Brandy's Braces, SARPE, Jaw Surgery Journal

This is my daily journal to my eventual perfect smile and Apnea free life. It logs my surgeries, and daily progress.

Wednesday, February 14, 2007

UPPER, LOWER, and GENIO! Oh MY Freaking Gosh! I had an appointment with the OS today. I'm completely in shock, feel sick to my stomach, and want to cry. He totally wants to change the surgery plan. Instead of just having BSS0 (lower jaw advancment) he wants to do it all! Upper, lower, and genio. He said that my lower jaw advancement would only be about 4mm and that he is worried that we would go through all of this and my problems would not be fixed. He said that to get the best results regarding correction of my apnea, he would like to cover all the bases. What he is suggesting is the latest and greatest in the Sleep Apnea world for surgical correction. I just so wasn't planning on anything so major. Even the genio is considered medical, as it changes the pull on the soft tissue in the palate (insurance will still probably not cover it though.)

I'm so torn right now. I just can't wrap my brain around all three! I feel like things have gone from a rather simple procedure, to major serious surgery. I'm terrified! I didn't ask any questions, my mind just sorta went blank once he told me what he thought. It was like on Charlie Brown, when the teacher talks...waaat, waaat, Wa. That was all I heard. My surgeon wants to talk to my ortho, then draw up some models and computer images to discuss with me. These will show the changes in my profile etc. I'm so totally traumatized....even as I type this I feel like I'm in a daze.

I did speak to him prior to this about the questionable area in my pano. He said that I could have a perferation and that he would recommend that once my braces come off we run another CT so we can get a better picture of the palate area without all the reflection. He said he has never heard of someone having ongoing sinus infections after SARPE as usually the sinuses are opened up a bit and breathing and drainage improve. Anyway....we also talked about the bone graft for the implant.

I was so looking forward to no Catheter, no hospital stay, nothing major, now I'm completely unsure of what to do. We could do lower and genio, but the os says that it would suck to go through all of that only to not fix the problem. What about the changes in my appearance? I mean, I sorta like the way I look right now, not sure I want any major changes, and the swelling, and just healing process in general.


Here is a website that explains MMA (maxillomandibular advancement) for Apnea (click where it says manual download on this page), or you can read my comments to see an explanation of why this would work.


  • At 12:14 PM, Blogger Kristen said…

    Oh my gosh, I'm so sorry to hear that, Brandy. What a bummer!! Your surgeon really should have set the right expectations from the get-go.

    But, as it stands, not all is lost. It'll be a tougher process, sure, but you'll get through it just fine. At least there's something you can do about it.... proceed with the surgery, and the problem will go away. It's a solvable problem.

    When I first went to my ortho for consultation at the end of 2005, she told me that she wasn't sure I'd be eligible for the whole operation because of clicking sounds in my jaw joints. They had to take x-rays to make sure that there wasn't anything more complicated, and that surgery would, in fact, make a difference. Imagine how bummed out I was - to first find a solution, and then, be told that it might or might not be able to help me. But, here I am. A year and four months later, post surgery, and healing well.

    I think you'll feel better about it once you get over the shock. Give it some time.... I'll keep you in my thoughts.

  • At 1:24 PM, Blogger Mrs. Shanton said…

    Oh, baby. Dear, dear.
    How about a second opinion? Could you ask for one? Is one available?

    I didn't have a catheter. My hospital doesn't do catheters unless you don't pee within, what, 24 hours after surgery?
    Hospitals are nice after surgery. I was just wondering, since I was so out of it afterward, what the poor lower-onlies do. How do they make it to the car? I slept for so long, and they give you nice humidified oxygen and pain meds.

    Oh, I was just thinking in my shower this afternoon, all this is easier said and read about than done. I know it. But your surgeon is right. What if they do lower only, and your facial balance is thrown off? Or, they decide that they're going to need to go in later and do upper surgery after all?
    On the other hand, the surgeon gets more compensation for a more-involved surgery. More practice, too. Which I would never bring up to a guy who's about to cut me while I'm asleep. But a second opinion would be valuable.

    Don't let this ruin your Valentine's Day. I think recovery is difficult no matter WHAT surgery you have; better to get it all done at once.

    BTW, you are a super-sleuth. I think you MUST have drainage where you think you do--your X-ray seems to provide further evidence!

    Do you have to have a hip graft? I hear THAT sucks bad. It hurts.

    Pobrecita. There, there.

    Don't fret. It's going to be OK.

