Thursday, October 30, 2014

Treatment Plan (or lack thereof)

Well after I left the hospital and went home to wait for surgery, it was a giant fog. I have to say that I don't remember a whole lot from that time, other than being in a LOT of pain and that my parents took my son to their place for the weekend so that I could rest and not worry about scaring him. Bless their hearts.

I went home on the Wednesday, probably sometime around noon, and crawled into bed with a heavy dose of narcotics. Still with my front lower teeth flopped out, still with my lower canine hanging on by a thread in my mouth. I know that somehow I made it to Friday like this, because that's when I went in for my surgery - the oral surgeon put my face back together.  Essentially this involved pushing the block of bone holding my upper front teeth forward, pushing the block of bone holding my lower front teeth back together, and re-inserting the lower canine that had been avulsed.  Since it had been loosely attached and remained inside my mouth all this time, it had a good chance of being viable.

Here are before and after photos from the procedure:

The interesting part about these photos is that the wires and arch bars are attached and holding my bone/teeth where it's supposed to be, but did nothing to address the broken condyles.  According to the x-rays, only the left side was displaced, and the right side, while a complete break, was not displaced.  The general treatment plan for this type of condylar fracture pattern is to leave well enough alone, hoping that the undisplaced side would help to maintain the position of my mandible and allow the whole thing to heal on it's own.

As you can see, I wasn't even wired shut. A diet of soft food only - strictly NO chewing - would help to keep the pressure off the breaks and allow them to heal.

The other thing that I notice when looking at these photos is how straight my bottom teeth are, and the top don't look too bad either, with the exception that I am missing the cap from the lateral incisor. Embarrassing, yes, but only a temporary situation.  Since the wires that hold the arch bars in place are  wrapped around individual teeth (and mine were crowded to begin with) they don't do great things to your teeth orthodontically.  Now that I'm 11 weeks out from this day, I can see how much my teeth have moved, and not in a good way. You will see in later posts.

From this point on, I am in for weekly visits with the oral surgeon to monitor my progress, jaw placement and tooth status. The main things he was watching for are that my jaw is healing in the correct position and that none of my teeth (particularly the one that he had to replace) are dying.

2 comments:

  1. I'm sitting in the Pediatric ICU, up at 2am, with my 5-year-old son sleeping in the hospital bed beside me.

    He crashed on his little bike yesterday morning and smashed face-first into rocks by the side of the bike path. He broke his right arm and smashed his lower jaw into a lot of pieces.

    They have put wires around the teeth that could be saved and have wired his mouth shut. He woke up briefly after surgery, but was so freaked out that they had to help sedate him to calm him and get him to sleep.

    I'm sitting here wondering exactly what it is like for him to go through this (Can he breath ok? Will he panic and hyperventilate? How will he get through this?) and just wanted to say THANK YOU.

    Thank you for sharing your experience. For sharing your photos and for giving details on everything you went through. I'm not even finished reading, but wanted to thank you, truly, for taking the time to put the information out there to help others.

    Mickey (and little Gabe) <3

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    Replies
    1. Hi Mickey, first of all I am SO SORRY that this happened to your little man. What a terrible accident. I'm glad that you found my blog so quickly.
      There are a million things I want to tell you right now. Let me try to keep it brief.
      - I knew I would awake wired shut, but I found it less scary and claustrophobic than you might imagine. You can breathe well through your teeth, although it is a pain to hold your lips open to do so. You can also be understood when you talk.
      - This is what I consider Big Pain. The kind you need to set timers for so you take your pain meds before the pain gets out of control. Make sure to keep him comfortable and advocate for that.
      - He will be hungry. Unfortunately, that will come in several days (he likely won't be hungry due to the shock/pain meds, etc) but you can't fill up on liquid. Thankfully there are lots of shakes, protein powders, liquid vitamins so you can get him nutrients.
      - Make sure you get a handle on what's broken in there in terms of bones and be confident in the treatment plan (as much as you can, without a DDS or medical degree). I had my case reviewed by a pediatric oral surgeon in Boston to get opinions on treatment plans. I can give you her name if you would like.

      Stay strong...and ask my as many questions as you need to. I will be thinking of you and wee Gabe constantly.
      Hugs.

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