Gap closing.

Two updates:

1) They have changed my wire on my top teeth, which has closed the gap.
2) Braces have been fitted on my bottom teeth in order to straighten them in preperation for next years operation.

I really cannot wait until this is all over now, one step closer to an awesome smile! The second operation should correct my bottom jawline (which as you can see is slanted), by making my jawline more symmetrical and pushed up.

Another restless night - post expansion

More of a personal blog entry if anything:

I can't sleep yet again.

I must say one of the hardest things about this whole experience (aside from the general discomfort and pain), you realise how boring things can get, simply because you don't have the energy to do much; the jaw is still healing afterall.
Much of my day is spent listening to music (John Coltrane, Jeff Buckley, Muse, George Benson at the moment), sleeping, reading a book every now and again, surfing the net, staying in contact with existing friends by means of facebook/phone/in person (the latter - for those currently in London) etc.

Now, this is all great, especially when you have people around you that really care about you, and go to extreme lengths to show it. (during times like these, you really realise who your true friends are for example.) But it becomes pretty mundane after a while. Life becomes boring.

In some ways this can also be a very frustrating experience, as I know if I were fit and healthy at the moment I would be travelling right now; socialising; meeting new people of all walks of life. With this not being the case at the moment I have had to turn down the opportunity to travel to Spain, France and Dubai this summer. That was what I had lined up, along with chilling with my friends over here. As my initial expectations were that I would have a speedy recovery.

I guess this is again pretty age dependent, at 23 years, whilst facing the prospect of going back to University in a month time, it is an inconvienience simply because ideally I wanted to feel "refreshed" before my final year.

On a positive note however, I know that it is best to get this sorted out now then later on, but still I must say in the journey so far; coming to terms with how monotonous things can get is harder then it seems, especially when you just know you could be having a great summer as opposed to being bedridden.

This definently has to be the toughest battle mentally one has to face during this whole process. Saying that, I am confident that I will come out stronger by the end of it and in that respect this is a blessing in disguise.

Weight Loss - Post op.

Another blog entry for those individuals about to have this done:



As you can see I have lost a lot of weight around my face and neck area, this was a photo of me pre operation:



That aside I have had comments that the region surrounding my upper jaw area is looking fuller. I don't know if it is down to the swelling or if it is actually fuller. Aside from internal changes, I just can't tell.

I would say since the procedure I have lost a stone, or in the metric system 14 pounds of bodyweight. To prevent me from losing anymore weight I have been supplimenting with a weight gainer, but to be honest I don't have much of an appetite anymore due to the discomfort of not being able to eat anything solid for a while.

I am expecting to hit the gym 8 weeks from now to regain my lost muscle mass. But its all good, in the mean time, inside jokes with regards to looking like David Blaine have been made, funny shit!



Additional information:

Weight gainer I am currently supplimenting with can be found here:

http://www.in-trim.co.uk/ProLabNLarge2.jpg

Pain - Sleepless Nights

A blog entry for those individuals about to have this done:

Today I had a great day, had my closest around me, and on top of that had a good friend from out of town unexpectedly visit me. Not to mention, many of my closest friends not in London have been sending me spontanious (yet) funny text messages out of the blue, or have generally been taking an active interest. Don't you just love them?!

It is now 5am as I write this, I am unable to sleep yet again due to the pain. It is a week since expansion has stopped. To cope, I've just taken 2 painkillers to deal with it. I imagine the pain is a positive thing, as it probably means that my upper jaw is now healing. However, the area around my upper jaw seems to be swelling, with there being general discomfort in the surrounding region. The pain that hits this region is normally quite sharp, but not continious, though swelling has made my skin feel irritated & sore. I think the humid whether adds to the irritation.

As of yet the gap between my front two teeth left from expanding has not closed.

