Introduction:

If you are reading this blog, it means that either you or someone you love is dealing with a broken jaw and for that I am very sorry. My 15 year old son broke his jaw on March 3, 2013 and had his mouth wired shut for 4 ½ weeks. His healing is still ongoing, but now that his jaw is unwired, the worst is behind us and we are able to look back on what has been a very emotionally and physically challenging time. Upon returning home from the hospital after our son underwent his initial surgery for his broken jaw, I began scouring the internet for information on everything from what to eat when one’s jaw is wired shut, to how to manage pain when swallowing pills is not possible. While there are some terrific blogs on the internet about broken jaws and liquid diets, I found that no one blog provided all of the information that I was seeking. Therefore, as we navigated the challenges of eating, sleeping, pain management and more, I kept detailed notes in the hope that by sharing the information that we learned, others who find themselves with a broken jaw in the future will benefit from our experience.

How Did This Happen?

Upon telling family and friends that our son broke his jaw, the first question people usually ask is “how did it happen?” I should first tell you how it did not happen. He was not skateboarding, mountain biking, playing hockey, baseball, or participating in any of the other high risk activities that are the usual culprits. My son’s fracture resulted from his fainting and falling face first from a standing position onto a tile floor. The cause of his fainting (a first for him) is unknown, though the fact he had exercised earlier in the day, was probably somewhat dehydrated and hadn’t eaten for a number of hours are likely contributing factors. Thankfully, my husband and I were with him at the time that he fainted. After helplessly watching him fall to the ground from across the room, we ran to his aide. Two telltale signs of a fractured jaw were immediately apparent: a deep gash across the bottom of his chin and the fact that he was unable to close his mouth. We knew he needed immediate medical attention and took him to the emergency room of the nearest hospital.

X-rays showed that he had a displaced fracture of his lower jaw. Our son was in such excruciating pain that even the intravenous morphine they gave him at the hospital was insufficient to alleviate his suffering. While the emergency room doctor who attended to our son was competent in ordering the appropriate diagnostic tests, he was not trained to fix a broken jaw -- we needed an oral maxillofacial surgeon for that. I should mention that this happened to be a Saturday night, which is not the best time to find yourself in need a specialist in the emergency room because you are not likely to find one. Since we happened to be at a teaching hospital, they called the oral maxillofacial resident (a doctor still undergoing his training) who was on call for the evening. This young doctor operated on our son and stabilized the jaw by wiring the upper and lower teeth together in what we were told is called maxillary mandibular fixation (“MMF”). However, this resident unfortunately didn’t do such a terrific job of realigning our son’s jaw because the following morning, my son became aware of the fact that his bite was significantly off from what it had been before the break. We immediately called a local oral maxillofacial surgeon in private practice and since it was a Sunday, we got through to his answering service. He agreed to meet us at his office that Sunday afternoon to examine our son. This well respected and experienced surgeon agreed that the jaw had been improperly set by the resident in the hospital and that he would need to re-operate on the jaw in order to re-set and re-wire the jaw shut so that it would heal in a proper alignment. Two days later, our son underwent a second surgery during which his jaw was re-set and then re-wired shut. He would remain wired shut for 4 ½ long weeks. Hopefully, the need for a second surgery will not happen to you or your loved one, but I mention it because you should be aware that if your bite is wired shut in such a way that you feel it is completely unnatural, you should obtain a second opinion immediately. Having said this, our experience as well as that of others I had read about has been that once a jaw is broken, the person’s bite will never be quite the same as it had been before the break. In our son’s case, despite having his jaw re-set and re-wired in a second surgery by a very experienced oral surgeon, his bite still remains slightly off from what it was before the break. Luckily, in our son’s case, he happened to be undergoing orthodontia when he broke his jaw, so some of the problems with his bite (“occlusion”) that were caused by the break will be corrected as part of his ongoing orthodontic treatment. I have since learned that many times after a person sustains a jaw fracture, that person will need to seek orthodontic or dental treatment once the jaw heals in order to make some adjustments to the bite in order to put the teeth back into a proper functional occlusion.


Liquid Medication:

When we left the hospital that first night, the nurse handed us some discharge papers along with a 60 mL syringe with a tiny (and I mean tiny) catheter attached to the end of it. To my horror, she told us that this syringe would be the sole means by which our son would be ingesting food and medication for a number of weeks. She also gave us prescriptions for liquid Hydrocodone (a narcotic combining Codeine and Acetaminophen), liquid antibiotics and a small yellow paperback book titled “Eating Through a Straw without the Straw.” More on this little yellow “cookbook” in a moment, but first let’s talk about managing pain because chances are, for the first few days, you will be in too much pain to even think about food.

