As I said in my last post, I started to question a few things going on with all of my planning and the collaboration between my team. I actually had quite a bit of anxiety going in to this appointment. Enough that I ate a xanax for breakfast the day of. I was afraid I was going to walk in and feel rushed, feel like my records got pulled up out of their system for the first time in a year and he would talk vaguely about things like he hadn't even looked at them in the last year and forgot about me. Thankfully, I didn't get that feeling at all. He seemed up to snuff on everything; like he had been looking at things and thinking about my case. Phew. Good. He took a look at my molds. At first it seemed like all was well starting with a look at my left side first, and then when he took a look at the right....he paused. I wasn't class I on the right when he brought my lower jaw forward with the molds. Dammit. So he starts explaining that he needs to talk to my ortho and see what they are going to do. If it's something they fix prior to surgery, we could be eyeing surgery dates in March/April. And even with that he didn't sound certain. On the other hand, we can proceed with surgery sooner rather than later and fine tune my right side post op. I really get the feeling that in a perfect world, he would advocate for the ortho on the front end, but right away he mentioned that he knows I am looking at taking a new job that is pending my surgery and subsequent healing months after. I also mentioned to him that I already bought plane tickets for my mother to fly from Philly to San Francisco to take care of me through February. Thankfully it's Southwest Airlines, so I can always put those tickets off. I told him of course I am ready to go with whatever the team decides is the best thing to do. I don't want to rush things and risk a worse result for it. But if we can do the surgery first and still get the same results with doing the ortho after, then I kind of am leaning towards doing it first for a ton of different reasons. I am getting pretty sick of trying to plan my life around all of this and constantly having to shift it back.
My surgeon opened the floor to me for questions and stuff. Of course in the heat of the moment I always brain fart and forget what to say. This is one of the reasons I encourage patients to go in with everything written down before hand. I didn't do this since I was running short on time before the appointment. He confirmed that he is definitely doing a 1 piece lefort on the top jaw now that my ortho has expanded me enough. If all goes well, 1 night in the hospital again... and this time in a private room. YES!!!! He is sending me for CT/MRI/Xray stuff soon and he'll use that to look at a few more things as well as start some 3D surgical planning. I asked him if it was OK that I can be apart of that. If he can make a long appointment with me and sit and walk me through everything with the program and modeling. He said he would be happy to. Phew. I need that after what happened to me the first time around and I am glad he understands. He also asked me for a list (in order of biggest issue to smallest issue) of what I would like fixed and my expectations for revision surgery. I got around to getting that to him today:
Functionality. I would like to achieve class I skeletal and dental to be able to chew and bite through food properly for the first time in my life. Also to help in the long term health of my teeth and joints. I've always experienced face/head strain and headaches due to my bite. It's been much worse since the first surgery. I am hoping with a class I result, the face/jaw strain and headaches will improve. I have always clenched too, but I think part of that is stress which is something the surgery won't help, but an even larger part of it is clenching down to be able to close my lips over my teeth that stuck out. I know improvement in clenching is not guaranteed, but hoping I can see a bit of improvement there post op.
Upper Jaw Too Far Forward. I had an overbite/overjet and lip incompetence before the first surgery and it was never in the plan to move my already prominent upper jaw 4mm forward. I would have never agreed to it, but somehow for whatever reason it was done and done without my knowledge or consent. It's left me with a really full upper lip and significant strain. You can't even see an indentation in the philtrum anymore. That combined with the other issues has caused major lip/cheek/mouth/mentalis strain and sometimes cramping around my mouth. These muscles are also just constantly tired and sometimes even lock up a bit and make speaking/eating difficult. Aesthetically I would like better lip competence, but primarily I am looking for better comfort if we can lessen the strain I'm experiencing. I am hoping the upper jaw can be taken back enough (and lower jaw forward a bit more) to help with this.
Upper Cant. I understand the lower is canted as well, but the upper seems much worse and definitely less aesthetically pleasing. I am not sure how much I was impacted with the first surgery, but it was very obvious even a week or two post op it was lopsided. My VME was much worse prior to the first surgery. My left anterior gum line is probably in a good spot now with the right canted a few mm lower. I feel like in the posterior there is still maxillary excess. If everything can be evened out where it should be, I will be happy both functionally and aesthetically. Overall though I would rather be a little under impacted vs. over impacted to keep a little youthful appearance and avoid additional mouth/skin sagging later in life.
