Today I saw Dr. Miranda as well as my usual optometrist, Dr. Tran. I am scheduled for surgery tomorrow at the California Pacific Medical Center Pacific Campus at 2351 Clay St. My surgery is at 8:45 am but I'm supposed to be there at 6:45 am because that's just how it is.
My optometrist did a regular vision check and also checked for muscular, nerve, and retinal issues. She didn't find any problems.
The surgery that Dr. Miranda will be performing tomorrow is listed on my consent papers as an "open reduction internal fixation of left zygoma maxilla and orbit". There are basically three things he's going to be fixing.
The first is that the CT scans show that there was an orbital floor blowout greater than two square centimeters. The orbital floor is a paper thin piece of bone that normally holds the eye up at the correct vertical position. When there is a blowout of this size then typically what would happen is, if uncorrected, the eye itself would sink down into the region where the orbital floor was damaged. This would make my eye look sunken down and asymmetric. In most cases this will not cause long-term vision problems, but the asymmetry would make me look hella goofy, so they're going to fix it. In rare cases they can put the bone fragments back in place, but in most cases they need to construct a new orbital floor (I believe out of plastic?) which is held in place with small metal screws. This general process is called internal fixation. He said that after I heal there shouldn't be any outwardly visible issues, but I may be able to feel the screws when I press that area with my fingers. This will all be done through an incision in my lower eyelid.
The next issue he'll be fixing is a damaged area of bone in my cheek, that is the zygomatic process of maxilla. The CT scans show that the bone in this area is crushed in, so again he'll create an internal fixation to repair the area. Again, this isn't a serious medical problem with my face, but if the procedure wasn't done my cheeks would be asymmetrical and my left cheek would look sunken in. This will be done through an incision inside my mouth, in my inner cheek.
The third issue that he'll be fixing is the pinched nerve I have that is preventing me from feeling much on the left side of my face/jaw/lips. Currently there is damage where my maxillary nerve exits my skull at the foramen rotundum. That is, there are some bone fragments in this area putting pressure on my maxillary nerve. This will be fixed by an incision at or near my eyebrow. This is actually the thing that will take the longest to recover from, the doctor told me it could be several months he said before I regain full feeling in my upper lip.
These procedures are all pretty common with this type of trauma, because the injuries I have are to the weakest parts of the skull in that area. It is common for all three of these procedures to be performed together.
I will be on a liquid only diet for about a week after surgery, and clear liquids only for about a day after surgery. This is because the incision area in my mouth can't be fully sterilized, and the area they're working with are near my sinuses which also cannot be fully sterilized. Therefore there's a risk of infection in my mouth and sinuses after surgery if food or bacteria enter the incision. I'm also going to be given a regimen of antibiotics for preventative purposes.
I have to be up bright and early tomorrow for this procedure, so that's it for now. I'll update again after the surgery.