Orthognathic Surgery (2)
I fully understand my patients' feelings.
College students have their breaks, office workers have summer vacation.
They time it perfectly for the season, hoping to undergo orthognathic surgery and emerge with a completely different, prettier, more attractive face. I get their desperation all too well. I can see it plain as day—without even needing micro-expressions—how they've endured mocking stares and treatment in their social circles, how it's built up into a massive knot in their hearts.
KRRRRING—!
KKKKKANG—!
But even if patients don't know better, shouldn't doctors—the bastards—stop exploiting that? Fucking dogs.
I try my hardest to keep stray thoughts out during surgery. But is it because this is my first orthognathic surgery in this world? Even as I slice horizontally across the gleaming white maxilla exposed inside the incised gums, images of Earth's quack doctors flash in my mind, wrinkling my brow.
GIIIING—!
KKKANG—!
KKKKKANG—!
No matter how advanced the era or how much info floods the internet, patients are just ordinary folks. They can't easily sift through the ocean of data for real medical knowledge. That's why doctors have a duty to provide accurate information—especially the precautions before orthognathic surgery.
If you're a doctor, you can't treat patients like mere ATMs.
Of course, I do my utmost to empty their wallets too. But that's always fair compensation. I precisely inform them of surgical risks and minimize complications by detailing the procedure, side effects, and aftereffects.
It's the bare-minimum responsibility of any doctor, one I never shirk.
No doctor worth their salt doesn't know pre-surgical orthodontic alignment to even out the teeth is essential. Anyone ignorant of that should cut their own wrists instead of bones. With hands more useless than jewelry, they'd cause more harm than healing.
If you get orthognathic surgery without aligned teeth, the uneven arrangement or lengths will throw off facial symmetry even after.
Impatient patients sometimes whine to do the surgery first and braces later.
But post-surgery, the jawbones have already set. Fixing symmetry becomes a nightmare—that means an asymmetric face.
KRRRRANG—!
KKKAK!
KKKKAK!
Damn, what kind of thick bone is this?
Sawing horizontally through the lower left maxilla, then starting on the upper surface—definitely half-orc toughness; this bone's no joke. Generally, orthognathic surgery is tougher on men than women because their bones are thicker and harder. That's why I charged male patients double, even if it drew flak from other hospitals.
Tough luck—do it right yourselves if you hate it.
But I'm top-tier at this too. The bone tower that made Cache faint on her first Beauty Tower visit wasn't built for show.
KKKKAK—!
KKKKKAK—!
Usually, the maxilla has lots of empty space, so the saw glides through without much trimming. But sometimes, like today, it's packed solid with bone—especially in a male patient—and that's a bloodbath.
KRRRRKAK—!
KIIIKAK—!
What bone makes a metallic screech like that...?
I call these "thick-bone patients," and Jason, with his orc blood, is thick-bone incarnate. As someone who's sawed plenty, this guy's top-tier: the saw barely bites, and bleeding's intense.
"Maxilla left side done. Right side now."
""Yes!""
KRRRRR—!
KKKKKKAK—!
PSSSHHH—!
PSSSHHHK—!
If amputation mages saw an electric saw inside a human mouth, even they'd drop their bloody blades in shock. Orthognathic surgery demands precision, yet half-assed know-nothings mock patients for "going crazy for beauty." They'd deserve a hammer to the face.
"Hammer, osteotome."
"Here."
Stella handed me the surgical chisel and hammer over my hand that set down the saw.
THUD—tok—THUDDOK—tok tok—
Sure, more patients lately can't bear the stares or crave peak beauty. But whatever the reason, orthognathic surgery treats malocclusion. No one should brand them "beauty-obsessed crazies" just for that!
"Intervening bone removal."
""Yes!""
The witches efficiently extracted the bone between the severed upper and lower maxilla as I set down the hammer and osteotome.
TSSSS—TSSSS—CLICK—CRACK—
Jaw deformities fall into three main types: facial asymmetry from uneven overgrowth; retrognathia, the "no-chin" look from underdeveloped mandible; and prognathia, the protruding "jawstick" from overgrown mandible.
Beyond cosmetics, most patients seeking it can't enjoy normal daily life—what thoughtless fools belittle. They'd shut up if their own jaws acted up.
These folks suffer malocclusion: poor chewing, slurred speech.
Maybe orcs' monotone speech hides leaking pronunciation shame?
Rarely, TMJ disorders require orthognathic surgery to correct bite, position, and occlusion. Surgery on both maxilla and mandible? That's orthognathic.
