Hardware out!

A few weeks ago I went back to my oral surgeon for my 6 month (and final) check up on my jaw.  I had another panoramic x-ray taken and everything has healed nicely.  The plates were bothering me some, mainly because I could feel them, particularly the top one, and the lower one stuck out the side of my face a bit. It also felt like my chin really doesn't move quite normally. None of this was a huge deal, but not something that I wanted to experience for the rest of my life.

So, yesterday I went back to my oral surgeon to have my hardware removed and have my wisdom teeth extracted.  The recovery from this has been pretty easy.  I feel no pain at all from the wisdom teeth extraction sites which is really surprising to me.  My chin is sore though and swollen, but not as bad as after the original surgery.  And, unlike the first time, I have almost normal energy levels. Unfortunately, my medical insurance would not cover the plate/screw removal, but it was worth the money to me to have it done. Considering that they promptly paid ~40k (probably ~15-20k with negotiated rates) in medical expenses from the accident I'm not too pissed about it.

This will likely be my last post unless something happens related to my poor jaw in the future. Looking back on my previous posts I'm a bit embarrassed at how OCD/pessimistic/distressed I was during the recovery process, but that's just they way I am I guess :)  So happy to put all of this behind me!

Update

Progress has definitely slowed in terms of being able to open my mouth further, I've gained maybe a mm or 2 since my last post.  It's not something that's bothering me though as I can eat pretty much everything except maybe a big subway sandwich or something.  I'll likely keep up the exercises another couple of weeks or so and then stop if I fail to see progress.

I recently read an article comparing mouth opening of patients with bilateral condylar fractures who were treated either surgically or closed.  The study found no difference between the two groups, and the only significant factor they found was age of the patient.  Patients with bilateral fractures who were under 30 were significantly more likely to regain normal functioning (defined as 40mm opening or greater) than patients over 30.  From other things I've read, I believe the difference is due to the fact that age limits the amount of condylar remodeling that is possible. The ability of the facial muscles to stretch and compensate likely also decreases with age. This was a small study (as most of the studies I've found have been), and I wish they would have listed descriptive statistics (gender, mean and sd of age) as well as mean and sd of actual mouth opening.  There's a huge difference functionally between being able to open 35mm and 20mm. Sample size likely limited their ability to analyze the data with age and mouth opening as linear variables, or perhaps they didn't record exact measurements on mouth opening. An interesting study to me though as it only included patients with fractures like mine.

I recently went to the dentist and got all of the nasty plaque scraped off my teeth and had my chipped tooth filled.  It's so nice not to feel rough spots on my teeth.  I also went for an ortho consult and have two more scheduled.  I'll be in braces for around 2 years and may have some extractions.  I am going for a "compromise" treatment though as there's no way in hell that I'm going to have jaw surgery to get a perfect result.  There are limits as to how much I'm willing to put myself through :)  Hoping to get a better idea of how much improvement I can expect from the next consult.

Done with PT

I saw my oral surgeon today and I am done with PT.  I wasn't exactly happy with the PT and I'm confident that I can do almost all of what they did on my own.  I have made some more progress on my mouth opening, it is now 34mm.  My mouth isn't really deviating on opening all the much either, it goes a bit to the right, but its barely noticeable.  So, it looks like I don't need to spend $400 on a therabite (insurance doesn't typically cover the cost) as the tongue blades seem to be doing the trick.  If they hadn't though, I would have gladly paid that to be able to get to normal opening.  The plan is to keep adding tongue depressors until I make no more progress or get to 45mm.

Since I can feel that my front fracture is not solid, I asked how much longer it will take to firm up.  At 6 months from my surgery, I'll get another x-ray.  If its not healed by then, she may have to "go in there again".  That doesn't sound fun.  I'm going to go against my nature though and just assume that it will heal fine.  I've been convinced to varying degrees throughout this recovery that things were not going to turn out well, and so far have been wrong.  I'm getting better at not freaking out about every little thing.  I think it helps a lot that I can eat normally now, the liquid diet/soft diet where it took forever to eat small amounts of food really screwed with my head.  Plus I'm just more prone to worry than the average Joe.  I can blame that on the genes from my mom and maternal grandmother for that, as they are the same way.  I'm hoping that I didn't pass that on to my son.

Significant Improvement

I've now had 4 physical therapy sessions by 4 different physical therapists. What the hell?  At my third appointment, I ran into the woman who saw me the first time and instructed me to check with the front desk to make sure that I was on her schedule.  It seems like maybe this should have been arranged before I scheduled my appointments after the first visit.  Annoying...and of course when I checked with the receptionist, she only had one opening all week and it was at a time I couldn't make.

All this said, I liked the woman I saw today, probably because she caused me the most pain.  I know that sounds strange, but I almost took a nap at my last appointment as the dude mainly just gave me a neck and check massage.  If I'm going to go to physical therapy, I want to be pushed, otherwise what is the point?