For the first several days after being wired shut, our son was in a lot of pain and his face was very swollen. We administered the Hydrocodone at prescribed intervals by filling the syringe with the proper dosage and squirting the bright yellow liquid into the back of his cheek so it could seep through his teeth and down this throat. While the Hydrocodone was fairly effective in dulling his pain, it simultaneously caused him to become quite nauseous. It didn’t take long before he began to associate the awful taste of the yellow fruit flavored Hydrocodone with being nauseous. The thought of vomiting with one’s jaw wired shut is not only extremely anxiety provoking, but potentially life threatening as well which is why they give you a pair of wire cutters when you leave the hospital and tell you to keep it with you at all times. However, we were advised that throwing up is usually not a reason to use the wire cutters since the person will have only ingested liquids, therefore only liquids will be regurgitated and thus the vomit can dribble back out the same holes between the teeth that it went through in the first place. Disgusting, I know. The doctor did tell us that should our son happen to vomit, he should keep his head forward and down to let gravity assist. What we discovered on our own is that the heaving that accompanies vomiting causes pressure on the broken jaw which is extremely painful. We were given a prescription for liquid anti-nausea medicine which unfortunately, tasted so nauseating that it compounded rather than alleviated the problem. In a desperate attempt to quell the nausea, we tried Compazine suppositories as well as a Transderm Scop skin patch, both of which required a prescription from the doctor. We also discovered that there are some pain medications that are formulated as suppositories in the event that you cannot keep down the oral liquid pain medication.

Another nasty little side effect of the Hydrocodone is its well-known propensity to cause constipation. Straining to go to the bathroom with a broken jaw is, as you might imagine, extremely painful. We discovered that dissolving a laxative powder such as Miralax in some juice helped to combat the constipation. I should mention that we momentarily thought we had come up with a clever way to circumvent the need for liquid pain medication by trying to crush some pain pills. I got out a Ziploc bag and a hammer and placed two capsules inside the bag and pulverized the pills into a powder thinking that I could dissolve the powder in some juice. Sadly, this experiment was a total failure. The powder did not dissolve but instead floated to the top of the juice and the bitterness of the pills was more disgusting that the liquid Hydrocodone we were trying to avoid. We were told by his doctor that if his pain was not sufficiently controlled by the Hydrocodone alone, we could give him some Ibuprofen in addition. We soon discovered, after calling every pharmacy within a 10 mile radius of our home, that liquid Ibuprofen (aka Advil) is only formulated for pediatric use and that in order for our 145 pound 15 year old to get enough Advil in his system to be effective at all, he would have to swallow at least 20 mL of this awful tasting syrupy liquid. The liquid Advil came in three flavors; fruit, bubble gum and grape. Our son found that of the three flavors, the grape flavor was the most tolerable, provided it was mixed with about 8 ounces of Welches grape juice in order to disguise its flavor.


Swelling:

The morning following his break, my son’s face was completely swollen from his eyes down to the bottom of his chin. We were told to use ice packs on and off at 15 minute intervals to help reduce the swelling for the first 24 hours. Since the ice packs become warm fairly quickly once they are applied to the skin, we purchased three ice packs which we kept rotating in and out of the freezer so that we always had one which was cold and ready to use. Our son’s face remained swollen for nearly a week after the break and he found that using ice packs helped to soothe his pain even after the first 24 hours. Therefore, although we were told that icing is only helpful to reduce swelling during the first 24 hours, he continued to apply ice packs to his jaw for several days.


Muscle Pain:

After having been wired shut for several days, my son began to experience muscle pain in his jaw and occasional muscle spasms from being immobilized. He also began to suffer from earaches as well as migraine headaches. We found that using a heating pad and alternating it from one side of his jaw to the other in 15 minute intervals was helpful to soothe his muscle pain. He also found that taking long hot showers and letting the water run over his face was helpful in easing some of the muscle pain.

