Video of turning the expander for the first time

Above is a video of my husband using a key to turn my expander for the first time after SARPE surgery.  This is to demonstrate that it was not a painful process at all.  You might feel some pressure, but not pain.  It is recommended to take Advil/Ibuprofen 30 minutes prior to having this done. 

Below is a close-up of the bonded expander in my mouth.  This photo was taken before any activation had taken place.  You can see the small holes and the arrows indicating to turn to the back of the mouth.

 

Here is another video of my husband explaining how to turn an expander.  This video actually demonstrates how the expander is activated, and how to use the key for activation:

Post SARPE Photos - WARNING! You may not recognize me!

Here are my post-op photos from Day1-Day 5.  I am hopeful that my final photos will be much more attractive.  I have no where to go but up, from here :)

Day 1 (Monday):  These were taken at 10pm the day of surgery 3/14/2011

(See blog post SARPE Surgery day and words of advice)

Day 2 (Tuesday):  Notice the bloody nose.  It had dried and clotted to such a point that I thought I was going to pull out my brains when I went to dislodge the clot.  Word of advice:  use a hot towel to moisten the area first, then clean.  This is the day that I used my timer to remind me when to put ice on my face.  15 minutes on then 5 minutes off.  I used the alarms on my cell phone to remind me.  I spent the entire day in bed icing my face, and reading blog posts on my lap top computer regarding SARPE surgery.  My favorite site was http://www.archwired.com.  I was hungry for knowledge, and photos of what other people looked like during this process, which is when I discovered Google blogs.  Reading the blogs and seeing the photos relaxed me and made me feel human again by connecting with others, which is why I wrote this blog for someone else.  I felt much better after I realized that what I was going through was normal :)  It was my therapy.

Day 3 (Wednesday):  No photo, sorry I was too tired that night.   This is the day I decided I wanted to write a blog (even though I had no idea what one was at the time, or how to start one) and began talking with my husband about ideas of how to help our patients who might be going through the same thing.  We always get excited about talking about our patients and ways to help spread orthodontic knowledge, so this got my energy flowing again, to the point where I spent the morning reading and writing, all while using my timer for icing my face.  By noon, I was so exhausted that I slept then entire rest of the day (fell asleep with the ice on my face), woke up for dinner, iced again, and then slept hrough the night.  Even though I felt strong and fairly good this day (minus the swelling, of course) I thought I had more energy than I truly had.  Some things that I remember are:  Being very hungry (once I could eat, I would feel stronger),  when I got out of bed, it was only for a short amount of time (I walked downstairs for the first time this day and then right back up, because I was too tired.), and talking on my cell phone (it was awkward talking around the expander, so I focused on really over pronunciating all of my words and this helped tremendously).   Words of advice:  you may feel like you have enough energy to start working again or take on household responsibilities, but it is good to start these things slow and allow the body to continue to rest and recuperate. Day three was a day of rest for me and the last day of icing for timed intervals.

 Day 4 (Thursday):  I started bruising as you can see in the photos above.  Mainly around my jaws and under my eyes.  I have such fair skin, that it is not a surprise for me to bruise this way.  I did take Sinecch (Arneca)  (as recommended by my surgeon and friends) for the complete cycle (starting the night before surgery), to help with the bruising and swelling.  Also, the swelling felt like it started to subside this day.  I spent this day on the phone and the computer working from my home office.  It was nice to be out of bed!  I iced a little bit (just because it felt good on my face) before I took a couple of naps that afternoon.  I finally took my first shower that evening.  I should have probably done that sooner and felt more alive this week.  What a fantastic feeling! This is the night that my nose started to feel much better so I didn't take the affrin spray before going to bed, what a mistake.  I woke up in the next morning with a terrible post nasal drip that has lasted all day.  Don't stop taking the decongestants.  They are a necessity! 

