About 8 months in...

I haven't really had any new developments to share since the last post.  It's been about eight months since the braces were put on and things seem to be going just fine.  It's a frustrating point in the process because I can't see any progress myself.  Gaps between teeth form and then are closed up again from orthodontist vist to visit, but I can't see any overall change.  There have been a few teeth that were twisted that are now facing the right direction, which I take as a good sign.  Dr. Swiatek says that things are going perfectly and at the pace he had anticipated, so he expects I may be ready for surgery in November.

I am hoping this will be the case.  I graduated with my paralegal certification in May and I am holding off on finding a new job until after the surgery.  I am not sure that there's ever been someone more eager to have their jaw cut into pieces.  The sooner the better!

Since I hadn't seen the surgeon since August 2010, I decided to schedule an appointment with him in June.  During my first consultation with Dr. Levin, I was still concerned that we were in for a long fight with the insurance just to get the procedure covered.  I was more focused on getting the coverage than actually talking to him about the surgery, the recovery, and the issues involved.  I felt like I needed to get in there and ask some questions to ease my mind and help me plan for what's coming up. 

Apparantly this sort of "follow-up consultation" appointment is not normal and the office staff was a little perplexed as to why I was there.  After explaining that I was not there for a post-op visit (I wish!), they took down my vitals and Dr. Levin came in to talk to me.  He went over where things stand right now and took some more measurments of my bite.  He agreed that things seem to be moving along quite well and said that he leaves the determination of timing up to the orthodontist.  A little piece of me had kind of been hoping he'd look at my teeth and say "I think it looks ready! Let's do it next week!".  Ah well, a reality check was needed.  Patience is a virtue, right?

Then he asked "Do you have any questions for me?".  My mom, who had come along with me, laughed a bit in the corner of the room and handed me my purse.  "Actually... I made a notebook... I'm a bit OCD."  For those of you that know my love for notebooks and list-making, this should come as no suprise.  I made a "Jaw Surgery Information" notebook.  It has the information for all of my doctors, questions that I think of that I want to remember to ask, and timelines for appointments and such.  I'm a nerd.  I felt like I was interviewing him for the school newspaper as I went through the questions I had prepared.  But, I got them all answered and nothing was forgotten. 

So, as it stands, I am hoping the surgery will be in November.  I am waiting for the ok from Dr. Swiatek.  Once he thinks we're there, he'll take models of my teeth (braces and all) and send them to Dr. Levin so he can do "model surgery" on them to make sure that everything will fit right when it's done.  Then, it'll be time to schedule the surgery.  I've never been a huge fan of the summer season, but this year, more than ever, I can't wait for it to pass by. 

Brace Face!

I don't know why, but that's one of my favorite teasing names.  This post is a little late, but I think this gets me on track so that future posts will be more current.  On November 16th, I got my braces on. 
I had forgotten how uncomfortable the whole process can be.  That adhesive stuff tastes awful!  It was quicker than I thought it would be though.  The whole thing took less than an hour.  Now I have a full set of upper and lower braces.  Dr. Swiatek was great about working with me and know that, as an adult patient, I don't want a full mouth of gleaming metal.  However, I also have budget concerns and will be having surgery while the braces are still on my teeth.  We decided, at his recommendation, to put clear braces on the top teeth that show in the middle part of my mouth and to put standard metal braces on the bottom teeth and those in the back on the top.  I am impressed with how well the clear braces blend in.  You can still see them, but they aren't the first thing that people see when they look at me. 
A lot of people have asked me why I didn't just go with Invisalign.  Unfortunatley, Invisalign wouldn't work for me because the braces have to stay on before, during, and after surgery.  If they had to wire my mouth shut after surgery, they would use the braces to fix the wires in place.  In my case, they are going to use plates and screws to keep the jaw parts in place while they heal, but pulling the Invisalign on and off of my teeth just wouldn't work.  And, to be honest, I'm the kind of person that would take the Invisalign off to eat lunch and then forget to put it back on again.  Thus, the classic braces are the only option for me. 
Check out my dorky braces smile!

I had to do a really crazy face to get the metal braces to show.



I know what you're thinking... "How is she still single?!?!"





The Plan

Now that I've assembled my elite team of medical professionals, there has to be a plan of attack. 

The first step is to get braces (again).  The braces have to align the teeth at three key points during the process.  First, they have to correct any pre-existing alignment issues.  Second, they have to align the teeth in preparation for the surgery.  My teeth will, hopefully, be aligned based on how the structure of my mouth will end up after surgery.  Finally, the braces remain on during and for a certain amount of time after surgery in order to tighten things up and align my teeth in my "new" mouth. 

The surgical part of the process is the most anxiety-producing portion for me.  It will involve at least one night's stay at the Hospital of University of Pennsylvania (HUP) and general anesthesia, neither of which I've experienced before.  There are also potential complications.  Since my jaw is being cut almost into two pieces, there is the possibility of nerve damage, damage to the bones or teeth, and all that good stuff.  Most of these are very rarely seen in this procedure, but still have to be considered. 