The healing process begins

After a trip to my orthodontist today, he was very happy with my progress and has decided that it was time to stop expanding my upper jaw. As it stands the total amount of upper jaw expansion sits at 7 mm:

(before)



(final expansion)



To ensure that the top jawline does not retract back to its previous position, my top brace has been locked with cement:



My upper jaw measurements (to deduce how much expansion is needed) is done in the following way (click on the image below to enlarge):



Now here is how a perfect bite to compare the above photo with, looks like:



If you compare both photos you will see that in the photo where the bite is perfect,the canine is directly ABOVE the first lower left premolar. And as my lower jaw is slanted (this will be corrected with my second procedure next year), he has approximently measured with that in mind how much expansion to do. This is because my second operation purpose is to not only close the gap, but to also create bite symmetry. My orthodontist did this by measuring the width of both upper and lower jaw to see if they are the same width, as well as using visual techniques to formulate a calculated guess in preperation for next years op.

Also as you can see, from going from a V shape (and I WISH I had taken before photos of my upper arch to show you), my upper jawline is now being widened so that it forms a nice curved "U" shape. To reiterate, the area between the gap is where my jaw is split in two, this area will take two months for new bone to fill the void left by the expansion. This should in turn close the gap that has formed between my two front teeth. For now however I still remain housebound and on a liquid diet, and I have lost immense amounts of weight which is the least to say very depressing due to my height. This and not being able to socialise due to spitting, eating food without being able to chew, and other activities involving my mouth due to the strain it puts on my upper jaw is equally depressing. Close family and friends have kept my spirits high through these difficult times, that and the fact that I can see progression has been made. My next checkup with my orthodontic consultant is in two weeks time, in the mean time I have been advised against doing any physical activity, I was hoping to start hitting the gym again in order to regain my lost weight.

A sign for things to come, when my upper jaw is strong enough, I will be wearing a light weight brace to keep my upper jaw in shape, rather then the bulky heavyweight one that I am wearing now. The battle now is to maintain the shape of the upper jaw, as it will as stated previously would want to retract back to its previous narrow shape. As a contingency plan, we have over-expanded the upper jaw in the event that this happens.

Post Operation - SARPE

Updated 28/07/2009 -

After an 8 hour wait during the day, my blood pressure was checked and consultations with my surgeon and his team to tie up any lose ends I or they may have were done. My operation finally commenced. It was a 3 hour operation, and a massive success.

Post operation I slept a lot, and felt very swollen. I was given a lot of painkillers during this period to cope with the pain; I couldn't speak, and was given antibiotics to deal with the swelling and to avoid infections. My nose was heavily bleeding, my mouth would fill up with blood and often I would be spitting blood out, and as for food my diet from this point on would be a liquid diet. I was eventually discharged from hospital a day later following a post op assessment:



As you can see I look battered, but my spirits remained high for the first few days because I was happy that the ball had finally moved for me. The pain of waiting four years was probably much worse then the physical pain I had been enduring at this point.

There was extensive swelling around my nose, and my upper jaw region, smiling was hard, and I was put onto a diet of mashed potatoes, soup and other mashed food. The swelling finally subsided after a week despite looking absolutely perplexed:



However to measure how wide my upper jaw was becoming, a gap forming in my front two teeth was used as a benchmark:



The gap here was 1mm (click on the image to enlarge). You can tell that my nose is still pretty swollen, this eventually subsided (Note: I am unable to smile as it is painful):




After a week and a half of twisting my SARPE brace:



My jaw at this point has been widened by 2mm. Smiling unfortunantly was still painful by this point, or any rigourous mouth movement for that matter. Weight loss had fully gone under way by his point, a diet of potatoes was not cutting it. I noticed the loss of weight on my neck, and face. (see my latest post) Also throughout (and even now), physically I felt very tired if doing anything for long periods of time, and the jaw pains made sleeping, eating very difficult.



The jaw here has been expanded by 5mm, after twisting the brace 3 times a day with the key shown in an earlier blog entry. This means that my upper jaw has been expanded by 5 mm.

