How is Jaw Augmentation performed?

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Depending upon the amount of augmentation and the technique and implant used, Jaw augmentation can last about 1 and 1/2 hours to 2 hours or more if reconstruction is needed.

First, you will have monitoring "pads" attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation. When you are brought to the operating room, electrodes will be "plugged" into these pads which are connected to the monitoring equipment.

Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date. If you had been given an oral sedative or valium prior you will have less anxiety. They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular "doorway" for anesthesia, antibiotics, and other medications. If you haven't been given a sedative, it is more stressful for some patients. If you feel that you may experience anxiety inquire beforehand regarding an oral sedative. Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time. It's the initial placement of the IV that may sting a bit. Some people get heir IV placed in the crook of the elbow, some the hand - it all depends upon your veins though. So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet. After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein. This is called a "catheter". The catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body. This is usually done before you get into the actual O.R. - by a nurse - and you have a saline bag hooked up to you. The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively.

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body. The the effects of the anesthesia are felt soon after injection or opening the stopper - a few seconds in fact. It may feel similar to a sensation of "heat" entering your arm or hand at the catheter site. It then feels as though it is creeping up your arm - then it "jumps" from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized. The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

You will then be marked with a magic marker type pen which helps the surgeon determine the placement areas. . You will then be scrubbed with Betadine, the surgical marker markings will remain - although not as dark. You will be injected with a solution of Lidocaine, epinephrine and saline. The epinephrine is a vasoconstrictor. This will impede your skin's ability to bleed excessively.

The incision will be made in the predetermined placement, the implant situated directly on top of the bone (or right on top the overlying tissue covering it and either sutured or screwed into place. It may take several tries as the implant is usually customized to your facial structure for comfort and aesthetics.

The surgical team then performs a sponge and instrument count and your surgeon then closes your incision with, more than likely, a non-dissolvable type suture. Sometimes percutaneous sutures are used but only very rarely with jaw augmentation. This is normally reserved for malar implants. This is where the sutures stick partially out of the skin and can be removed later on by tugging gently on them after they have partially dissolved within. They can also be sutured with dissolvable stitches inside the surrounding tissues. Even still, they may not be sutured at all, relying on your body's collagen to secure into place. If no internal sutures are used you will more than likely wear your tape or a head wrapping longer unless the pocket specifically fits your implant snugly. This wrapping will be worn post-operatively during the day for the recovery period and is worn at night to help it heal properly in the face per your surgeon's instructions. If you are not familiar with this "look" it involves wrapping a dressing around the top of your head to underneath your jaw, sometimes slightly over your ears. Of course there may be differences in surgical technique depending upon the preference of your surgeon.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released. This is dependent upon the individual but may take up to two hours. Your face may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia. You may also experience "rigors" or shivering. This may feel uncontrollable and is usually from the medications - more than likely epinephrine that is used as a vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable. You may even be fortunate to have heating lamps.

Some patients feel nothing different although if you have had General you may feel a little sick - hopefully your surgeon gave you something to lessen this. Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately. You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.