FAQ

FAQ Last Updated: 21st March, 2013
When I was researching this type of surgery, I found myself looking at lots of blogs, forums, and other media to find answers to the many questions that I had and and so I thought it would be useful to create a FAQ.

The FAQ covers all aspects (pre-surgery, during surgery, post-surgery recovery) of this experience aand even though (at time of writing) I am almost at the 1 year post-op anniversary, I will continue to add questions, update responses, etc., as needed.

The questions and responses relate to my experience in recovery and are not to be taken as anything other than my experiences and do not constitute professional medical advice.

As it relates to the questions and responses below, please read my disclaimer!

 

Preparing for surgery (1 - 12+ months before surgery)

    Did you need to wear braces in preparation for the surgery?
    Did you have any other dental work pre-surgery?
    What is the anticipated cost of the surgery?
    Did you have to have a pre-surgery appointment?

Post-Surgery Recovery

In an effort to keep the questions organized, I have created sections such as eating, pain management, swelling, etc. and related questions are placed under each section

Surgery Related and The Surgical Splint
    How long do you stay in hospital?
    Will I feel nausea after surgery?
    Waking up after surgery . . .
    What is a surgical splint?

 Breathing and Congestion Related
    Is it hard to breathe through your nose and mouth after surgery?
    Was there a lot of nasal congestion? Did it hinder breathing through your nose?
    Do you drool?

Swelling and Bruising Related
    How much swelling to expect?
    Will my lips swell or crack?
    How much bruising to expect?
    Ice packs and / or heat packs?

Sleep and Sleep Apnea Related
    How do you sleep?
    Does surgery help with Sleep Apnea?

Eating, Opening Jaw, and Jaw Exercise Related
    When can I chew again?
    Did you have to perform any jaw exercises. If so, when?
    What is your diet post-surgery?
    How do you eat with a splint on your teeth!?@!

Pain Management
    Is there much pain?
    Did you have to take a lot of pain medicine? When did you stop taking it?
    I suddenly have painful earache, why!?
    When can I start exercising again?

Teeth and Rubber Band Related
    How do you clean your teeth?
    How easy was it to take the rubber bands off and on?
    Did you experience sensitive teeth?
    Were you wired shut?
    Are you able to take your bands off at all?

Miscellaneous
    Returning to Work
 _____________________________________________________________________________
 

Did you need to wear braces in preparation for the surgery?

Yes, most (if not everyone) people will need to wear braces in preparation for orthognathic surgery. I have worn them for the last 14 months and visited my orthodontist every three to four weeks so that adjustments could be made so as to achieve the desired results.

I was worried that wearing braces at the age of 38 and in a job that demands a high degree of communication would be challenging to say the least. It hasn't been an issue however and let's face it, if you are having this surgery, you need to stop worrying about what other people are going to think in terms of your looks!

The amount of time you will wear braces is obviously dependent upon the correction that needs to take place prior to surgery. Some people indicated they wore braces just for a few months, some for quite some time. . .
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Did you have any other dental work pre-surgery?

In my case, I needed to have one tooth extracted as my lower jaw was overcrowded. It is at that stage I realized I didn’t like to be put ‘under’. Doesn’t bode well for the surgery – I have anxiety about the anesthesia in a major way :(

I also scheduled a final teeth cleaning the month before surgery as it will be a while before I can get that procedure done again!
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What is the anticipated cost of the surgery?

The cost of surgery is completely dependent upon the type of work that you are having performed, your insurance plan (if you are in the US), as well as other factors.

The one constant however where orthognathic surgery is concerned is that it is not cheap, especially here the US. Once my surgery is over and all the bills have been tallied I will provide a detailed breakdown. Of course, this will be relative dependent upon where you live . ..

My insurance company to date has been great and so hopefully that will still be the case post-surgery when they receive all of the bills!
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Did you have to have a pre-surgery appointment?

