbs. Up until recently, I was hanging on to a 10 pound loss. In the last week or so, I’ve crept up a couple of pounds, so I’m hanging around an 8 pound loss. I believe it’s because I’m still eating a lot of carby foods because of the soft diet, so I probably need to find some alternatives to mashed potatoes and mac & cheese, which have become easy go-to staples. I also need to start getting some more daily exercise now that I’ve got some reliable energy. Hopefully, I’ll be able to capitalize on the modest weight loss that comes with the surgery, and get into better shape this summer.

Food: I’ve settled into my soft diet at this point, and it is very routine. Smoothies, ground beef, mac & cheese, mashed potatoes, and any other thing that I might find amusing to throw in the blender is easily consumed. Dr. Kupferman says I’ll be able to begin slowly transitioning to a chewing diet after week 8, so it’ll be a while before I can enjoy a trip to In-N-Out.

A New Adventure: I’m now transitioning from being a surgery patient to an orthodontic patient. The next appointment with my orthodontist Dr. Chang is next Tuesday, at which point I expect some pain and discomfort as the teeth are coaxed around. It’s all part of the fun!….