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Week 4: One Month Update!

Wed Jun 20, 2012

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!….


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