My Jaw Surgery - Sagittal Split Osteotomy

In February of 2000, I broke my upper left jaw joint as a result of a fall from a
2nd story hotel room in Paris. The way the bones healed caused a gap on the left-hand side
of my bite (you could slip a quarter in and out between the top and bottom rows of teeth). My
bite was also twisted. My orthodontist also decided to correct some crowding in my front lower
teeth. Added up, I was left with a gap, twist and overbite. Enter "Sagittal Split Osteotomy".

This operation is performed on the lower jaw (mandible) in order to move it
forward (in the case of a deficient lower jaw), or backward (in the case of a large lower jaw).
It is performed behind the back teeth (not in the joint) and the jaw is sectioned
in such a way that bony contact is always maintained. There are no gaps in the bone
that have to be filled in, and it is not necessary to wire your teeth together during the
postoperative healing period. Rigid fixation is now commonly used for the postoperative
healing period, and this surgical technique eliminates the need to wire teeth together.

The operation was performed by Dr. Todd E. Crowley, of "University Oral & Maxillofacial Surgery"
on Tuesday, November 6, 2001. It took about 2 hours and according to Dr. Crowley went without
a hitch! :-)

During the healing phase I was not wired up (as explained earlier) but I did wear a couple
rubber bands between the top and bottom rows of teeth and a plastic splint that was wired to my top row.
This was all part of the process of retraining my muscles to the new bite. I have to say it was relatively painless.
In fact, I've had discussions that were more painful. To me, the worse part was the swelling. Even five days after
the procedure my face was yellow and bruised in places. Compared to Paris, though, this was a cake-walk! I am
not sure if it was the soup diet, the swelling or a combination of factors, but I wasn't really "right in the head" until
about 5 days after the surgery. Perhaps I was still coming off the anesthetic, but I was in a sort of daze; and by
5pm... forget it! I needed to sleep.

There was also the complete numbness of my chin, bottom lip and gums. This is caused by the way
the surgery disturbs the two main nerves that control that area. They run right through the bone
that was cut. Dr. Crowley said the nerves themselves are really big (about the size of spaghetti) and
it is very rare that they get completely cut. In my case in fact, Dr. Crowley didn't even see them during the
procedure, yet my chin was still numb afterward. Recovery from this takes the form of a shrinking circle.
Think of the numb area as a circle around your chin and bottom lip. As the sensation comes back, this
circle will shrink. I still had control over my chin and lip: I just couldn't feel them. Even after a month I still
had a pretty big circle, though at that point I was getting some tingling and itching in the "dead"
area. In Paris, I almost bit my tongue off (3 stitches) and had no feeling in the complete right half of it. That all
came back in time, so this should too.

I wore a face bra (if you're expecting pictures, don't... I have SOME dignity <g>) and iced
my skull all day trying to get back in the pink. Below is photo documentation of my progress. Please
excuse my disheveled appearance on some of the days: when your entire head is swollen your don't really feel
like placing it under hot running water to wash. <g>

Finally, a word about the doctors. I cannot say enough about the staff and doctors who were with me
through this. My surgeon, Dr. Crowley, is a great guy who spent more than ample time answering all my questions
both before and after the surgery. All the doctors at my Orthodontists office (DRS. HULL, BURROW & CASE, P.A.)
are excellent as well. All and all, I couldn't have picked a better team to rearrange my face! :-) And TALL... geeze,
is there some kind of height requirement to get into dentistry school?

What to Expect Post-Op

• Numbness
  - You'll have a loss of feeling in your chin, bottom lip and bottom gums. See above for a more detailed
  explanation of this.
   
• Swelling
  - Immediately after the surgery you're going to look like a squirrel preparing for winter. Keep elevated
  for the first few nights and keep icing your face. The ice helps reduce the swelling and actually felt
  great too. Don't expect it to go down all that fast. After my major swelling subsided, I still had
  some around the actual area until week 3!
   
• Loss of Energy
  - It was pretty bad for me up until day 5 after the surgery. Dr. Crowley said I didn't lose that much
  blood, so the extent of your tiredness may vary. My surgery was on a Tuesday at 7 am and I actually
  expected to return to work the following Monday! HA! I didn't go back until Wednesday of the NEXT week...
  and I sit at a computer all day. Do yourself a favor: take the time and recuperate right.
   
• Disdain for Soup
  - This is a little joke, though you will be taking mostly liquids for the first little while. Targeted full recovery
  time for me was 10 weeks, during which time the solidness of the foods I could eat was progressive. You
  will typically start with liquids through a syringe and end with solid foods again. Don't force it!
   
• Weight Loss
  - If you're like most Americans, you're probably thinking "YEEES!". Well, you can expect some weight loss
  due to your adjusted diet... but DON'T OVERDO IT! Your body is healing and it needs vitamins and nutrients
  to do it right. You need to eat. Just eating soup (Tomato, Cream of Chicken, Green Pea) I was still able to
  drop 15 pounds. I can't emphasize this enough, though - EAT!
   
• A Mouth Full of Plastic, Metal and Rubber
  - You'll be fitted with this little plastic splint that will be attached to your top teeth. The purpose of this
  splint is to help train your muscles to the new bite. It takes a few days to get used to and it's difficult to
  talk with it in. It makes cleaning your teeth harder as well. My advice is to avoid sticky or small foods
  (like rice and CousCous). I found cleaning my teeth after this type of meal to be a real pain.
  
  You'll wear some rubber bands as well, between the top and bottom rows of teeth. These help keep your
  jaw still as you heal and you wear them all the time (except when eating your soup <g>). Not to worry,
  you'll be popping them on and of like a pro in no time.
   
• No Pain
  - Honest! When Dr. Crowley told me this procedure doesn't hurt, I thought he was suffering
  from a loss of oxygen (he is pretty tall after all <g>). Once again though, he was right. The only discomfort
  I experienced was after a long period of talking and sometimes if I brushed my teeth too vigorously and
  poked the healing areas with my brush. Day to day activity was pain-free since day 1. Amazing, but true.
  I actually poured out the liquid pain killers they gave me because I didn't need them. Maybe I'm getting
  adept to pain (having a French guy sew up your tongue is not a pleasant experience and would toughen
  most people up) but really, it wasn't bad at all.

• X-RAYS. Click here to see some pictures from before and after the procedure.
   
• Recovery Pictures. Click the links below for photo documentation of the recovery period with commentary on how I was feeling, etc.
  
  Day1    Day2    Day3    Day4    Day5    Day6    Day7    Day8    Day9    Day13    Day30
   
• FAQ. I get a lot of e-mail from people who who have had or are having this procedure or one like it. Their questions are often the same, so I've put together this little FAQ in the hopes of answering yours.

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