This surgery is obviously considered major surgery so pre-ops are important.

My pre-surgery visited last just over an hour and essentially it was a full physical exam, including an EKG. The hospital had sent me a a whole bunch of questions that my primary care physician was required to submit. I actually thought I could drop the paperwork off at his office and that is all that was required of me but alas, this was not the case.

Perhaps it is because I very, very rarely go to the doctor and so he used this opportunity to actually get me in his office to make sure I was still alive and well!
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How long do you stay in hospital?

Unfortunately, another of the It Depends answers; In the US, the typical stay is one night only. From what I have read in the UK, it is somewhere between 1-3 nights. Your surgeon will tell you exactly.
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Will I feel nausea after surgery?

Tell the anesthesiologist of your concerns obviously but typically in this surgery they ensure that provide you (IV) with lots of anti-nausea medicine. Even then you may find that your body reacts to the anti-nausea medicine or the painkillers (I did) but the nurses were on hand and administered other anti-nausea medicine.


I felt nauseous but thankfully I was not sick! I have only read of one or two instances (out of hundreds) where this was a problem. Being sick whilst having a banded mouth would not be fun :)
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Waking up after surgery . . .

I hate to say It Depends but unfortunately it does. Different people have different reactions to anesthesia; some people snap out of it quickly, others (like myself) take a long time. I was pretty much out of it for hours after my surgery and when I was finally semi-conscious I didn’t feel all that great. See my post here.
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What is a surgical splint?

The splint essentially is a horseshoe-shaped plastic device that is wired to your top teeth. It is designed so that your teeth will fit perfectly in to it after surgery and it ensures that your top jaw will not move  to its pre-surgery position until such a time that your bones are stronger than your jaw muscles.

By this I mean that the bones will be able to resist any pressure that your jaw muscles exert in an effort to revert back to its former position. The surgeon refers to it as jaw memory, a concept I have never heard of before but he says that the jaw muscles basically need to learn their new position and how to chew, bite, etc., in their new position. Interesting. Geeky. Perhaps both. Once the splint is removed, the Orthodontist typically places a new, thicker, top arch wire, to your mouth that provides strength to your mouth until the bones are strong enough.

In terms of when the splint is removed, it is very much dependent upon a number of factors. For me, the splint was removed in the third week and replaced by a thick top arch wire.

So there you have it, you now know as much as I do about the world of orthognathic splints! It is inconvenient because it protrudes considerably into the top of your mouth and inhibits eating, drinking, tongue movement, and most importantly, talking!

I have a few posts concerning splints, so simply search for term or else look at the label cloud :)

It is important to note here that not everyone actually gets a splint. It is dependent upon what happens during surgery, movement, intended aim of surgery, etc. Even though my surgeon made a splint prior to surgery, he told me he would not know if I needed it until the actual surgery itself.
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Were you wired shut?

Being wired shut creates images of actually being wired shut. Now whilst this was a common (and only) practice a decade ago, rarely are people permanently wired shut nowadays. Instead, tight elastic bands are used in place of wire. These bands are much easier as they can be taken off as per your surgeon’s schedule. (See below question for my schedule). It is also important to note that not everybody who has this surgery is banded shut! I wish that were the case for me but alas, I was very much the proud owner of rubber bands!

The surgeon will tell you when you are ready to remove the bands and show you how to do it. It is an art form and requires practice! Not to mention the fact you will be cleaning your mirrors very often! :) You can read about how to take the bands off and on in a question below. Alternatively, click here to see a post about this.
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Is it hard to breathe through your nose and mouth after surgery?

I am a complete mouth breather and honestly, this was one of my top concerns before, and after, surgery. I wrote about it a lot on my blog in multiple posts (see here for one such post) but the reality is that your body adjusts and you will get through it and be fine.

That doesn't mean you will not be anxious and worry about it, you definitely will but you will manage to breath both through your nose and your mouth. Essentially, focus on the recovery and the results and try not to be myopic about one or two concerns .

