ADVICE PLEASE - Gunshot Wound to Mandible, Arch Bars destroying mouth

[nadp2oxide]

Hello, I am so glad that I've found this community; I hope that it will be helpful. I've never met anyone in a situation similar to mine before.

I suffered two gunshot wounds to the face, vaporizing the front of my mandible, nearly died, spent a month in the intensive care unit - I was released with trach, external fixation, and arch bars. I was released in april. I have had surgery after surgery due to complications with my mouth healing correctly. Eventually (somewhat recently) it was decided to remove the antibiotic cement bridging the gap in my mandible, I was told that my body was most likely rejecting the material.

Fast forward to this week... In the shower I was washing my mouth gently and I felt the left arch bar move and this was followed with intense pain that has persisted, the front of my arch bars were connected originally but during the surgery the piece covering the area where I was shot was removed. This has left a jagged sharp metal edge to stab me in the bottom of my mouth, and the arch bar that has come loose is tearing my mouth to pieces, overnight my gums have visible damage and I am in intense pain.

I shambled my way to the local ER and they did nothing other than take an x - ray, and told me to follow up with my surgeon (duh) well, my surgeon is busy until next Tuesday, I managed to get a hold of his nurse and she relayed his advice to me: go to the ER. Imagine how frustrated I am with that. The x ray clearly shows two screws not in place, one.

What do I do?!? How can I relieve the pain, inflammation, gum damage, etc. This is killing me and I really don't want to loose all of my teeth, I lost two already due to the gunshot. Advice please?

[Ridingboots]

I really have no advice but could ER give you something for the pain?

[nadp2oxide]

the er gave me 1 perc 5 and sent me on my way. i wasnt there seeking pain meds to help me for 4 hours. this has been an ongoing problem all week and my surgeon is booked up

[kelse]

Is wax any use? A big blob on the shape bit.

It sounds horrendous - can't believe they sent you home??!!

[snapdresser]

nadp2oxide - I had archbars too, but I'm not going to pretend I had as complicated of a setup as you do. I just got them off last week. Anyways, I second kelse's advice about the wax. A wire from my archbars was digging into my lip and making it bleed so I just picked up some orthodontic wax and smushed it over that wire and it instantly felt 1000x better. Where is the intense pain? In your gums near your teeth or in the lip? Archbars, as it sounds like you're well aware, have a way of loosening teeth. So if it's your teeth hurting, it might be a loosened tooth. If it's your lip hurting from being stabbed by the cut archbar, then the wax should help. Perhaps your surgeon could trim the archbar a little differently when you see them such that it doesn't cut in so much? But if it's flopping around in there and damaging your gums, they'll probly have to remove it. If it's flopping around in there it's not doing any good anyways. If you're concerned that the damage to your gums is going to cause you to lose that tooth, I would say there's a good chance you won't lose it as long as you get that resolved and obviously if the pain is just in your lip that shouldn't affect it either. I had a tooth loosen and my surgeon just removed the wire around it and it got much better on its own. What's the purpose of the archbars now that they've been disconnected?

[nadp2oxide]

thanks for the responses.

I actually picked up some wax yesterday, I have never used this before. I'm not quite sure how to use it, seeing as the jagged edge I mentioned is directly adjacent to the area in my gums in which there is no bone underneath (where the cement spacer used to be), there are sutures there and it is very sensitive - how would I go about using it there? I put it on the bars at the top of my mouth in a long strip and it stayed just fine, but I've had a lot of trouble (and wasted almost all of the wax) trying to apply it to the bottom teeth and have it keep in place.

I'm not entirely sure why the surgeon has not removed the arch bars, considering I've had three (maybe four?) surgeries since I was released from the hospital, and as far as I've been told, when my mouth cooperates and heals properly I will be ready for the bone graft and removal of the titanium fixation bars will occur during this procedure.

During the last surgery in pre - op my surgeon actually asked me if I'd like him to remove the bars. It kind of stunned me, and I said "...well I certainly don't like them, but you're the doctor so I'd trust your best judgment."

Due to the severity of my injury it is possible that he has opted to keep them intact in case of some unforeseen complication down the road in which I would need to have my jaw wired shut once again.

As for the pain: It is in my lip, it is in my gums, it is in multiple teeth. It is the epitome of mouth pain (not to mention the pain in my jaw which is unrelated to the bars).

Considering how remarkable it is that I survived I should not be complaining, but it does seem like the hospital, and my surgeon have been negligent to my concerns post- release.



explain to me how the wax is typically applied please?

[kelse]

When I put wax on u braces I just tried to suck air past the wires to dry them out a bit, then mould the wax around the sharp area. The wax will stick better to a dry area, and also one that is not too smooth.

Hope you get some relief from pain soon

[snapdresser]

nadp2oxide - The wax isn't "sticky" really, so it won't stick to your teeth. You have to mold it around a shape for it to stay in place. It has no pain-killing or other special effects. It's just for molding around a shape and making it so that shape doesn't poke into your flesh. So for the pokey edge of your archbar, you just want to mash it all the way around the sharp part as best as you can, making sure that it you get a little between the sharp part and the area of your gums it's poking into, and also on the outside of the sharp edge, where it sounds like it's also poking into your lip. Unless the top archbar was poking into you, you didn't need to use it up there. If you're short on wax now, maybe you can take some of the wax off the top and reuse it on that bottom arch bar that's digging into you.

I wouldn't be super concerned about keeping the bottom archbar in now that it's been cut. If your surgeon suggests they take it out when you see him next week, that's probably for the best. It does no good flopping around and can cause your teeth to loosen too (all archbars can do that, cut or not, but if the archbars aren't functioning, there's no reason to carry that risk). If they need it to help hold your jaw in place when they do the bone graft, they can put the bottom one back on during the operation. But until then, while you're happy to be alive, there's no reason to go through this additional pain.

I'm still having a hard time figuring out what part (or parts?) of the lower archbar is digging into you and where. A pic could be useful, but I understand if you're not comfortable with that.