Getting Mouthy, Pt. 4: A Singer’s Worst Nightmare- Jaw Surgery
Installment #4 of re-posting previous articles chronicling my teeth-grinding journey. This was originally published in the fall of 2013…..
In May of 2013, I had facial reconstruction surgery. This was major surgery- a six-hour procedure, intubation through my nasal passage, a night in the hospital, and a summer of slow, often painful recovery.
Although the surgery was ‘successful,’ I experienced a myriad of complications:
extreme dizziness,
constant inner-ear pain,
loss of appetite,
chronic weakness,
highly erratic emotions,
long-term swelling,
facial numbness,
unsightly bruising,
flashes of nausea,
rapid weight loss,
frequent insomnia,
propensity to acne breakouts,
painful mouth sores,
intestinal tract issues,
restless leg syndrome,
random nose bleeds, and
muscle spasms.
But the most difficult part? Having my jaw rubber-banded shut 24/7 for ten weeks. While many singers and voice teachers spend their summers attending summer training programs and traveling, I spent my summer on the couch. And at 15 weeks post-surgery, I still have a long way to go on the road to recovery.
I had initially shared my story in 2011, “Teeth Grinding and My Voice.” What I did not reveal, due to legal matters, was that the best long-term solution to my dental problems was going to be major surgery. My dental issues led to a medical malpractice suit that settled out of court, which enabled me to have jaw surgery in May 2013. Although the prospect of jaw surgery is absolutely horrifying for a singer, it was my best solution. This has been by far the most challenging experience I have ever had to endure, both emotionally and physically.
My previous dental issues meant that my dental health was rapidly deteriorating.
My face was asymmetrical.
I had an annoying lisp.
I would incessantly grind my teeth.
I was prone to tongue thrusting.
My malocclusion kept worsening.
And that’s not all.
Because my jaw was so far out of alignment-
My chances of having degenerate joint disease increased.
My breathing airway was only open to about 15-percent capacity.
Without surgery, my health problems would only worsen as I aged. Luckily, I found Dr. G. William Arnett, a world-renowned oral and maxillofacial surgeon in Santa Barbara, CA, who specializes in these kinds of cases and often collaborated with my Las Vegas orthodontist, Dr. Darrell Spilsbury.
Once I knew that I could go forward with the surgery (insurance did not cover a dime), I scheduled my procedure for the end of the spring semester. My surgery included breaking my upper and lower jaw in four places with a chisel. This would enable me to breathe with a normal-sized airway and would eliminate the asymmetry of my lower jaw.
The procedure?
Eight titanium plates where Dr. Arnett cut into my jaw.
Plates fused used together with a local bone harvest from
the floor of my nose,
bone cadaver,
my own plasma.
Minor upper-lip reconstruction.
A chin implant.
Botox to alleviate possible teeth grinding post-surgery.
A temporary screw in my forehead to use as a guide during surgery for symmetry.
I woke up in the recovery room with over 20 stitches in my mouth and numerous rubber bands stabilizing my jaw. My lips and face were swollen beyond recognition, making merely talking a difficult endeavor.
The first several weeks were intense and frustrating. Initial post-op instructions were to rest, but since I was so weak and dizzy, I could not even perform normal day-to-day tasks like driving—not that I wanted to venture out in public. I was so swollen and bruised that I did not even look like myself. I was so weak from lack of nutrition that I did not have the energy to even go to the grocery store. I also had 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.
For the first eight weeks, I was not allowed to use a straw, to blow my nose, or to sleep on my side—and I was not permitted to brush my teeth until week three. Instead, I had to do salt water and hydrogen peroxide rinses every few hours. One of the highlights of my recovery was being able to brush my teeth again after week two, although I was only allowed to use a baby toothbrush.
Singing was out of the question. In fact, simple tasks such as laughing, coughing, or sneezing were incredibly painful. I was on a clear liquids-only diet for the first two weeks as my rubber bands slammed my jaw shut for 24-hours a day.
After two weeks I was allowed any kind of liquid or blended food and was instructed to have my rubber bands off for an hour a day in order to complete jaw and lip exercises. After having my jaw completely shut for two weeks, my jaw joints were stiff and the scar tissue in my mouth meant that my lips were exceptionally tight. My surgeon likened my joints to that of the Tin Man in The Wizard of Oz. I had to do jaw exercises in order to get my jaw joints “oiled” and working again.
When I first began this process, I could open my jaw only a few millimeters. As a coloratura soprano, this discovery was absolutely terrifying. Singing anything higher than a G5 was physically impossible as I could not open my mouth wide enough. Just talking was difficult because I had to talk with my teeth completely closed. Talking on the phone was certainly out, but I was at least able to FaceTime with friends and family.
The worst week for me by far, was one week after surgery—specifically, Memorial Day weekend. Since my jaw was rubber-banded shut 24 hours a day, I could not take any of my regular medications, which include two different prescriptions for acid reflux and gastritis. Any medications I was taking related to my surgery were in liquid form. Prior to surgery, I was not concerned about this and, in fact, I was looking forward to eating nonacidic foods and trying to wean myself off of my meds.