Day 5 (Friday):  Today is the day that I went in for my first post-op appointment with the oral surgeon.  He was very happy with my progress.  He told me that the swelling and bruising was normal and that it was going to take some time to heal completely.  He also told me that the bruising would follow gravity, and not to be surprised if I woke up Sunday morning with the bruising around my neck and collar bone area.  Unfortunately, he also said that my swelling was going to take a while to subside.  He said that the first week of swelling is when you see the most dramatic changes, after that, things will progress a lot slower.  He told me not to use ice anymore (since that is used to hold the swelling, so that it doesn't increase), instead use hot towels around my face to promote the blood to come into my cheeks and carry the excess fluid away.  I used the hot towels and they feel even better than the ice.  I also massaged my cheeks and took a hot shower, that felt terrific.  I am trying to drink a lot of extra fluids as that will also promote the blood to carry away the "bad stuff".  Today I feel much more like my old self.  I enjoyed being with people again and being outside.  I still feel the discomfort of the swelling, but at least I can smile and move my mouth more than before.  My biggest complaint now is the tingling sensation in my face now that the swelling is starting to subside.  It is like that feeling you have when your foot goes to sleep, but in your cheeks, not the most comfortable feeling; but not pain.  I try to tell myself that it is the feeling of "healing" and that helps me keep a better mental attitude.


Over all this week has not been as bad as I imagined it to be.  This has not been a painful experience at all, and I have had more energy than I thought I would by the end of the first week.  I am going to continue to rest through the weekend (even though the house is a disaster) and give myself a break, knowing that things can wait, because it is more important that I listen to my body;  Of course I'm not sure when my body will ever tell me that it is time to clean the house and do laundry again :)  For now,  I am preparing myself to go back to "life" on Monday and take it easy on myself throughout the week.  I'll let you know if that plan changes.   So far I have been able to get my dosage of pain medication down to one time a day, before bed, and Advil/Ibuprofen during the day (every 4 hours) this has helped with the "groggy" feeling since the prescribed hydrocordone makes me sleepy.  My surgeon also recommended taking Aleve in the evening as well as the pain medication to help me sleep, as I am finding it harder to go to sleep with that tingling sensation.  I will try it tonight and see if that helps.

Words of advice for the first week:

1)  Sleep with a neck pillow

2)  Take the nasal sprays or decongestant the Dr. prescribes

3)  Take the pain medication as prescribed

4)  Blend all foods

5)  Drink lot's of protein shakes

6)  Continue to take vitamins and/or extra iron pills

7)  Ice well for the first 24-48 hours

8)  If the ice is too cold on your face, use a paper towel between your skin and the ice

9)  Plan for leisure activities the first few days:  Movies, books, ect...

10)  Let friends bring you meals the first three nights.  Freeze meals ahead of time for the rest of the week.

11)  Have someone to take care of you the first two days for sure, the first week if possible.  

12)  Have a driver for your first post-op appointment, unless you are off of the pain medication.

13)  Take a shower, you will feel alive again.

14)  Sleep sitting up.

15)  Eat well and often to prevent nausea.  Eat before taking any medications.

16)  Have your doctor prescribe liquid pain medication, since it is easier than swallowing pills the first week.

17)  Relax and know that your body will heal, it is just going to take some time.

18)  Know that you have accomplished a big step towards that final goal, reward yourself in some way.

19)  Call your surgeon or your orthodontist with any questions.  No question is too silly, if the answer will put your mind at ease.

20)  Relax and enjoy some time-off.  It is well deserved.

SARPE surgery day and words of advice:

3/14/2011 - SARPE surgery completed in surgeons office with general IV anesthesia.   This picture was taken in the recovery room immediately following surgery. 

After Surgery all I wanted to do was sleep.  I was exhausted and nauseated from lack of sleep the night before (too nervous).   I tried to get up and out of my bed in the recovery room several times.  Each time I crawled back in, begging the nurse and my husband to just let me rest a little longer.  They let me do this a couple times, then they gave me more Zoffran, and about an hour later I was able to use the restroom and head out the door.

I really don't remember much about this day.  By the time we got home I was really drugged up and tired, so I zoned out in front of the TV and watched movies all afternoon.  Some words of advice for the first day:

1)  Let someone take care of you:  you won't remember when to take pain medication and you will be too exhausted to get up and get new ice.  Don't plan on doing anything! 

2)  ICE, ICE, and more ICE:  make sure to ice every part of your face as you will see later.  I wasn't so great about this the first day and I paid the price later with swelling.  Ice is what keeps the swelling down.  I used double freezer bags filled with  Karo corn syrup (It doesn't freeze and molds to your face easily, just make sure to double bag so you prevent any leakage).  The only down side was that it gets warm fairly fast, so have plenty of bags on hand in the freezer.

