What causes difficulty in opening mouth after fractures in jawline and chin?
My Wife had undergone a surgery recently, but is still not feeling comfortable. I am enclosing pre and post operative scans and medical diagnosis report for further details.
The patient had 2 fractures one in the jaw line and the other in the chin area and the doctors recommended putting two plates at both the areas.
During the Post operation follow up, the oral/ dental doctors mentioned that the jaw line plate has not been inserted and the bone has grown in a wrong direction which needs immediate correction through a surgery.
The second opinion from the plastic surgeons who did the surgery says that there is no need for second operation and the treatment is going in the right direction.
The patient is still suffering with pain an d is unable to open her mouth. She is on liquid diet since her operation day.
Pls advise if we need to go ahead with the second operation.
Try Jaw opener and physiotherapy even before revision surgery
Hello Mr. XXXXXXX
I checked through the discharge card and the Xray's provided.
As per the post operative photograph the symphyseal (Chin) fracture has been well on recovery course with good anatomical reduction of the fracture.
The jaw line fracture site doesn’t show any plate. This made the operating doctor feel good about the surgery as the fracture was reduced as per the normal anatomy by just doing Inter-maxillary fixation(IMF) with Arch bar application and Inter-dental wiring. This is a standard procedure in such cases and widely followed. We call this a safe variety of ramus fracture. So its not absolutely necessary to put plates across jaw line if good reduction of fracture and good dental alignment is achieved by Arch bar and IMF(procedure already done).
Second, the healing fracture may show a bone growth in different direction initially which is generally remoulded in due course of time.
Third, The pain may be residual factor in such traumas due to multiple fractures which takes really long time to resolve. Generally such severe fractures are associated with collection of blood at local site also known as haematoma. This may cause irritation to the surrounding muscle and thus pain. Also after IMF, Arch bar application with ORIF, jaw muscles are kept in resting position for weeks so they go into spasm and further pain.
So the pain and inability to open the mouth adequately may be a result of trauma, fractures, surgery leading to spasm of muscle. It is also good to check for Temporomandibular joint(TMJ) dislocation/subluxation with CT Scan as she is unable to open the mouth.
Such condition requires patience, and gradual exercise to open the mouth adequately. A XXXXXXX like instrument known as JAW OPENER may be used to facilitate gradual and progressive opening of mouth (which will be available with your physiotherapist). Please remember, initial few days will be painful and will require dedicated efforts by surgeons, physiotherapist and patient herself. This treatment may be assisted by giving suitable painkillers and muscle relaxants. The person may be progressively given normal diet to activate muscles by chewing. Actually it would be a good idea to consult a Oral Maxillary surgeon(OMS) who will be able to give opinion about difficulty opening jaw and occlusion.
In my opinion, it will be a good idea to wait before you get a 'revision surgery' done. In fact use the above mentioned remedies to open the mouth. The Plastic surgeon and Oral surgeon should jointly discuss before the revision surgery if you are planning in future. Consider a revision surgery only after adequate investigations like a 3_D CT scan of facial bones and Temporo Mandibular joint.
Hope this answers your query. All the best !
DR XXXXXXX S JAHAGIRDAR
CONSULTANT PLASTIC SURGEON.
Note: This communication should only be taken as medical guidance as the opinion is being formulated only on the basis of X rays and the discharge card scan provided. The doctor who actually examines the patient and evaluates the case is the best judge of the situation
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