FAQs

What was the duration of the surgery?

Duration of the first surgery was approximately 9 hours (from the time I entered the operating room to the time I was transferred to the ICU, where I stayed overnight).

Duration of the second surgery was approximately 4 hours.

So that’s quite significant amount of general anesthesia experienced and health wasted in vain (as it turned out in my case).

You mentioned you did not take any painkiller medications after the surgery - how is that even possible?

It’s important to understand that after orthognathic surgery one experiences loss of sensation (temporary in most cases, though). Therefore, the feeling of pain may range from slight to none. Of course, there are exceptions, but in my case, however, all I experienced was swelling (and even swelling was not too bad). I did have constant stomach pain, likely due to medications administered during the surgery and intense antibiotics therapy during the first week post-surgery, so taking even more medications did not sound like an appealing idea. Stomach pain completely disappeared in a couple of weeks time.

What was the cost of the orthognathic treatment?

The cost of the surgery itself, including the stay at the hospital, was covered by the Lithuania’s state health insurance. Out of pocket expenses, however, which included everything starting with initial x-rays and consultations, wisdom teeth removal, braces, surgeon’s fees (paid directly to dr. Grybauskas ~$6,000), liquid specialized meals (such as protein shakes), etc. totaled somewhere around $10,000 USD.

Were the revision surgeries performed by the same doctor? If so, what were the revision costs?

Yes, the surgeries I’ve had so far were all performed by the same surgeon – dr. Simonas Grybauskas. Those surgeries were performed free of charge.

How did you eat post-surgery?

Initially, it’s nothing but a liquid diet. The best way to eat during this period is with the syringe and a catheter or a tube. You are probably laughing right now, but believe me, this is the best way to consume food at this stage of recovery if you want to experience the least possible amount of trouble. Get a big syringe, fill it up (with water, juice, smothie, liquified food), place one end of the cathether on the syringe tip and the other in your mouth on the right or left side (whichever is more comfortable for you), push syringe slowly at the speed that would allow to swallow food without causing it to leak out of the month or chocking. In my case, I was using this method for about two months until I was allowed to start opening mouth slighly and using flatware.

What did the liquid diet consist of?

Besides standard water and juices, liquid diet consisted of smoothies (all kinds of fruits and vegetables blended together) and liquified food. You can liquify anything you want (such as potatoes and meat for dinner), but be sure to add enough water or other liquids (such as broth) to make food liquid enough to be suitable for use with the syringe and the catheter/tube. 

On a scale from 0 to 5 how would you rate your orthodontic and orthognatic treatment experience overall?

1

You mentioned that chin surgery can be a cause of backaches you started experiencing after second surgery. How are the chin position and back pain related?

It is a scientifically proven fact that maxillofacial imbalances can cause not only pain in the jaws, but in many other areas of the body. The way it works is that each body part is equipped with sensors which send signals to the the brain informing it of any problems. In turn, brain analysis the data received and issues commands aimed at problem resolution. You may not even be aware of what your brain decides to do – it does what it feels is best for your body.

If you have misaligned jaws (or misaligned chin, in my case), brain knows that something is wrong and that your jaws are not aligned properly or, again – based on my personal example, chin is not where it supposed to be. This causes brain to send commands to the body aimed at restoring the balance. In reality it works in the following way: if you have a gap between the lower and upper jaws on the right side, you are likely to experience neck and back pain on the left side as brain tries to stabilize the left side and bring it in balance with the opposite side. Such attempts by the brain to resolve maxillofacial imbalances, result in increased tension and stiffness on the side which, in brain’s opinion – so to say, needs fixing, and that may very well be a likely cause of the pain. In fact, one of the causes of scoliosis is a bad bite.

So, indeed – bad bite can cause a wide range of health issues, some of which,  you would probably never even think of attributing to the bad bite. But it is a sad truth.

And remember – you cannot fool your brain. If there is something wrong with your body – it does know about it.

What would you recommend to minimize swelling?

Try to walk as much as possible and get outside as soon as you feel comfortable doing it. Staying in bed or not moving much will definitely slow down the process of swelling reduction. If you notice swelling is not subsiding or increasing, see your doctor as soon as possible as that may be a sign of infection.

As of your last surgery, what conserns still remain?

  • Jaw asymmetry;
  • Protruding upper lip;
  • Asymmetric  lips;
  • Numbness in lower lip;
  • Lower lip being pulled to the right side;
  • Excessive amount of bone graft on the right side (along jawline);
  • Face too wide, round, big;
  • Asymmetric chin (does not match position and direction of the jaws);
  • Clicking sound on the left side (in jaw joint area);
  • Big spaces between the lips and teeth (both lower and upper jaw);
  • Crooked front teeth (upper jaw);
  • Constant cheewing on one side (right side);
  • Head-back-nech-shoulder-aches which were not present up until after the first surgery.

If you are not completely happy with treatment results, maybe problem lies in you setting expectations to high?

It has been confirmed by the specialists in the field on maxillofacial surgery that my jaws are asymmetric (left side higher than the right), chin is not very it should be, left side slimmer (bone deficiency), while the right side is fatter (too much bone graft), lips asymmetric, pale and uneven, partial nerve damage (lower lip being pulled to the right side), other issues. In untreated, present jaw asymmetry may lead to further bite deterioration and TMJ problems. New treatment, however, would require complete revision of the previous orthognathic treatment (that’s a process lasting at least a year and would require wearing braces again, revision double jaw surgery, and revision chin surgery). So, no, my expectations are not high. It’s dr. Grybauskas’ expectations that are obviously low if he considers such treatment results as good outcome.

How did it happen that your surgeon refused to provide you with the photos collected over the course of treatment?

An official request was sent to Vilnius implantology center asking to provide all clinical photos, x-rays and tomography images collected over the course of my treatment (years 2009-15). In regards to x-rays and tomography images, it was expressly requested that images be provided not as whole iCAT files, but rather in standard viewable formats (such png, jpg, gif, etc.) that do not require additional specialized software for opening and viewing files. It is important to note that over the long treatment period, many photos were collected by dr. Grybauskas at VIC and those photos are very important. Initial response was that clinical photos could not be provided as they “could not be located”, while iCAT images had not been provided at all. After several attempts, some clinical photos were miraculously located and request to provide clinical photos was fulfilled partially by the VIC (dr. Grybauskas, by the way, is/used to be a co-owner of VIC) as not all clinical photos were provided and most digital iCAT imaging data was not provided at all.  This confirms that dr. Grybauskas is trying to avoid comprehensive evaluation of the treatment services he provided, which is not surprising as every maxillofacial surgeon I had consultation with, said they would had done everything differently and there would be no jaw asymmetry at this time and things would look better.