The key for me was to make sure I kept using the nasal spray every two hours as that relieved all congestion and I was able to breath through my nose. Like I said though, I have always been a mouth breather so I was worried about simply using my nose to breathe but I managed just fine. I have asthma and so truthfully, I I believe that I used my inhaler twice when I was having difficulty breathing and that helped.

Also, given that my jaw was moved forward, my airways actually had more room to breathe. This helped a lot with sleep apnea related issues. See below for more details where this is concerned.
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Was there a lot of nasal congestion? Did it hinder breathing through your nose?

Double jaw surgery typically causes significant nasal congestion (because the anesthesiologist uses your nose as the vehicle for the breathing tubes!) and for most of us, breathing and congestion concerns go hand in hand and they are definitely not a fun part of the recovery process.

Where I was concerned, the surgeon prescribed a decongestant spray every two hours and that helped immensely. You cannot blow your nose for quite some time and so definitely take the medicines! Humidifiers are a life-saver also :) As for breathing issues, see the above question.
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Do you drool?

This may sound like an odd question but if you have double jaw surgery, the probability is that you will not be able to feel much in your lips and / or chin for a while. What does this matter you might ask? Well, if you cannot feel your lips and chin then you do not know if you are actually drinking  and if you are not, it has spilled and you cannot feel it dripping down your face! :) Sounds gross but drooling is just one of the little things you have to deal with so accept it and move on!
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What is your diet post-surgery?

The length of time you will be on a liquid diet is really dependent upon the speed of you recovery. Most people are on pure liquid for 2-5 weeks and then transition to soft foods after that. In each of my blog entries, I wrote abut what I ate. I am presently 30 days post-surgery and I am still on a soft food diet and am not allowed to chew anything until at least the six week mark. Presently, I am addicted to instant pudding and mashed potatoes however! :)
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How do you eat with a splint on your teeth!?@!

The reality is, for me at least, is that it was just plain frustrating eating with a splint, no matter if I was eating through a syringe or whether I was allowed to eat so-called soft foods, the result was always the same; a frustrating experience.

The reason is really one of inconvenience; your tongue finds it rather difficult to navigate the splint, you cannot open your jaws wide enough to actually remove the food that is stuck in the splint, and the benefits do not outweight the hassle of then having to somehow clean (swish and swish your mouthwash) until the food is free and your splint is clean.

For me, it was far easier to simply eat milkshakes and smoothies when I was told I could eat soft foods whilst my splint was in. I was able to get the requisite nutrients whilst also able to clean my teeth! :)
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Are you able to take your bands off at all?

Where my bands are concerned, this has been (continues to be) the schedule:

Week 1 Post-Surgery: Bands on continuously.
Week 2 Post-Surgery: Bands off for 1 hour, 3 times a day
Week 3 Post-Surgery: Bands off for 1.5 hours, 3 times a day
Week 4 Post-Surgery: Bands off for 2 hours, 4 times a day
Week 5 Post-Surgery: Bands off for 2 hours, 4 times a day
Week 6 Post-Surgery: Bands on for just two hours in the middle of the day and then after 7pm
Week 7 Post-Surgery: Released from the care of my Oral Surgeon and orthodontia work once again resumes with my Orthodontist. At the time of writing (7 weeks post-op), my Orthodontist told me I will be wearing Orthodontic bands for next six months. These bands are much more flexible and forgiving however than the surgical bands. Thank goodness! :)
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Is there much pain?

Truthfully, this is a difficult question to answer as obviously you experience a lot of pain and discomfort and the first week post-surgery has definitely been the hardest and most miserable.

The key is to ensure that you continue to take the medicine for as long as your doctor tells you take it! I thought I was managing the pain so stopped mid-week in my first week. Big mistake. Take your medicine, sleep, drink (syringe) liquids to keep yourself hydrated and you will get through it!

