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My Double Jaw Surgery: The 7th and 8th Weeks After Surgery

It's been 8 weeks since I underwent maxillary and mandibular advancement surgery to treat sleep apnea. Although the initial healing was complete after only a few weeks, there are still ongoing issues to contend with as the tissues undergo further remodeling.

In week 7 I began to notice the sensation of pins and needles on the right side of my tongue. Until this point, I had been experiencing an annoying discomfort on my tongue, which felt rather like a burn, canker sore, or similar injury. However, the surface of my tongue appeared normal, so instead it seems that I was experiencing dysesthesia, which is an abnormal sensation of pain without a stimulus. Often when we think about numbness, we think of an area that is completely lacking sensation (called hypoesthesia), however this is not always the case. There are various types of altered sensations that can occur, including paresthesia (altered sensations like pins and needles or crawling skin) and various types of dysesthesia (painful sensations). So at this point I would consider one half of my tongue to be in the parasthesia phase, as it is tingling.

One benefit of these nerve fibers slowly coming back to life is that I do think my taste perception has improved. My taste was fairly drastically altered (called hypogeusia) after the surgery, and around week 7 it seems to be around 60% of normal.

So it was during week 7 that I decided to undergo more surgery. Crazy, I know. But let me explain. I have extremely thin bone around my lower front teeth. Not pathologic (meaning nothing wrong with them), just genetically predispositioned to thin bone in this area, as is very common. So before I even started any of the orthodontic movement, I was sure that my lower front teeth were going to need gum grafting, because those teeth were lingually inclined (meaning they tipped towards the tongue) so in order to correct this they needed to be brought buccally (towards the lip) which was going to pull them out of their thin bony housing. In essence, this caused some not-unexpected recession.

Besides the recession, you can see the fibrous tissue attachment, called a frenum. In my case, due to the location where it is attaching at the gumline it is not ideal. You can actually see how the frenum is pulling the tissue away from the gumline.

My wonderful boss and friend, Dr. Duy Anh Tran of Beaverton Periodontics and Riverplace Periodontics, was gracious enough to perform two types of gum grafts for my lower teeth. The first was done using donor tissue (human cadaver) and extended from molar to molar. This was done about 3 months prior to my double jaw surgery. This did help thicken the tissue and also achieved some tissue height back from where the recession had occurred around the posterior teeth).

However, as the teeth continued to move orthodontically, some of the sites re-receded, mostly in the lower front teeth area. Again, not surprising, since this is where the bone was so thin to begin with. A very effective procedure for improving gum tissue thickness (called biotype) is called a Free Gingival Graft (FGG). No, that doesn't mean free as in it costs no money. It means it is using the free edge of tissue (or outer layer) from the palate. This epithelial layer is then transplanted onto the site where thicker tissue is needed.

In my case, week 7 was the ideal time to do more grafting. There's been enough healing from the major surgery that it is okay to proceed, with the added bonus of having no feeling whatsoever on my palate. Having done about a thousand of these gumgrafts for my patients, I am well aware that the most difficult part of this procedure is dealing with the palatal donor site, which is usually quite sore after surgery (think about the last time you had a pizza burn on the roof of your mouth - ouch!). Additionally, at this point I am still in a holding pattern orthodontically speaking, while I await my next set of Invisalign trays. So I am still wearing a maxillary retainer which has an acrylic palate, so it will protect the donor site post-surgically as well.

I had the surgery on a Friday afternoon, and resumed a fairly normal schedule the next day. I even played in a competitive tennis match on Sunday. The lower grafted sites were definitely sore but never painful enough to require taking narcotics - I simply took a combination of ibuprofen and tylenol as needed over the first day or two. I'm kind of a pro now with a liquid diet (bone broth anyone?), so it was no big deal to start that again for the first 4 days after this surgery. I then transitioned to soft mushy foods with (about the consistency of eggs) for a week after that. Between a soft diet and no brushing (thank goodness for antimicrobial mouthwash!), this allows for optimal healing of the grafting site with minimal disruption to the area while it is re-establishing a blood supply.

Of course, I used some of my previously mentioned biohacks for the post-surgical healing period as well. Collagen, laser biostimulation, Vitamin C, face in a bowl of ice water, and red light therapy just to name a few.

When the site is finished healing I'll add some post-op photos so you can see the difference in tissue quality and thickness.

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