I gotta broken face, I gotta broken face, I gotta...
March 23, 2015 4:57 PM   Subscribe

I'm looking for advice, stories, resources, statistics, reassurances about what to expect as far as jaw repair when there's dislocation of the bone.

So it turns out that what I thought was a hairline condylar fracture that would heal on its own with immobilization is actually pretty badly dislocated, and that I basically exploded my TMJ on that side to boot. Whee.

The oral surgeons I've been seeing told me that I basically have two options: I can either have surgery on my face to set the bone in place and seal it with plates (ORIF). This guarantees that the jaw will heal correctly and symmetrically. It also has a small risk of damage to the facial nerve, along with all of the normal risks of surgery (infection, inflammation, anesthetic, etc.) Or, I can wait, see if it heals correctly in-place with wires (MMF), and adjust with orthodontics and possibly with a later surgery in which the jaw will be broken and reset to give proper alignment. In this case, it's likely that the jaw will heal in a misaligned position (at least initially), and it's not clear how much intervention it will take to restore the alignment. Apparently they've consulted with other surgeons and couldn't get consensus for one or the other, so...it's basically up to me.

My main priority is getting back as much jaw function/preventing further TMJ pain as much as I still can. I like to cook and eat, I already get migraines and the prospect of another chronic/recurring source of pain is overwhelming and upsetting. But I can't really seem to get a clear answer on what route will let me do that.

I've been low-level dissatisfied with these surgeons--nothing major, the initial surgery went very well, but there's been a lot of last-minute scheduling (calling me in the morning and saying "can you come in today" and...no, I have a job?), a lot of hurry-up-and-wait, some weird miscommunications (including the part about how badly my jaw was broken and what to expect about healing, although to be fair that was a pretty hectic day and I wasn't really at my sharpest at that point.) the doctor who was there today (there are two partners) was not really being helpful in answering my questions about the surgical options. I don't think they're incompetent or dishonest, but I'm not really feeling great on relying on their advice. I called my regular dentist (who is great), but I'm still waiting to hear back. I've done a bit of research this afternoon, most of which seem to say that outcomes are similar for both methods, but those are mostly about cases where the bone isn't badly dislocated. ORIF seems to be preferred for cases with dislocation, but I couldn't find much information on relative success in that case.
posted by kagredon to Health & Fitness (10 answers total) 1 user marked this as a favorite
I have no idea but speaking of post-surgical eating from many years of braces and TMJ pain:

Lots of soups and shakes and smoothies. Don't wait until you are super hungry to eat; too hot will of course hurt like hell and too cold will make it hard to drink and then you'll try too hard to suck it. Immersion blender will help you enjoy some of your favorites for soups, etc.

I'd honestly talk to a sports oral surgeon if there is such a thing, or one who deals with professional musicians and singers. They might have a third opinion.
posted by tilde at 5:53 PM on March 23, 2015 [1 favorite]

I am not familiar with this, but I had a completely unrelated surgery on my face in my twenties. When I expressed concern that I might need reconstructive surgery to correct the scar, he was taken aback and insulted and said something like "You won't need reconstructive surgery after my work." I relaxed at that point and went ahead with the surgery. The scar is less visible than the small issue (an infected sebaceous cyst) that it addressed. People who knew me for years and years when I had the small bump on my face could not find the scar, even knowing I had surgery.

In contrast, some dentist removed an infected tooth and it left me with phantom pain for upwards of a year and I still have nerve damage on that side of my face. He was kind of a jerk who didn't really take me seriously. It was an emergency situation etc.

Please find a surgeon you feel really confident in. This is not something you should have to take a shot in the dark over based on what internet strangers say. The surgeon should be able to give you good info and should have experience.

This is not just a vanity thing. It is too close to the brain, eyes and other important organs and there are too many nerves involved and the working of the jaw is rather important to your ability to properly care for yourself by eating every day. Some medical procedures are okay for your run of the mill doctor. But joints and stuff dealing with the head -- both are complicated and a big deal.

Please try to find a surgeon that can really advise you and convince you they know what they are doing.

I am so sorry you are dealing with this.
posted by Michele in California at 6:00 PM on March 23, 2015 [3 favorites]

Agree, find a surgeon that you are completely confident in, who isn't pulling scheduling shenanigans and making you wonder about your diagnosis.

My husband had a correction to his severe underbite about 15 years ago. He had Kaiser at the time but somehow lucked into getting scheduled with a surgeon that every doctor in Los Angeles concurred was the best in town.

His upper jaw was fractured and pulled forward, and then held in place with permanent screws. His lower jaw was pushed back, and there were two very tiny incisions near or behind his ears that contributed to that move, and may have involved a bit of shaving the bone down, I don't remember. We can't even find those scars today.

His nose and breathing were affected short term, for about a week while he was healing (he had some nosebleeds) but otherwise didn't look any different.

His jaw was wired shut for about 4-5 weeks. He was on a liquid diet, and even though he tried to keep his calories up he lost about 30 pounds.

