Singer and voice teacher Michelle Latour shares her experience with jaw surgery and recovery, short and long term.
In May of 2013, I underwent major jaw surgery. This was not by choice, but was necessitated due to teeth grinding and a dentist giving me a device called an NTI in order to stop my nocturnal teeth grinding. The result was that my teeth kept trying to grind away at night, despite wearing the NTI. My teeth erupted in the back, meaning that the surrounding teeth moved so significantly that my molars in the back once again touched.
Why Surgery?
My dental health rapidly deteriorated, and I experienced a plethora of symptoms including facial asymmetry, incessant teeth grinding, tongue thrusting, an increasingly worsening malocclusion (inability to close my bite in the front), and an audible lisp. Most alarming, because my jaw was so far out of alignment, my breathing airway was only open to about 15 percent capacity, and my chances of developing degenerate joint disease was greatly increased. Although the prospect of jaw surgery is absolutely horrifying for a singer, it was my only viable option as I was told that without surgery, my health problems would only worsen.
Surgery was a six-hour procedure whereby the surgeon broke my jaw in 4 places and inserted eight titanium plates. These were fused together with a local bone harvest from the floor of my nose, bone cadaver, and my own plasma. I received a chin implant and minor upper-lip reconstruction and had a screw inserted above my two front teeth and a Kobayashi Hook in the skin below my bottom teeth so I could wear rubber bands. I also had a temporary screw inserted on my forehead to use as a guide during surgery.
Part of the overall medical plan required me to wear braces before, during, and after surgery in order to stabilize my jaw, and I had numerous rubber bands attached to my braces. I woke up in the recovery room with over 20 stitches in my mouth, and my lips and face were swollen beyond recognition.
This Is Recovery?
Although the surgery was deemed a success, I experienced a myriad of complications including extreme dizziness, constant inner-ear pain, chronic weakness, long-term swelling, facial numbness, painful mouth sores, intestinal tract issues, and random nose bleeds. The healing process was long, arduous, and often painful.
Pre-Surgery
1 Week Post-Surgery
1 Month Post-Surgery
The first weeks of healing were intense and frustrating. I was incredibly weak and dizzy and could not perform most normal day-to-day tasks. I also experienced a constant feeling of choking or having something caught on the roof of my mouth as a result of my uvula being swollen post-surgery. This annoying sensation lasted for several weeks.
Taking medications took on a whole new meaning during recovery as I could not open my mouth wide enough to swallow a pill. Any surgery-related medications I was taking were in liquid form, and I quickly learned how serious my acid reflux and gastritis were. After 10 days without these pills, I was in agony.
This was coupled with the emotional effects of the remaining anesthesia wearing off. I could not even watch a commercial of a puppy without bursting into tears, and I was experiencing the added complications of fever, insomnia, and an uncontrollable squirming of my legs. Upon reading my medication warning labels, I discovered that a possible side effect of the anti-nausea tablets was restless leg syndrome. I had to either endure constant leg twitching or frequent waves of nausea; I chose nausea. The multitude of symptoms made for some long and miserable days.
For the first eight weeks I was not allowed to use a straw, to blow my nose, or to sleep on my side. I was not permitted to brush my teeth until week three. Simple tasks such as laughing, coughing, or sneezing were incredibly painful. I was on a clear liquids-only diet for the first two weeks and then regular liquids from weeks 3 to 10.
About halfway through my convalescence, I learned that I was considered a high-risk patient. This was one of the toughest setbacks for me emotionally. Due to my age, my lack of bone density, and the severity of my surgery, my healing process would be longer. Instead of the standard diet restrictions for 16 weeks, I had to extend the regimen of liquids-only for 10 weeks followed by soft-chew foods only for another 10 weeks. The additional four weeks was incredibly disappointing as it also meant that my jaw was going to be rubber banded shut for five months.
At 15 weeks post-surgery, I painstakingly started to take my life back. However, facial paralysis, swollen cheeks, abnormal speech, and chronic fatigue were still ever present. Also, during this time, the two pesky appliances, the screw and Kobayashi Hook that were inserted during surgery, caused much discomfort. My body actually began to reject the screw, and it started to slowly come out of my mouth.
Before and after malocclusion
A decade later, how have I adjusted? Although I mostly feel “back to normal,” my body is permanently altered, and there are consequences that come with that. Not surprisingly, new health issues have emerged.
My Face!
