Bimaxillary Osteotomy - Double Jaw Surgery

[Scotty10]

Hi all, new member here. I did do a quick search of the group to see if there was much conversation about this topic but couldn’t find much. I am (probably) about to embark on the journey to this procedure. I am not necessarily asking for anyone's opinion on the procedure, or whether it is worth getting or not. I am asking if there’s anyone in this group who has been through it, and would be willing to share their experience with me? 

Some context.
I am 30 year old male and have struggled with constant tiredness, waking up feeling unrested, unable to not nap and suffered from anxiety and depression for years now. I went down a lot of avenues for a long time trying to find out why to no avail. Sleep apnea wasn’t suspected initially because I do not snore, wake up out of breath, have high blood pressure and not overweight.
I was diagnosed with mild OSA a year ago. My sleep study showed anywhere from 17 to 27 events per hour (closer to 17 on my side, and 27 on my back). I was non-compliant during my 2 month CPAP trial. I was never able to get more than 3 hours of therapy per night and struggled with restricted movement, claustrophobic feeling of the appliance on my face (and I tried basically every type), pressure waking me up and face soreness.
Was referred to a soft tissue ENT surgeon however this was not an option due to not having any excess soft tissue to remove. Then referred to an Oral and Maxillofacial surgeon. He believed I would be a good candidate for a Bimaxillary Osteotomy procedure to help my OSA by opening my airway due to my underdeveloped lower jaw (slightly underdeveloped upper) and slight overbite.
My journey to a good night sleep is to have all of my wisdom teeth plus two lower premolars removed. Followed by 15 to 18 months or braces and orthodontic treatment. Surgery. Then 6 months more months of orthodontic treatment. And the obviously long recovery that comes with this procedure..

Thank you

[mswertfager]

Hi Scotty, 

About 16 months ago I had a similar surgery, Maxillomandibular advancement (MMA) surgery, which also involves moving both the upper and lower jaws

OVERALL: 
Overall the surgery was less painful than the mUPPP surgery I had the year before. The results have been positive. While I have never been over weight, I have struggled with OSA for several years. I have addressed my sleep issues with the following over the years (while not all at the same time): turbinate reductions, mUPPP, mouth mandibular advancement device (MAD), CPAP/BiPAP, chinstraps, various sleeping prescriptions (associated insomnia), positional therapy device, and lastly the MMA jaw surgery.  At the time of the MMA surgery, I was only using the MAD and positional therapy device. After the surgery, I am feeling more awake and better focused. I have added the positional therapy device back into my nightly routine. 

Here are the highlights of what I went through. I’ll try to keep it brief but also include what it is really like beyond doctor summations on the net. 

THE SURGERY: 
The surgery went smoothly...they added 15 mm of space in my pharynx. However, when I woke up with my mouth banded shut, only one of my nostrils were clear. It was strenuous to getting enough oxygen through just one nostril. The fear of my only source of air closing up was quite stressful. While the surgeon verified there were no blockages in my upper nose and sinus, it continued every night following. Once I was able to use some Nasonex all was good. To this day, I use a nasal spray at night to prevent blockages. It is important to note this was a pre-existing condition before the surgery. A turbinate reduction 3 months before did not help solve it for me.

Back to the MMA, I spent two days in the hospital on morphine with ice packed around my jaw, and drinking clear liquid out of a syringe. The pain was not too bad. For the most part, I was able to walk around every few hours.  I don’t remember much due to the drugs.

As for your personal experience request, obviously random things can go wrong and should be weighed into consideration when any big medical procedure is done. Here was mine…the most painful part of the surgery/hospital stay was a nurse in training pulling and reinserting a catheter. This ended up giving me a UTI which resulted in a night in the ER visit a few weeks later. Maybe TMI but it comes into play latter and you asked for it.  

RECOUPING AT HOME:
Week 1:  Living on clear liquids and lots of rest. Sleep was pretty good without any accessories (eg. CPAP or mandibular advancement mouth device). I did sleep at about a 20% angle. Across my various surgeries, I have noticed that mouth swelling actually keeps things in place pretty well when sleeping. It takes until the swelling goes down (multiple weeks) to completely understand how well the surgery worked. I still woke up a lot and had some form of maintenance insomnia. 

