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Medical Stuff

Orthodontics

Lots of young people need orthodontics, which is a specialised dentistry to make your teeth straighter and your top and bottom teeth aligned. Most teenagers have braces on their teeth. For you this may be your second lot of treatment with the Orthodontist. Did you have some work done before your bone graft operation? Because of this you will probably get to know your orthodontist pretty well and they often become part of your life. 

This second lot of treatment straightens your teeth and makes sure you will have a beautiful smile. This orthodontic treatment also aims to make your occlusion (bite) good. Sometimes this work is done in conjunction with a Maxillofacial Surgeon and together they get amazing results for you. 

Dental Health

For orthodontics to work all teenagers need to have healthy strong teeth so looking after your teeth is really important. 

Here is a simple checklist to make sure your teeth will be around long enough for the Orthodontist to do their magic. 

  • Brush with a fluoride toothpaste after breakfast and before you go to bed.
  • Only eat sugary foods and fizzy drinks at mealtimes.
  • Go to your dental appointments at the school dental clinic or cleft clinic.

Maxillofacial Surgery (orthognathic surgery)

About 50% of people born with cleft lip and palate will require this surgical procedure which aims to get a better relationship or balance between the top and bottom jaw which alters the profile of the face. 

This procedure will also create ‘low maintenance dentition’ which means your teeth will be easier to look after as you grow older. This is a procedure which is done in close liaison with the Orthodontist and requires lots of planning work. 

This is the general order of what happens…

1. Pre-operative orthodontic treatment to position the teeth in the upper and lower jaws so they will match well when the jaw bones are cut and repositioned. 

2. Planning work using photos, plaster dental models and x-rays of your facial bones and teeth. 

3. Maxillofacial Surgery. 

a. If your jaw only needs to be moved a small distance they will break the jaw and reposition in the correct place. This is called maxillary advancement. Sometimes this will require a further bone graft to be put in. 

b. If you jaw needs to be moved 5ml or greater they can use a technique called, distraction osteogenesis. In this technique, pins are placed on each side of the cuts in the bone. These pins are then attached to an external frame called a distraction device. Screws on the device are turned daily and pull the healing bones slowly apart until enough lengthening has been achieved. This generally takes up to 6 months. There are lots of visits to the Maxillofacial Surgeon to supervise the speed of lengthening.
Read Adam’s account of this procedure further down on this page. 

4. Final orthodontics – which usually lasts about one year, the final bite relationship between upper and lower teeth is established. 

Things you may like to know about Maxillofacial surgery

Maxillary advancement

You will be in hospital about 3-5 days for this procedure usually followed by having 2 weeks off school and up to 6 weeks off sport. Because it is pretty hard to eat after this surgery, and you can only eat sloppy food, generally this means you lose on average of 6 kgs 

Those who have had this done report huge amounts of satisfaction with the results and of course, the more prepared you are for the recovery period the easier it will be for you to bounce back to your normal self. 

Distraction Osteogenesis

You will be in hospital for the placement of the metal plates about 3-5 days followed by about 2 weeks off school and up to 6 weeks off sport. 

  • It is quite difficult to eat after this surgery, but over time you get more used to it.
  • Cleaning your mouth is very important to stop infection. for some great tips read Adam’s story.
  • The bolts that you screw lie inside your mouth, so no one can see them. The most uncomfortable part of this procedure is the bolts sticking out and irritating the inside of your cheek.
  • This generally takes about 6 months and requires a further surgery to remove the metal plates.

General points

  • Not everyone needs this procedure.
  • It is your choice
  • You must have finished growing. They can check this with x-rays
  • Jaw surgery can move the septum (in your nose) and can help alleviate any breathing issues you may have.

How to prepare for either option?

  • Take your time with the decision
  • Ask questions
  • Understand the pros and cons of the procedure. Make sure you understand what results to expect so you don’t experience disappointment
  • Talk to someone else who has had this done
  • No one can make this decision but you
  • If you would like to talk to someone to help you come to your decision ask the Cleft Team for a referral to someone who can help you, or contact Cleft New Zealand.  You may want to join the Teens Facebook page to chat to others your age.

Adam’s Story – distraction osteogenesis

Adam and Bayley, King & Queen of their school Ball and only 2 weeks after surgery!

Adam and Bayley, King & Queen of their school Ball and only 2 weeks after surgery!

These are my experiences with the distraction procedure. The aim of this surgery is to align the teeth and provide a more normal looking appearance of the alignment of lips.

Distraction

Simply put, the procedure of distraction entails the breaking of the top jaw and the insertion of the distraction device. This surgery generally takes 6hr +. The fine details of this procedure can be better explained by your surgeon. 

In the lead up to this surgery

 You undergo a C.T scan. This is later used to form a plastic model of your skull so the plates of the distraction device can be moulded to your face prior to the surgery. Moulds of your teeth are taken to use in predicting the distance the top jaw will be bought forward. Some other general surgical fitness tests like blood pressure, bloods, height and weight are taken. 

