Tag Archives: jaw fracture

What’s the first thing you should do after you break your jaw?

18 Jul

Start a blog, obviously. If you must insist, you can go ahead and seek medical attention first, but I do hope that you’ll consider publicly documenting your recovery.

When I first learned that my jaw would be wired shut for three weeks, I had a lot of questions about the road ahead. I wondered about things like how I would eat, how I could keep my teeth clean, and whether I’d be able to teach my classes. My oral surgeon and dentist gave me some answers, but I wanted to hear from people who had been in my position. I didn’t know anybody who had broken his or her jaw before, so I turned to the internet. Google turned up a few accounts, but these were generally either forum posts focusing on a single aspect of the recovery or summaries with only the most general information.

I started this blog because I wanted to document my recovery in a way that might be useful to others with similar injuries. I aimed to share everything that I learned and experienced through my recovery, just on the chance that it might help somebody else at a later time. Looking back, though, I didn’t do a particularly good job of it. Somehow, I neglected to take any pictures of my mouth while it was wired shut, and I wrote relatively little about food. This doesn’t necessarily mean that I’m a bad blogger and that this is a bad blog, but it’s a reflection of the fact that having a broken jaw can be overwhelming, and it’s not really possible for one person to write about everything that’s relevant to the topic.

It is also the case that people’s experiences with broken jaws will differ. Different people break their jaws in different places, recover differently, and have different daily routines that are affected in different ways. This level of diversity ensures that anyone with a broken jaw is uniquely qualified to add something to the understanding of broken jaws.

As for the practicality of starting your own blog, their are a number of sites that will run a blog for free. This blog is currently on WordPress.com. Another popular service is Google’s Blogger. These days, I’m also seeing an increasing number of blogs on tumblr, but my knowledge of that service is minimal. I honestly don’t really know how these three services stack up against each other, and I don’t think it matters much. All of them are more than sufficient for communicating information.

Finally, if you do decide to start your own blog, please send me the URL, either by leaving a comment or by email, so that I can add it to my blogroll.

Facial asymmetry

17 Jul

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.

Closed mouth

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.

Teeth

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.

Mouth narrowly open

One of the more striking asymmetries is seen when I move my lower jaw as far as I can to the left…
Lower jaw to left
…and then to the right.
Lower jaw to 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.

Wide open mouth

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.

Recovery update

12 Jul

It’s now been fourteen weeks since my accident and a month since I had the arch bars removed. For the most part, I’ve considered my recovery a success ever since I got the arch bars out and ceased to be under the care of the oral surgeon, but that wasn’t really the end of this adventure. Some things have continued to get better, but other things aren’t completely normal. Here’s my list of things that have improved and things that haven’t.

  • My mouth is opening a little bit wider than it was four weeks ago.
    Open wide
    By my measurement that’s about five centimeters between my upper and lower front teeth. That’s a full centimeter better than my last estimate. I also do better on the three finger test.
    Three fingers in mouth
    That’s a lousy picture because it’s actually pretty hard to take good pictures of one’s own mouth with a camera in one hand while sticking one’s other hand in one’s mouth. In spite of the bad picture, it’s significantly improved from last time, and in fact, I’m able to pass the test without my top teeth even making contact with my fingers.
  • Four weeks ago, I wrote about as “tingly numbness” on the left side of my face. This has perhaps improved somewhat, but it’s definitely still there. I’m hopeful that it will eventually go away altogether because it’s similar to the sensation I had on the left side of my face after having my wisdom teeth removed. That lasted a few months but did eventually go away.
  • Four weeks ago, I also mentioned a creaking sound from my jaw. That has gone away.
  • I continue to get occasional feelings of soreness on the right side of my jaw, but I think that these feelings have become less frequent.
  • I haven’t mentioned this before, but for several weeks, I’ve been getting occasional sharp pains on my left cheek.
  • There’s a region in my left jaw which is somewhat tender. I’m guessing this is the area around the fracture.
  • As you might notice in the first photo above, my face isn’t very symmetrical. I’ll write about this more extensively in the near future, but this isn’t something I expect to improve.

Carrots

7 Jul

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).

One of the three carrots I ate, in my hand (which I did not eat).