UPDATE:

This is currently my upper jaw after 6mm expansion (as signified by the gap), you can see now that there is a perfect curve forming in my upper jaw, and my smile is now starting to look like a proper smile minus the gap, the stupid face and the teeth not touching. Amazing progression from this - where you can see my top teeth were inwards:









Ha. Special mention goes to my EVIL big sister for pointing this out - rock and roll!

A note to others having this done:

1) Brushing your teeth is an absolute nightmare as your top jaw is very sensitive. Often food would get trapped in my brace brackets, resulting in me doing an half arsed effort with my brush because of the pain; meaning that the food will remain stuck. Eventually, you'll have to push through the pain barrier in order to get over this. Otherwise you'll risk an infection or plaque build up.

2) Often you will spit blood out.

3) I have lost 14 pounds of body-weight and it is showing on my face and my body considerably. Living on a diet of liquids takes it tole.

4) Tiredness and fatigue is constantly in the background. Simple tasks such as playing computer games is hard work. So do not challenge anyone for money in a comp game! YOU HAVE BEEN WARNED! :D

5) Nights are restless due to the pain. Face goes through periods of swelling during the night as you rest your top jaw on the pillow. You will generally feel like shit.

6) The boredom hits you hard after a while, psychologically and this is an age dependent thing, but at 23 it does kill me from time to time that I am not out there with my friends partying, rather I am housebound due to this. So it should come to no suprise if you start self pitying yourself sulking about why you and not your buddies are having this done!

Note: As a word of advise, if you ever feel like this, try and:

a) Visualise the end result. It is important to remember why you have put yourself through this in the first place, as it will remind you of the bigger picture!

b) Use this as a learning experience to mature you mentally; afterall what you are undergoing here is a hardcore life changing experience (one that many will not experience or be able to relate with) and lastly:

c) Spend time with those closest to you and talk to them about it. People that you can trust and care about you. I strongly advise NOT getting this procedure done if you are living alone without a support structure surrounding you; no man is an Island.

7) Check-ups are done weekly with your orthodontist. You are unable to work out as it may increase blood pressure in case you are wondering, which can interfare with the healing process. Actually there is no healing done at the moment because my upper jaw is still being expanded. The jaw will heal once expansion has stopped. So I will approximently say it will take a good 2 months before you are anywhere near healing considerably.

8) The soreness will not subside until expansion has stopped and the real healing process has begun.

9) Travelling anywhere is a NO NO, I had plans to travel to Dubai and then France but it is in tatters at the moment.

10) The gap will close with the upper jaw healing process. When you widen your upper jaw a massive gap in the middle where the initial surgical incision that was done to split your upper jaw becomes wider. During the healing process, a blood clot is formed there, and the cells within your blood form new bone to fill the void left by the incision(and expansion). As this happens, fibers in your upper jaw causes your teeth to realign themselves naturally closing the gap like magic!

11) You wont be able to smile and forget about being able to kiss anyone! :)

The night before the operation - SARPE

My operation was scheduled for 1st of July, I was psyched up and ready for it. I was excited because after waiting for four years it has become a reality. On the day however it was cancelled due to a lack of hospital ward beds. Following this, I was extremely pissed off due to my history with my trust and I immediately felt they were fucking me around again. I tried to get hold of my surgeon that day, couldn't get through to him that day or the next few days, rather I was put through to a middle man that had no clue on what was going on either.

Very down and frustrated at the beuracratic nature of the NHS, I was strongly contemplating getting my local MP involved again, as I didn't want to face the prospect of waiting until September to get operated on due to university commitments. That and now I wanted to just get the ball moving as I have another operation on my bottom jaw to look forward too next summer. Any further delays meant that this would be prolonged. But before doing this, I made sure that I found out what my rights were in the event of a cancelled operation. In my search for viable answers,I found the following information from the NHS web-site:

http://www.nhs.uk/chq/Pages/2563.aspx?CategoryID=68&SubCategoryID=162

Armed with my rights, I decided to give my hospital a bit of time to rectify things before doing anything drastic. Luckily, my operation was rescheduled for the following week and on July the 8th I was operated on.

