Inside I'm hollowed out / Outside's a paper shroud / And all the rest's illusion

I've been Twittering a bit about my upcoming jaw surgery, but not in any detail. However, I had another consultation yesterday, and finally have a general timeline for the whole process.

It's not particularly noticeable (unless one is looking at my face in profile) but my lower jaw (mandible) is rather small. This causes all manner of delightful muddles like uneven bite pressure, odd wear on my teeth, and temporomandibular joint (TMJ) stress. I don't have sleep apnea, but a sleep study a couple of years ago indicated that my respiration rate during the night was slow enough to cause undue stress on my heart. About eight years ago, jaw surgery was recommended as a possible solution, but I wasn't too keen on the idea. At that point, they wanted to break both my upper jaw (maxilla) and my mandible, and wire my mouth closed for six weeks; eek! So we pursued other options. My teeth have always been pretty straight, but I wore a twin-block retainer for a couple of years to train my mandible forward, and then braces for a year to approximate a proper bite. I take a low dose of Aleve (naproxen sodium, an over-the-counter anti-inflammatory) twice a day if my TMJ starts to grumble. These issues haven't been a big deal, but then again, they haven't been ideal.

So when I acquired health insurance again recently, I procured a referral to Dr. JT, a maxillofacial surgeon at Kaiser in Santa Clara. I gathered up a portfolio of radiographs, panoramic x-rays, dental photos, and models of my teeth and jaw from my previous doctors to bring to our meeting. During our initial consultation, she examined my data, performed measurements, and announced that I only required the mandibular portion of the surgery, and that my jaws would most likely not have to be wired closed during recovery. I was very pleased. The procedure is called a mandibular osteotomy. Dr. JT also demonstrated the surgery on a model of the skull for me (so cool!). Then she walked me through the process:

1. wisdom teeth removal with Dr. LM (three oral surgeon visits done, one scheduled) [Done!]
2. any dental sealants necessary with Dr. GB (three dentist visits done, one scheduled) [Done!]
3. pre-surgery orthodontia with Dr. KT for six months (consultation done, two more ortho visits scheduled, then monthly follow-up appts) [Done!]
4. surgery with Dr. JT (two-and-a-half hour surgery, including a bone graft, hospitalization at Kaiser Santa Clara for three days, at least two weeks before returning to work)
5. post-surgery orthodontia with Dr. KT for six months (monthly follow-up appts, then one to remove brackets)

Slightly boggled, I went on my way with another list of appointments to schedule. So far, I've had my wisdom teeth removed and had half the dental sealants completed (final appointment on 17 Nov). Orthodontia needs to be installed beforehand in order to anchor my jaws during surgery and to fine-tune my new bite, so that will be done on 29 Nov (but I'm able to have clear ceramic brackets on top, which is pleasant). The main surgery at Kaiser Santa Clara is scheduled for June 2008, after another consultation with Dr. JT three weeks prior, in which she goes over the recovery process. For six weeks I'll be restricted to blended foods, which will be an adventure.

Getting my wisdom teeth out was my first experience with general anaesthesia, which served as a little preview for the main surgery. It went very well, and I seem to have no long-term nerve damage (impressively, one of my mandibular nerves was actually tangled up in the root of wisdom tooth #17). My oral surgeon, Dr. LM, performs the tricky surgeries that others won't, and she's all kinds of awesome. (And she gave me Vicodin.) During the upcoming jaw surgery with Dr. JT at Kaiser, there's a 20% chance of permanent nerve damage, but it shouldn't be extensive if it does occur.

So, yes, I'm more than a little preoccupied by all this. In particular, the financial wranglings haven't been very fun. Kaiser covers almost the entire main surgery, but absolutely none of the other steps. I do have Delta Dental, but it has been almost entirely unhelpful (so far our out-of-pocket total has been almost 10K, which is simultaneously ridiculous and terrifying on a teaching salary). But I digress. As I told a friend recently: on the one hand, the upcoming year promises to be, well, rather wretched―but then it will be behind me, and I can look back and hopefully be impressed at how gracefully I've navigated my way through. Plus, I can has more chin! This almost reconciles me to the fact that the words "bone saw" and "my skull" are involved.