Talking with Your Jaw Wired Shut:

While it is no easy task to talk with one’s mouth wired shut, it is possible to do so. For the first several days after being wired, our son’s speech was garbled due both to his jaw being wired shut and his significant swelling. However, within a week, his swelling went down and he became quite adept at speaking fairly intelligibly and I became better at listening carefully to what he was trying to say. Since speaking was painful for him, particularly at first, I tried to avoid asking him to repeat himself whenever possible and we occasionally had to resort to rudimentary sign language. The ability to articulate words with one’s jaw wired shut is akin to the skill required of a ventriloquist.


Stitches:

If you are unlucky enough to also have stitches in your face like our son did, you will need to perform some wound care. We were told to soak the stitches with a cotton ball soaked in Hydrogen Peroxide 3% and then put on an antibacterial ointment such a Neosporin or Bacitracin. While the Hydrogen Peroxide did not sting as my son had expected it would, putting any pressure whatsoever on the wound was painful and therefore cleaning the stitches was a dreaded daily ritual. Since wound types can vary, you should follow your own individual doctor’s instructions with regard to your wound care. We were told the stitches should remain in his face for no longer than 5-6 days so that he would not have a “railroad track” scar where the stitches were sewn through the skin on either side of his laceration. His stitches were removed on day six and the place where the laceration had been stitched closed was bright red and was raised. I wondered aloud whether the stitches should have been removed even earlier since the track marks left by the stitches were red and quite visible. In an effort to reduce the redness and elevation of the scar, our doctor suggested massaging vitamin E oil on the scar several times each day. We purchased the oil but the scar was so tender to the touch that rubbing oil on it was not a feasible option. Further, the research I did on the internet was inconsistent with regard to whether use of Vitamin E oil to minimize the appearance of scars had any efficacy. We had been told by a plastic surgeon about a product called NuGel which comes as either a silicone sheet or a silicone ointment that you place over the scar for at least 12 hours each day. We started with the silicone sheets but found that they lost their adhesiveness after one or two days of use. So instead, we purchased the silicone gel and this seems to be helping to reduce both the redness and the height of the scar. The product is a bit pricey but can be purchased online at http://www.newgelplus.com/. The gel needs to be worn every day for a period of several months to obtain the full benefit so I will continue to provide updates on his healing as time goes by.

Sleeping:

Sleeping with your jaw wired shut is difficult at best. The doctor advised us that our son should lie on his back at a 45 degree upright angle for the first week or so in order to help keep the swelling down. Positioning him at the proper angle required that we prop four pillows up against his bed’s headboard. Getting the pillows at just the right angle so that he could lie somewhat comfortably took about 20 minutes each night. Even after we thought we finally got him positioned just right, he would often slide down after falling asleep and awaken in terrible pain. If he would lie back on too shallow of an angle, he would be in pain and we would have to literally lift him back to an upright sitting position since lifting his head and neck on his own put too much strain on his jaw. Even after the first few weeks of being wired shut, he found that lying on his back at any angle lower than about 30 degrees put too much pressure on his jaw and caused him pain. If you have a study pillow, you may want to try using that as back support and putting a soft pillow on top of it for head support.

Eating With Your Mouth Wired Shut:

The most important piece of equipment you are going to need is a powerful blender. We purchased a Vitamix blender from Costco and found that it worked very well. We must have used (and washed) our Vitamix blender upwards of 10 times per day. The reason you are going to need a powerful blender is because anything that is not already in liquid form will need to be liquefied in order for you to “eat” it. I use the word “eat” loosely here because in fact, what you will be doing is not really eating, but drinking. How thick the liquid you can consume can be will depend upon how much space there is between your teeth or how much space there is in the back of your mouth where your wisdom teeth would otherwise have been (presuming your wisdom teeth are missing). For my son, even apple sauce was too thick to get through his teeth and it therefore needed to be blended in the blender with apple juice to make it thinner. The bulk of my son’s diet consisted of high protein drinks such as Boost, as well as smoothies, soups and milkshakes.