The night before my operation I was very nervous about what laid ahead, I had heard stories of not being able to talk, excessive weight loss, swelling, and pain pain pain during my research of the operation. That and there were risks in this operation such as losing your sense of taste or losing sensitivity in your upper jaw due to the chance of ones nerve endings being damaged in the process. I completely felt as though I was venturing into the unknown at this point.

Luckily for me, in the ward bed next to me was a guy who had his arm operated on jacked on morphine. He proved to be a great ward room mate and really helped me out more then the nurses in the hospital. He showed me around the place, offered to get me food and gave me any assistance that I needed if the nurses were not around. He reassured me that everything would be ok.

...Still the night before the operation I felt uneasy, couldn't sleep due to a mixture of excitement and fear that something may go wrong. Afterall they are operating on my face here! Throughout this period I was heavily texting a friend Luke Shaw Harvey a fellow guy who is going through the same thing, and he was great help throughout by telling me exactly what to expect as he has been through SARPE.

A BIG THANKS mate!

The night before my operation, my last solid meal was fries and a chicken burger. I joked with friends that this is the equivilent of going onto death row, where the prisoner is spoilt for choice with regards to food, prior to being executed.

For those about to go through this procedure, your blood pressure will be checked and you will be told not to eat 12 hours before your operation as this will ensure that you don't puke blood up during your operation.

SARPE Preperation.

Prior to my upper jaw operation taking place, braces were placed on my upper teeth from August 2008 - July 2009, this was done because the orthodontist who was responsible for overseeing the project was not satisfied by my top teeth and felt that it needed to be straightened before SARPE took place. This required me to go back and forth from Aberdeen to London once a month during my third year in order for my braces to be tightened.

Every now and again to judge if my top teeth had become straighter, a model was taken and renewed every few months.

Two weeks before undergoing SARPE a SARPE brace was placed onto the roof of my mouth in order to assist with my upper jaw expansion:



The brace is fitted in before surgery as it is the main mechanism responsible for the expansion of the upper jaw. The purpose of SARPE itself is to weaken the upper jaw by splitting the upper jaw in two so that it is mouldable. The incision is normally made bang in the centre of the roof of the mouth.

Once it is weakened, my orthodontic surgeon is hoping to expand my upper jaw by 10mm, by telling me to use a key mechanism and twist the brace (there is a hole in the silver box in the middle) 3 times a day until the desired amount of upper jaw expansion is reached. Each twist of the brace widens my jaw by 1/4 mm.



A change in toothbrush was required to ensure proper cleaning post operation. I was required to change my toothbrush to one with a small head, so that I could reach those hard to reach areas post operation.



Yes I know what you are thinking, and yes it is a toothbrush for 2 year old girls!

In addition to this prior to my operation I had a pre-op assessment with a Facial Maxillo doctor who told me about what laid ahead. In her words, she branded this whole journey to be a "life changing experience", as it not only will be hard and painful, but the rewards at the end of it will be amazing. This however remains to be seen...

The Anterior Open Bite - what is it?

I have spoken extensively about what this is in my previous posts. And as pictures are worth a 1000 words, the following image is of another sexy poor sod with the condition:

BEFORE:



A patient prior to treatment in Japan with an Anterior open bite, and long face syndrome. She does not however have a slanted bottom jaw, or a narrow upper arch (crossbite) unlike myself.





Despite looking like I have no problems at all physically, given that I am a relatively attractive guy. If you look closely you will notice that I do suffer from an AOB just from my outer appearance with my mouth shut. I have a) long face syndrome b) my bottom jaw is not aligned at the centre of my face, you can see that my chin slants the right - which this woman does not suffer from. The big give away however is a weak "pointy" jawline. So not only will my bottom jaw need to be respositioned (or reset), my teeth also need extensive work on as shown from the next batch of photos, me smiling with teeth:



My bite.