By mid week, I was up and walking around just fine. I would often walk around the neighborhood for some exercise. Most of my communication was through a handheld white board. Communication gets frustrating…I found most people don’t have the patience to wait for you to write more than 1 or 2 sentences. For phone calls, I started using my computer with a speaking feature turned on. Combine this with a file that has standard phrases and things almost work smoothly (e.g “Hi Michael here. I just had jaw surgery and need to type things out…please bear with me”)

As explained on the net, it was hard to get enough calories via clear liquids. I ate mostly strained soups, apple juice, and Ensure. Lots of feedings just to get enough substance. With the mouth banded completely closed, you feed yourself through the syringe with plastic extension behind the mollers. Here was an interesting discovery…If there was any pulp in the liquid, it would seal up any airflow between the teeth and cause a complete airlock. It also caused a mess to clean up between the teeth. If eating soup, strain it multiple times. 

My tongue, lips, chin and roof of my mouth were completely numb...

For teeth hygiene and maintenance, I used a water pick twice a day. I started off on the lowest pressure and worked my way up. Additionally, I used a neti pot to keep the nose/sinuses clean. 

For pain management, I did ground up Tylenol through a syringe. 

~ Week 2:   
Lots of rest and syringes of food. I felt like a baby bird (lol). Sleep was still fine. About this time, the swelling went down enough to get a sense of what my new face might look like. The surgeon did a great job keeping everything symmetrical.

Towards the end of week two, I was watching a movie with the family, and I had so little energy I was fading out every few minutes…after an urgent care and ER visit (due to COVID protocols) we discovered the UTI from the hospital. I had lost 22lbs in 2+ weeks thanks to the infection and the clear liquid diet.

Day to day got a lot easier once the UTI was addressed with antibiotics.

I believe I was off Tylenol by the end of the the 2nd week.

~ Week 3: 
I got a few bands off, allowing me to open my mouth a crack. This allowed me to switch from clear liquids to liquids with pulp. At this point, getting calories was much easier…and it was so great to expand to other flavors. Sleep continued to be alright. I never woke up fully rested…and I still haven’t to this day. However, I was not waking up trashed, just a little sleepy with pretty good focus. 

By now I could feel my lips, tongue, and lower gums. My upper mouth and chin were still numb. 

~ Week 4: 
About this time, I got the remainder of the bands and the bridge (the metal grill the bands hooked onto) off and was able to eat soft foods. If I ate at normal speed, occasionally I would get a weird popping under my tongue for each bite. While the doctor did not know what was going on, something was not right with the swallowing process. This continued in some form for another year. TMJ started showing up. To manage both of these eating issues, it helped to eating slowly and not open my mouth more than a 1/2 inch.

Even through the bands were off, the doctor recommended to keep talking to the minimum. 

Due to the metal threading holding the bridge on, my teeth were all jacked up. As I saw from your post, you correctly have orthodontia planned also following your surgery.

Almost all the swelling was gone. I looked fine, my wife and kids like my new pronounced jaw line. Some friends like it even more than my earlier jaw…I have since gotten rid of them . Looking straight on, I am comfortable with the new look…however, my profile still throws me a little. 

Transitioning between some phonemes was surprisingly no-longer the same..I never thought through the fact that the front of my lower jaw moved forward but my tongue stayed mostly where it was. So transitioning between a “th”, “ch”, and “t” to another phonemes quickly was no longer a happening naturally. So, I have to consciously sound those out…now, again, like a kindergarten student. lol. 

~ Week 5 
I went back to work…sleep was still fairly well as far as apnea events. The upper mouth and chin were still numb. Due to the popping and the TMJ issues, I stayed on soft foods, even though I got the go ahead to eat harder foods (e.g. sandwiches). 

~ Month 3 or 4, 
About 3 or 4 months after the surgery, I noticed that I was waking up a little more tired than expected. While not nearly as tired as before the surgery. This was not just caused by my ongoing maintenance insomnia, there was some apnea coming back into play. This may have been due to a reduction of the swelling. I added positional therapy back into my nightly routine. I had previously built a positional therapy notification device with an electrical engineer friend. This keeps me on my side through the night and I feel less tired and more focused in the morning. 

~ Month 16 (today) 
I have feeling back to most of my mouth. The top jaw is still about 50% numb. I am hoping that will be resolved in a few more months.
I still have some maintenance insomnia. This has little to do with the surgery and more to do with going untreated with OSA for several months before insurance approved my surgery. It is getting better slowly. I am still using the positional therapy device. 

There are a lot of little details I avoided mentioning to attempt brevity. If you have any questions feel free to ask.