The musings of a final year medical student

Tuesday, 10 February 2015

Orthagnathic surgery

I thought today I would talk about something a little different, a subject which I think is worth discussing for others contemplating this operation.

In brief, I have an overbite and it is going to be corrected through surgery this Summer. An overbite can be classed as a facial disfigurement, but I would never say that I had a facial disfigurement because it is not particularly visible from just looking at me. There is a misalignment of the jaws, whereby the lower jaw is more recessed than normal in relation to the upper jaw. It is normal for the lower jaw to be slightly behind the upper, but mine is too recessed. In addition, in my case the actual angle of the jaws is incorrect.

So what does this all mean, and why surgery? 

I began developing an overbite when I was 15, and didn't realise I had one until I got braces just before I turned 16. But what I did notice was that it became more and more uncomfortable to play the flute. For some unknown reason, I could only play a page of music without my chin and jaw feeling so tense that I had to stop playing and wait for everything to relax again. This was incredibly disappointing, because at that time I was about to take my ABRSM grade 6 examination, but the jaw problems took all the fun out of music lessons, so I gave up. An orthodontist later explained to me that the overbite would've been a key factor in that. 

In addition to this, I began to really struggle to eat. I've now become accustomed to my jaw and nobody would particularly notice that I didn't eat in a normal fashion, but it is difficult. It is also really hard to eat with my mouth closed, so it's quite a laboured process to eat without looking rude! 

However, the thing that affects me the most is the difficulty in keeping my mouth closed. Something so automatic in everyone is really tricky. To keep my lips together, there is a lot of tension in my chin which causes dimpling on the skin. I can only really keep my mouth closed for about a minute at a time before it feels too uncomfortable. Although this is not essential, it does make me feel self conscious if I am having a conversation with someone or if I am sat by myself and am not talking, so should be expected to have my mouth closed. 

So, when I began orthodontic treatment, I was offered to undergo orthagnathic surgery to correct the overbite. This involves in my case that an incision on the inside of the mouth is made, breaking of both jaws (for others only one jaw is required to be broken) and they are repositioned and screwed together. This is then followed by a few weeks of liquids-only diet, as elastics are applied vertically across the braces so that you can barely open your mouth. This is done to allow the jaws to heal, which takes approximately 3 months. 

I didn't want to write this post as a 'poor me' rambling, but because there are many people who have considered this procedure, and for obvious reasons it's a really hard decision to make. Will my symptoms go after the procedure? Will it be sore afterwards? How risky is this operation? Is it really worth it?

If you're considering this surgery, I would say that every case is different and your decision should be based solely on yourself. What I mean by this, is to understand what problems your overbite/underbite is giving you, consult your surgeon if these have a likely chance of being eliminated. Just because I have a similar jaw-related problem as you and have decided to go along with the operation doesn't mean you should, too. If your problem is affecting you on a daily basis then I think that's a strong reason to do it. 

In terms of actually having the operation, that's been a little more complicated. You are required to have your braces on for the procedure, as they are used as a guide and this is where the elastics are attached after the operation. I was due to have this done in Summer 2014, however, when my orthodontist moved hospitals there was a lag in the hospital administration, I didn't see my orthodontist for months and so I hadn't completed all the prep work in time for the operation to take place. Prior to the operation, wafers (molds) need to be taken for the surgeon to practice the operation using a model of what your jaw is like to see the exact measurements each jaw is required to move. You need to see a dietician to advise you as to how to eat healthily on a liquid-only diet. You also need to have lab tests and such to prove you're healthy enough to have the operation. It was very disappointing to have missed the operation because I wanted to have my jaw corrected before I came to medical school. I wrote the whole summer off, no holidays or festivals booked because I assumed I  would be recovering in that time. I desperately wanted my braces off before I went to university.

Due to the short holidays of my medical school, the next viable time to operate is this Summer 2015. I am scheduled to have the operation done 2-3 weeks after my term ends on 8th June. Nothing is guaranteed, not even on the day of the procedure, because if a patient enters A&E with a severe maxillo-facial injury requiring surgery, then clearly this is prioritised as it is an emergency. My surgeon and orthodontist seem very optimistic. I have been having appointments alongside medical school and my next one is in April where they're going to see if the wafers previously made still fit, and I will probably see a dietician as well. 

I can't tell you how excited I am for this. I am now 19, I have had braces for almost four years and I cannot wait to see the end of them! It is very frustrating that I still have to wear them even though my orthodontic treatment finished 2 years ago. There is one other medical student in my year with braces, but I expect he'll manage to get rid of his before I do! Now all I hope is that the operation actually happens - with it now being almost a year late, it couldn't happen any sooner. 

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