After the first week, the pain as far as I have / am experiencing is more of the aching jaw joint variety. Additionally, what helped to relieve the pain and discomfort was using the ice / heat pack on rotation. This helped a lot.
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Did you have to take a lot of pain medicine? When did you stop taking it?

I talked about the pain medicine in this post. I presume it is different for every person but I was not used to taking pain medicine whatsoever prior to surgery and so I was very, very worried about taking painkillers. That said, read my post I just mentioned and learn from my stupidity! :) I stopped taking the Lortab after my surgeon told me to and simply use Ibuprofen as needed now (6 weeks post-op).
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How much swelling to expect?

Unfortunately, this is another of those it depends answers! The reality is that the first week you will experience a lot of swelling (look under the Photo Journal section of this blog for a facial timeline which shows the degree of swelling) but if you are diligent in applying ice packs then the swelling will go decrease a lot in that first week. Around week 3 the swelling will plateau and, as in my case, you have a full face or as I like to say, a chipmunk face! :) The swelling will stay that way for anywhere up to one year believe it or not.

Remember, your bones have been broken, they need time to fuse together and heal properly. Use the ice packs, they help!
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Will my lips swell or crack?

Most definitely. It is ironic that out of all of the issues in the post-surgery recovery phase (swelling, bruising, aches and pains, medicines, etc.) I honestly think my lips proved to be the most frustrating.

I knew, prior to surgery, that I needed to use Vaseline or chapstick constantly so that my kips wouldn’t be dry and cracked. So I used Vaseline constantly but it didn’t seem to matter – my lips cracked and were painful to say the least, no matter what product I used.

My surgeon told me the problem was that I was using  too much of the product and so they could not repair themselves. So I only used Vaseline three or four times a day and my lips repaired themselves! :) Other people have suggested Lanolin or Bag Balm.
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How much bruising to expect?

Erm, I hate to say, It depends once again but it does! :) Some people experience minimal bruising, other bruise a lot. There is no rhyme or reason to it as it depends how much blood loss you have that travels under your skin.

I bruised quite a bit and it took three weeks for it to completely disappear. Heat packs help the bruising disappear. Getting the idea – apply ice and heat in rotation and it will help with your swelling and bruising!
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Ice packs and / or heat packs?

The hospital provided a Jaw Bra in the hospital which essentially allows you to put bags of ice down both sides of your head so as to help with the swelling. I asked for another one in the hospital just in case something happened to the original as I couldn’t live with that piece of equipment!

However, I found it laborious to say the least to fill bags of crushed ice and somehow manage to fit them down the openings in the Jaw Bra. My father-in-law gave me some ice-packs which were the perfect size and they also could be microwaved to act as a heat pack for later in the recovery cycle! So basically all I had to do was put them in the freezer, take them out when I wanted and slide them in the Jaw Bra. Worked like magic. The ice / heat packs that I used can be found here.

In terms of schedule, I iced exclusively for three or four days (ice is for swelling) and then I was allowed to use the heat packs (heat is for bruising and just making life a little bit better!). I essentially would rotate the ice and heat throughout the day. If you want the swelling to go down, ice, ice, ice! :)
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How do you sleep?

The short answer, not well, especially in the first week :) You have to sleep sitting upright for the first four weeks at least as obviously you do not want to be sleeping on your side ad letting your jaws slide down whichever side you are sleeping on. I have never been able to sleep sitting up prior to surgery and have always been a side sleeper but so far (30 days post-surgery) I have slept sitting upright and I am sleeping throughout the night presently though it was a good two to three weeks before I was able to do so. The first week I pretty managed on just a few hours of sleep a day as I needed to take pain medicine.
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Does surgery help with Sleep Apnea?