I could not have been more wrong: I had no idea how serious my acid reflux and gastritis actually were. After 10 days without medication, I was in extreme pain. On a scale of 1-to-10, I was at a 10. Of course, this development reached a climax on late Friday afternoon of Memorial Day weekend. After a quick Google search and a desperate call to my pharmacist, I discovered that I could have been taking my pills via liquid form, but I had to have my gastroenterologist rewrite my prescription, which was not possible until Tuesday morning.
I figured I would just have to suck it up and deal with it over the weekend. Unfortunately, this was coupled with the emotional effects of the remaining anesthesia wearing off. I do not consider myself a “crier,” but I could not even watch a commercial of a puppy without bursting into tears. I was experiencing additional complications, including a slight fever and insomnia. On Friday evening, I noticed that my legs were incessantly twitching, and I could not remain still. After reading the warning labels on all my medications, I found the culprit, my anti-nausea prescription. Great! Now I had to either endure constant leg twitching or frequent waves of nausea. I chose nausea.
I slept very little that weekend as I waited for my plethora of symptoms to dissipate. I mostly just sat on the couch and looked out the window as the hours slowly passed through the night. I did not have enough mental clarity to accomplish anything more productive than staring into space. The emotional instability, increasing abdominal pain, fever, and insomnia made for a long and miserable holiday weekend. By the time I was able to take my meds again, the only food I could handle was soy milk and chicken broth: hardly enough to sustain anyone for a long period of time. I ended up dropping 10 pounds in about a week and was so weakened that I could barely walk. I was not overweight to begin with, so any reserve strength I had quickly evaporated.
About halfway through my recovery process I learned that I was considered a high-risk patient. This was one of the toughest setbacks for me emotionally. Most people who have this type of surgery are between 16 and 20 years old, so my age alone meant that my healing process would be slower. Additionally, my lack of bone density and the severity of my surgery meant that I was a high-risk patient. What did this mean? Liquids-only for 10 weeks followed by soft-chew foods only for another 10 weeks. Regular patients had to follow this regimen for just 16 weeks total. The additional four weeks, although it might not sound overly traumatic, was incredibly disappointing.
I ended up losing a total of 13 pounds in a matter of weeks. Most people joked about how they would love to have their jaw wired shut in order to lose some excess weight—but I seriously would not wish this on anyone. Not being able to eat solid food for 10 weeks is exasperating, especially if you have never been a fan of smoothies or blended drinks. Food is a very social experience, and not being able to go out to eat for months was extremely disappointing. I had to “eat” in front of a mirror for a good part of my recovery because I could not feel my face. Without the aid of a mirror, my meal would run down my chin. And since my jaw was rubber-banded shut, I had to loudly slurp everything—not a pretty picture, and definitely too embarrassing to attempt at a public restaurant.
I probably tried returning to teaching earlier than I should have—but after five weeks, I was not only starving for real food but also for some sense of normalcy. After my students got over the initial shock of how different I looked, lessons were fairly productive. My face was still mostly numb, and I still had to wear my rubber bands, so I had to talk and sing with my teeth slammed shut. Additionally, at barely 97 pounds, I was still pretty weak and scrawny. I had very little energy and, after teaching four or five students, I came home and literally passed out on the couch.
Because my energy level was visibly down and I could not demonstrate for my students, it forced them to figure things out on their own to a certain extent. Ironically, I had several students experience major breakthroughs. Each week I felt stronger and stronger, and I was so thankful to be able to teach again.
At 15 weeks post-surgery, life is slightly more even keel. I still cannot feel parts of my face, and my cheeks are still swollen. In fact, I am a bit concerned about being able to physically smile for my upcoming wedding. My mouth does not open all the way. I can stick my thumb in between my teeth, but not two fingers yet. I still talk a little funny and I definitely tire out pretty quickly. I have a screw inserted in my mouth above my two front teeth and a Kobayashi Hook inserted in the skin below my bottom teeth that will remain until week 16 because I have to wear my rubber bands at night. These two pesky appliances have caused much pain and discomfort, resulting in daily applications of wax. By week 14, my body actually began to reject the screw, and it started to slowly come out of my mouth.
On the bright side, I am sleeping more soundly, my teeth touch once again in the front, and I savor ecstatically my soft-chew food. I am back at Bikram yoga and I can walk the dogs three to four miles without having to stop and rest. But running or hard-core workouts? No way.
And the implications for singing and teaching? With my face being balanced and symmetrical again, singing will eventually be better than ever; but for now I have to take things slowly. I cannot open my mouth wide enough for high notes, and coloratura is definitely impossible. Sadly, I will have to miss out on Messiah season this year.
Teaching is much easier, and I was pleasantly surprised at how well I made it through the first week of classes at UNLV. I was very concerned about my ability to teach full-time again because of my energy level but, frankly, it was wonderful to be back. Talking and singing all day, though, is physically challenging and painful, because my jaw tends to hurt and the sores in my mouth are a constant annoyance.
I have tried to maintain a sense of humor. I have laughed with my students about it and I encourage them to ask questions, but it has been difficult. I consider myself a pretty tough chick, but there honestly were moments when I did not know how I was going to make it through the day. The extreme weakness from lack of nutrition, the excruciating pain from my acid reflux and gastritis complications, and the incredible discomfort of facial numbness and swelling made this a process difficult to endure. I am still trying to decide if it was worth it. Here’s to hoping that I can actually smile at my own wedding next month.
