May 2nd, 2014 - 20 Days until my surgery (First Post)

         Hi guys, welcome to my blog. I will be tracking my progress throughout my procedure that is scheduled for May 22, 2014 (3 weeks from now). Leading up to this point I have found it very helpful to read through all the different jaw surgery blogs that are available on the internet. It really put me at ease to learn a bit about the process so that I wasn't completely blindfolded going into my own surgery. I just want to pay it forward and share my experience with anyone out there that may require jaw surgery in the future. I have read many of the other blogs and taken notes on them, so I hope to share all of the best tips for a great recovery.

Background information:

     My name is Shane and I am 20 years old. Ever since I was very young my dentist told me that I seemed to grind or clench my teeth a lot during the night; he could tell by the wear and tear on my teeth. By the time I reached 10 years old I started complaining to mom that my jaws were a little bit sore when I ate. Of course, this just started out as very, very mild symptoms. These symptoms progressively got a little bit worse as each year passed, but they were only related to eating.
     In my grade 9 year, out of the blue, I started to have arthritic symptoms in both of my hands. All of the joints in my hand (but not the wrist) would ache with every movement. It bothered me a lot at the time in my gym class. It didn't seem to really affect my performance in most sports but it made it quite uncomfortable. I loved sports and wasn't going to let that stop me! My mom brought me in for blood work that revealed I had a slightly high R factor. This marker can indicate if a patient has rheumatoid arthritis. My level of R factor was just a little bit above the threshold that would indicate an arthritic patient. To get through the year I was taking ibuprofen for the pain. Before I knew it, all those hand symptoms were gone by the summer and I still to this day have never experienced anything like that again. For all I know, this could be unrelated to what is happening with my jaw. Whenever I go and see doctors about my jaw I always mention this incase there is some relationship.
      Back to the jaw. As I said above, my jaw symptoms have pretty much slowly, but steadily worsened with each year. I got braces at the end of grade 9 and they were taken off at the end of grade 11. The reason for them was just that I had both of my top eye teeth pulled down to the level of the rest of my teeth along with some minor straightening. Here are some pictures of me below on the day that I got my braces off:

Here is a nice little momento of my time at my orthodontist's office. It was supposed to be a farewell gift, but I ended up having to come back a couple of years later.

                             
                           

                                                 My bite has not looked this good since.

                                                                 

          My regression into the symptoms/problems that I have today can be tracked by looking at my lower jaw year-by-year. What has gone wrong is that due to my constant grinding/clenching of my teeth during the night growing up, the articular cartilage that cushions the head of my mandible (lower jaw) into my skull has worn away; leaving me with bone on bone contact. Basically, the head of my lower jaw is eroding away. Due to this, my jaw began receding as a function of time.
       

       Based on pictures of my past, I've estimated that my lower jaw structure started to change at some point in grade 11.

         As I said, I have read MANY of the jaw surgery blogs out there on google and it seems that most people are having TMJ (temporomandibular joint) problems because of either an over or under development of their mandible. My case is a bit different as I have a deterioration problem as opposed to a growth problem; though the end result is still an under-developed mandible. Below is a younger picture of me just to show that there were never any visual signs of jaw problems as I was growing up, until-mid high school:

                                                                around 13 years old

         After getting my braces off, my symptoms were still worsening and my jaw was getting shorter and shorter in length. What also started to happen was that I was losing occlusion of my teeth (my teeth of each jaw were not coming together properly, which you will see later in pictures of me today). Because the mandible is an L shaped bone, if deterioration happens at the head, the jaw is going to want to recede back into the socket where the head sits. The result is that as the jaw recedes, it will also rotate the jaw downward so that the front teeth come apart and the back teeth are closer together. This altered position of my jaw causes a lot of tension to be put on the chewing muscles, especially my masseter muscle; trying to massage it is like playing the harp but with enormous strings (knots). I am also known for being THE SLOWEST eater on the planet. Back in grade 11 or so my brother timed me while I ate a 6 inch sub(way) for 18 minutes!

            Ok, so this pretty much brings me to today. Below are all of the main symptoms that I currently have with my jaw today:

-tender/sore jaw muscles
-limitted jaw opening
-jaw fatigue/discomfort all the time
-jaw pain when eating
-less ability to talk
-tight neck muscles
-difficulty swallowing (only within last year)
-clicking or popping jaw joints (only within last year)

        Only a couple of these symptoms came on within the last year. Two other noticeable symptoms that are often mentioned by people are headaches and locked jaws. For whatever reason, I thankfully have not experienced these.

Here are some pictures of me today:

                                                                                                               

Above here are my side profiles at 17 and 20 years old. As you can see, my lower jaw has receded more within these 3 years indicating that there has been more degeneration of my lower jaw.

