My Double Jaw Surgery: The 4th Month After Surgery

I've now had 4 months of recovery after maxillary and mandibular advancement surgery to treat sleep apnea. I'm still dealing with a number of residual issues but am slowly seeing improvements as well.

My active orthodontic treatment using Invisalign has resumed.

This has had the downside of being quite painful to start moving teeth again, but with the upside of already starting to regain some overjet and overbite. This in turn has allowed an increase in the amount of tooth contact that I have, as while I had been waiting to resume the Invisalign, I had only the tips of my front teeth touching which made chewing very difficult and I experienced many minor choking episodes.

My surgeon recently explained to me that during the LeFort surgery on the maxillary arch that both of my pterygoid plates fractured, and this often leads to an increase in TMD (Temporo Mandibular Disorder). So when symptoms were not resolving, in the fourth month I also started seeing a physical therapist who specializes in treatment of the jaw, Sarah Stuhr at PhysioPDX. She was able to identify some of the other issues that have been contributing to my severe TMD. The largest problem besides the pterygoid issue was limited mobility of the cervical spine. The fix for this was intense manual therapy to improve the mobility, followed by a prescription for home exercises, most of which involved various double chin exercises. So if you ever see me driving by while repeatedly giving myself a double chin, you'll know I'm just following directions. Another option is to sit against the wall with the back of your head fully touching the wall (this alone will likely put you into a double chin position) and then try to lift the back of your head slightly higher on the wall but without using your shoulders. But this would require a few minutes of sitting down at home without being jumped on by three children, so the car exercises are the ones that actually seem to get done...

I've been noticing neck tightness

This causes it to be very uncomfortable to look up. This appears to be related to the severe stretching of the digastric muscles, which connect to the hyoid bone, which is located in the front, middle part of the neck.

If you think about advancing the mandible forward, you can see how much tension that would create for these muscles, as well as for those on the floor of the mouth. A good comparison is that you are stretching out a muscle, but instead of backing off after a minute or two like you normally would, you just permanently stay in the stretched position. So instead of having a chance to relax, there is chronic tension and it gets really uncomfortable until eventually the muscles learn to relax. It turns out my muscles are still in this learning-to-stretch phase. So my homework includes the very basic stretch of simply lifting my chin to look up, as well as self-massage.

Ongoing paresthesia

My palate is still completely numb. However my lower lip now has only slight to moderate residual numbness and no longer has random shooting painful sensations. But it now has a strange pressure sensation that dissipates out past where the stimulus was applied. This means I can touch one part of my lip and feel a crawling sensation extend out past the area by 1-2 inches. So strange. But a definite improvement over shooting pain, so I'll take it.

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