After the surgery 

The jaw surgery is quite major so no matter what, you will have some discomfort. The bolts of the distracters will have a “cap” over the top of them to prevent them from digging into your cheek; the cap allows pressure to be dispersed over a larger area so is not as uncomfortable as when the bolt is uncovered. An uncovered bolt will cause cuts in your cheek and be very sore due to the constant friction caused by bolt, preventing the ulcer to heal. I found that even with the caps the bolts were irritating however, as the distraction process moves the jaw forward this decreases. The bolts are in for around 6 months and can be very annoying at times; however this procedure does give amazing results. Personally I am very happy with the results and would not think twice about choosing it again, pain is temporary, and the surgery results are forever. 

After the surgery I was in hospital for 4-5 days and off school for just under 2 weeks. Whilst the jaw is healing I had to live on a diet of soft food.  Initially this took a bit to adjust to and for a few days I would go to school until lunch time.  Eating with the bolts in place is a skill to start with, but I soon adapted.  It is important to remember to get school work to do while away as I found that it wasn’t that I was not well enough to go to school but due to being unable to eat very well, having to take meds and also constantly dribbling I was unable to for a few days. 

The main pain from this surgery comes from the bolts digging into your cheeks; there is no pain when your jaw is wound forward. The winding of the jaw is done with a speciality “screwdriver” which can be attached to bolt. This is turned twice a day to slowly move the jaw forward. Winding continues until your jaw is in the desired position.  This is determined by the surgeon in visits, 3-5 days apart. 

Personally I found that through aligning my teeth, biting things off while eating is a lot easier. After surgery and for around 3 months after you will be on soft food, due to the jaw bone healing and the inability to open your mouth very wide.  During my recovery period I lost 7kg. 

Personal Advice: 

  • After surgery drink powerade. This helps hydrate you and is a lot better than hospital food. As you will be unable to drink from the bottle and will have limited jaw movements use a syringe to squirt into your mouth.  This drink has a lot of sugar so remember oral hygiene is still important.
  • After surgery do not drink fizzy drink, which will cause burping, which is uncomfortable.
  • Do not eat rice until you have good movement of your jaw as it is very hard to remove rice from around the bolts in the early stages of recovery.
  • You will need to buy a babies tooth brush (smaller the better), a tooth brush with only a few bristles on top (it helps clean top teeth above braces)
  • When using brushes to “floss” push them through the holes between your teeth, these can most easily accessed through inside of teeth arc.
  • It will take a long time to do your teeth, however it must be done properly every time.
  • As you are unable to eat solids, buy liquid meal replacement drinks, this can be collected from chemist and comes in small cans. You can order them in bulk.  They provide the recommended dietary nutrients.
  • Don’t stop doing sport.  I had to stop my competitive swimming but continued to go to the gym to stay fit.

I had the distracters removed the week before Christmas, approximately six months after the insertion.  This was only a one hour surgery and I was home the same day. After the removal of the distracters I was able to eat any food I desired, but until the sutures dissolved, where the device was removed, I was cautious.  My braces were removed six weeks later and all the discomfort has definitely been worthwhile.  To have near perfect teeth is fantastic.  

I would highly recommend this procedure in my opinion it gives a fantastic result and is well worth the struggles the bolts causeAdam Moss 

Nearing the end of your medical journey

It is nearly over -after all these years it can feel very exciting to be almost finished; it can feel like a whole new start- so celebrate! 

Your family, the medical team, your friends and school have all had their part to play in your progress, but the person right at the centre of all this is you. Pat yourself on the back for all you have gone through, learnt and accomplished- pretty amazing! 

You may want to thank some of the people who have been there to help and support you along the way. 

Final surgeries

You are able to meet with the Cleft team for a final time to discuss your feelings about the outcomes of this treatment. Sometimes this can include a speech assessment and a consultation with the team. So, if you are not happy about anything now is the time to speak up. 

You are able to have some cosmetic plastic surgery work if you wish. Things like lip revisions and rhinoplasty (nose jobs) may be something you would like. 

Remember to balance the expected outcomes with living through the procedure. Often it doesn’t matter how much work people do, it doesn’t always make them feel 100% content. If there are other psychological issues that are affecting your happiness, then please talk to them with someone. 

Discharge

This is the formality of being signed off from the Cleft team. You can self refer back to the team in the future, it is up to you. 

What now

The world is your oyster – make the most of it . And of course if you want further professional help and advice you can now go through the public health system for … 

  • Any future cosmetic plastic surgery you may want
  • Any investigation and possible surgery for residual speech issues
  • Referral to a geneticist if you would like to talk about starting your own family
  • Help with your psychological health

It’s up to you to…

Look after your dental health and hygiene and especially to look after your adult dental plate because if you lose it you will have to pay for the replacement. 

Your experiences are unique and have helped to shape the amazing person you have become and will continue to be. If you would like to help others, please contact Cleft New Zealand to see how your skills and life experience can support someone else. You may have some great suggestions about services and support that Cleft New Zealand could develop. We are interested in your opinion! 

Do you want to be a ‘buddy’?

What do you think about supporting a younger person, someone who was born with a cleft like you and would really like to have an older, wiser buddy who has been there and done that? Please use this form to register your interest in becoming a support buddy for others going through the same issues: 

Buddy Application
  1. (required)
  2. (valid email required)
  3. Would you be willing to be trained to support others?
 

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