In the above photos you can see how narrow my upper set of teeth are in comparison to my bottom set of teeth. The purpose of my first operation SARPE is to correct this by expanding my upper jawline so that it is the same size (width wise) as my bottom jaw.

By doing SARPE first, this will ensure that I will have a perfect bite once they operate on my bottom jaw to close the gap between my top and bottom teeth.

BEFORE & AFTER:






Same patient after successful treatment two years later. You can see that the longness of her face has been reduced, much more defined jaw-line (pointyness has gone), her teeth now touch, and her smile is great. This at the moment is the best example of how I expect my face to change after everything is completed, and although the changes are subtle, her physical appearance has changed ever-so slightly. From an aesthetic point of view, incidently, oral facial maxillofacial specialists refer to this type of physical change as "bringing balance" to ones face during the correction of ones bite.

So to conclude this post, an anterior open bite is one where ones top and bottom teeth do not touch as shown above. When ones jaw is narrow, and this could be either/or both the upper or bottom jaw, is technically referred to as a "crossbite".

References:

Severe Anterior Open-Bite Case Treated Using Titanium Screw Anchorage

http://www.angle.org/anglonline/?request=get-document&issn=0003-3219&volume=074&issue=04&page=0558

The four year battle

Before any treatment could begin, the following conditions needed to be satisfied as requested by my hospital:


a) Excellent oral hygiene
b) Staying in the same location throughout the treatment, in my case this was London.


To ensure that treatment goes to plan, you are assigned an orthodontics consultant who oversees the whole project and makes sure it is going to plan. Typically to assess your bite, the procedure that is typically initially taken place is to take moulds of your teeth, X-rays, and standard braces are normally put into place to make sure that your teeth are aligned correctly prior to surgery. You then have another consultant who in effect is a surgeon, his role is to do any surgical procedure involving your bite and that’s it. This obviously varies between individual, but one thing for sure moulds will be taken as they need to assess how bad your malocclusion is before putting forward a plan of action.

In 2005 at the age of 19, I was first put forward to a different orthodontic consultant to the one I now have. Anyway, the situation became complicated as she was very unhappy that I would be studying in Aberdeen during term time. If it wasn't this, then she would nitpick on me due to my plaque levels. To cut a very long story short, the first stage of treatment did not get rolling (braces) due to my previous orthodontic consultant being stubborn and difficult. This resulted in me taking a gap year at 22 as I was adamant to get this issue resolved as soon as possible. That and I wanted to have some real world experience for a while.

I remember during this period of my life feeling very depressed by the whole thing, when you are a young man, you want to be your best self physically as you are playing the dating game and socially it did affect me immensely psychologically. As I couldn't smile with my teeth touching (I have been asked on more than one occasion by girls I have courted to smile with my teeth during a photo taken with them), my face (although not noticeable to others) being asymmetric, jaw pains, linguistically being affected - my bite has resulted in me sounding very nasal for example (due to the jaw being connected to the nose), and my pronunciation of certain words is not perfect as it requires phonetically for my bite to touch. For instance back in the day I took a module at university to learn Spanish for the banter, I learnt from a Spanish girl on a drunken night out that to pronounce the word "Espaniol", you will find that to do this correctly requires your teeth to touch. In the German language there are many many words that require this, and it was little things like this that dented my confidence badly over time. Saying that despite its drawbacks, I have had to learn to adapt to this issue rather then let it dictate my reality, due to the demands of an active social life even if it is subconciously in the back of my mind.

