It's been nearly two months since my last post, but I finally have good news to report. I have been released by my oral surgeon to go to the dentist for a cleaning and checkup and to an orthodontic consultation about braces. Not that I am thrilled about either of those as I really detest going to the dentist, but it must be done, and I am relieved to be moving forward after my jaw fractures way back in April. At my last appointment, my oral surgeon was very pleased with my progress and the position of my jaw, but he continues to reiterate that I will need orthodontia. I wish I could get away without it, but I know my bite is still a bit off -- though it's far better than even when I stopped wearing the elastics and got my arch bars off. Chewing is getting easier, but it still feels a bit odd, and I continue to avoid very hard and chewy foods, like nuts, caramels, and apples.
So, we shall see what the dentist and orthodontist have to say. I have back to back appointments on August 21 and 22 so should have a lot more information after that.
I am also pleased to report that I am back on my bicycle (outdoors), as of this week! I had been riding on an indoor bike trainer for awhile to stay used to the saddle and keep up my fitness, but this was the first time I'd ridden my road bike outdoors since April 21.
I was a little nervous for my first ride, but not as much as I would have expected, given how bad my last outdoor ride was! And by the second ride, I was pretty much back to normal. I know some folks reading this might be surprised to find me back on my bike after suffering such trauma, but bicycling is one of my passions, and I just can't imagine never doing it again. Despite the risks, it keeps me sane and healthy.
Here's to many safe miles ahead!
It has now been just over five weeks since I had my jaw wired as a result of my bicycle accident in April, resulting in three jaw fractures. Although it seemed like forever when I was going through the process, looking back now, the time actually went fairly fast.
I was wired for only two weeks. Many jaw fracture patients are wired for up to six weeks, but from my reading (and in the opinion of my oral surgeon), that long a period can cause real issues in regaining the ability to open one's mouth wide, especially in folks over the age of 30 -- and I'm well past that! So, my surgeon cut the wires after only two weeks and put me on heavy-duty elastic bands that hooked to the arch bars screwed into my upper and lower jaws inside my mouth. These elastics helped hold my mandible (lower jaw) in the appropriate position but did not prevent movement and made talking much easier. I could also remove them three times a day to eat and to exercise my jaw by opening my mouth as far as I could and stretching the opening with my fingers. Very soon I found that I could open my jaw far enough to put three fingers in (stacked vertically), which is pretty much the gold standard for jaw opening. I'm sure I could open farther prior to my accident, but I was relieved to manage this much opening so soon after surgery. My jaw felt stiff, and it is tiring to open that far, but there has been no real pain since the first week after being wired. Whew!
I wore the elastics religiously for three weeks, changing them out after each meal. Although they were an improvement on wires, I felt more nervous during this time, afraid that my jaw would move out of place, but that fear was unfounded as my malocclusion actually improved from the first to third weeks of elastics, much to my surprise. It's not perfect as my teeth still touch first on the left, but at least I can bring the right side of my teeth together now; something I couldn't do before surgery.
Earlier this week, I returned to the oral surgeon to have the arch bars removed. This involved IV sedation (thank goodness!) and a few stitches inside my mouth. My mouth still feels strange as I can feel where the hardware was, and I am a bit swollen in the lower face, but this should improve every day as my gums heal. The bars caused some gum recession above one of my front teeth, and I may need a small gum graft in the future, but my surgeon advised me not to do anything about my gums until orthodontia is complete, as braces cause gum movement and changes as well.
My diet since getting the wires cut has been one of soft foods such as oatmeal with bananas cut into small pieces, well-cooked and finally chopped vegetables, mashed potatoes, yogurt, ice cream, fish cut into small bites, rice, and applesauce.. I am still on this soft diet but my surgeon told me I could gradually start eating more normally over time. It will likely be months before I can eat anything very hard or very chewy, but that is okay with me. I am patient as I don't want to do anything to mess my jaw up after all I've been through.
I go back to the surgeon in five and a half weeks for a final (I hope) 3D x-ray and check-up, I am not thrilled with having to have so many x-rays, especially in my head area, but these will be helpful when I go to an orthodontist. My surgeon said that I had to wait until he releases me for that, and I'm not complaining. My bite isn't perfect now but is much improved, and my teeth appear to me to be a little more crooked than before the accident, so orthodontia is definitely in my future. I'm not looking forward to that, but I think the results will be worth it. Unfortunately, having to be present for so many appointments while I wear braces will severely limit our ability to travel for quite awhile.
My experience certainly shows that no matter what plans you make, one unexpected event can change everything. I hope we can eventually get back to having more fun and adventures, but for now my health is job one!.
As I explained in detail in this post, I had a serious bicycle accident on April 21 while riding in a campground near Augusta, Georgia. It's been a month since I wrote that post and five weeks since my accident, so I wanted to write an update on how I've been doing since then.
