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https://imgur.com/a/JjRsFHB

Orthognathic surgery was the hardest physical experience I have been through, and I’ve had prior (fairly minor) surgeries before, and ran a marathon. I do not regret it for a second. I can breathe through my nose, my mouth rests closed, I have far fewer headaches and haven’t been sick nearly as often as before, and don’t experience numbness. My mouth doesn’t open as wide as before, but I’m working on that.

Pre-op I had an anterior open bite due to tongue thrust, mouth breathing (allergies, deviated septum) and a posterior cross bite. I had a two piece Lefort and BSSO. I was banded shut with a splint for 7 weeks.

Key takeaway list here, more detailed description below if anyone is interested.

Lessons learned/potentially helpful tips:

• First night: If you have a competent family member/friend available to stay with you, prep them, and then clear it with the hospital when you go days before your surgery. A letter from my surgeons may have allowed my sister to stay overnight with me, and that would have exponentially helped my experience
• If you’re going to a hospital with a bad reputation, consider asking to recover in the ICU.
• First night: Have a pad of paper/pen and a phone with an app you can type into. It was painful and difficult for me to write because of my IV bruising, but it was extremely necessary
• First night: Ask for pain meds.
• Get your ice pack/jaw bra on ASAP
• First night/hospital: Pack your comfort bag: change of clothes, deodorant, jaw bra, phone charger, paper/pen
• To get meds down, mix crushed up pill in something thicker than gatorade, like a protein shake, with stevia and chocolate syrup.
• Get two jaw bras so you can always have ice packs cold/ready. Use this for the first couple days, then switch to warm/heat
• Buy extra syringes, because over time they get stuck/don’t plunge easily. After the first couple weeks, I was using large syringes and ketchup bottles to get high volumes of water
• Food: in retrospect, I should have given up the Huel because, though it is calorie/nutrient-dense, it is a thick consistency. Drinking a few 100-200kcal protein shakes would have been easier than failing to drink one 800kcal Huel smoothie.
• Build a schedule of meds for you/your care team. You’ll have to wake up in the middle of the night for a while and having this posted helps (eg- 9am pain meds, steroid, 12pm pain meds, 4pm pain meds, steroids, etc.)
• I recommend breathing exercises months pre-op. Practice exhaling more than you inhale, breathing through one/alternating nostril at a time to get used to less oxygen. This helped me not freak out when congested and wired shut. Read Breath by James Nestor
• Speak up. Obviously it’s hard to without an actual voice, but the infection I had maybe wouldn’t have been so bad if they gave me antibiotics the first time I said “I think something could be wrong” vs days later “omg something is horribly wrong”
• It helped having someone come to follow up appointments with me
• Ask for help, and thank your people because I was certainly not at my best and needed a lot of hand holding and comforting. I couldn’t have done it without family around.

The first night in the hospital was a complete nightmare. I was on a general med/surg hall and the nurses were not equipped to care for someone like me. They had a very heavy ice pack one literally plopped onto my face (I cried from the pain), there was no way to communicate, they kicked out my nurse sister due to their overnight guest policy, even after the surgeons told me weeks and days before that she could stay with me in the room, I got very little pain med care until my family called in the morning to request pain meds. (even when she called, they transferred her call to me in my room. When I couldn’t talk…). My surgeons operate in a hospital known for sub-par care and told me afterwards they consider moving their patients to the ICU for that first night, but don’t due to cost and priority.

The first time I stood up to go to the bathroom, I sort of “threw up” basically just spit up a pile of blood that had been disturbed from standing. It wasn’t proper vomiting and it was over in an instant. Around 5am, the surgeons came to check on me, but I wasn’t able talk to them or even really remember what they said. But they did check on me and overall weren’t concerned! I had IVs in both my hands and the one in my dominant hand went bad, so it hurt immensely to write, which was the only way to communicate. Later on I downloaded a text to speech app and had fun changing the voices/accents every so often

Later days:

I was very weak, and eating and drinking was a huge challenge. Using the syringe to drink water even became tiring. Crushed up meds tasted ungodly. My smell and taste the first days post op were EXTREMELY sensitive (I thought my mom smelled like rotting meat every time she was near me). I was congested the first ~1-2 days only. Breathing exercises, nose strips, and nasal decongestants helped.

Unfortunately I developed an infection in one of the stitches on my upper right side. At my first follow up appointment, I mentioned to the surgeon it didn’t look right that one side was still more swollen than the other and seemed puffier? In a way. He brushed it off because it was so early, and swelling is often not even. Over the weekend, this wound started dripping blood and the foulest smelling/tasting green fluid into my mouth. Every 20-30 minutes my mouth would be partly filled with this putrid puss. We had to wait until the office opened on Monday, but we got in. They had to manually extract what they could (like popping a huge pimple, insanely painful, there were tears), I had to milk the infected site over the next week as the antibiotics got to work. This is what pushed me to the edge, mentally. Starving, in pain, swollen, and now constantly tasting something that makes you want to vomit. I wasn’t sleeping more than an hour at a time because I’d wake up needing to puke. I also could no longer use mouthwash because it inhibits tissue regrowth and I needed that gap between the stitches to close. Rinsing with a neti pot helped eventually. After the first couple days, you should put heat on your cheeks with the jaw bra, but it was so hot because of the infection, I still liked ice or using an ice roller.

With the splint and banding shut, I could only take water thickness consistency liquids through the syringes/catheter tubes. I planned to eat Huel blended with spinach, fruit, greek yogurt, etc to bulk up with calories, however, the Huel itself was too thick. We ended up diluting it with water ~3-4x and filtering it through a fine mesh. It was miserable and I starved for a few weeks. Eat anything that works (soy milk/nondairy ice cream melted was a treat that helped my mood a lot, but I was afraid of eating too much sugar and didn’t allow myself this very often)

Going for walks every day helped mentally too, even if they were slow.

Maybe the infection slowed things down, but I (29) needed a fair amount of help for the first two weeks, and went on short term disability leave for 7 weeks. I was so weak because of the decreased food/splint and feeding/watering myself took so much time out of the day.

I’m 8 months post op, and still have some orthodontic work left (surgery created a posterior open bite/back teeth don’t touch). Chewing hasn’t come back as easily/fast as I expected because of this, but I can eat most things now. I had lingering swelling in my nose especially for months. Don’t judge yourself too quickly!