       Managing the Syringe: The syringe they gave us upon discharge from the hospital was worthless. The tube which attached to the syringe was so small that even liquid could barely get through it. A friend of mine had mentioned to me that another child from my son’s school had broken her jaw several years ago and had to have her jaw wired shut so I called the girl’s mother to ask her for advice. She told me to head straight over to the local medical supply store and buy several 60 ml syringes along with a number of different sized catheter tubing to attach to the syringe. I bought about a half dozen syringes and catheters of varying sizes and then after experimenting with the catheters to find just the right width, cut the plastic catheter tubing to the correct length with a scissors. I know what you are thinking because I had the same thought. . . eating and drinking through plastic catheter tubing that is intended to be used for bodily excretions such as urine is disgusting. You will need to mentally force this image out of your head because if you don’t, then you will completely lose your appetite and starve. Thankfully, the catheters come in sterile packages so there is no need to worry about them ever having been used for any other purpose. Of course, you will still want to clean them with soap and water before eating through them just as you would with anything new that you purchase that you are going to put into your mouth. The catheter needs to attach firmly to the tip of the 60 ml syringe (but not so firmly that you cannot get if off to clean it). The best way to get the catheter tubing on and off the tip of the syringe is to twist it. You need to make sure your hand is dry when you try and twist off the catheter tip for cleaning because if your hand is wet, it will slip and you will have a difficult time getting it off. The catheter also needs to be wide enough in diameter so that a substance such as yogurt can be squeezed through the tube upon pushing the plunger of the syringe. I should warn you that the syringe is a complete menace and disaster waiting to happen. At first we tried to fill the syringe by putting the tip of the catheter in the drink or food and drawing back on the syringe so as to suction the liquid into the syringe. This is a very inefficient way to load the syringe. Through trial and error, we discovered that it is better to remove the plunger altogether and load the syringe from the back with a spoon and then after it is filled almost to the top of the syringe, to put the plunger back in and get ready to squirt.

I must warn you that it is virtually impossible, no matter how skilled you become, to fill the syringe without getting some air pockets. As a result, the pressure created by the plunger will cause whatever food substance is in the syringe to sporadically and unexpectedly spurt out at great velocity. We had chocolate pudding, amongst other stain producing foods, fly onto our ceiling, our furniture, our clothes or simultaneously all of the above. If the tubing happens to still be in your mouth when the air pocket explodes, the food will forcibly squirt into the side of your tender gums causing you pain. Even after 4 weeks of using a syringe multiple times per day, we still experienced a syringe disaster at least once daily. However, the most important tip we learned about using the syringe was to use olive oil to lubricate the rubber tip of the plunger before each use so that it slides more easily through the syringe. If you fail to lubricate the plunger with oil, the plunger will get stuck and require tremendous force to get the food in the syringe to move through the catheter tubing. The more viscous the substance you are trying to move through the syringe, the more back pressure there is and the harder it is to get the plunger to push through. My son finally figured that the best method of plunging the food through the syringe was to place the base of the plunger on the kitchen table and use the table as resistance to push down on the syringe instead of trying to use his free hand to push the plunger in mid-air. The procedure was as follows: 1) He would remove the plunger from the syringe and fill the syringe with the food using a spoon to scoop the food in one spoonful at a time; 2) he would use olive oil to lubricate the rubber tip of the plunger; 3) he would then place the plunger into the top of the syringe; 4) he would place the tip of the catheter in his mouth and lean over the table while pushing down on the syringe causing the food to squirt out through the catheter into his mouth. Since the syringe only holds 60 mL of food, he would have to repeat this procedure multiple times for each meal.

Since using the syringe is cumbersome and frustrating, the best advice I can give you is to try and get permission from your doctor to use a straw, which will allow you to limit the need for use of a syringe. Two weeks in to being wired shut, my son had an appointment with the oral surgeon at which time we asked permission to start using a straw. He gave us the green light and we immediately discovered that using a straw rather than a syringe made our son’s life much more bearable. However, we quickly learned that you cannot use just any sized straw because sucking liquid through a straw, particularly anything thick like a smoothie or milkshake, creates negative pressure on your jaw and will cause a great deal of pain. Therefore, you need to have a straw that has a very think diameter so that it doesn’t require much suction to get the liquid to move through it. The best straws are plastic “Milkshake Straws” that can be purchased at Bed Bath & Beyond and cost a very reasonable $1.99 for 50 straws. We bought multiple packages of these colorful straws and kept them with us at all times. We kept a stash in the glove compartment of our car for when we were out and wanted to stop for a milkshake or smoothie. We began using straws for everything from soups to smoothies. However, for thin liquids such as Boost or Ensure, my son found it easiest to drink straight out of a small 5 ounce paper cup, the kind you use in a kid’s bathroom. He was able to put the cup up to his lips and sip so that the liquid would seep through his teeth. We found the 5 ounce paper Dixie cups worked best for this purpose. Once we discovered the Milkshake straws and the 5 ounce paper cups, we limited our use of the syringe for the more viscous foods such as pudding or yogurt that were too thick to either sip through the straw or directly from a paper cup.

