Lefort 1 (~4mm), combined BSSO, sectional genioplasty, and genioglossus advancement (~18mm) and partial turbinectomy.
I had my five week follow up yesterday. There was good and bad news.
I have been cleared to blow my nose, use a straw, and use heat and light massage on my face and swollen areas. I was also cleared for a "two chew" diet: I can eat anything that I can gently chew twice and swallow. I thought I would only be approved for things like scrambled eggs, but they want me to begin reconditioning my jaw. I can eat tender meats, fish, buttered toast, cooked veg, biscuits (the flaky US kind, not crunchy cookies as in the UK), shredded salads, and sandwiches with chopped fillings. The advice is to make sure all foods have some moisture and are cut small. It's a bit easier said than done, but I did get down a slice of French toast (pain perdu) with maple syrup and butter yesterday. I was also advised to do daily stretching to work on my opening which is currently just over 1 finger. If all goes well, in a few weeks I will go to a "three chew" diet.
My surgeon pointed out that by 5 weeks the noticeable pockets of swelling are usually resolved, but given my "very large movements" it's not surprising that I still have significant pockets on either side of my nose, along my jawline and under it, and in my submandibular lymph nodes. The RN also mentioned my large movements and commented "we really did a number on you, so you are doing great for this stage!". They were very positive about my progress, but before my surgery I'm not sure I was given the context that my procedures were unusually significant compared to the average patient. I also learned my lower lip and chin may take months to improve (I cannot feel either and my lower lip feels huge) and due to my age, may not fully resolve. I kind of knew this, but it's sinking in now. I have a lot of lip tingling so I hope that's promising. They did point out again how unusual it is that I had tingling and sharp nerve pain just a few days post op.
They took out the 8 temporary screws, which feels great. The process was easier than expected: they just sprayed a dab of light freezing on each one then removed them with a manual screwdriver. The back one on the right was a bit difficult because I've had issues with nerve pain there all along, but overall the process was quick and painless and I'm happy to be done with the elastics. I still have to wear my aligners most of the time.
I had one small area where my incision had not closed properly so they put in two stitches. That required some light dental freezing, but again it was no big deal. There was very mild soreness where the screws came out but it resolved overnight.
My right lymph node is still hard but much smaller since I was on the antibiotics and the bruising has resolved, so thankfully they didn't feel I need any more antibiotics. My two weeks on metronidazole was a nightmare of constant nausea and food aversion so I'm really happy about that. However, that node is in the area where the wound did not heal properly and he's decided that the plate in that area should come out at about six months. I have a three month follow up to reevaluate. I have a decision to make: since he has to put me under to take out one of the titanium pieces, do I want them all out?
The two weeks on antibiotics were honestly worse than my first two weeks post op because my disgust with food has been profound. I could not even think about my favourite meal without feeling revolted. I have been off them for 1.5 days now and am taking lots of probiotics. I hope that resolves soon!
My philtrum is still very puffed out. The scar tissue under there feels very thick and I'm advised it will soften and smooth out over about six months. My midface overall is quite puffy to the touch. My nose looks a bit crooked right now but that is changing often as the swelling shifts. Using heat seems to be helping. If my nose ends up a bit wide he said he can cinch it a bit when I get the bit of hardware out.
My stitches mostly came out this week. It started with spitting out what looked like bits of black lint when I rinsed my mouth. Yesterday I decided to lightly nudge the ones above my top front teeth with a wet q-tip and they came right off. It feels great having them out.
To remove or not to remove hardware: I have asked a couple of medical professionals why hardware is routinely removed in Germany. I was told that Germany and one other country (I forget which) pays surgeons automatically for hardware removal without the need to show a medical cause, so the clinics automatically book patients for removal and advocate strongly that there is a medical benefit. In countries without that pay model, it's not routinely done or advised. In Canada, the feeling is that since 95% of patients have no issues with the hardware, it's unnecessary surgery that is stressful for the patient physically and otherwise with associated risks of poor wound healing, infections, etc. Given the inherent risks of putting someone under anesthesia and reopening healed wounds, and the need for a second recovery period, that seems reasonable to me. Here, removal is done when there is a medical issue, or when the patient requests it.
I studied medical anthropology for one year in university and it was VERY illuminating: e.g., in countries where doctors are paid to write prescriptions people get about twice as many prescribed drugs. In countries where doctors are paid by the hour instead of by the patient, patients get a lot more doctor time. The big takeaway was that in countries where doctors are paid to prescribe birth control pills and require annual pap tests to continue prescribing them, they are highly reluctant to advise any other form of birth control even when patients ask. There was a study showing the overall annual loss to the average medical clinic if they lost just 10% of their patients on regular birth control and it was absolutely staggering.
So, I am unsure if Germany has identified a medical need given the conflict of interest. Assuming that a busy jaw clinic may do hundreds of surgeries a year and doing a second surgery for each patient would easily net a few $million per surgeon annually. I'd like to hear a solid argument for automatic removal from a country where there is no clear financial pressure. (Germany, in general, has a very solid medical system, but studies have shown where a procedure brings in reliable income the pressure to continue it can be intense because the loss of that income requires a major shift in the clinic's budgeting and expenditures).
In my personal case though, there is a medical need to remove one piece and it seems reasonable to consider getting it all out at the same time. I have plenty of time to decide. He did mention taking out the plates on either side of my nose would slightly slim down the area. That's hard to picture right now given how swollen it still is. I sure to feel my chin plates when go out in the cold though.
