Tag Archives: broken jaw

Ten weeks

14 Jun

My accident was ten weeks ago today. With the teeth having been repaired and arch bars off, there are no obvious visual signs of serious injury remaining. I do still have scars from the road rash on my elbows and hands. My facial wounds healed long ago, but I’m finding that the bump on my chin where I had stitches is very prone to getting cut when I shave.

I sometimes get a tingly numbness on the left side of my face, but this seems to have grown more slight over the past few days. Occasionally, I feel a little discomfort (which I would not describe as pain) on the left side of my jaw. I do get a little bit of pain on the right side of my jaw when I open my mouth very wide, but I think it’s just a pulled muscle. Sometimes I also get a soft sound coming from the left side of my jaw when I open or close my mouth. The best word I can think of to describe it is a creaking sound, but I don’t think that captures it perfectly.

Good enough

12 Jun

I went in to the oral surgeon’s office today expecting to learn some new jaw exercises. In view of my recent reading, I was somewhat skeptical of the idea that my opening was actually going to get better, so I showed up prepared to ask whether it was reasonable to

When the oral surgeon came into the examination room, he asked me how my opening was. I started to answer before he clarified that he wanted to see it. I opened my mouth, and to my surprise, he told me that it was better than he expected. He added that most people can put three fingers in their mouth, and then demonstrated by trying to put three of his fingers in his mouth. The third one didn’t really fit, though. He had me try to do the same, and I was able to put two fingers in easily, but my opening wasn’t wide enough for a third finger.  The oral surgeon said it was close enough,  demonstrated with his fingers that it was only a millimeter or two from normal, and then watched as I opened and closed my mouth a couple of times to make sure that it was opening straight. He said that I “totally qualify” to have my braces taken off and asked if I wanted them removed right then. I wanted little more, so I answered in the affirmative.

The oral surgeon told me that the wires around my teeth would poke my gums as he pulled them out, so he gave me three options for counteracting the pain: nitrous oxide and a numbing gel; nitrous oxide, the numbing gel, and  novacaine; or general anesthesia. I chose the first of these options, and the oral surgeon told me that most people can handle it, adding that it was “like having a really mean hygienist.”

The oral surgeon moved me to another room, where an assistant put gauze in my mouth, spread the numbing gel on my gums, and hooked me up with nitrous oxide through my nose. The oral surgeon came into the room and started to say, “The adventure that began in April…”. He said it in this overly dramatic tone that sounded like it might have come from one of Barack Obama’s speeches (video; see 9:44), but the second half of the oral surgeon’s sentence, “…comes to a close,” was decidedly less dramatic. He then took the gauze out of my mouth, told me to open my mouth, and cut each of the wires on the top of my mouth before pulling them out. It hurt a little bit, but the pain went away when the wire was out, so it wasn’t bad. At this point, I realized that I had actually started breathing through my mouth again, and I wasn’t feeling the nitrous oxide as much. The oral surgeon then removed the bottom wires. Somewhere in the middle of removing the bottom wires, I noticed that I was sweating a lot, but I don’t know if this was nervousness, an effect of the numbing agents, or a result of the room actually being hot.

The oral surgeon turned off the nitrous oxide and turned on a supply of oxygen, and told me that I didn’t need to return to his office, but I could call if I had concerns. He added that I’d be ready to chew the hardest foods (which he identified as crisp apples, hard French bread, and very hard vegetables) around July 4. The assistant gave me a toothpaste and toothbrush and had me brush my teeth. I had brushed before going, so there wasn’t anything but blood on them, but I complied anyway. The assistant told me that my gums would bleed easily for the next two or three weeks, but that I shouldn’t let this keep me from flossing.

Finally, I have some pictures. First up is a picture of my mouth, sans arch bars.

open mouth

It isn’t perfectly straight, but the appearance of crookedness is exaggerated by the fact that my front teeth are not the same length. The second picture is of me trying to stuff my fingers in my mouth.

I tried to stick my fingers in my mouth before I got caught by the vegan police.

I tried to stick my fingers in my mouth. I suppose this endeavor was made slightly easier by the fact of my having slender fingers.

Teeth cleaning

12 Jun

I just got back from my routine six-month cleaning at the dentist’s office. I only saw a hygienist; the dentist didn’t look at my mouth. To my relief, she didn’t find any cavities. She told me that one of my back teeth has a deep groove in it that will need to be brushed extra carefully, but she emphasized that this was the anatomy of the tooth rather than a cavity.

When my mouth was wired shut, I was unable to brush most surfaces of my teeth, so I find it quite remarkable that I don’t have any cavities. A large part of this, as the hygienist pointed out, is that I’m lucky to have hard enamel. What I don’t owe to luck, I owe to my WaterPik, which proved to be an absolutely indispensable tool for cleaning my teeth and the wires around them.

I also learned that the dentist’s office has already billed my second insurance for the rest of the charges on my account. I should be receiving a bill for whatever they don’t pay in a few weeks. The statement of benefits from the insurance company, however, will probably go to my parents’ address.

Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

The jaw today

29 May

By now, my jaw feels more or less normal. On the left side, the tingly numbness around the site of the fracture has diminished considerably. The area is still tender to the touch, however. I’m chewing most foods normally. In fact, I find that I’m more cautious about not breaking my newly repaired teeth (which are on the right side) than my jaw, so I’ll usually bite with my left teeth rather than the right ones. Oddly enough, I experience pain more often on the right side of my jaw than on the left side.

Other than that, all I have to share is a picture. I made an attempt to record a movie displaying the range of motion of my jaw, but I found that to be too difficult. Even taking a closeup picture was challenging and required several attempts.

IMG_0802

It seems to me that the size of the opening is progressing pretty well, but I don’t really have any good reference points. What is clear, though, is that my mouth still isn’t opening straight. This is perhaps most obvious from the misalignment between the lines between the pairs of teeth at the center of the top and bottom.

The longest I have ever taken to eat a Clif Bar

24 May

The last thing I ate before my accident was about 90% of an Iced Gingerbread Clif Bar. I had purchased 30 of the seasonal flavor Clif Bars at the Grocery Outlet the day before (for $0.59 each), and I brought one along for my ride. I ate most of it at the first regroup, about five miles before my accident. The remaining 10% survived the accident, so I put it in my freezer with the rest of my perishable foods.

This afternoon, seven weeks and a few hours after I opened the Clif Bar, I removed the little remaining piece from the freezer and left it out for a few hours to allow it to thaw. After thawing, it was hard enough that I didn’t want to bite into it directly, so I broke it into small pieces, which I allowed to soften in my mouth before chewing. I think it was a little bit harder than a normal Clif Bar, but it tasted fine.

The almost normal diet

24 May

My diet has been pretty much normal for the last few days. There are still things I can’t eat, but these things are few enough that I don’t really notice them.

Yesterday, I made a Tofu Kale Stir-fry which has been good except that I was too lazy to devein my kale, so it is a bit chewier than I would like my jaw to have to handle. I’ve also eaten various vegetables, some udon noodles, some seitan, and I haven’t had a problem with any of it.

I’ve been pleasantly surprised with the way the food I froze after the accident has turned out. I’ve had a couple of sandwiches on the bread I threw in the freezer, and I can’t even tell that the bread has been frozen. I’ve left the Chickpea Cutlets in the freezer, though. I’m guessing those are still too hard.

Chewing

20 May

When I went to the oral surgeon’s office today, I was surprised that he didn’t do anything–save asking me how I was feeling–to verify that I was ready to chew again. There was no x-ray and no poking or prodding of the site of the injury. I now have medical clearance to chew everything except for “super-hard” foods. This class of excluded foods includes beef jerky, crisp apples, peanuts, pretzels, hard French bread, and carrots. The oral surgeon assured me that there is still “a ton” of food that I can eat, but my jaw just isn’t ready for the harder foods yet. I assured him that I wasn’t feeling psychologically ready for those foods yet either. Even though my jaw had felt strong for a while, I couldn’t imagine testing it on something hard yet.

The surgeon only looked at my mouth to see how far I could open it without the rubber bands, which I will no longer have to wear. He said that I still had some work to do, and he explained that in the next six weeks, we would be working on getting my mouth to open further and straighter. He instructed me to spend a couple of minutes a day just opening and closing my mouth in the mirror, making sure my chin remains straight. I’ll be returning to the oral surgeon in about three weeks, and he said that he’ll give me some more specific exercises to do if my jaw isn’t back to normal by then.

On my way back to campus from the oral surgeon’s office, I stopped for a falafel sandwich. I’ve tended to eat out very infrequently since starting graduate school, but this seemed like as good a time as any to splurge. The only difficulty in eating the falafel was getting it into my mouth, which required me to squeeze the (rather thick) sandwich a little bit. It was late to be eating lunch, and I was hungry, so I chewed and ate it quickly.

Since the first meal, I’ve been munching on various things. I’ve had a couple of different kinds of cookies, a frozen burrito, and a Trader Joe’s Spicy Spinach Pizza. The (cheeseless) pizza had been in my freezer since the week of the accident, and I found it to be a bit chewier than the ones that haven’t been frozen, so I took care to let it start to dissolve in my mouth before I chewed it. I would have liked to start cooking, but I didn’t have ingredients for anything until after I completed a shopping trip, and by then, it was late, and I was hungry. I’ll make a celebratory meal tomorrow, though.

A healed bone (I hope)

20 May

It’s been six weeks to the day since my surgery. I’m going to see the oral surgeon this afternoon, and if all goes well, he’ll find that my bone has healed and tell me that I can start chewing softer foods again. I don’t know how he’ll determine whether the bone has healed, but my guess is that he’ll take an x-ray.

Regardless of what the surgeon might say later, my jaw feels ready. There’s still a little bit of numbness in the area, and I still can’t open it all the way, but it has acquired a feeling of strength that wasn’t there a couple of weeks ago. Three weeks ago, as I approached the moment of my unwiring, my excitement was gradually replaced by nervousness, but (at least so far) that isn’t happening this time.

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