Losing Weight:

Getting sufficient nutrients and calories when your mouth is wired shut is a challenge. My son lost 7 pounds the first week his jaw was wired shut and we began to panic. He was thin to begin with and could not afford to lose too much more weight. For several days I begged and pleaded for him to drink more protein drinks so as to increase his calorie intake but it was hard to keep track as to what his total daily calories and nutrient intake consisted of. Then my son discovered a fabulous free online app called www.myfitnesspal.com. This app allows you to track not only the calories, but the nutrients contained in everything you consume each day. The beauty of the myfitnesspal.com website or app is that it is already programmed with the information such as the grams of protein, daily percentage of calcium, sodium, sugars, and calories counts for nearly every food you can imagine. Let’s say you drink a medium sized smoothie from Caribou Coffee, or a milkshake from Dairy Queen. You simply type in the product brand name and size and the app fills in all the nutrient information. The website keeps track of not only your calories, but your sugar intake, sodium, calcium, etc. so you can see where you need more of less of any of these nutrients as you go through your daily intake. My son was able to take responsibility for tracking his calorie and nutrient intake which lifted the burden off of me and made him responsible for maintaining his health and his weight. Despite counting calories and trying to stay above 1500 per day, my son lost about 10 pounds in the first two weeks. His rapid weight loss was due in part to the fact that for the first week, he was in so much pain that he barely consumed anything. Then it took us another week or so to figure out what he could get through that darn syringe. However, after the first two weeks, his weight stabilized likely due to his being more vigilant in drinking several high calorie protein drinks each day such as Boost Plus (after trying them all, he liked the Rich Dark Chocolate flavor the best). He also lived on homemade yogurt smoothies and ice cream milkshakes which helped to keep his calorie count up.

Regarding that yellow book called “Dinner Through a Straw Without the Straw” which claims that one can eat perfectly palatable foods while having one’s mouth wired shut, quite frankly, they’re lying. Sure, you can liquefy most anything if you add enough chicken broth or milk to it, but the resultant liquid is disgusting not only in flavor but texture. The problem we found was that many of the suggested recipes found in this “cookbook” which claims to be intended for people with their jaws wired shut were too viscous to get through a syringe or a straw. Even on those few occasions when we were able to blend the ingredients to a consistency that would allow it to fit into the syringe, the mush would end up pooling in his cheek and not be able to seep through his wired teeth so that he could swallow it. Once the substance was plunged through the syringe into his mouth, he had a real problem since there was no way for him to use his tongue to spit anything out of his mouth since his tongue was locked inside his wired jaw. Therefore, he had to use his finger or a paper towel to try and pull the food back out of the inside of his cheek. The whole process is not only unappetizing for the person with their jaw wired, but for anyone who happens to be dining with the person at the table.

The few bits of useful information that we did find in the yellow paperback book our surgeon gave us were tips such as adding several teaspoons of peanut butter to smoothies in order to add fat and protein. Protein powder is also good to add to smoothies. If you live near a Jamba Juice, they can add a “boost” of protein powder to their smoothies. There are several protein powder options and my son found he liked the “whey” protein powder the best. You can hardly taste the protein powder once it is blended into the smoothie.

After several weeks of drinking sweet beverages such as yogurt and fruit smoothies and milkshakes, my son was craving something more savory and filling. We tried to puree basil fried rice in the blender with some chicken broth but we weren't able to blend it into a thin enough consistency so that it wouldn’t get clogged in the syringe. Soups were a much better option. If the soup had vegetables or anything in it, we would put it in the bender until it was thin enough to either be plunged through the syringe or more preferably, be drunk through a thick straw. We discovered that hot and sour soup from our local Chinese restaurant was a good option since it was very spicy and flavorful yet thin enough to drink through a straw once we strained out all the vegetables and eggs through a strainer. Hot cereals such as rice cereal or cream of wheat were another good option as long as you add enough milk to make them thin enough.

