A Tale of Three Surgeons

It’s Sunday afternoon as I write, and I am still in Philadelphia. This has not been a pleasure trip. My younger daughter needed emergency surgery last week, and, with her permission, here’s what happened (a long story):

A week ago Friday, my daughter had what was supposed to be a routine procedure at her oral surgeon’s office to extract two impacted wisdom teeth from her lower jaw. We texted in the morning beforehand, and despite a snafu with her planned ride, who had to cancel at the last minute, she was able to get to her appointment and find a substitute to take her home. “I hope that’s the only thing that goes wrong!” she texted. “Me, too!” I answered.

This was not to be. A few hours later I received a text: “Done just waiting for the anesthesia to fully wear off. My jaw is broken on the right so they need to see me on Tuesday or Wednesday but otherwise shouldn’t be too bad.”

To which I responded, “What???”

She couldn’t really tell me much more when I called her, and it was painful to talk because of the jaw fracture. So I called my own periodontist for advice, spoke to one of the nurses who knows me well from all my dental implants, and followed her suggestion to call the oral surgeon, Dr. N, in Philly, with my daughter’s permission, to find out what the hell had happened.

He took my call right away and explained that, indeed, her right jaw had fractured during the procedure and that her jaw would probably need to be wired shut for six to eight weeks. She had an appointment Tuesday with him, and he was working on getting her added to the OR schedule for Wednesday or Thursday at the nearby hospital. He attributed the issue to “soft bones.” Since she has Celiac, this is an actual possibility.

I called my daughter and broke the news, then told her I would fly down on Monday, Memorial Day, and stay with her for the week. She welcomed the idea, given the very upsetting prospect of jaw surgery and complicated nutritional issues for recuperation.

Fast forward to our Tuesday morning meeting with Dr. N. He had encouraged us to write down all our questions and we had a long list. He came into the exam room after a 45-minute wait and told her that she would need to have her jaw stabilized with a metal plate and then wired shut—possibly using elastic bands to keep her jaw closed, but maybe using actual wire to close it permanently during the recovery period. He insisted on giving us worst case scenarios for healing time. He demonstrated how she would have to learn to speak with just her lips because her jaw would not be able to move. He explained how she would be on a liquid diet the entire time.

Let us just say that it was not an upbeat conversation. Again, he said she had soft bones, but never explained beyond that why this happened, just focused on the surgery. He also informed us that he would be handing off the procedure to two of his practice members, Dr. B Sr and Dr. B Jr, who were highly experienced working on trauma jaw repair for children. Since my daughter is very petite and has a small face, this made eminent sense. And we were both just as glad that he would not be involved. He has sterling credentials and also is very experienced with facial trauma surgery, but the Drs B have even more experience.

She was scheduled for surgery the next day, but as an add-on to the OR list, so we were told to get to the hospital by 1:30 p.m. and her procedure was scheduled for 3:00 p.m or later. All this time, I should add, she was holding up remarkably well, given the situation, but in a lot of discomfort because of her jaw fracture and could not eat much.

Once she was prepped in pre-op, I was allowed to sit with her until the procedure started. We waited a long time. Finally, Dr. B Sr came to explain the surgery. And here is the difference between Dr. N and Dr. B Sr. He actually explained, in very understandable terms, with a photocopy of her jaw X-ray, what had happened and why.

My daughter has, like me, large teeth for a small jaw. Her impacted wisdom teeth were large and lodged sideways, so removing them left a big hole in her gums on either side. There’s not much left, now, above her slender jaw bone where the teeth had resided. The right extraction caused the jaw to fracture and move upwards, pinching a nerve.

But the key point here is that she would have been at risk of even more complicated fractures had she not had the extractions done, because she has what is called a ‘glass jaw.’ Some boxers have this issue: if they have impacted wisdom teeth and relatively small jawbones, when hit, their jaws fracture. My daughter was always at risk of a fracture with the wisdom teeth removal, though no one ever told her that. If she had waited any longer for the extraction, her risk would have gone up. It was basically a no-win situation. Dr B. Sr explained that this is an issue for petite people like her. (And it was not a case of soft bones, because she had a bone density scan within the past year and was fine.)

We both were very relieved after we spoke with him. Finally, it all made sense. Dr. N had not screwed up. It was not a fluke. It was just a real risk that, unfortunately, played out. And Dr. B. Sr knew what he was talking about as chief of Maxillofacial surgery at one of the children’s hospitals in Philly. His son is also an expert in the field and on staff at the same hospital.

She was finally wheeled into the OR around 5:00 p.m. Three hours later, the Drs. B came out to meet with me in the waiting area. All went as well as possible. Although the OR team had initially said they had none of the elastic bands we had hoped would be used during the procedure and she’d have to be hard-wired shut, the Drs. B had figured out an alternative, McGyvering a piece of catheter tubing to do the trick. They had to make an incision externally to put in the jaw plate, because her mouth is too small to do it from the inside, but otherwise she was in good shape with an excellent prognosis.

A while later I got to see her in recovery. True to form, even as she was still woozy, she was already in charge, instructing me whom to contact (boss, family, best friends) to give an update, and able to speak understandably, even with her jaw shut tight. As they wheeled her up to her hospital room for overnight observation, I said good night and headed back to her apartment, a half-hour drive away. I was able to find my way and even park in a tight street spot, like a true Philly resident.

Thursday, she came home from the hospital and we began to experiment with making smoothies with all kinds of ingredients, so she could finally eat. On Friday, I drove her to see Dr. B Jr. for a follow-up. Like his father, he was calm, clear, a great listener, and willing to go the extra mile to help her. He swapped out the substitute elastic for the real thing and also told her how to remove and replace the elastics, so that she can take her other medications. He expected to be able to switch her to more stretchable elastics in a few weeks, and he was hopeful that she’d be out of the elastics at four weeks. The metal hardware in her gums that hold the elastics would come out a couple of weeks after that.

As of Sunday, the swelling in her face is nearly gone, she is able to take all her meds in pill form, and she’s been enjoying my creative smoothies. Her favorite is chocolate oat “ice cream” with oat milk and protein powder for an afternoon snack. She can smile and talk without a problem, though it’s tiring after a while. We’ve taken some walks and gone to an art museum. We see Dr. B Jr. again on Monday, and then we’ll drive back to Massachusetts on Tuesday so that she can recuperate with us for a couple of weeks.

This is a long way of saying that so much of going through an experience like this depends on good communications with medical professionals. While neither of us fault Dr. N for the mishap, his personal style was far too blunt and focused on fixing things, not on my daughter as a person in a vulnerable situation who was in pain and scared. The Drs. B had a totally different approach, setting a calm tone, educating, encouraging, and giving us confidence that this would work out. And, thank God, it did.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.