GRIIIIING—GWAAAAANG—TSS—TSSS—
Intervening bone and fragments removed, I lowered the cut maxilla slightly forward.
"Occlusal splint ready."
"Yes!"
I fitted the mouthpiece-like splint under the dangling maxilla to check its new position.
"Fixation plates, ready."
"Yes!"
GGIIIIING—!
"It's shifting. Hold still!"
"Sorry."
WHOOOONG—WHOOOONG—DRRRK—DRRRR—DRRRK—
Cautioned Hazel for bumping a plate during suction, I drilled holes and screwed the maxilla left and right fixed.
"Focus! Halfway done. Healing magic, then mandible."
"Yes!"
GRIIIIING—TSS—TSSS—KKKAK—!
KRRRRKAK—!
Removed the splint between upper and lower teeth, sliced both mandibular rami vertically.
KRRRRRANG—!
KRRRRKKAK—!
Pushed the separated anterior mandible back, carefully avoiding nerves, trimmed excess—and the angular parts per half-orc tastes.
KRRRRR!
KRRRKAK!
TSSS—!
TSS—!
KRRRRKAK!
KRRRRKKAK!
"Occlusal splint, fixation plates."
WHOOOONG—WHOOOONG—DRRRK—DRRR—DRRRK—
Arm numb from Jason's rock-hard mandible, fixed left and right with plates and screws. End in sight.
"Chin now."
KRRRRKKAK!
KRRKAK!
TSS—!
TSSS—!
KRRKAK!
KRRRRKKAK!
Mandible fixed, trimmed protruding chin, compared sides, evened asymmetry horizontally with saw.
"Healing magic, please."
"Yes."
Rebecca cast it; fixed mandible bone, gums healed visibly. Healing magic's versatile. But selective healing would be ideal—like now, reopening gums to remove plates/screws.
GIIIIING—GIIIIING—TSS—TSSS—
...Bone already covering? Feels years later already?
Incised upper gums horizontally; sure enough, bone over plate partially.
Rebecca's mana pool dwarfs Hazel/Stella's, healing stronger—why I use her mainly. But for screw-removal surgeries like this, over-healing's a drawback.
"...Ultrasound, please."
"Here."
KIIIGIK—KIIK—KIIIGIK—TSS—TSSS—CHKK—
Ultrasound cleared bone over plate/screws for removal.
Cheekbone, square jaw, V-line surgeries embed "plates" and screws. But if too long, bone overgrows—like now—so visit 6-12 months post-op for removal.
Plates/screws harmless; rare inflammation unless loose/broken. Still, I recommend removal.
Plate/pin types evolve; delay turns quick fix into major surgery.
KIIIGIK—KIIK—KIIIGIK TSS—TSSS—CHKK—
Memorable patient: 20s orthognathic, returned 40s. Screws archaic—slotted vs. Phillips mismatch.
10-15 min removal stretched over an hour.
Day surgery otherwise; I urge plate/screw removal for such cases. Fine now, but future issues possible—like impacted wisdom teeth near plates, or brain scans rejecting cheekbone plates.
"Healing magic again. All done now."
And the biggest reason: they show on X-rays.
November 25th, Year 11 of the Ailene Era.
The dungeon zone entrance in Frederik Territory now brimmed with golden banners and crowds—not just local merchants/adventurers, but out-of-towners. Notably, mostly women.
KWAANG!
CRACK—KWAANG!
"Oh my... not just a great body, the strength too. Amazing."
"Right? I'd love if someone kidnapped my husband. Then I could meet a guy like that."
"Better if they kidnap me. Faster that way?"
Beyond the control line stamped with Gold Territory's gold-bar tower emblem, women ogled the lumberjacks.
Exactly three weeks ago, masked men started shirtless lumberjacking. Initially ignored as oddballs axing in near-winter chill with just masks.
"Eek! There! Last masked hunk coming out!! Look here!!"
"Housewife, go bake bread. What 'hunk' here? Damn?"
"What, you anchovy bastard? Oh, honey?"
"...Yeah. Me."
But from November 4th, one daily unmasked—each face sculpted perfection. Crowds braved biting winds for the reveal, swelling with neighboring folk into cheering clouds, tossing flirts at the 22.
Yet the face-body mismatched hunks ignored all, ox-like silent workers.
"Oh? Logging nearly done? Wraps next week."
Only one man halted the peak-popular studs, drawing smiles.
"Welcome, Director! We don't rest! Finish by week's end!"
Lumberjacks swarmed at the voice, chests bulging. The black-haired man smirked inwardly.
Logging done—what to use these guys for next?