Today I attended the Pre-Admission Clinic at the hospital and met my surgeon one more time. I'm now finished all my pre-op appointments and the only thing I have to do is remember to show up at the hospital! I had all my last minute questions answered and I'm feeling much more confident about surgery (not sure how long this will last though!).
I arrived at the hospital at 8am for the Pre-Admission Clinic and first they put me in a room with about 5 other surgery patients (not necessarily having jaw surgery) and had us watch a 1/2 hour video about hospital procedures before and after surgery. This included fasting, registration, changing into hospital clothing, meeting anesthesiologists, starting an IV, and recovery room procedures. It was well done but made me really nervous! One tip from the video: remember to take out your dentures prior to surgery! Haha.
Next a nurse met with me privately to take blood, go over the specifics of jaw surgery, and answer my questions. I found out that I most likely won't have a catheter (phew!) and only about 0.5% of jaw surgery patients have needed a blood transfusion during surgery with my OS. The OR has been booked for 4 hours and 20 minutes for my case, but I'm assuming this includes prep time and isn't the length of the actual surgery. The nurse also gave me a snazzy red hospital bracelet that I can't take off until after the surgery (maybe it'll help me to get more sympathy at work on Monday?) and some pamphlets to take home. One of them has a few liquid diet recipes. Most seem okay, but some look disgusting! For instance, there's a recipe for "blended breakfast": 2 cooked eggs, 1 slice of buttered toast, 1 cup of warm homo milk, and maple syrup (optional). Gross! I guess I shouldn't knock it 'till I try it...
Later this afternoon I went to see my oral surgeon for the second part of our pre-op meeting. He had the models remounted and checked the fit of the wax bite again. It fit well and he was pleased. He's still thinking that I most likely need double jaw surgery but is going to prepare two splints for the surgery, one for double jaw and one for upper jaw only. His plan is to do the upper jaw first, moving it upwards 4 mm and forward 1.5 - 2 mm. Then he'll analyse whether the lower jaw is needed and go from there. He said that if the upper jaw wasn't moved forward at all that I may be able to get away with only the upper jaw, but usually the upper jaw is also moved forward a little bit because it helps to lessen the interference with bony structures behind the nose (eg. sinuses) and makes surgery easier. He also said that my bite may be less stable with only upper jaw surgery and that the only reason he's considering it is because of my TMJ history. I guess I'll just have to wait and see! Though given all the negatives he listed off, I'd be very surprised if I woke up to find I only had the upper jaw done.
The 4 mm of upper jaw impaction was determined by the amount of tooth I show when my lips are at rest. He measured that I currently show about 8 mm of tooth, and the average is 3 - 5 mm. So by moving my upper jaw up 4 mm I'll end up showing about 5 mm of tooth at rest (the lip moves up by about 20% of the value of the jaw movement, so this accounts for the lost mm). This should get rid of most of my gummy smile, but he wants to keep me showing more tooth rather than less because it's considered "youthful" and we progressively show less tooth as we age and our skin sags. Also, in his experience he's found that patients with gummy smiles tend to prefer to show a little more tooth than average rather than a little less tooth. I agree, and it'll keep me looking like me, only better. :)
I'm also planning on having a genioplasty. I was really hesitant about it at first but he explained that even with the auto rotation of the lower jaw after the upper jaw impaction, and the possible few mm's of forward movement with lower jaw surgery, I'll still have a pretty recessive chin. I don't want to go through all of this and not love my new profile! So I agreed. He assured me that he wasn't in the business of doing large chins and he prefers smaller, more natural ones, so I'll just have to trust that he'll give me a chin that works well with my new face. It still makes me a bit nervous, but I've seen lots of before and after pictures of jaw surgery patients who had their chins done and they always look great. For me, I think it's more the issue of getting used to a larger chin on your own face after you're used to having a weak chin. This whole process is definitely an exercise in faith!
My next post will be some official before photos, and then it's the big day! I'm looking forward to chowing down on lots of awesome crunchy foods this weekend. It may be a while before I can eat them again!
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