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Sunday, Dec 14, 2025 - 21:41 SGT
Posted By: Gilbert

Jaw Restore

It's been eleven days or so since my double jaw surgery (which explains a few days of the lull in blogging since then), which might be considered as a natural follow-up from the bite-fixing journey previously documented here in March 2024. Suffice to say that continued Invisalign and then traditional braces application had failed to budge the top row of teeth further, which left surgery as the main remaining option for correction if I wanted it - which I did.

The story can probably be extended slightly further back to August 2023 when I had all four wisdom teeth extracted, and upon review it appears that I had not covered the situation in detail back then. Having generally maintained a "hands-off" approach to bodily development, I had resolved to give my wisdom teeth every opportunity to grow in - which the top two more or less did. Alas, the bottom two got themselves impacted horizontally, which was beginning to cause issues. Thus, all four had to go in a mass downsizing exercise.



Textbook impaction case


I can't say I regretted not having them extracted during National Service, as more forward-planning recruits would have done, because I do like giving chances - but evidently two decades wasn't enough for sufficient forward growth. This was accompanied by a slight overbite and slant to the jaw, the latter of which can quite confidently be attributed to a very consistent side-sleeping pattern. The end result would be jaws that were just a little off, in every dimension. Functionally, there were no real problems with eating, but the many possible benefits of getting them sorted out (including a widened and straightened airway, and improved resting tongue position) at a single fell go proved irresistable eventually.

By the way, it is my current personal opinion that wisdom teeth extraction might contribute to jaw retrusion, whatever the official line on the matter; in particular, this would be due to the remaining teeth shifting (slightly) backwards into the space left behind by the extracted molars. Granted, the effect probably won't be large in an absolute sense, but given the common (and substantiated) refrain that "millimeters are inches" on the face, one supposes this effect to perhaps be significant. Indeed, the official surgery plan received by November had the vast majority of the movements being 6mm or below - which however made very obvious differences in the skeletal simulations.

And on the surgical planning, while we're at it. The field appears to have come pretty far in the last twenty years or so, with CBCT scans providing high-resolution 3D images that allow for calculation of the required cuts and movements, down to the sub-millimeter. It does give some extra assurance when one understands that the surgeon knows exactly what is needed - and where the nerves are - and moreover has custom-made titanium plates and guides for the execution. Not to downplay the skill and education required, of course, but the less guesswork required on these things, the better.



Le Fort I how-to


Technically, the double jaw surgery consisted of a Le Fort I Osteotomy for the maxilla and a Bilateral Sagittal Split Osteotomy (BSSO) for the mandible, which basically involves detaching the upper jaw and lower jaw respectively, and repositioning them into their optimal orientations. This would further be a two-piece Le Fort I, in which the maxilla is split into two for additional adjustments. All this is by the way performed inside the mouth, which allows for a complete lack of external scarring, so props to the geniuses who figured that out.

Well, the process can hurtle along fairly quickly in private consultation, and after an initial sleep study and about half a year of braces (not very effective), the surgery got scheduled. A price estimate of between forty to eighty grand in Singapore dollars was provided, which seems about average for this operation. The more budget-conscious might of course shop around for foreign options, with places such as Turkey, Italy and Korea sometimes popping up online, but this of course brings other issues into play, especially where complications or revisions are involved. It remains to be seen as to how much of this will be covered by insurance, given the attention over rising premiums and (unreasonably) denied claims following a much-derided deal to sell NTUC Income to Allianz (now fallen through)


Day Zero: No eating or drinking for eight hours before the operation (i.e. from 5 a.m.), not that I had much of an appetite anyway. The hospital weigh-in had me at 86.3kg, of which I'm expecting to shed a few from the ensuing liquid and no-chew diet. After leaving my stuff in the ward, I got wheeled to the operating theatre, where the attendings prepped me very professionally. The anesthesiologist dropped by to introduce herself too, which I thought was a nice gesture. It's a critical (if maybe not "primary") specialty to get into, and there's something to be said about a vocation where the patient sleeps through it all (if it goes right, that is)

I confess that I can't recall whether they told me to count backwards as is traditional, but a timeskip of some seven hours later, it was all done. My major concern had been whether there would be outsized numbness or pain, after browsing through a bunch of relevant forums in the build-up, which included scare stories about total numbness below the nose. To my great relief, sensation remained essentially normal over all of my face, excluding a small area directly below the lower lip and extending to the tip of the chin, which felt vaguely like a huge blister (which I suppose it was)


Days 1 to 3: I had intended to spend my ward time (which at about S$850 a day, counted amongst the priciest staycations I have been on) catching up on Civilization VII, but it looks like it'll take a few more major releases before it catches up with the previous edition in terms of addictiveness. The major irritants would be having to be hooked up to an IV drip, and sleeping (or trying to) in an elevated position. Actual pain was minimal - mostly about one on a ten-point scale - with soups and juices delivered regularly for consumption by straw. I don't recall ever feeling hungry, that said, and was successfully discharged about noon on the third day.


Days 4 to 6: This was the period of maximum swelling, as expected, which peaked around Day 5 (to felicitations from Mr. Ham for the resemblance). There would be occasional very minor spasms about the lower jaw, which I suppose was it getting used to its new position - very roughly half a cm forward, to the right and downward, as measured from the middle incisors. The teeth remained banded tightly shut in basketweave, which had me resigned to four servings of Ensure Plus or Fresubin a day. This was also when Panadeine intake peaked at five tablets a day, towards mitigating jaw and earaches, of which the latter was more intense.

The greatest worry turned out to be an intermittently-blocked nose, which was especially problematic since my mouth was banded shut, which made breathing difficult. While this was partly resolved by decongestant nasal drops and liberal application of Vicks, it remained a huge obstacle towards getting proper rest, even with the trick of applying external pressure from the top of the nose bridge. There was in fact a time when I became concerned about empty nose syndrome, given how I could barely feel the airflow despite my best efforts, before later confirming that it was just actual (removable) gunk.


Days 7 to 11: Day 7 saw the first post-op follow-up, at which the surgeon confirmed that everything was mostly fine, and restrung/loosened the elastics, which allowed for porridge consumption (fish and century eggs). Perhaps surprisingly, I only really started to get the sensation of the maxilla having shifted about this period, with perceptible tightness on the right side (towards where it had been moved). I suppose it will take some time before all this is forgotten as the muscles remodel themselves, as with the ICL eye surgery. Breathing does in general seem much improved from the pre-surgery state, and it's wonderful seeing the midlines line up in the mirror for once. No progress on the weight end, unfortunately, with the Day 11 weight being... 86.3kg. So much for the reports of "losing 20 pounds over three weeks"... or maybe we'll see.



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