Furthermore, aside from the above, not getting anywhere with my previous orthodontic consultant added to the frustration and pain, if say my oral hygiene was perfect for example she would complain that I was studying in Aberdeen, and as I am not in London throughout term time, treatment could not begin due to hospital policy. She was very happy however for me to get treated in Aberdeen despite the fact that:

a) I am not in Aberdeen for most of the year anyway! So it is no different if I get treated there or in London. If anything, getting treated in London would have been logically a better idea due to my family being here!

b) Any operation during term time would seriously disrupt my studies due to the post recovery period following any operation involving my jaw.

Leaving me to think what is the difference, even if I got treated in Aberdeen they would have the same problems. Given the above I had to take a calculated risk, I had no choice but to take matters in my own hands as I realised that she saw me as another patient with no power; she was on an ego trip. Adamant to get the ball moving, first and foremost I eradicated each excuse one by one. To ensure that she could not complain about my oral hygiene I would get my teeth cleaned by my dentist the day before my appointment. This however had no effect, as the problem then was Aberdeen. With this seriously pissing me off as I was unable to reach a compromise despite their flawed logic, I kept a record recording everything that had been said (complete with dates and the name of the person who said it), built a case and brought this topic up with my local member of parliament. I just was not happy that she expected me to stop my studies during a critical period of my life when my schedule at university is flexible enough to work around. It was logically all utter bullshit to me, and it came across as though she didn't want to treat me.

In the end, my actions had a positive outcome, my previous orthodontic consultant who was overseeing the project moved position, and was replaced by another one. I have had no problems with the new one since.

After this happened, I felt very proud of myself as my hard work paid off. I fought and won.
So my advice to ANYONE else going through similar problems with consultants of any nature is to stand up and show them that you can't be pushed around, by first trying to reach a compromise with them. If this fails get their superiors on their tales that are no way affiliated with the hospital trust (due to bias), but rather are politicians or highly influential people that will listen to you because they need your votes and directly/indirectly affect decision making within the hospital with regards to funding etc etc.

My first post

Right where do I begin? It is two weeks post op from my SARPE operation, and before I go into that, first and foremost I will give you some background info on how and why it got to this stage.

Note:

Before I continue, my intention of this blog is for it to serve two distinct purposes:

a) Inform those individuals suffering from an Anterior Open-Bite, or Cross-bite of what to expect during THEIR orthodontic journey. I wish I had this information avaliable to me, but I had to search long and hard on google to educate myself about my condition.

b) To give those that are interested an insight on what it was like going through this. I am hopeful that after reading this you will go away feeling much more aware of orthodontics surgery and the work that is done during it.

*) As I know people are generally lazy when it comes to reading vasts amounts of material, to avoid repetition I will add material, text, photos to my existing posts. This will save me from repeating myself as this should make this blog concise and straight to the point as well as user friendly - in the sense that you don't have to go sniffing through 10000 posts to see what the deal is!

Now back to my little story, a combination of mouth breathing, excessive sweets caused me to lose my baby teeth very early at the age of 5. This along with thumb sucking had a negative impact on my bite. The mouth breathing had an affect by causing me to" develop long face syndrome"; where my face is quite long, whilst the thumb sucking was responsible for my upper jaw to be very narrow which resulted in the development of a cross-bite. Due to the combination of both, this inevitably resulted with myself developing an Anterior Open Bite. An othodontic term to describe when your upper and bottom teeth do not touch.

It is often argued that this is caused by genetical reasons, and although this may be the case for many, given that many members of my immediate/extended family do not suffer from this condition I doubt that this was the case for me.

Unaware until the age of 19 of my malocclusion (improper bite), due to not knowing any better. It was only after my first trip to Scotland prior to choosing my University, that my Uncle Tony pointed out that I should get braces fitted in. After a short trip to the dentist to address this, my dentist referred me to the orthodontics department at Kings and then the next stage of my battle began, getting treatment started to correct my bite. This I will address in my next post.

References:

http://www.answers.com/topic/long-face-syndrome

For a brief History of the development of Orthodontics go here:

http://en.wikipedia.org/wiki/Orthodontics