The accident revisited

4 Jul

I have to begin with a confession. When I wrote about my accident, I wasn’t entirely sure that everything I was saying was true. I didn’t say anything that I knew to be false, but I didn’t remember all of the details of how I had fallen. When I had no information about something, I didn’t say anything, but there were a couple of statements I made that were guesses based on what I did remember and what seemed to be the best information at the time.

For example, I wrote that I had been taking the downhill stretches faster than I was accustomed, and claimed that this was the cause of my accident. It’s true that I had taken some downhill stretches faster than I would have when riding alone, but I never had any specific recollection of going fast down the particular hill where the accident took place. When I stated that I had been going faster at the time of the accident, I was extrapolating based on what I did remember in a way that seemed to explain why I had fallen. Similarly, when I said that my bike crossed over the center line in the road, I didn’t have any specific recollection of that having happened at that particular turn. I had some recollection of it having happened somewhere, and it seemed reasonable to conclude that it was the place where I had crashed.

Anyway, I needed to make that confession because I revisited the scene of the accident this morning, and what I saw there led me to question both of the claims discussed in the preceding paragraph.

As I approached the turn where the accident took place, I could see that there were plenty of signs warning of a difficult turn. First was  something painted on the street by a well-meaning amateur.

SLOW!

Then there were the road signs as I approached the turns.

Right Turn, 15MPH
I’ve always been a careful cyclist, so this signage came as a surprise to me. I just couldn’t believe that I’d ignored it. The fact that I didn’t remember it being there  might suggest that I wasn’t paying close enough attention, but I also could easily have forgotten in my post-accident shock. (It also occurred to me that when the EMT asked how fast I had been going and eventually got me to agree that I had been going 20 to 30 miles per hour, I had admitted to breaking the speed limit.)

When I got to the actual turn, there were even more warnings.

Yellow Light, Right Arrow

I stopped at the corner to reflect on things and examine the scene for a while. Obviously, with the accident having happened 90 days earlier, there were no visible traces of my accident. However, one patch of pavement did catch my attention.

Cracked pavement

With the shade and an unfavorable angle, the photo doesn’t adequately display the magnitude of the hazard that this presents to bicyclists. In particular, it’s hard to see in the picture how deep some of the ridges were. Here’s another shot, which still doesn’t really do it justice, but it provides a little bit more information.

Another view of the cracked pavement

Also, the hill that preceded this turn actually did seem pretty steep, contrary to what I had thought when I looked at it on Google Street View.

Somewhat steep hill

In the hours since my return to the site, I’ve become increasingly convinced that the condition of the pavement played some role in my accident. The evidence is far from conclusive, but my biggest objection to that theory was easily resolved. This objection was that the cracked pavement was only found on the side where I was supposed to be riding, and I remembered crossing over the center line. As I mentioned previously, though, that memory of crossing the line may not be from this particular spot. Moreover, even if it is from that spot, it’s possible that I lost control on the broken pavement and then crossed over the line and fell.

I’ve spent a good amount of time examining my injuries and the scratches that the bike acquired in the accident, trying to figure out exactly how I fell and whether that might convey any information about the quality of the pavement I was on. The main way that such information might arise is if the bike were scratched in places that wouldn’t touch smooth pavement when I fell on it, but might have been able to touch pavement that was sufficiently uneven. Indeed, there are some scratches in places that seem like they shouldn’t have made contact with the road, but it’s not clear to me that the scratches could have come from falling on the ridged pavement either. The only other possibility seems to be that these scratches predated the accident (but I didn’t notice them until afterwards) or that they were acquired while the bike was at the fire station.

Since the morning, I’ve also had flashbacks of falling from my bike towards badly cracked pavement. I suspect that this isn’t an actual memory but something that my mind has fabricated to support my new theory of the cause of the accident.

Of course, all of this speculation on what happened that day has only minimal practical value. Determining the cause of the accident isn’t going to change the fact that it happened. Nor would it change the fact that the worst effects of the accident have, by all indications, passed. The only possible benefit from knowing why I fell would seem to be liability purposes, and not only does it seem unlikely that I’d be able to build a strong enough case, but I have no interest in pursuing litigation against a city that is broke when my insurance companies seem to have picked up most of the tab for my bills. I’d much rather see money go to fixing road hazards, which is why I reported this spot on the East Bay Bicycle Coalition’s hazard reporting site. Much to their credit, Oakland’s Public Works Agency apparently does a good job of fixing hazards quickly after they are reported, according to an article in the East Bay Express.

