Oral Maxillofacial Surgery

How Did My Face Measure Up?

My oral maxillofacial surgeon is Dr. Leonard Kaban at Massachusetts General Hospital. Before meeting up with him, some of his colleagues did a bunch of pictures, measurements, x-rays, and scans.

<--- What adjectives do you like to hear when people look at your face? I got "moderately convex." That's ok. At least my face isn't severely concave.

In my profile x-rays (below), you'll see in the first one that my profile is relaxed and my (endearing) overjet is hanging over my lower teeth like a prominent dental awning. In the second film, they asked me to jut my lower jaw as far forward as I possible could. (Then they told me to "try harder.") Notice the diameter of my trachea indicated by the red crossbar. My airway is significantly closed off by my recessed jaw and opens when I move it forward. I've even learned to do this now. When I take a deep breath, I move my jaw forward and I can breathe easier.

What is the Medical Term for F#@ed Up?
As one of the fellows measured my facial landmarks with odd tools and dental floss, he mumbled distances and comments to an assistant who took notes. "Mr. Shull presents with hypothelorism and diastema," he stated indifferently.

"Just so you know," I interjected, "I know what those words mean and I'll try not to be offended. (A little medical humor on my part). But, I was surprised by the first. Hypothelorism is abnormally close-set eyes and diastema is a gap between the two front teeth.

Knowing I'm a speech pathologist, he added "Oh, you must've learned those terms in your Craniofacial Abnormalities class." Wow. Really? Ok. Then I really was offended... a little.

The Plan(s)
During my follow-up with Dr. Kaban, he presented three options. The first step in each required getting braces (done) and the extraction of some impacted wisdom teeth. The goal of the braces is to move my teeth so my bite will align post-surgery. He also wants to open my narrow upper arch and move my upper teeth as far forward as possible to reduce the distance my jaw will have to be displaced. In essence, increasing my overjet. To which I replied, "I'll look like a rake!" Yeah, I got nothing. I suppose it's good to have surgeons without senses of humor.

Once my teeth have been sufficiently moved forward, they will break my lower jaw (and probably upper jaw) and move them forward and set them in place with titanium screws. 

I am fourteen-years-old again

Today was a big day. Dr. Murthy put my upper braces on. They gave me the option of ceramic or metal. The ceramic ones are slightly bigger and are more likely to break. So I opted for the less vain/ more Ugly Betty, metal ones.

Orthodontics for me are necessary. No, not only to prevent me from looking like an extra in The Hills Have Eyes. They're part of my prep. for surgery. So I thought they might be covered by insurance. They're not.  In total, the orthodontics will cost $7,450. I'm lucky, though. My dental insurance actually covers up to $2,000 for me (not just my non-existent, presumably buck-toothed children). So it's like I got a coupon for braces. I put $2,235 down and will pay $160-something per month. That covers everything from impressions and x-rays to retainers.


The whole process was a piece of cake. I had heard that the spacers felt worse than braces and that was true for me. It was quick and painless. (I did, however, make sure to take a massive dose of Advil™ before I left for my appointment.) Another blog suggested making sure your lips are moisturized so I slathered them with Vaseline™ in advance as well. That was a good tip, because they tried to tuck my lips behind my ears. [See below.]

The process brought back vivid memories of the last time I had braces. "Wait," you say, "You had braces before?" Yes, insensitive reader. I did. During one of my regular visits, my dad went back into the orthodontist's private office for a long time while I waited up front. When they came out, they announced, "Your braces are coming off today." Looking back I guess that the doctor told my dad that I needed jaw surgery and my dad declined. I was in high school, so I was glad to get them off. But no follow-up care was given. My teeth separated faster than Brittany and Kevin (or Charlie Sheen and anyone.)

So, what do you think? Should I use that photo as my new Facebook profile picture? When it was all done, the assistant gave me a bag of goodies and said she wanted to go over some issues regarding care of the braces. I asked her if we could speed it up because I was meeting a friend to go to a taffy tasting. (No, she didn't laugh either.) At any rate, I will have these sexy metal numbers for 18-24 months. The bottom set goes on in May.