Monday, August 27, 2007

What I asked my Doctor Prior to Surgery and What He Told Me

How long will my surgery be? - About 5 hours, maybe more, maybe less, I won't know til I get in there for sure. Then you will be in recovery for about another 2 hours.

Will I have a Catheter? Yes, we use a catheter on anyone whose surgery goes over 3 hour. It won't get put in til after you are out though, and will be removed before you wake up so you won't even know you had it.

Will I have an NG tube? No NG tube, but you will have a breathing tube inserted after you are out. It too will be taken out before you wake up.

How long will I be on liquids before I can switch to soft food? Well really you won't have to be on liquids. You can eat anything that you can smash with a fork or that does not require any chewing. You are to do no chewing at all for 6 weeks, then you can go onto soft foods for another 6 weeks. At 12 weeks you can start eating anything that doesn't really hurt.

Will I have drainage tubes? Yes they will run from the inside of your incisions to a small collection bag on you chest. This is to keep the blood out of your system during the first 24 hours. I will come see you the next day and remove them.

What if I wake up during surgery, how will you know? - We do not paralyze you like some surgeries do. If you wake up and start moving around at all we will put you right back out. You will be able to move and trust me, if you do, I will notice!

How long will I be in the hospital? - Well it depends. You have to be able to take fluids in and keep them down, pee, and walk around. Once you can do all of those things you can go home. I would plan on 2 days in the hospital though. That is the standard amount of time. We will see how you are doing and if you want to go home sooner you can, but plan on two.

How will I keep my teeth clean? - Use a small baby toothbrush, you can use regular toothpaste, and will want to frequently rinse throughout the day with warm salt water. NO water piks! You need to wait til your stitches are completely healed before you use anything like that. I will let you know when it is ok to use that again.

When can I start biking/exercising again? - At about 2 weeks it should be fine, as long as you are feeling ok, and not still taking pain meds. If you feel up to it, and your not too weak or light headed then biking, or walking should be fine.

What post surgical meds will I be taking? - I will be giving you liquid Roxicet (demerol) for any pain, and liquid Cephalexin (antibiotic) that you will be taking for 7 days following surgery. Can I get these today so I can get them filled before next week? "that's what these are right here" (hands me the perscriptions) Wow, you are certainly on top of things around here! "laughing...we try to be"

Is it ok to take all my vitamins etc now and post surgery? - Yes that is fine, I do want you to quit taking everything you are taking now though, with the exception of the vitamin C. Vitamin C is the most important thing you can take right now. Most of these are fine as they are just vitamins, but there are a couple here I'm not really familiar with. I would hate for you to show up for surgery and have the anesthesologist say that he doesn't know what these are and that he needs to cancel the surgery til he can research it. The Arnica and Bromelain are fine afterwards also.

How long will I have to be on liquids? We call it the fork smash diet...anything you can smash with a fork and swallow is fine, you just CAN'T chew ANYTHING with your teeth for 6 weeks.

So what about a splint? Will I have one of those? - Nope! No splint for you! I only use a fixed splint when I do a multiple piece Lefort. Since you will only be having a one piece I will use splints during my surgery to make sure I have everything where it supposed to be but I will be taking them out as soon as I get everything anchored and you will not have any splints in your mouth when you wake up.

WOW! I'm surprised, Well Ok...what about rubberbands, how will those work? - You won't have any rubberbands either. I use a new type of fixation. It is made out of a newer material that is actually stronger then titanium. Due to the fact that this material is stronger they can make the plates and screws smaller too. Once I have your rigid fixation placed and I take the splints out, your jaws aren't going anywhere. There is no reason to hold your jaw shut after that.

What about retraining my jaw? - There is nothing to retrain. Once its advanced and secured with the plates and screws it is not going to move back, it is locked into its new position.

So no splint? No rubberbands? NO NOTHING? - will be able to open your mouth as soon as surgery is done. Your jaw joints will be a little stiff for a few days but other then that you will be able to access your mouth just like now. You just have to be careful not to bump you jaw, or chew anything for 6 weeks.

Well so if I won't be having rubber bands why do I need surgical hooks? - Good question! I use those during surgery to hold your splint and align things properly. So I need them for my stuff, but yeah, you don't really need them for anything other then that!

Will I have incisions in my cheeks? - I will make some very small incisions to get the screws into the lower jaw, however, what we do is we pull the skin up from underneath your jaw bones, make the incisions, then let the skin go back to its normal location. You will basically have two very small dots underneath your jaw bones that no one will be able to see. We put surgical tape over them and they don't leave scars. You will see two tiny spots though for a couple days though.

So may I ask how this surgery will change my appearance? - He pulls out my tracings...."I take artistic license with these. I don't use computer imaging, I like to do my own measurements. " He said that after you take all the measurements into account (the standard which doctors work off and is considered to be the norm) that 11 is considered balanced symmetry based on the measurements. He said that my measurements are at about 17 or 18 right now, but with the 3mm advancement on top, the 6 -7mm on the bottom, plus the chin advancement I will be at a perfect 11 when we finish. He said from the front it will not be much of a change, other then having a more prominent chin, but you will really see a difference in your profile. He said that some patients experience a slight up turn in their nose, but that he does a lot of stuff to prevent this from happening, and has never had anyone be unhappy with their results, or dislike their noses.

Can I continue to do nasal irrigation after surgery? - For the first couple of days you will experience some bleeding from your nose. You may use q-tips and saline or whatever is most comfortable for you to remove any buildup in or on your nose but you may not blow it at all! Hold off on using the nasal irrigation until I give you the go ahead to blow your nose again. Also, you may suck from the back of your throat to get stuff out, but just don't force any air out for awhile.

This was about it for questions, although they did tell me that I can call anytime between now and next Thursday if I think of any other questions. My pre-op labs appointment is next Tuesday. They told me to bring a copy of my EKG, they will do a pregnancy test, and draw my blood to check my platelet counts etc. I'm to arrive Thursday morning at 6:00am, and surgery is scheduled to begin at 7:30am. YIKES!

I'm so amazed that I won't have a splint or bands. Sorta freaks me out. I think I will ask if I can have some rubberbands just in case my jaw gets tired. Seems like some people have reported that they found the rubberbands comforting at times, that they sorta gave their jaws a break.

These were all the questions I asked, and is a pretty good list regarding post surgery follow up. Every doctor does things a little differently so another persons answers might be totally different depending on how their oral surgeon does things.