This is a long post. Just warning you.
The Hippocratic Oath includes the promise "to abstain from doing harm" although it does not include that precise phrase. While doctors take this oath and parents do not, I think that we can all agree that *most* parents (abusive scumbags not included) do whatever they can to prevent their children from experiencing pain, both physical and emotional. One of the worst days of my life was watching 2 week old Elliott get a spinal tap. Followed closely by watching them place the 2 IVs and 1 PICC line. Oh, and don't forget the 20+ blood draws that got worse and worse as he got older and older. What made those procedures a teeny, tiny bit more tolerable was knowing that he would never remember them. He didn't look me in the eye and tell me he hated me for doing that to him.
Let me rewind a bit. I'm about to show you a picture that I have never shared publicly. Ever. This is me the day after my jaw surgery, in July 2006. I actually don't look too bad, all things considered. I feel like puking when I see this picture, though, because it causes a weird flashback where I can actually feel the pain in my face and smell the pain medications. I couldn't lay down because my sinuses had been cut in half and I was so swollen that my airway was compromised. I couldn't open my eyes because my eye sockets had literally been moved and the light nearly killed me. I couldn't eat. I couldn't drink. I couldn't talk.
This jaw surgery that I speak of was a Le Fort I osteotomy. The Le Fort I osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. My oral surgeon moved my maxilla forward, rotated it and then fixed it in its new position with titanium screws and plates. I still have 4 plates and 17 screws in my maxilla. I always will.
This is my x-ray from October 2006, a week before I got my dental implant (see my missing tooth?) and a few months before the braces came off.
The braces combined with the Le Fort I osteotomy was my final attempt to fix my misaligned jaws. This was after I had 2 palate expanders and braces as a kid.
I have given birth naturally, with no pain medication, which I wouldn't recommend to anyone actually, but I have to say that if I had to chose between natural child birth and the Le Fort I'd probably go with the childbirth. At least it was quick and it ended with a baby. I wasn't back to normal for a good 2 months after the surgery and the really bad pain lasted close to a month.
When I was pregnant with Spencer, Michael and I joked that we wanted him to have my eyesight and language abilities and Michael's jaw/teeth and math skills. So imagine my devastation when it was apparent at age 3 that he had the same jaw misalignment it took me 26 years to correct.
We decided that we would take him to see my orthodontist because I trust him completely. If he tells me something needs to be done, there is no second opinion. We do it.
The first year I took Spencer, in 2010, all Dr. F could do was get Spencer to bite together. He was too little for X-Rays and he didn't cooperate with the pictures. The bite was all that he needed though. He recommended we start treatment when Spencer was 5.
Last year, when Spencer was 4 he was still too little for X-Rays, but we got some good pictures. Dr. F still recommended we start treatment at 5.
I got my first palate expander when I was in 2nd grade and the second one in 6th grade (when I also got my first set of braces). Both times I had a rapid fixed expander. These appliances work by breaking the median suture of the maxilla. They literally rip the bone and muscles apart. Then the two halves of the maxilla can be separated to the desired position with little resistance. The appliance remains in position until the bone has had a chance to fill the gap between the two halves of the maxilla.
No wonder I used to beg and plead with my mom to NOT turn the little key to crank the expander!
Dr. F does not use rapid fixed palate expansion. He used slow fixed. Rapid palatal expansion has been shown to produce forces ranging from 3 pounds of pressure to more than 20 pounds of pressure. Studies have documented bone fragments, bleeding, microfractures, cyst formation, vascular disorganization, and connective tissue inflammation during rapid expansion. But slow expansion procedures allow physiologic adjustments and reconstitution of the sutural elements. Slower expansion has also been associated with more physiologic stability and less potential for relapse than with rapid expansion. The neuromuscular adaption of the mandible to the maxilla in slow expansion allows a normal vertical closure.
Dr. F's recommendation is that we use slow fixed palate expansion with a face mask to align Spencer's bones. The face mask pulls the upper jaw and teeth forward by pushing against the face.
Spencer tried it on last year when he was 4.
We were back to Dr. F's office on Monday. This time Spencer was finally big enough to take x-rays.
He did great.
He did less great with the lip spreaders for pictures but we were able to power through.
Dr. F thinks his bite and his jaw alignment has actually gotten worse since last year. I agree. His midlines are also off, though not by as much as mine were.
Dr. F has assured me that by doing this now, at age 5, that Spencer will never have to have a Le Fort I osteotomy. There is no guarantee that he won't have to have braces (he probably will), but I am trying to do everything in my power to prevent them from surgically breaking my baby's face someday.
Everything was going great at the appointment. We got through the X-rays and pictures. We paid the, gulp, $2,700 bill in full (bye bye nice patio furniture) and had our consultation with Dr. F. Then it came time to do impressions. And everything fell apart.
For those of you that don't know, to take a dental impression, they fill a little tray like this with a bunch of goo, shove it in your mouth and wait for the goo to harden before pulling it out. I loathe having it done. It makes you gag, it hurts your lips and it can cause little painful abrasions on the inside of your mouth. I have never had a good impression experience, and I've had about 8,467 of them done.
They wanted to make sure that the tray fit before filling it with goo. This was when Spencer gagged, pulled it out and started crying. And started asking me if we could leave. And started making compromises with me as to what he would do instead of having impressions taken. So here I am, causing my kid physical harm and forcing him to do something that I myself hate doing, all while trying to not start crying too.
It sucked. It was a real failure as a mother moment.
But, I pulled it together, bribed him with cookies and Thomas toys, reviewed exactly what was going to happen (reduce fear of the unknown) and then held his hands while they took the impression. And we got through it. With only 1 try. I told him he did a better job than I've EVER done. That made him proud.
We go back on the 22nd to have the actual expander placed. I don't think Spencer has any idea what is about to happen. They want him to spend about 3 weeks getting used to the device before he starts wearing the mask. The more he wears the mask the quicker his bones will move. He does not have to ever wear it to school or in public. He will wear it all the time when he sleeps and he can wear it when he is just hanging out at home. Total treatment time is 6-9 months. Those little bones of his are soft and pliable and very easy to manipulate, so it should go very fast.
In the meantime I just have to keep reminding myself that while it seems terrible right now, we have to keep our eye on the prize. And the prize is a future free of god-awful, face breaking, $50,000 dollar surgeries (mine was totally covered by insurance thank goodness).
I keep forgetting my own message though and feel guilty about the pain that I'm willingly leading him into. Spencer is very sensitive. And he's 5. He can be bargained with, but I don't think he gives a flip about himself 20 years into the future. I also wonder if it would be easier for me to agree to all of this if I didn't have a total understanding of what he will experience. Yes, the expanders are different and work in different ways, but they both expand the palate. The method we are using for Spencer is supposed to be less painful, but I know it is not pain free. I just can't believe after all I have been through, all of the oral pain I have endured, that I'm going to do essentially the same thing to him.
I have a feeling that our supply of Thomas memorabilia is about to go from Gold to Platinum status.
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