Most importantly, the folks at the ER misread my jaw CT scan. They told me that I had no jaw fractures, and I initially believed them. When I saw my primary-care doctor, she agreed that since my bite was still seriously out of whack, I needed to see an oral surgeon ASAP and referred me. By the time I could get in, it had been 2.5 weeks since the accident, not an ideal situation. Had I not been misdiagnosed initially, I would have been able to get this taken care of much sooner, which is highly recommended in the case of jaw fractures.
And yes, my jaw is indeed fractured. The oral surgeon took panoramic 3D x-rays and confirmed three jaw fractures: bilateral condyle fractures and a parasymphyseal fracture on the left of the centerline of my lower mandible. The condyle fractures were causing the severe malocclusion of my bite (only two teeth meeting on the left, none on the right) and open bite (like a severe overbite).
While doing research on jaw fractures, I learned that the mandible (lower jaw) is the tenth most often fractured bone in the human body. It is commonly broken in sports injuries, like mine, car accidents, and from blows to the face in fights. I found several blogs from other cyclists who'd suffered jaw fractures, which helped me feel not so alone plus provided much information on surgery and recovery.
My oral surgeon recommended closed fixation and jaw wiring. I was relieved, as one of the options had been open fixation, which involves cutting into the skin on both sides of the Condyle area and making the repairs from the outside. That would leave even more scars on my face, and the healing process would be longer. With closed reduction, no incisions are made. Rather, the surgeon physically manipulates the jaw back into place, then wires it shut so bone healing can begin and the muscles of the face can re-adapt to the correct position. This would be done under sedation so I would not feel any pain (thank the gods!)
My surgery was scheduled for 3.5 weeks after the accident. This complicated matters a bit as my facial muscles had already tightened up and were pulling my mandible rearward quite a bit, making the surgeon's job more difficult. Fortunately, with some effort, my surgeon was able to massage and work the muscles to manipulate my mandible back in place. Although no actual fixation of the parasymphyseal fracture was performed, he could also feel it come back into alignment. Yes!
When I woke up from the surgery, my surgeon informed me that he was very pleased with how things had gone. He told me that he was able to get my teeth aligned on both sides before wiring the jaw shut, so I should have a good result. He reiterated that I will probably need to have orthodontia (i.e., braces) to complete the work. Even so, I was very relieved!
I've been wired now for just over a week and will get the wires cut exactly two weeks post-surgery. They will be replaced with tight elastics and gradually changed to looser elastics. At some point, the arch bars that hold the wires and elastics will be removed. I guess at that point I'll know for sure if I'll have to have braces on my teeth. It would be wonderful not to need them, especially given our nomadic lifestyle. Braces obviously require a longer commitment and frequent visits that would likely keep us stuck in one spot for much longer than we prefer. But I'll do what it takes to ensure full healing and correction of this injury.
Post-surgery, my entire lower face was very swollen, and I was in a lot of pain, mostly from the screws in my jaw that hold the arch bars, top and bottom, into place. I started out alternating Norco (hydrocodone with tylenol) with ibuprofen every three hours, Over the days, the swelling continues to decrease, and the pain has lessened to "discomfort". I'm only taking one Norco daily, right before bed, and the rest of the time alternating Tylenol and Ibuprofen, stretching the time between doses a bit more each day.
Since I'm wired, I'm on a liquid diet, and Barry has been great about making all my smoothies, soups, and milkshakes in a blender. Together we've come up with some healthy and delicious concoctions. We're using whey protein powder, Greek yogurt, peanut butter, fruit, and veggies to ensure I keep up my health and weight while on this restricted diet. Once I go to elastics, I'll be able to start eating soft foods again and gradually add more and more foods to my daily menus. Joy!
From other blogs I've read, the last foods I'll be able to add are hard or chewy foods such as apples, nuts, pizza, and other chewy breads or meats. Pizza is going to be the hardest for me; we always crave what we can't have most of all.
I am not allowed any alcohol while wired. That makes sense since I'm still taking NSAIDs and Tylenol, and the combination is not good with alcohol under any circumstances. I guess the other reason is to avoid any clouding of judgment that might lead to me making a bad decision, like deciding to cut all my wires! I haven't had any desire for alcohol anyway; perhaps that is part of the body's healing process? I expect I'll enjoy the first glass of wine, though!
Not for the faint of heart, I'll post a few photos taken pre- and post-surgery. Because of the screws and wires in my mouth, I can't smile at all now, and that is frustrating for me -- and for Barry, who misses my smiling face!
Since we won't be traveling for awhile as I continue to go to medical appointments and concentrate on healing, posts to this blog will be pretty infrequent for awhile. Hope you'll stick with us as we do plan to travel again just as soon we can!
Emily & Barry
We're a long-married, early-retired couple who are currently traveling as nomads with no fixed home base. After years of living in North Carolina (Emily's home state), we spent 18 months living oceanfront on Ambergris Caye, Belize, a year road-tripping the US in a Honda CR-V, a year in Playa del Carmen, Mexico, and are now roaming North America in our 32' motorhome, Pearl, following warm weather whenever possible.
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