It's been 6 months since having maxillary and mandibular advancement with palatal expansion surgery to treat sleep apnea. It's been a long journey with many appointments, but I can say that I've really started to see some positive changes.
The most impressive of which is the results of my at-home sleep test.
My AHI (Apnea Hypopnea Index) came back as 5!
This is pretty incredible, considering 0-5 is considered no-to-minimal apnea range. For a variety of reasons, I still have not been feeling like I'm getting a great night's sleep though, as I still often wake around 3 or 4 am and have trouble going back to sleep. Since the at-home test does not give nearly as much in-depth information as a proper overnight sleep study while connected to a plethera of electrodes, my plan is look deeper into the ongoing sleep issues by seeing a sleep physician again.
My palate finally starting to regain some sensation.
This has been such a relief, as I had started to fear that the roof of my mouth would be permanently completely numb. This improvement seems to have a positive effect on my taste perception as well, so I'm thankful for that.
I'm starting to try to use my teeth on the right side more now.
I have been hesitant to do so because they have had so little feeling that they feel like small wooden pegs in my mouth, and it is difficult to ascertain the amount of pressure I am putting on them so it feels as though I may accidentally break them or otherwise cause harm. The teeth on that side have slowly transitioned from completely numb to now also having the odd sensation of being somewhat painful when used for any significant amount of biting pressure, such as nuts. But the good news is that I have started adding those harder foods back into my diet over the past few months. Even though I feel as though my occlusion (my bite) is still going through a lot of transition via Invisalign and the back teeth don't line up very effectively, I can chew fairly well on the left side, and just slowly manipulate the food on the right side to try to strengthen the muscles and I'm hoping that the continued use will allow the strange nerve sensations to settle down and encourage the teeth to start feeling like my normal teeth again. We'll see if my theory is correct over the next few months.
I'm continuing to work with my Physical Therapist
The jaw pain is much more intermittent now than it was previously. For the first 4-6 weeks following surgery it was daily, now it is every few days, but may last for a day or two depending on how much it has flared up. A big issue has been my limited maximum opening, which is just over 2 fingers stacked vertically at this point. My physical therapist, Sarah Stuhr at PhysioPDX has been doing a lot of C1 work for these issues. In addition, she has prescribed self-massage, which I find to be more like self-torture unfortunately. My massage emphasis has been on the masseter (major chewing muscle that bulges when you clench together) and releasing tight tissues under the tongue. Also I self massaging any areas of scar tissue to try to loosen it. Personally, I find it much easier to have a professional manipulate these areas because it is painful to do it and for some reason I seem to tolerate someone else putting that pressure on me better than I can do it to myself. I'll often only do it for a few seconds whereas I'll allow my massage therapist or physical therapist to work on it for minutes at a time. It's usually sore for a few days after but then as the acute inflammation settles it all loosens up and I achieve an increased range of motion and decreased pain.
From a biohacking perspective, I'm constantly looking at tweaking my supplements and other environmental factors to help my body function better and improve the recovery process. I've had a difficult time swallowing ever since the surgery, and I've written before about how I've dealt with multiple moderate choking episodes, which we dealt with through physical therapy. Additionally, not chewing properly had not been giving my salivary enzymes a chance to appropriately begin the process of digestion, so my digestion has been suffering since surgery as well. To help with that, I began drinking a small shot of apple cider vinegar about 15 minutes prior to meals to help prime the stomach acid. If I forgot, my backup plan was to take Betine HCL in a capsule form. Additionally, I added digestive enzymes from Bioptimizers as well as a proteolitic probiotic of the same brand. It took a few days of an adjustment period for these supplements, but then I noticed a big improvement in my digestive system.
I don't notice many facial changes at this point as compared to a few months ago, so I suspect the swelling has mostly resided. As you can see, my lips move very normally in a full smile despite the parasthesia. And although my teeth don't function as well as I'd like, they are aligning nicely from an esthetic perspective. An odd finding has been that I can feel the screws on my left side, very close to my eye. My surgeon confirmed that it is indeed a screw that I can palpate with my finger, even though I was shocked to learn that he was able to gain access intraorally to the base of my orbit, and even more shocked that I never got a black eye from that part of the procedure. It turns out that the left side screw in that site is indeed slightly higher where the tissue is very thin, thus making it more prominent and palpable. At this point there doesn't seem to be a compelling reason to undergo another surgery to have the plates and screws removed unless any of them become loose or get infected in the future. In some countries, removal of the plates and screws prophylactically s a common procedure, but in the US the general view is that the risks of undergoing another surgery and creating more scar tissue is higher than the potential risk of infection, so it is common to leave them in place until a problem arises. Despite not being a big fan of artificial parts in my body, I personally agree with this philosophy, so for now I'll just keep an eye on it.