Loose ends, Part I

16 Jun

With my recovery nearly complete, my posts here will be less frequent than they once were. I’ll still be posting about billing and insurance when there’s news on that front. I’ll also post updates on any new developments with my injuries if and when things arise. Eventually, I’ll get around to posting about some of the things I’ve learned from my accident and its aftermath (including a guide for those who are recovering from similar injuries) and how my experiences have influenced my worldview.

In the mean time, there are a few things that I probably should have mentioned a while ago. I’ll post three here. I may include more in subsequent posts.

  • Some time after I returned from my oral surgery, I found an x-ray of my mouth among the things that I had carried home from the surgeon’s office. I have never had any recollection of the taking of the x-ray, but it was apparently done after I had my mouth wired, as the wires are visible. Here it is. Note that the left side of my mouth (with the fracture) appears on the right side of the image.
    x-ray
  • It seems that I’ve neglected to explain that the part of my jaw that I broke, the condyle (or maybe it was the neck of the condyloid process, just below the condyle) is located near the joint with the upper jaw, rather than near the teeth. I suspect that this made the recovery easier than it otherwise might have been because the pictures of jaws broken between the teeth look far more gruesome than anything I saw on my own face.
  • A few days after the oral surgeon wired my mouth shut, my mother mentioned to me that she had read that people who have their jaws wired shut often have to carry wire cutters for emergency use. I had no recollection of the oral surgeon saying anything to me about wire cutters, but I could not rule out the possibility that he had said something but I could not remember because I was still feeling the anesthesia. Furthermore, some research showed that my mother’s claim was correct. Moreover, I discovered a few days before my wireless upgrade that the instructions I received from the hospital said,

    If your jaw was wired shut, it is important that you be able to open the wires in any emergency that makes it difficult to breathe, such as vomiting, extreme coughing or choking. Therefore, you must carry a pair of small wire-cutters with you at all times. Be sure you know which wires to cut in case this is necessary. If not, ask your doctor.

    To be clear, this came from the hospital, and I had my jaw wired a few days later by an oral surgeon at a different practice. But I never carried a wire cutter. I’m still alive today. Go figure.

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.

Twenty-three with braces

2 Jun

These days, the only major sign of my accident is the arch bars on my teeth. The oral surgeon told me that they’d stay on until my mouth is opening normally enough that he is sure they won’t be needed again. As the days progress, I find myself increasingly impatient for this to happen. I don’t particularly mind the look, and the arch bars aren’t even that visible. It’s just that I feel like I’m about ten years too old to have braces on my teeth.

Over the last week or so, I’ve been stretching my jaw muscles more and more. The oral surgeon only told me I should work on opening wider, but sometimes I work on the side-to-side motions a bit, hoping that it might help to correct the problem of the right side of my mouth opening further than the left.

The truth is that I don’t even really know how far my mouth should be able to open, or even what straight is. The latter question seems like it should be easily settled, but it’s not so easy because my front teeth aren’t perfectly straight. Some of them have shifted slightly since the accident (owing to my inability to wear a retainer while my jaw was wired), and two were chipped and then repaired artificially. The oral surgeon wants me to focus on keeping my chin straight, but even that’s not so easy because my chin has a small bump on the right side where it was stitched up. As for the width of the opening, I haven’t been able to find out what is normal, but I’m pretty sure that it’s wider than my opening of about four centimeters.

If there’s one thing that keeps me from sitting around and exercising my jaw all day long, it’s the understanding that my trying too hard to fit in may well have caused the accident in the first place. I’m not quite sure what could go wrong here. I doubt that my muscles are strong enough to break the bone again, but I’d rather not find out.

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.

A day late

28 May

Somebody from Alta Bates returned my call a few minutes ago. It didn’t seem like she had any record of billing Blue Shield of California, but she did take my correct insurance information. She seemed surprised that I didn’t have a group number for my primary insurance, but she took my father’s name, date of birth, and employer information instead. She also told that they had the wrong member number for my secondary insurance.

Now I’m back to waiting for more bills (and non-bills) to roll in.

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