Never having been diagnosed with sleep apnea, I was not until I met with my Oral Surgeon a week before surgery that he told me that the surgery would help with snoring significantly and probably resolve it completely. My snoring was really bad (my wife would roll me over constantly throughout the night as she thought I was dying!) and so this was welcome news! :)

Even though I had the surgery because a different medical necessity, a great benefit to be derived as a result of the surgery was going to be resolving my snoring issues. Dr. Egbert tells me that if you move the jaw 6-8 mm forward it will effectively resolve sleep apnea and so when you consider that my lower jaw was moved forward 18mm he was very confident that my snoring would cease. Imagine your airways having that extra space and you can understand why the surgery makes a difference to my snoring!

Was he correct? Absolutely! I have not snored once since my surgery and even though I am sleeping in the upright position I am completely cured of snoring! Serendipitous as far as I am concerned (because I was ignorant I know, I know) but how fantastic is that, especially for my wife who now can enjoy a peaceful nights rest! :) You see, double jaw surgery is worth it!
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When can I chew again?

Typically, you are not allowed to even start chewing until week 6 post-surgery. After that, I am unsure as to the schedule as I only 30 days post-op so I will keep this response updated!
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Did you have to perform any jaw exercises. If so, when?

Day 30 was when my surgeon told me to start with some jaw exercises. You can read about them here.
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I suddenly have painful earache, why!?

At around the four to six week post surgery timeframe, I experienced significant earache, especially in my right ear and in the evening. Apparently it is completely normal because your jaw joints are finding their *new* position in terms of where they are sitting. Combine this with the increased amount of talking that you are doing (and consequent movement of jaw joints), and the result is increased pressure on the joints, which affects the ear structure. Hence the earache. . . 

It does go away. Apparently. :)
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When can I start exercising again?

My surgeon told me that I can start exercising (he made the erroneous assumption that I do actually exercise!) after the six week mark . .
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How do you clean your teeth?

Cleaning your teeth happens in a few phases, splint vs. non-splint.

Period whist wearing a splint: Let’s just say that I love my baby toothbrush! I could only brush the outside of my teeth obviously and I had to do so very delicately as it meant moving my swollen and cracked lips but it got the job done. Swilling the medicated mouthwash is not a pretty picture however as imagine having your mouth closed with liquid in it. How do you (a) swill it around and more importantly, (b) spit it out if you cannot open you mouth!?

See my point. You basically just let it drip out between your teeth. Long, laborious, and definitely not pretty.

Period when the splint is removed; Ongoing process as it depends upon how wide your mouth opens! Basically though I am using a regular toothbrush and I gingerly brush all of my teeth. I still use antiseptic mouthwash throughout the day as it psychologically convinces me that my teeth are cleaner as a result!
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Did you experience sensitive teeth?

Yes I did, especially around weeks 3 and 4. I wrote about it here.
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Returning to Work

This questions is one that only can be answered with a nebulous response of, It depends. It depends on the type of job you have, recovery, etc., and so really only your doctor can tell you!

For me, I returned to work (I talk a lot, present a lot, etc.) after a fortnight and truthfully it was too early. I still had my splint in and that made talking very difficult. Plus, it wears you quickly! So for me, I should have returned once my splint had been removed (3 week mark).

Talking a lot also causes a lot of aches and pains but the reality is, especially here in the US, you are only are allocated so much sick leave and so you have to do what you feel you can do. Not much of an answer really :)
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How easy was it to take the rubber bands off and on?

As with everything, with practice it became very easy and I was able to take six bands off and on within a few minutes. In the beginning however, it took quite a while! The key for me was that I needed to use one hand to position the bands and hold the scissor clamp / tool and then use my other hand to position the bands over the surgical hooks and / or brace wings with my fingers. Initially I tried using nothing but the tool but it was too difficult given the small space between my gums and the wire hooks. Using my fingers helped tremendously.

Once my Oral Surgeon placed the bands on each week (each week had a different placement or configuration) I would first of all draw the new design / pattern / configuration so that I would remember what position they were in so when I had to put them back on I knew where they needed to be! An example can be seen here.
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