He had a difficult time making himself understood, especially the first week while he was swollen. A few days in he spilled his liquid pain killer. I called his doctors office to get his script re-prescribed and we had a helluva time getting that done because the nurse kept insisting that he had to get on the phone and identify himself, while I kept insisting that his jaw was wired and he couldn't talk. Finally he got on the phone and mumbled his name and request, which I couldn't even understand sitting right next to him, and she acquiesced and called in the script. On top of that he was pretty well bedridden for the first 4-5 days, and was a bit woozy from the nosebleeds/blood loss. So, all that to say, you won't want to be recovering alone, at least for the first week.

Hope that helps, feel free to me mail me if you have more questions.
posted by vignettist at 7:15 PM on March 23, 2015

Get a second opinion, even just for your peace of mind. I had my upper jaw realigned and broken as a part of my orthodontic treatment and I'm glad I was picky about my surgeon. The first two I saw didn't sit right with me even though they were both good surgeons. I figured if I was going to let someone operate a saw on my skull, OK wasn't good enough. The third guy was awesome and did a great job! Good luck.
posted by snowysoul at 7:38 PM on March 23, 2015 [1 favorite]

Just another person chiming in to say that it's absolutely critical that you get a surgeon you trust. A year and a half ago I got the underbite surgery that vignettist describes, and I cannot overstate how important my surgeon and his office were in my recovery. I was in constant contact with them for questions and follow-up appointments, and they were a solid source of encouragement and advice through what was a difficult recovery.

I talked to dozens of orthodontists to get surgeon recommendations and ended up with the names of the three best people in town. I took the time to consult with all three, and all three gave me a different opinion on how they would handle my case. Ultimately, I chose the one I was the most comfortable with - who was also arguably the top of the field - and went with what he thought was best. I was certainly not left to make complicated medical decisions on my own. I find it odd and worrisome that your surgeons are leaving something like that up to you. I'm glad I took the time to find people I was comfortable with. I can't imagine going through this without a doctor I trusted.

Also, I'm not sure if this was just a matter of nomenclature, but I did not get my surgery from an oral surgeon. What you want is a maxillofacial surgeon, someone highly specialized in these types of surgeries, not the same person who would take out your wisdom teeth. (You probably shouldn't be getting advice from your dentist on something like this either, no matter how great he is.) These were highly respected professionals who were highly sought out and consequently their wait time for initial consultation appointments was very long. There was certainly no hap dash last minute scheduling. Once I became a patient, I was treated very well, with all of my many questions answered.

Good luck.
posted by unannihilated at 7:59 PM on March 23, 2015 [1 favorite]

A cardiac surgeon with his jaw wired shut for six weeks, recommended Slimfast, because of the fiber, over Ensure etc. Best to you, and your healing. Six weeks goes quickly, take that glucosamine with chondroitin and MSM, when I had a bad injury, I could feel that stuff start the healing process on almost a cellular level, the inflamation lessened noticeably. Get a softer pillow for a time.
posted by Oyéah at 8:50 PM on March 23, 2015

Response by poster: Folks, I've already got an open question about liquid diet survival, I would gently ask that this thread stay focused on the ramifications of further surgery.

My dentist called me back, and told me that he'd discussed my condition/x-rays with several oral/maxillofacial surgeons he knows, and that both believed more conservative treatment would be best. I may ask him for a referral, though that would mean having to drive ~1 hour for treatment instead of going to the guys in town. I have an orthodontist in town who I'm already comfortable with and who I'd probably ask to handle the orthodontics if I go that route.

Important details neglected to include: the surgeons I've been seeing said up-front that they would have to refer me out if I opted for the facial surgery; they aren't experienced with it, but know a doctor (also ~1 hour away) who is. I think I'm also going to ask for contact information for him and at least pick his brain for what advantage he thinks surgical intervention will present. The window for making a decision is closing, so I don't have a ton of time to shop around; the initial break-and-wiring was about two weeks ago (I wish I'd had more choice in surgeon then, but it was an emergency situation), and if I want surgery, it has to be soon.

Thanks for all the advice so far.
posted by kagredon at 9:01 PM on March 23, 2015

Abstract from a 2008 meta-analysis that makes it sound like the jury's not in yet - there were differences in infection and nerve damage in favor of closed reduction but they didn't reach statistical significance, and there was no difference in occlusal disturbance. There hasn't been an update on the systematic analysis that I've found.
posted by gingerest at 9:25 PM on March 23, 2015

Having just recovered from a bout of Bells Palsy, I can tell you that injury to the facial nerve is no joke! It really affects your entire life - speech, expression, appearance. I would attempt a conservative route first before risking that.
posted by yarly at 5:49 AM on March 24, 2015 [1 favorite]

The surgeon who did the minor outpatient surgery on my face was in the neighborhood of 45 minutes to an hour away from where I was living. Granted, it was really minor surgery compared to what you are facing. It was totally worth the drive.

I was a military wife stationed in Germany. We didn't have a real hospital where we were. We just had a clinic. I got referred out to the regional military hospital (same place my second child was born) because there just wasn't anything local for dealing with the kind of issue I had. All we had was a clinic.

But, still, totally worth it to travel a bit to see an excellent surgeon with whom I had good rapport. Good rapport matters when you have a serious medical issue because it fosters good communication. That really makes a difference when you feel like crap and your current and future welfare are on the line.

Best of luck.
posted by Michele in California at 10:35 AM on March 24, 2015

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