And, complaints aside, I am seeing great improvement!  I honestly attribute that more to the tongue blade therapy my doctor started me on, though the exercises they gave me at PT were likely helpful as well. I can now open 30 mm.

Also, I saw the cardiologist today for follow-up.  Since my symptoms have greatly improved (I feel light-headed sometimes still, but much less often) and my heart rate and BP are normal, I am done there! I really think it had a lot to do with the weight loss, and expect that I'll be totally back to normal if I gain a little weight.

Physical Therapy

I've now had a couple of physical therapy sessions, by physical therapists that don't really have any experience in treating limited mouth opening (trismus). Treatment has consisted of ultrasound therapy, isometric exercises focused on lateral and vertical movement, internal muscle stretching and joint distraction.  The only part that is painful is when they push/massage on  the sides of my face and have me open as wide as possible.  I was also given instructions on mouth exercises to do at home. According to my doctor, all of these are appropriate.  What concerned me is that the physical therapist didn't know how to correctly measure mouth opening, and didn't know what a "normal" mouth opening is. She also had never heard of the therabite or tongue blade therapy.  All of these are mentioned in this article.  Perhaps she'll google it before my next appointment :)

I had a different PT for my second appt., and he was equally clueless, but at least was upfront about it.  I guess its just something that they don't see a lot of.  I suppose as long as the exercises they do are appropriate it doesn't matter all that much.  My doctor gave me some tongue blades and discussed the possibility of ordering a therabite device in the future.  My current mouth opening is 24mm initially, which can stretch to 28mm after exercise.

I also recently discovered that my lower bottom teeth move a bit when I floss, which is sort of freaky.  I brought this up at my last appt, and it is related to the front fracture, and will hopefully firm up as that bone continues to heal.  Surprisingly, the canine that was so loose doesn't move.

Things are going well overall, no pain, and I can eat most things.  I am having a bit of medical fatigue though...its been 2.5 months and I'm still having visits to my surgeon, physical therapy, and next week have a follow up appointment with the cardiologist. No big deal though, at least I am being taken care of.

Freedom!

I had the arch bars removed this morning under general IV sedation.  So nice to be free and my gums really don't hurt that much.  They look kind of yuck, but should improve over time.  I got a script for pain meds, but the aleve I took earlier in the day is sufficient so far.  It's strange going under...I had the most painless IV insertion ever, was told they were giving me something to relax and I was totally out a minute later.  Woke up hearing a conversation about gerbils between my nurse and someone else and felt the need to chime in for some reason.  Ended up talking with her about dogs though I can't remember half of our conversation.  Apparently I'm very talkative while on drugs.  I'm like that when I drink too, so not surprising I guess. At least I didn't spill any of my deepest darkest secrets.  I feel pretty much back to normal already from the sedation, all in all much easier than I thought.  So glad I opted to be put under.

I got a referral for physical therapy and set up an appointment for next week.  My current mouth opening is ~2.2 cm, and I can just fit 2 fingers in my mouth. Normal is 4cm or approximately the ability to fit 3 fingers in one's mouth (stacked vertically). I'm curious as to what they'll have me do.  Stacked tongue blades, rubber plugs and special devices like the therabite are commonly used items according to what I have read.  I am hopeful that I will regain normal opening.  I am less optimistic that I will ever have normal lateral movement, as I haven't seen any improvement in that, however, that is less important in terms of function.  I just want to be able to eat hamburgers, sandwiches, bananas etc. without having to cut them up first.  There's also no way that I would be able to perform a certain type of sex act at this point, though I'm not really missing that ;) Yes, I just went there.

My last appointment with my oral surgeon is in one week.  I am cleared to see a dentist 2 weeks after that. I look forward to getting my chipped tooth fixed (it is sharp!) and my teeth cleaned.  My bottom front teeth in particular have some serious plaque build up from the month or so that I couldn't brush them.

9 days to arch bar removal

I went for my appointment today and everything is looking good.  I am scheduled to have the arch bars removed on Wednesday the 13th.  I was hoping to get started with physical therapy this week, but it looks like that will get set up at my next appointment.  I currently have ~2cm mouth opening, so still a ways to go, but at least I can chew now!

Last weeks cardiology appointment went well, the doctor listened to my heart and did another EKG, both of which were normal.  I also had an ECHO done, and am waiting for the doctor to read the results, but the ultrasound tech told me not to worry about it.  I still feel lightheaded when I get up sometimes, but not as often and I'm not feeling nauseous or like my heart is beating really fast.

Feeling better in general now, which I think has something to do with my ability to eat more food, its not as much of a chore now.  It still takes longer to eat than a "regular" person, but I can generally finish my food before it gets cold now :)  I also feel like I'm starving all the time...I find my self eating lunch at noon and 3:00 and last night I had mashed potatoes and a biscuit at 11:00 at night.