Asymmetry. I completely understand that the asymmetry will be difficult to fix, with some of it even being impossible to fix. Unfortunately that is the deck of cards I've been dealt with that and I am approaching this one as realistic as possible and will be fine with whatever results we can manage for this, even if it's not perfect. Aesthetically my biggest issue is the facial asymmetry. I think I always had more of a square face, but it was pretty symmetric prior to the first surgery. Immediately post op I noticed the bulge on my lower left side and saw I was sunken in on my right side. I was told by Dr. O'Ryan that it was an infection and associated hematoma, citing that I must have ripped a stitch down there to cause it. We now know that isn't what it is at all, so now the question is, is it fixable? I think you said in my initial consult that this may require a third surgery down the road to fix the gonial angle on that side. I may revisit this down the road (but maybe not if it's only for the sake of aesthetics), but I would like to understand more of how this may change in revision if the yaw is corrected and whatever CW/CCW rotation is done may change it. I actually still don't fully understand how my bones got set to make this asymmetry happen, but I am guessing it has to do with the yaw/rotation that maybe only one proximal side of my mandible saw? Otherwise functionally, I would like the yaw/rotation/cants leveled out (both upper and lower jaw) as best we can to achieve a good class I skeletal/dental.
Nose. This is definitely a last but not least kind of thing. I know when the maxilla is impacted and moved forward that the nose changes are almost unavoidable. Some surgeons try to tidy it up a bit with an alar cinch. My operative report says one was done but I still feel like I saw a significant widening of my nose. If that is the price I have to pay to have the jaws moved in a functional position, then so be it. I am willing to pay it, but if there is anything you can do to avoid any further significant widening, it would be much appreciated. I am hoping that I saw additional widening because my upper jaw was moved too far forward, and maybe it won't get worse (maybe even get a little better?) when it's moved back. Otherwise, my nose came out pretty symmetric after surgery from what I can tell and hope that the second one will be uneventful in that department.
Paresthesia/Nerve Damage. Another thing that I understand is almost unavoidable, especially for my age and even more so for revision surgeries. I understand my nerve has already lost some elasticity in it form the first procedure, and there will be scar tissue around it to battle as well. I am not expecting miracles and I am willing to pay the price of a little more numbness/tingles if I can get the class I functionality, but if any extra care can be taken to prevent further damage (right now I currently have paresthesia in a strip down my lower lip/chin on my right side as well as through most of the gums on my right), it would be greatly appreciated.
So, I feel like what I am asking for is fair. And I feel like my expectations are fair. And if they aren't, I hope he knows he can tell me and I will definitely be able to understand and work through whatever we have to. For the most part I am pretty easy going.... surprisingly even when it comes to something major like relocating bones in my face.
So.. that is that. I am kind of just floating in limbo. The frustration I've had with the limbo thing the last few months just continues on, which is even more frustrating when I was hoping this was the appointment that would end those frustrations. Kind of funny how life works sometimes. I don't have another appointment set for the surgeon, I don't have my appointment set (yet) for the CBCT/Xray/Ect, I see my ortho on Mon for I don't even know what. Just to check in? Hopefully he talks to my surgeon and can give me an update then. I need to figure something out because my work already has me on our published February schedule for sick leave, my mom's plane tickets need to be canceled, and I would need to put in for more leave to take weekend days off and go snowboarding some more (I know... sucks, doesn't it? lol At least there is ONE good thing that can come out of this!).
Last little bit for this already long post---- The work thing I really need to figure out asap. We have a big event the first week of February that they would rather me there for. I am honestly not tripping all over myself to do it because I got royally hosed on the schedule for it and they are bringing in enough temporary forecasters to more than cover me if I am gone. So, super hosed. Like, embarrassingly hosed. I was thinking this would be the last week I would be at work before surgery. Usually I take that week off since I am a nervous wreck that can barely function, but for the big event I figured I could tough it out. My office is usually not open overnight, but for this event we are. I LOVE overnight shifts. Weird, I know, but I like them vs. working morning shifts. Plus for me it would be the less stressful shift in a week I don't need the stress before surgery. A week I am already going to be a walking xanax filled basket case. A shift that would have less talking. Less people mingling with less talking. Less opportunity for me to drool all over myself in front of high level management. A shift I wouldn't have to go out and drop a wad of cash on new business attire for. Why? Because I can't fit in to any of my business clothes right now with the extra 20lbs of pre op weight. If I work day shifts I would have to go get new business clothes that I am just going to turn around and not fit in a week later because I am going to drop all of my weight being wired shut. (we don't normally dress business, but for this event we will) So, I figured my request to take all of those shifts was fair. I didn't expect a fight for them since nobody likes working overnight shifts. Turns out.....everybody wanted them! WTH?! So, despite what I thought was legit reasoning with my request.... I get none of the shifts. Nope. Nada. One of our guys wanted them, and having the scheduling powers to do so, schedules himself for all of them. Talk about a kick to the balls. Sorry, but that is really how I feel about the whole thing after pleading my case, which included the brutally honest embarrassing reasons like how I can't fit in to my business clothes right now. So, I was kind of thankful I had surgery coming up to just say 'peace out' to all the hassle of it, but now it sounds like I might have to go back on the schedule. Ugh. Again, more of the limbo frustration to deal with. On top of the work frustrations. On top of all the other frustrations. I just can't wait for a week where I can finally get some good solid news and stop being frustrated!!!