Oral Hygiene:

I am going to be honest with you, my son’s breath smelled horrible despite the fact that he brushed the outsides of his teeth multiple times each day using this tiny soft toothbrush that was given to him by the hospital. After a few weeks the bristles started to fall out and get stuck in his wires so we needed to find a replacement toothbrush. I recommend that you purchase an extra soft toothbrush at the drug store. After trying several brands of allegedly soft toothbrushes, we found that the Ultra-Soft 360 by Colgate was by far the softest. Since my son’s teeth were very sensitive from having the arch wires holding his jaw shut, he found that he could only tolerate brushing his teeth with the ultra-soft toothbrush. He also used Listerine at least three times per day but despite using mouthwash, his breath still smelled terrible. One thing that bears mentioning here is that when your mouth is wired shut, you cannot spit anything out. Therefore, when using mouthwash you need to sip it, swish it on your tongue, and let it dribble back out through your teeth. I suggest having some tissue on hand to wipe your mouth since the mouthwash will dribble down your chin. About two weeks into having his jaw wired shut, we read on the internet about other people who had their jaws wired shut who raved about the benefits of using a Water Pic. We purchased one and my son found it to be extremely useful. Therefore, I highly recommend that you purchase one as well. It comes in various models with various features but the basic unit can be purchased for as little as $39.00. We purchased ours at Bed Bath & Beyond but they can be found on Amazon as well. Since you will not be able to spit and since the Water Pic is highly pressurized water, you will need to lean over the sink so as to let the water dribble out of your mouth and down your lips and chin as you attempt to dislodge any food that is caught in your wires. Have a towel on hand because it’s a bit of a mess, but well worth it.

Unfortunately, no matter how diligent you are about oral hygiene, you are going to have bad breath because you can’t brush the surfaces or inside of your teeth and you obviously can’t brush your tongue. Needless to say, flossing is not an option either. The only good news is that a person typically can’t taste or smell his or her own bad breath. We literally had to hold our breath when we sat next to our son on the couch since it smelled so bad, but he was not really bothered by his own breath.

Getting a Cold:

You should do everything you can while your jaw is wired shut to avoid getting sick. We insisted my son wash his hands more diligently than normal to try and avoid getting sick. However, despite our best efforts to have our son avoid illness, he managed to get a cold at the end of his third week of being wired shut. Since your ability to breathe through your mouth is restricted when your jaw is wired, the inability to breathe through your nose makes it feel as if you are suffocating. My son felt as if he was hyperventilating and could not get enough oxygen. The best remedy we found to easing his congestion was a nasal spray or pump called Afrin. It is administered by squirting the medication into the nose and it works almost immediately to relieve congestion. Since swallowing decongestant pills was not possible due to his jaw being wired shut, the Afrin was literally a lifesaver. We did find that there are some liquid decongestants available over the counter at the pharmacy and although most are formulated for pediatric use, there are some liquid decongestants that are formulated for adult strength. However, just like the liquid Advil, these medicines tasted terrible and therefore my son found that the Afrin was a quicker and more effective way to manage his congestion. The feeling of not being able to get enough air can cause one to panic which in turn causes the person to hyperventilate and become dizzy. Therefore, we tried to keep my son as calm as possible and reassure him that he was getting enough oxygen. We also propped him upright at an almost 90 degree angle to allow gravity to help his nasal passages to drain. We also put a fan in front of him to circulate the air and this helped him to feel as if he was able to get more air into his lungs.

Yawning, Sneezing and Coughing:

Our son found that yawning and sneezing with his jaw wired shut was particularly painful because the jaw instinctively tries to open therefore putting tension on the wires holding the jaw closed. His teeth were very sore from being pulled by the wires and anything he did that put extra tension on the wires was very painful. He became skilled at stifling his yawns.

Attending School with One’s Jaw Wired Shut:

My son broke his jaw during second semester of his sophomore year in high school. Attending school during the weeks that his jaw was wired shut was very challenging and we needed to seek accommodations from his teachers and the school. I began by sending a group email to his teachers, his guidance counselor and the school nurse informing them of my son’s broken jaw and that he would have his jaw wired shut for a period of what was anticipated to be at least 4 weeks. I also faxed to the school nurse a copy of the note that the oral surgeon gave us which instructed that our son was not to attend gym class until further notice.