  • At 1:51 PM, Blogger Amy said…

    Brandy, you must be in shock dear, what a change. First, this is just a consultation...they haven't operated on the models yet, so there is a chance things will change. I never expected to get the call that they weren't going to do my lower and got it days before surgery. So things are not set.
    Also you may elect not to do everything. Remember that you are in control, maybe you say no to the genio.

    And I know what you mean about not wanting to change your appearance. But even with the surgery, you will still look like you. Look at Kelsie, look at me and Steph. We have changes, but we still look like us. Maybe our profiles are different, but from the front we still look like who we were before, with a few differences in the width and the balance of our face.

    Your beautiful Brandy and you will be just as beautiful post surgery. I know it.
    Once you feel up to it, tell your doctor everything and question this big change. Tell him all the things you are feeling, your concerns. What you want and what you don't want. I know this is hard. I know it's a big change.

    I am sending you a big virtual hug! Amy

  • At 3:12 PM, Blogger Graham said…

    Shocker is right! Wow, definitely caught me off guard there too. I'm curious to know exactly how doing upper/lower/genio will help with sleep apnea compared to just the lower. Maybe a technical explanation will help ease your mind? I assume your improvement with the new supplement is not a replacement for surgery? Like, could you get away with just lower and the supplement? I think I agree with Amy too. You won't look that different and might as well get it all done at once. Considering how you did, your recovery likely won't be much worse than SARPE I'd imagine. And you still have the huge benefit of the whole summer to recover.

    I wish more OS's and OD's would spend more effort on helping us not get attached to any one outcome. Like Amy said, it all changes right down to the last minute. I admit that I'm kinda hoping to have all 3 myself, but it could very well be that I'll only get upper.

  • At 3:23 PM, Blogger Brandyleigh35 said…

    I guess that with any procedure you just don't know until you know. When we started they said I needed palate expansion, and to get my bite lined up before we could really know what would be done. Originally from what he saw he planned to do the BSSO since I have a Class II and figured this would work. Well now that the palate expansion is done, and my occulusion is lined up, the amount that they would need to move it forward would be small. Only about 4mm. He said that he could still do this, but given the fact that I'm doing it to correct my apnea, and not just to align my bite, he said he is worried it will not fix my problem.

    The current procedure for surgical elimination of sleep apnea is called MMA maxillary/mandibular advancement. Basically they down fracture your maxilla and move it forward a few mm. Then they bring the lower forward to meet the top. This lengthens the jaw, but also makes the tissue in the soft palate more taunt so that the apnea is eliminated. Genio has also been shown to have some benefit to apnea. It is done a bit differently but changes the pull on the tongue and hyoid muscles in the back of the throat. So......basically if we do all of these I will have a 100% guarantee that my apnea will be eliminated. If we just do lower, or lower and genio, there is no guarantee, and it does not look promising with such a small advancement. So my doctor is looking at what is best to eliminate the sleep apnea issue.

    It is just soo much more involved than I had thought it would be. He wants to draw up some diagrams, and do some computer graphing, etc before we talk again but this is what he thinks would work best. I'm very leary as I rather like the way my face looks now from the maxilla up, and I so don't know at 43 if I have it in me to get through all this! I mean basically I'm looking at another year or more of recovery! I'm just blown away right now, and frustrated, as I feel like I don't really have any choice if I want to be sure and fix things.... It just sucks.

  • At 12:02 PM, Blogger Mrs. Shanton said…

    Well, it sounds like they know what they're talking about, anyway. Just relax. Nothing is ever as good or as bad as you think it will be.

  • At 11:38 AM, Blogger Mary said…

    Hey Brandy! Wow, big news, you are probably starting to get over the shock as it starts to sink in. I guess in a way its not surprising since you have expressed concerns about the surgery not fixing your sleap apnea problem. In the long run, your down time will probably be about the same, the only added issue I think is the upper swelling and sinus issues. So far everyone seems to be dealing with those quite well and you have already been through that. I doublt that the change to your face looks-wise will be drastic. If you look at the people who have had upper and lower, like Kelsie and Kristen, they just look improved but still retain their original look. In all the surgeries I have seen including mine the change seems to be suble. Ultimately I think it will be a big plus as this procedure will provide a "reverse facelift" effect. You will appreciate this more in your later 40s I assure you. Before my surgery I had what we Germans call "hanging cheecks" that I no longer have. I'm sure once you have had a chance to digest this emotionally, it will begin to make sense to you and you will get more comfortable with it. Regards, Mary


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