The surgery

Monday, August 13th 2012 - the day of my right TMJ eminectomy.

Contrary to my expectations, I was able to sleep a few hours before the surgery. I guess the tiredness of several sleepless nights took its toll. I woke up at 06:00, had a quick shower and prepared the last few things to take to the hospital. At 07:00, I called the Short Stay Surgical Unit and I was asked to go straight to the University Hospital of Wales (Cardiff) as I was the first on Mr. C.'s list of surgeries for the day. Davide and I arrived at the ward just before 07:30, and shortly after I was called inside, barely having time to properly squeeze Davide in my arms.
The nurse in charge of my case was very nice and kind. As she walked with me to my room, she started explaining what would happen before the surgery. There were some measurements and tests to be taken (temperature, blood pressure, pulse, oxygen levels, urine sample, weight and height), a long questionnaire to be filled, the anaesthesia consultation, a short visit from the one of my surgeons, and the hospital gown to dress, including special socks to prevent blood clogs. Before 08:30 I was picked up from my room to the anaesthesia ward. The anaesthetist was really nice and explained me every single stage of inducing me to sleep intravenously. After this, she would intubate me and give me local anaesthetics for the surgery. "I'll start injecting the general anaesthetics now, ok? Just relax, sweetheart. You can now start dreaming about your next vacations." She smiled and winked her eye. Those were the last words I heard.

I dreamt. I definitely dreamt during surgery. I can't recall the dream, but I woke up with the feeling it had been pleasant. Perhaps I dreamt about our next vacations.

I was awake by a nurse at the recovery room. She called my name and touched my shoulder. As I opened my eyes, she asked me if I knew where I was and what had happened. "I just came out of surgery." "Yes, very good!", she said. I think both of us were surprised how much alert I was. All the area surrounding the right TMJ was hurting, and she gave me a light dose of morphine (5mg) with paracetamol intravenously. She took measurements (temperature, blood pressure, pulse, oxygen levels) at short periods of time to ensure I was well. Since I wasn't nauseated or feeling sick, the drip bag was removed from my left hand. On my right shoulder I noticed the drain, which was well secured with tape and stitches on the head. It was half full of blood and it didn't bother me at all. It actually made me smile - it looked just like a small red chinese lantern, hanging from the right side of my head.
"What's the time, please?", I asked. "11:20, dear." It seemed quite late to me. The surgery was expected to last only one hour, meaning I would be out at around 10:00. This thought made me worry about what might've happened during the surgery. Was it more complicated than what was initially expected? How was the disc? How was the disc? That was my main concern... I asked the nurse if she knew how anything about the surgery, but she was only able to tell me that all went well. She assured me that soon a member of the surgical team would come to check on me, and hopefully give me more information.
As I was responding well and my vital signs were good, I left the recovery room around twenty minutes later. I was moved to a different room from the one I was given before. I was now at the children's surgical unit, but just for a while - I would be moved back to my first room later.
I saw my bag near the bed, reached for my mobile phone and text Davide "I had a really nice nap :)", with a few other details. Davide had called the Short Stay Surgical Unit at 11:00, and just like myself, he was surprised when the nurse informed him that I was still in the operation theatre. However, he was quite happy to know I was out and doing well. I sent him a couple of photos of my head and he made me company through text messages - it was a bit hard for me to talk on the phone. Meanwhile, the pain was increasing and I was given 100mg of tramadol and 1000mg of paracetamol, as the anaesthetics were wearing off. My throat was also horribly sore due to surgery intubation, but there was nothing the nurse could give to help me on this. My mouth also felt extremely dry, so I kept drinking sips of water and hydrating the lips with vaseline.
The inside of the TMJ felt (and it still feels) slightly swollen and spongy, with extra volume between bones. I couldn't close my mouth fully, due to this extra volume. The teeth remained slightly separated and on a clearly different position than before - upper and lower front teeth aligned along the same vertical plane (before the lower teeth were slightly behind the upper). In this new position, if I forced the teeth to touch, only the front teeth did so - the back teeth didn't contact with each other to bite.

The first visit from the surgical team was around 13:00, by two surgeons that I had met before. I was told all went very well. The disc returned to its position above the condyle on its own, and remained so without being necessary to touch it or secure it. The eminence was smoothed really nicely. These were great news! I felt such a relief by knowing they didn't have to touch the disc at all! I was asked to open my mouth as wide as I could. I did my best, but the surgeons were not impressed. According to what I was told, this was certainly related with swelling inside the joint. They were confidant it will improve with time, as right after the eminence removal they were able to open my mouth much wider. The lower jaw shifts slightly to the right side upon mouth opening, as expected and as it was previously. They also asked me to frown and do some other facial expressions to check if I had any nerve paralysis. Despite being painful, I gave them the widest smile I could when they confirmed no nerve damage. They assured me that later in the evening I would get another visit from the team and, depending how well the wound was being drained, I would be discharged in the morning.


Visiting hours were from 17:00 to 21:00, and during this period Davide never left me. He helped me put on my pyjama, he arranged everything in my room area so I could have easy access to my things, he brought my favourite yogurt to eat and straws to drink water, he surprised me with the iPhone cover I feel in love with just a few days before, he got me the sweetest and funniest card ever to make me smile, and he made me feel much better.

At around 18:30, I got the second visit from the surgical team and two intravenous antibiotics were introduced to my medication list, together with an abdominal injection to prevent blood clogs. Due to their thick consistency, the antibiotics had to be diluted on a small bag of saline solution, injected slowly through my left hand tubing, and flushed afterwards with another small drip bag of saline solution.

The nurses came to turn off the lights at around 22:30. However, I couldn't sleep or rest because of the pain. To control it, I had to be given 5mg of morphine, with 100mg tramadol and 1000mg paracetamol, twice during the night. To keep my mind away from the pain, I started taking notes regarding the recovery process. Here is how I described the pain during the first 24 hours post-op:

The pain is completely different from what I have been having in the past year. It seems to me that it is not related to my previous symptoms. The pain is only associated with the wound and inside the joint, where tissues and bone were worked on. It flares up to pain levels of 8+ for short periods from time to time, but it remains mostly a deep 6-7. Pain drugs bring it down to comfortable levels of 3-4 maximum. Few of the stitches sting every now and again, but it is no big deal. I don't feel any of the pain I previously had along the branches and ends of the trigeminal nerve. No facial or head pain, apart from around the wound.

The night went by, and in the morning I had the surgeon's visit prior to discharge. The recovery was going very well. According to what I was told, the pain, the changes in bite and the small clicking noises are natural and shall improve with time. Some other details of the surgery were also explained - the joint capsule wasn't cut to expose the TMJ, as smoothing the eminence was enough to allow normal functioning of the joint, which avoided a much more invasive surgery. These were great news! However, there is a downside to this - the condition of the disc and condyle wasn't checked. We must hope they are healthy enough to maintain the TMJ functioning properly in the future.
My medication was checked once more: co-amoxiclav 500/125mg with penicillin (antibiotic) and 400mg ibuprofen (anti-inflammatory) were prescribed to be taken three times daily for the following five days. As for the pain, I continue taking 8x 50mg tramadol and 8x 500mg paracetamol daily.
After the visit, the drain - my little red chinese lantern - was removed, only with a minor discomfort and bleeding. With the nurse's permission, Davide came in to help me get dressed and pack my things.
We left the hospital after thanking all the nurses for their hard work, their tireless efforts to look after me and make me feel better, and their endless kindness when I needed the most.

Few minutes later, I arrived home for a week of post-op pain, swelling and discomfort.

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Thank you all for your kind words and support! They mean more to me than I can describe!