Nerve damage is one of the main risks of having orthognathic surgery. Nerve injuries can be caused by direct or indirect trauma to the nerves. Indirect trauma can be in the form of compression or swelling. Or direct trauma, caused by the nerve being stretched or cut during the operation. There are many nerves in your face that help with sensation and movement. During orthognathic surgery the two main nerves at risk are; the trigeminal nerve and the lingual nerve. The trigeminal nerve has three branches that spread across the side of your face and the lingual nerve serves the front 2/3rds of the tongue.
After lower jaw surgery it is expected that patients will feel numbness or pins and needles around the chin, lower jaw and lip area. This is completely normal and should only be temporary. In most cases the lower numbness starts to wear off within a couple of weeks. However, sometimes it can take up to 12-18 months for full sensation to return to the area. In a few cases the numbness may become permanent. As the muscles will be unaffected, the numbness should not restrict you from speaking properly or using your lip or lower jaw in the future.
If you are undertaking upper jaw surgery the area of numbness may be larger. With upper jaw surgery it would be expected for the patient to feel numb from the eye area downwards. The numb area can spread down the face and cause numbness in the upper lip, gum and teeth. As with the lower jaw surgery the upper numbness should start to fade between 8-12 weeks and full sensation would be expected within 12-18 months.
Finally, there may be a risk of damage or sensory loss to the lingual nerve following lower jaw surgery. This nerve controls the feeling in the front two thirds of the tongue and is responsible for taste. Although this is a recognised complication of orthognathic surgery it tends to be rare. This particular problem is usually associated with a patient who has had their nerve stretched or bruised by retraction during the operation.
In my case, when I woke up from surgery I was in a huge amount of pain, however, I could not feel my face from the eye socket down. Due to my unique anatomy my trigeminal nerve was in a different position from everybody else’s. My surgeon had not known this fact and had accidently cut the nerve during surgery. My surgeon stitched back the nerve on the left side of my face and hoped that it would make a full recovery. During the first few weeks that followed surgery, I would find myself stroking my eyebrows as these were the only things I could feel on my face. It brought me some sort of comfort knowing I could touch my face.
In the early stages of recovery my face felt fuzzy or hot. I could not feel my teeth, gum, nose, cheeks, chin or lips. If I touched the face, it felt as if someone had poured a glass of water down my face. In the weeks that followed the water running down my face sensation seemed to intensify and sometimes I would not be able to concentrate. I also had periods of a few days where I lost sensation in my tongue. The first time this happened I was lying in bed at night on my own and the sensation just disappeared. Because I had a blocked nose, I was breathing through my mouth. When the feeling left I could no longer feel the air flow on my tongue and started to panic. No one at the hospital had mentioned anything to do with my tongue being numb after jaw surgery. However, due to my high level of exhaustion from not sleeping for weeks, I decided to slow my breathing and concentrated on taking deep breathes. I used a syringe to have some cold water and this is when I realised my tongue was numb. I could not feel the cold water on my tongue and could only feel the coldness once the water had hit the back of my throat. The next day I had soup through a syringe and I had the same issue. I could not feel the warm soup and I could not taste the soap either. When I visited the hospital next, my orthodontist assessed me and said that it was normal to have tongue numbness and as mine was only coming and going it should only be temporary.
After this phase in recovery, there came the relentless itching and the pins and needles in my face and lips. This was highly annoying. As I was so sore, swollen and in pain, it was very hard to touch my face. I would try to distract myself when I had these attacks of itching. I saw this as a positive thing that my nerves were starting to wake up and heal at last.
In total, I would say it took 3 months to regain most of my feeling back in my face. I still have permanent numbness in both sides of my lower lip, chin and teeth, but I am learning to live with this. I would much prefer this, than to have nerve pain or constant pins and needles. The lower numbness does make me self-conscious and I do worry when I go out to restaurants or bars. I usually have a napkin to hand whilst I eat and take a small hand mirror with me in my purse to check my face after I have finished eating or drinking. My friends and family are understanding and would never let me walk around with food around my chin (well apart from that one time, thanks guys). I tend to use a straw when I drink as this gives me more control about where the liquid is going. I also use cups with small lips at the top, as this makes it easier for me to drink from than large rimmed cups or glass tumblers.
To read more about the risks involved in Orthognathic Surgery and to get more information and tips on how to help regain feeling in your face and reduce swelling….. why not download my “Jaw Surgery Survival Pack”?
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