Monday, 22 July 2013

Physiotherapy after orthognathic surgery and plate removal surgery

So where am I at, at this stage in my treatment?

Let’s take a quick recap of the story so far

I am 20 months post orthognathic surgery and 7 months post titanium plate removal. But to be fair time seems to just roll from one day into the other. Before surgery I experienced some of the hardest times of my life. I had a severe class 3 malocclusion, I could not bite on my back teeth at all, my face was deformed and I had the most excruciating pain running all the way down the left side of my skull and face. Doctors always say “describe the pain to me”… well its painful right? If I had to verbalise the pain, I would say on a good day it felt like a tense migraine and on a bad day there are no human words to describe the agony I was in.  I went on like this day in day out for nearly 2 years before my surgical team agreed to do the original planned orthognathic surgery. I had both my upper and lower jaw broken and fixed back into place with 6 titanium plates and 29 screws. After surgery I woke up and I could not feel anything from my eye socket down to my chest. But I was still in agony. This was a different type of pain but I always knew to remain calm because panic was not going to help in this situation. I had weeks of not being able to drink from a cup and having to use a syringe for strong pain medication and food. I could not lift my own head off of the pillow and I needed assistance when walking because I could not move my head or neck. The pain after surgery involved stinging, throbbing and stabbing spasms of all my face and neck. It took me months to get back to some sort of normality but I was still not back to the old pain free me. Instead I was left with permanent numbness in my chin, lower teeth and bottom lip, spasms around my whole face, reoccurring sinus infections and continuously tight and painful muscles in my neck, scalp and shoulders. I also lost a lot of hair and my skin and nails were in a bad way. 

1.5 years after the original surgery, I had my titanium plates and screws removed. I had hoped this would relieve the pressure and muscle spasms and also stop the reoccurring sinus infections. I had been on antibiotics for a year and because my body was so used to them they were not working properly and I was becoming immune. I was unable to breathe properly and could not lay flat at night. I resorted to sleeping elevated with 5 pillows. I did not manage to sleep much but I was grateful to get a few hours a night. Before the surgery I was unable to sleep at all due to pain on the left side of my face. Even the slightest breeze or wrong jaw movement would set off a flurry of shocks, followed by muscle spasms. At least I did not have to face that anymore. In December 2012 I underwent titanium plate removal surgery. The surgery was nowhere near as bad as orthognathic surgery. I was able to resume a normal diet after 6 weeks and I was able to manage the pain with high strength pain medications. Although I still slept elevated I was able to sleep a bit better after this surgery. My neck and shoulders would still spasm causing throbbing pain to radiate up into my head. Sometimes mum would rub the spasmed balls of muscle around my neck and shoulders and this would relieve some of the tension on my scalp.

By this stage the infections had stopped….hooray! Now I just needed to conquer the pain issues. I went to my GP and explained the situation and asked to undergo some more physiotherapy treatment. Unfortunately, in recent times the quality of the NHS has suffered due to the huge amount of people using the service and the lack of funds. But I was expecting some sort of help or relief. I waited 8 weeks before I was called up for my first physiotherapy appointment. I was only allotted 4 sessions and each session only lasted a maximum of 15 minutes. Tell me what you can achieve in 15 minutes? Not a lot is the answer. The physiotherapist I saw barely had time to ask me my name before I was ushered out of the door because my time was up. In the brief time I was there the physiotherapist gave me a few exercises to do at home. They included:

  • Look up to the sky for 30 seconds
  • Look to the ground for 30 seconds
  • Look right for 30 seconds
  • Look left for 30 seconds
  • Left ear to your shoulder for 30 seconds
  • Right ear to your shoulder for 30 seconds

I thought “that sounds simple enough for my first week”. Oh how I was wrong! I went home after my brief appointment and had a warm bath (as instructed) before doing my stretches. I was only able to hold each for 5 seconds before the pain set in. That night I was in agony and could not sleep. This was not supposed to be happening. I am a 24 year old young lady. The next day my muscles were really tight and constricted. I decided to give it another go and to stretch every day, as this would hopefully train my muscles to stay relaxed. But again, every day for 13 days the muscles would contract back and spasm up after the 5-10 seconds of stretching. It was like they were angry at me.

When I went back for my next appointment I explained my issue to the physiotherapist and he suggested cutting the time to 5 seconds and continuing with the same stretches. He added in a couple more and sent me on my way. I was disheartened but willing to listen to his advice and carry on. I remember one day walking around the supermarket, my face was playing up and my muscles were angry from the stretches the night before, my eyes completely shut for a moment and I could not grip my bag anymore. My face suddenly had a huge amount of pressure build up. You know the feeling you get when you jump in the swimming pool and the water goes up your nose and stings? My whole body was trembling and I had to stop in the aisle for a break. I tried to act normal around mum because I did not want to worry her. It only lasted for a short period but by the time I got home I was completely drained and my face was really painful. I took full pain relief and used a heat pack to soothe the pain around my face. This issue occurs quite frequently now when I walk or try to carry anything for a period of time. It seems like there is a huge pressure that builds up from over using my muscles.

By my 4 session there was a slight (and I mean slight) improvement in my neck flexibility but the pain and spasms were still the same. The physiotherapist told me to carry on what I was doing and if I needed more appointments I would have to go back on the list to get more. He seemed to believe it was just going to take time and that the issues would resolve on their own. Surprise, surprise they still have not resolved. I asked him if he could suggest any other treatments as I have tried acupuncture and that had a similar negative effect on me. He did not know and said he would rule out any form of deep tissue massage or sports therapy. I on the other hand was not convinced.

To be continued with blogs about massage therapy and osteopathy treatments. 

On my Jollys

Just a little note here to let you know I am going away on a family break from today until Thursday 1st August. I will be taking my phone with me, but will have very limited access to internet. I am really looking forward to getting away and spending some quality time with my mum and brother. I hope you are all well and I shall speak to you when I get back. Hugs and positive vibes. Love Steffie xxx

After orthognathic surgery and titanium plate removal surgery images stefanie grant

After orthognathic surgery and titanium plate removal surgery stefanie grant

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