One of the side effects of surgery was temporary nerve damage. Post-surgery I could not feel the lower half of my face. I had to sit in front of a mirror to consume all my meals as I could not feel liquid or food sliding down the side of my face. This persisted for nearly a month. I was also unable to smile. Any attempt resulted in a scary, crooked-looking grimace. There was a possibility that the nerve damage would be permanent. Luckily, I did regain all feeling in my face, but it took about four years for all sensation to return.
Another change is that I can chew on only one side of my mouth. It is impossible for me to chew on my right side. The mechanics just do not work, and any attempt is painful and uncomfortable. A side effect of this is that excessive plaque forms on my right side. Visits to the dentist are accompanied with a stern lecture from the dental hygienist about plaque removal. Having my teeth cleaned is very uncomfortable as trying to keep my mouth open for that long is painful.
2008
2011
Another change is that I can chew on only one side of my mouth. It is impossible for me to chew on my right side. The mechanics just do not work, and any attempt is painful and uncomfortable. A side effect of this is that excessive plaque forms on my right side. Visits to the dentist are accompanied with a stern lecture from the dental hygienist about plaque removal. Having my teeth cleaned is very uncomfortable as trying to keep my mouth open for that long is painful.
Although I no longer grind my teeth at night, I still do a fair amount of clenching. I frequently wake up in the middle of the night with my jaw extremely tight. I have to take a minute or two to consciously release my jaw. This has been ongoing for years.
2013
2017
My face looks different as my bone structure and facial components have been permanently altered. If you look at a series of pictures over the last 15 years, you can see my evolution from the emergence of my initial teeth grinding, shifting as my malocclusion worsened, transforming again once I had braces, post-surgery alterations, and then the final version of my countenance. I liked my appearance the way it was. I do have an actual jaw line and defined bone structure and, admittedly, I probably look better now. But after peering into the mirror for 40+ years prior to surgery, I was content with the face that looked back at me.
There are other outward changes, most notably asymmetry on my upper lip and neck when I smile or talk. The philtrum, the vertical grove between the base of the nose and the border of the upper lip, permanently and prominently slants to the left. Additionally, I’ve noticed loose skin on my neck that veers noticeably to the right. This becomes even more obvious every time I swallow. And the screw that was temporarily inserted on my forehead? It has left a permanent scar.
And My Voice?
Another adjustment was learning to sing and teach with braces. I ended up having to wear braces for over two years. This was more an annoyance, but maintaining a busy performing and teaching schedule meant that my lip would often get caught on my braces, and I frequently had throbbing mouth sores. Once my braces were removed, I had permanent retainers inserted behind my upper and lower front teeth.
Lip trills are difficult due to all the scar tissue in my mouth. I have learned to compensate, but it is not ideal when trying to demonstrate during a voice lesson.
Recently I have observed that my jaw aches after a long day of teaching. This is exacerbated when I am illustrating concepts for releasing jaw tension, singing rapid tongue twister vocalizes, or working on patter-style repertoire.
Current
What Now?!
About a year ago, I began noticing some significant changes in my sinuses. I was constantly having to blow my nose, was sneezing incessantly, and was experiencing chronic fatigue. I initially chalked it up to “Vegas Throat” as the allergies in Las Vegas are notorious.
After consulting my primary care doctor, I scheduled a CT of the sinuses. The results were surprising: a possible cyst blocking my left nasal passage, mucosal thickening of the maxillary sinuses, acute chronic sinusitis, and a deviated septum. I scheduled a consult with an ENT.
My next shock came after having a nasal endoscopy. I was told that these new symptoms were a result of my jaw surgery. What? According to the ENT, if you radically alter a part of your anatomy, there are bound to be repercussions. My sinuses are permanently damaged with significant mucosal wall thickening on the left side, chronic sinusitis on both left and right sides, and anatomic abnormalities. My left nostril is 70 percent blocked and my right nostril is 35 percent blocked. The cyst on the left side of my sinuses, called a mucous retention cyst, means that when I blow my nose, clear liquid (also known as refluxing liquid) often comes out of my left eye.
The solution? Using a humidifier, fluticasone nasal spray twice daily, and allergy pills. If my symptoms worsen, surgical intervention will become necessary.
A decade later, I can honestly attest this has been the most challenging experience I have ever endured. The new developments, a full 10 years later, are certainly discouraging. I am grateful that I no longer grind my teeth, but the jury is still out on whether the emotional and physical trauma of this ordeal has been worth it.