The plan for me, at least at this point, is for the surgeon to go in and cut through my upper jaw (right under my nose) and remove some bone in the back of the upper jaw.

Borrowed from Krames Patient Education pamphlet "Orthognathic Surgery" (2006)

Once the "extra" bone is removed, small plates and screws will be put in to hold things in place during the healing process.  While plates & screws may not sound appealing, they mean that my mouth will not have to be wired shut after surgery and that makes me happy. 

Dr. Levin explained that my lower jaw will rotate further up after surgery, to compensate for the changes.  This will make my chin stick out further.  I'm a little nervous about the fact that my overall appearance will be affected.  I'm no supermodel or anything, but this is my face and I've gotten used to it and don't especially want to look different.  Hopefully the change will be subtle. 

Even though my mouth will not be wired shut after surgery, I will be on a liquid diet for several weeks before I can chew even soft foods.  Those of you that know me, know that I love food and this is going to be a struggle for me.  Many of you also know how grumpy and dangerous I can be when not fed properly.  Needless to say, my parents are considering taking an extended out-of-town vacation while I'm recovering.  Anyone know if a bacon cheeseburger can be liquefied in a blender? 

What's all this then?

This probably won't be pretty or well-designed (sorry in advance to all my web savvy family members).  I also apologize for the corny name of this blog (I've had the movie Adventures in Babysitting in my head for no apparent reason) as well as for the corny entry titles that will come.

I'm creating this blog just to keep family and friends up to date on my progress toward jaw repair.  It's not a very exciting topic but, for anyone interested, I figure I'll put this information out there.

So what's the deal with Jenna's jaw?  It's not a real obvious problem, so people tend to not notice it if they're not looking for it, so I'll explain.  I have an open bite.  Essentially, I have about one to two teeth in the back of my mouth that actually touch when I close my mouth.  This leaves a large open space across the front (see ridiculously close-up photos).

It's been this way since I was little.  I had a round of braces, a pallet spreader, and various other orthodontic devices as a child.  These efforts closed the gap slightly, but since the underlying skeletal problem wasn't fixed, everything drifted back.  Besides a goofy smile, this misalignment causes me a lot of pain and is doing progressive damage to those poor little hard-working teeth in the back.  According to my dentist, it can't be ignored and has to be fixed.  I agree!

After some prodding from my dentist (Dr. Stephanie McGann), I started the process to get my jaw fixed back in 2008.  At this point, everyone has told me that orthodontics alone would not fix the problem and orthognathic surgery (to reshape the jaw) would be required.  I had a consultation with an orthodontist as well as a surgeon to see what the procedure would be.  

The journey seemed doomed as the surgeon (the only one in the area that accepted my insurance) claimed that my insurance was rejecting the pre-authorization for the surgery and that they flat out would not cover the procedure.  I was pretty upset.  However, I was even more upset when I found out that the surgeon's office was billing my insurance under another doctor in the practice (one who is out-of-network for my plan).  After a few weeks of trying to get the office to fix their billing, I was feeling like this surgery was just not meant to be.  Since my insurance wouldn't cover the procedure and I couldn't possibly afford it by myself, I let things go.

Fast forward to yet another dental appointment with Dr. McGann politely chastising me for not getting my jaw fixed.  She finally decided to pull out the big guns and inform me that those two teeth that do all my chewing would probably break apart in another ten years or so.  What?!?!  That was it.  I had to get this fixed.  No more pain, no more headaches, and certainly no destroyed teeth before the age of forty.  I went back to United Healthcare's website and searched for a maxillofacial surgeon that would be covered under my plan.  Since two years had passed since my last search, there were new options.  I scheduled an appointment with Dr. Levin with Penn Medicine and a couple months later made the drive up to Radnor for the consultation. 

After the tech took a few different x-rays of my jaw and head, Dr. Levin came in to review them with me.  One of the first things he said to me was something along the lines of "You barely have to look at these images to know that you have a problem and we have to fix it."  Okay, so I know that may sound bad, but for me it was reassuring.  This time, we weren't taking "no" for an answer, the insurance had to cover the procedure.  I was gearing up for a fight and, this time, I felt like I had a strong ally.  Dr. Levin took measurements of the spacing and angles of my teeth and my bite.  He told me he'd lay everything out and send it off to the insurance and we'd have no problem proving medical necessity.  Woohoo!  I left the office feeling pretty fantastic (considering I'd just been told I had a very malformed jaw). 

A few weeks later, I had my answer.  The surgery would be covered!  Apparently it was never rejected in the first place and is a covered procedure under my plan.  I have no idea what that other office did, but they were clearly wrong.  Lesson learned: Know your plan, don't trust the doctor's office to do things right. 

In the end, I think things worked out for the best.  I feel very confident with Dr. Levin as my surgeon.  He's been communicating really well with my orthodontist Dr. Swiatek, which is essential since they are the two main players in this deal. 

So that's the background on the start of this whole process.  I had a lot to fit in this one, but I don't plan on the posts being this long.  I should be posting again soon about getting my braces on and what they plan to do (surgically) to fix my jaw.  Thanks for reading.