This is just a picture showing a small patch of white hair that has been growing behind my left ear for the past year and a half. It is a bit more prominent when my hair is longer (I just got it cut) but for the most part it doesn't bother me. This is known as Poliosis and can be a sign of an autoimmune disease (arthritis for me). I've seen other people with this too, but it is usually just a birthmark.

Here I just took this picture to show how my teeth are coming apart at the front. As my jaw recedes, my teeth move farther apart. This is me biting down, so only my molars are touching when I do this. People that have this problem know that it is very difficult to eat thin foods that you can't grab onto with you front teeth; you've got to get it back to your molars to chew. It is also hard to finish your "s" sounds with this gap in your teeth.

        In the summer of 2013 I finally was referred to Dr. Tocchio; an Oral and Maxillofacial Surgeon in the Toronto area. He met with me and said that he has seen many cases like mine before and that he could fix me. Before I met him, I read a lot of great things about him from both the internet as well as my dentist and orthodontist. He is said to be "the best" in his field. My procedure was booked on June 2013 for May 2014. I am in post secondary school and will have a whole 4 months to recover before the beginning of a new school year. It was at this time that I was officially diagnosed with having degenerative joint disease (a form of arthritis).

The Procedure:

          There are a total of 3 procedures being done on me. The first is shown below and it's goal is to align my jaws so that my teeth will come together properly:

https://www.youtube.com/watch?v=LiUMaokTidw 

This entails them cutting off my maxilla (upper jaw bone), changing the angle on it, and then holding it in place to heal with screws. This will bring my teeth together for a proper bite. I haven't been told this by any professional, but a Leforte Osteotomy is the name for this procedure that I've found online.

         I got braces put back on (for the second time) last summer right after my consultation with the surgeon. They wanted to align some teeth a bit so that when they changed the angle here my teeth should fit together perfectly. This will reduce the stress on my jaw and hopefully relieve a lot of my symptoms.

         Secondly, they are going to do what is called a genioplasty. This is where they will move a small piece of my lower jaw forward to help my appearance and make it look as if I never lost any bone mass.
                                          https://www.youtube.com/watch?v=d_ExY370wbA

        The final procedure is totally unrelated to my jaw problems, but I'm actually having all 4 of my wisdom teeth taken out at the same time.
     
I was told that the procedure would only take 1 hour. Believe it or not, it turns out that what I'm having done is an easier procedure to do. I've read blogs about people with cross-bites and other horrible things that need 3-5 hours of surgery and their mouth wired shut for 6 weeks. I will not have my mouth wired shut at all.

What I know about recovering after surgery:

         My surgery is on a Thursday, so on Tuesday I will make the trip to Toronto to have an appointment with the surgeon to get a bit more information about how everything will work. On Wednesday I will have x-rays taken. I need to be at the hospital for 6:30am to have my surgery at around 9-10am on Thursday. I will stay the day and night there and then if everything is going well I'll leave to go home the next day. I will be on a liquid diet for the first 2 weeks, soft foods for the 3rd week and then after 4 weeks I should be able to eat anything that is not extremely hard. Nutrition is CRITICAL for recovering from surgery. The better you feed yourself, the more quickly you will recover.


        Swelling: The longer that your surgery takes the more that you're going to swell. Mine is only 1 hour so I won't be awfully swollen. I've seen some people that had surgery for 3 hours and their head was the size of a melon. However, most of your swelling will go away within the first 7-10 days and it won't be noticeable at all really after 2-3 weeks.

        Pain: I have heard that when you wake up after surgery you may be a bit nauseated but you are too swollen and numb to feel a whole lot of pain. It is during days 3-5 where you are in the most pain as you start getting sensation back on your face. People have said on blogs that the pain is no more than a 4/10 during this time if you are not taking any medication. Overall, people say that after day 10 they start feeling much better and it is much easier to get through it.

        Sensation/Numbness: You will be very numb when you wake up. It really depends case to case how quickly sensation will return. During surgery, the surgeon tries to preserve nerves but small ones have to be cut to do the surgery regardless. Nerve fibres have the ability to regenerate, so if they are cut they may take some time to do so. The rule of thumb seems to be after 1 year, the amount of sensation that you have is the amount that you'll have for the rest of your life. Generally people will get all (or almost all) of their sensations back. There are some cases where a small portion of their bottom lip (for example) will never feel again. It seems horrible, but people say that they get used to it and it doesn't bother them at all.

       That is about it for my first post, that took me a really long time to write up. I will probably be posting again a few days before my surgery or if I forgot something important that I want to share. If anyone has any comments or questions I would be more than happy to answer any questions. Also, if someone who knows better than me catches something that I was not correct about let me know! Bye :)