My biggest concern was how my son was going to be able to focus and keep up with his school assignments and take exams while taking medications for pain, feeling hungry from existing solely on a liquid diet, and tired from lack of restful sleep. I did not want his grades to suffer on account of his having broken his jaw. He simply lacked the stamina to study or focus in class for any prolonged period of time. I set up a meeting with the guidance counselor, the nurse and the administrator in charge of student services and explained my son’s condition and his current limitations. They proposed that a 504 accommodation plan be put in place for the duration of the time his jaw was wired shut. A 504 plan is intended to provide accommodations to help a student with health care needs participate in school. In my son’s case, the proposed 504 plan included the following accommodations: 1) My son was permitted to hand in his assignments late without penalty; 2) I was permitted to sign him in and out of school throughout the day as needed for him to go home and come back and the regular attendance policies regarding absences would not apply; 3) he would be permitted to sip protein shakes in class as needed; 4) most importantly, he was permitted to take his exams one page at a time over a period of several days in a designated “testing center” which was proctored by an administrator. By administering his exams one page at a time, he was able to decide whether he needed to stop testing for the day and continue the following day if he was in too much pain or felt too weak to continue. The above listed accommodations were critical to getting him through the period when his jaw was wired shut. Since our son did not want to be seen eating through a syringe in the school cafeteria, I often picked him up during his lunch period and brought him home in order to prepare and feed him a smoothie, a protein drink and some soup before driving him back to school for his afternoon classes.

Getting Unwired:

Four and a half weeks never passed as slowly as they did when my son’s jaw was wired shut. We literally counted the seconds until my son’s wires would be cut and there is a terrific phone App that provides a clock that will continuously countdown to a particular date and time. The App is an Android App called “Virtual Countdown.” It was helpful to my son to see the seconds ticking by knowing that there was an end date to his wired misery. My son was nervous that it would hurt when they cut the wires because his jaw and his teeth were very tender and sensitive. However, he informed us that the actual cutting of the wires, while unpleasant, was not terribly painful. After cutting the wires, the doctor took another panoramic x-ray to check his healing progress. However, what my son had not anticipated was how painful it would be for him to try and open his mouth. He was only able to open his mouth about 4 millimeters as measured by the doctor. We were told that due to muscle atrophy, that it was expected that he would only be able to open his jaw a few millimeters but that his mobility would slowly increase over the following weeks as he began to use his jaw again. He was given permission to eat only soft foods for a period of two weeks. He was also instructed to open and close his mouth as if he were yawning for a period of ten minutes three times each day so as to stretch the muscles and ligaments and break up scar tissue that had formed during the healing process. The stretching was painful but it noticeably helped to increase his range of motion. The simple act of chewing is apparently a natural physical therapy and serves to strengthen the muscles of the jaw that have atrophied due to lack of use. The good news was that even though he was only able to open his mouth about 4 millimeters upon being unwired, it was just wide enough to slip an Advil capsule through his teeth. We were elated that he could now ingest pain pills and that we were therefore done with the awful tasting liquid medicines. However, his vision of being able to eat a hamburger that evening was completely unrealistic. Due to pain upon chewing and the fact that he could barely open wide enough to fit a plastic spoon in his mouth, the most he was able to manage was some scrambled eggs and yogurt.

After coming home from getting unwired, our son ran to the bathroom to try and brush the inside surfaces of his teeth for the first time in over a month. However, to his dismay, he could not open his jaw wide enough to fit even a child’s toothbrush through his front teeth. It was several days before he was able to fit even the tiniest toothbrush through his teeth so as to be able to brush them.

By day three after being unwired, he was able to chew very soft foods such as pasta, a crumbled meatball, and mashed potatoes. Unfortunately, he continued to have pain upon chewing and had to take Advil 30 minutes prior to each meal. At his appointment with the doctor ten days after being unwired, he was able to open his mouth 28 millimeters as measured. This distance is called the interincisal opening and is the distance between the tips of the upper and lower front incisers. While 28 millimeters is considered to be barely functional, we were assured that with continued stretching and rehabilitation exercises, that he would regain further mobility over time.

As I write this, we are 7 ½ weeks from the date of his break and he is still experiencing jaw pain when eating or after talking for any prolonged period of time. He is now able to open his jaw 33 millimeters and we are hopeful that he will continue to increase his mobility so that he will fall within a normal range of mobility for an adult male. Unfortunately, he occasionally hears crackling or clicking sounds when opening his jaw which he finds very disconcerting. We were told that the clicking may or may not go away in time.


Conclusion and Follow-Up:

I hope that you have found at least some information in this blog to be helpful to you on your road to recovery from a broken jaw. I welcome your posts if you wish to share a comment or perhaps share a tip that you have learned that others may find beneficial. I wish you a speedy recovery!