3)  Nosebleeds are natural, use a decongestant:  I freaked out when my nose would not stop bleeding, but the surgeon assured me that this is a natural process.  After you have undergone this type of surgery the sinus area backs up with a lot of blood.  To dry up the sinus area he suggested I use a nasal spray like Affrin or a decongestent.  This helped tremendously.  Swallowing blood for awhile is normal and part of the process.

4)  Sleep, it won't be hard to do:  Rest is good for the body and promotes healing. 

5)  Nausea is normal:  I felt sick immediately after surgery, probably a combination of an empty stomach and lots of pain medication.  When I told the nurse, she was able to up the amount of  Zofran and had me drink some apple juice.  Eventually the feeling of nausea calmed down.  I would recommend having some type of healthy protein shake with you for after surgery.  These shakes are a definite cure to nausea for me. 

6) Your bite will feel "off": The first day I could not put my teeth together because I was so swollen.  I sat around with my mouth open all day.  When I tried to bite down I could only touch on one side.  I was a little nervous and thought that maybe my upper jaw got tipped to one side.   However, the surgeon and my husband explained to me that this is normal and that the swelling is what creates that "off" perception.  Also, the surgeon will have turned the expander while it is in your mouth during surgery to make sure that the jaw will indeed expand; this process, will also move your upper jaw out of it's normal alignment, so your bite will not feel the same as it did before surgery.

7)  I had a gap between my two front teeth:  I wasn't expecting a gap.  I knew this would come later, but I didn't realize it would be there immediately following surgery.  This was a very sensitive area for me.  When the air hit the gums between my two front teeth it felt very unnatural; not pain, but a definite sensitivity for me.

8)  Sleep sitting up:  It is important to stay upright when there is facial swelling.  I propped every pillow I could behind me and around me to keep me upright.  I even used an additional airplane neck pillow to sleep with at night to keep my head in one position.  This helped tremendously.

I'm sure there is more that I could write, but unfortunately I am writing this 4 days post-op and most of my memory of that day is already gone.  I don't even remember how I got home that day :).  My strongest memories of that day were how good the ice felt on my face, my bowl of soup for dinner, and sleeping with my mouth open all night since I couldn't breathe through my nose.  My best advice is to Ice constantly!  They say 15min on then 5min off.  I set a timer during the rest of my post-op days and this helped a lot, However,  I'm sure if I would have done this starting day one I could have prevented some of my additional swelling.  I sure hope this helps someone in the future.  

Before SARPE photos and why I chose to have SARPE surgery

Here are my before SARPE photos.  These were taken 2 weeks before surgery:

 Class 1 occlusion

 Upper Jaw.  Teeth are flared out.

 Lower Jaw.  Teeth are tipped in.

As you can see from above, my previous orthodontist gave me a nice bite and cosmetically straight teeth, however in order for my teeth to fit together he had to flare out my upper teeth in order to match the bottom teeth.  Unfortunately, if I were to continue this way my top teeth would continue to tip in (teeth do not like to be in a flared out position, it is not stable)  and my bottom teeth would follow (The bottom teeth always follow the upper jaw, unless you are in cross-bite, dentally speaking).  As we age, our teeth continue this caving in process naturally, without wearing a retainer.  In my case, my teeth would continue to tip in and in order to find room they would just get more crowded and start crossing each-other like my two front teeth (Not bad now, but given time I would have looked just like I did in high school.), even wearing a retainer every night, because my top teeth were so flared.  Also, it is hard to tell from the photo, but my skeletal upper and lower jaws are actually in cross-bite (My upper jaw is narrower than my lower jaw, skeletally speaking). I opted to have a SARPE done so that my upper jaw would be set to the correct width so that my upper teeth will not be crowded ever again and therefore my lower teeth would stay in an upright position longer.  This is obviously not going to be a huge cosmetic difference from the way I look now compared to other SARPE before/after photos I have seen.  I am not doing this for cosmetic purposes, rather for the stability of a wider upper jaw as I age.  As I have mentioned previously, if I would have had an expander at the age of 7 or 8 having SARPE surgery as an adult would not be necessary.  That is why my husband and I are such huge supporters of a Phase 1/Phase 2 orthodontic approach (if there are skeletal issues present).  Also, I have suffered from TMJ pain, possibly due to my skeletal cross-bite.  I am hoping that this SARPE surgery will give me a more comfortable biting position and therefore alleviate the pain in my jaw joints as well.  Only time will tell :)