As I mentioned last weekend, my jaw has healed in such a way as to compromise my facial symmetry. As promised, here are some more details. Note that all of the photos here, like most photographs, are mirror images.
The asymmetry is least obvious when my mouth and lips are closed. My chin looks a little bit slanted, but my lips look fairly normal.
When I open my lips but leave my teeth together, the asymmetry becomes a little bit more visible. My lips open a little bit further on the right side than the left side.
It becomes more obvious as soon as I open my teeth. My lips open significantly further on the right side than on the left side, and my repaired teeth are smaller than my natural teeth.
One of the more striking asymmetries is seen when I move my lower jaw as far as I can to the left…
…and then to the right.
No, I didn’t upload the wrong photo for that last one, I just can’t move my mandible visibly to the right.
Finally, here’s my wide open mouth. The picture’s a little bit deceiving because my head isn’t quite straight, but there is some serious asymmetry. My mouth opens considerably wider on the right side, and this is visible not only in my slanted chin, but the different amounts of tooth visible on the left and right side.
Unlike some of the other little remaining signs of the accident, this isn’t something I expect to go away. I’ve read much of a study (subscription required) by Edward Ellis and Gaylord Throckmorton in the Journal of Oral and Maxillofacial Surgery found that patients who had condylar mandibular fractures treated by closed methods developed shortening of the face (measured from x-rays of the facial bones). Ellis and Throckmorton found that asymmetry in patients with closed treatment tended to increase somewhat over time rather than decrease. One caveat is that their study didn’t include any patients treated by maxillomandibular fixation (MMF) as I was, but they speculate that patients whose jaws were wired might develop even more asymmetry than the ones in their study. Thus, I don’t think this asymmetry will be going away unless I should fracture the right condyle.
Since my return to the site of the accident the other day, I’ve spent a good deal of time thinking about how the locations of my various injuries might reveal some information about how I hit the ground. Unfortunately, the only conclusion I’ve come to (so far) is that something very complicated must have happened because there was evidence of contact with the ground in so many places.
Here is what I think is the complete list of body parts which showed evidence of hitting the ground:
- Right cheek (abrasions to the right of eye and mouth, black eye)
- Right earlobe (minor abrasion)
- Right side of upper lip (two chipped teeth and a cut which was sutured)
- Right side of chin (laceration was sutured)
- Neck (very minor scratches)
- Top of right shoulder (abrasion)
- Left elbow (small abrasion)
- Right elbow (large abrasion, some soreness for a few weeks after accident)
- Back of left hand (minor abrasions just below bottom knuckles)
- Palm of left hand (skin stripped from an area near the wrist)
- Back of right hand (small abrasions on lowest knuckle of index finger)
- Legs (various scratches and scrapes, none bad enough to bandage)
There were probably a number of minor scratches on my torso, but none seemed particularly significant at the time. Note that there’s no reason to believe that the left side of my face (where the mandibular fracture was) made contact with the ground. The fracture was most likely caused by the force to the right side of my face.
The one thing that seems pretty clear from the injuries is that I fell on the right side of my body. This is something I had assumed since the day of the accident, and something that seems consistent with the accident having happened while turning right. Beyond that, it’s hard to say much. It hardly seems geometrically possible that I could have fallen in such a way that all of these body parts could have come in contact with the ground. Here are a few of the more puzzling questions:
- How did I manage to scrape both the front and back of my left hand? I’m just baffled. I really don’t have a clue.
- How could I have scraped the top of my shoulder against the ground? Uneven pavement might have helped. Other than that, I don’t know.
- How did I scrape both of my elbows when falling on the right side?
- How did I scrape my elbows and my hands, but nothing on the arms in between?
While I typed these questions, I actually thought of an explanation for how I might have gone down. Here’s my best guess. After losing control of the bike, I fell to the right, with my right shoulder and face hitting the ground but my hands remaining on the handlebars. As my body slowed down but the bike continued skidding, my hands let go of the handlebars, and with the left side of my body moving faster than the right, I sort of rolled over so that both my left and right arms hit the ground. This course of events would seem to explain the second and third of my questions, but not the first or fourth.
It’s really all quite a mystery, and I’ll probably never know what really happened.
This evening (by which I mean Monday, July 6), I acquired three large carrots, weighing a full pound among them and ate them. My jaw handled them just fine, but I was concerned about my repaired front teeth, so tried to bite with my side teeth. This was somewhat challenging because it was hard to open my mouth wide enough to fit the thicker parts of the carrots into the side of my mouth. However, I did eventually succeed in eating all three carrots, allowing me to answer in the affirmative the question of whether it is possible for me to eat so many carrots as to make me feel sick. Fortunately, I’m feeling better already, though.
One of the three carrots I ate, in my hand (which I did not eat).
When the oral surgeon took my arch bars out, he told me that I’d be able to resume eating the hardest foods “some time around the fourth of July.” Obviously that was an approximate date, but it seemed as good a day as any, so yesterday I acquired a bag of eight Royal Gala apples. Originally, I was planning on saving them for breakfast, but I got hungry around midnight, so I ate one at about 12:05AM and another a few minutes later. I had another one for breakfast, and just finished another one a few minutes ago. So far, I haven’t had serious problems with my jaw, although with the first couple there was some pain on the right side (opposite the fracture). My repaired teeth also seem to have handled it fine.
In other news, I took a ride back to the scene of my accident this morning. I’ll write about my visit as soon as I can, but there’s actually quite a bit to say about it, so the post might not make it up for a day or two.
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.
For the first few weeks after my accident, and then again in the first several days after my chipped teeth were repaired, I’d often wonder what my teeth had looked like before the accident and lament that I’d never know. On this point, however, I was wrong.
When I got my braces off just short of eight years ago, my orthodontist made models of my teeth. These were to be used to shape the clear plastic retainers that I would have to wear regularly from then on. For most of the past eight years, the models have sat collecting dust in my old room in my parents’ house.
For me, the most striking thing about the models (which unfortunately my photograph doesn’t adequately show) is that they show that my right front tooth was actually slightly bigger than the left front tooth before the former was chipped in the accident. In the repaired version, the edge of my right front tooth (number 8 for the dental notation enthusiasts out there) slants so that the tooth approximately matches both of its neighbors in length where it meets them. In particular, the right front tooth is considerably smaller than its neighbor to the left, and it also looks weird.
The models also confirm that my bottom front teeth have moved a little bit. The two in the center now stick out slightly further than the ones to the left and right. This is something that I’ve suspected since my jaw was wired shut, when I detected a change in the way things felt to my tongue. I’m hoping that the movement is due to pressure applied by the wires in my mouth and that the movement is slight enough that my retainers will be able to nudge them back into place after I get the arch bars out.
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.
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.