Multiple jaw fractures and a mild brain injury

By October 18, 2021Articles

Article edited by Walter W. Kubitz, Q.C., a personal injury lawyer in Calgary, Alberta.

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Multiple jaw fractures and a mild brain injury.

Ms. Client was injured in a motor vehicle accident  as a pedestrian crossing a street within the marked crosswalk.

After Ms. Client was hit she flew through the air and landed about ten feet away from where she was hit. The witness said that Ms. Client was pretty dazed and didn’t seem to know where she was. She had their shoes knocked off and was described as being torn up and bloody. Ms. Client had hit the pavement face first.

Overall, the Accident caused Ms. Client to suffer:

  • Broken upper jaw that required surgical correction, including the insertion of plates and screws, followed by casting;
  • Minor fracture to her left cheekbone;
  • Broken nose that was left swollen and stuffy;
  • Loss of 2 upper teeth at the time, followed by the loss of 3 more teeth after;
  • Braces and elastics to keep the teeth and jaw in line while the fractures healed;
  • Numerous cuts, bruises, and scrapes;
  • Swollen face and lips;
  • Brain hemorrhage;
  • Two black eyes; and
  • Hospitalization from 1 week.

Ms. Client suffered many fractures to her upper jaw. As a result, she had to eat through a straw and lost 20 pounds in one month due to her liquid diet.

Prior to the Accident, Ms. Client was in very good health with no other accidents. She had no prior issues with her jaw.

At the hospital, the Emergency diagnosis was a closed head injury; nasal fracture; and multiple facial fractures. A CT scan of Ms. Client’s head taken the night of the Accident found multiple facial fractures; undisplaced left nasal bone fracture; undisplaced fracture involving the proximal nasal process of the right maxilla; minimally displaced comminuted fractures of the posterolateral wall and medial wall of the right maxillary sinus; comminuted fractures of the anterior wall of the left maxillary sinus; subtle undisplaced orbital floor fracture; comminuted minimally displaced fracture involving the left paramedial aspect of the alveolar process of the maxilla with fracture lines identified anterior to the left lateral incisor as well as posterior to the left first premolar; bilateral minimally displaced medial and lateral pterygoid plate fractures; and comminuted minimally displaced fractures involving the bony nasal septum as well as the vomer. The scan also demonstrated a punctuate focus of hyperdensity in the right inferior basal ganglia, suspicious for a hemorrhagic shear injury.

Ms. Client underwent jaw surgery in the form of an open reduction/internal fixation of a comminuted bilateral maxillary fracture with placement of arch bars. The operation was performed under general anesthetic; the maxillary arch was comminuted into three main pieces, and all fragments were highly mobile. The post-operative diagnosis was a comminuted maxillary fracture. The minimally displaced fracture of her left orbit was not treated; she underwent a closed nose reduction.

The upper and lower arch bars in her jaw were removed under local anesthetic in a later surgery. Ms. Client was seen four weeks following her surgery and the noted occlusion was abnormal, characterized by an anterior open bite. It was thought that the best course would be to let the fractures heal and do delayed dental reconstruction.

The Accident caused Ms. Client’s teeth to shift, and she required a lot of orthodontic work. She lost two teeth in the Accident and another one chipped; an additional three teeth eventually needed to be removed to make room for her required dental implants. Ms. Client required braces, which she wore for three years; after the braces were removed, the plan was to install permanent dental implants. Before the dental implants could be placed, a bone graft was required. An oral and maxillofacial surgeon stated that Ms. Client had a less than optimal surgical repair of her Le Fort I maxillary fracture; he recommended surgery, but Ms. Client did not want it and opted for 2.5 years of compensation orthodontics instead. Ms. Client eventually reconsidered the surgical option; however, due to the orthodontic work that had already been done, she needed decompensation orthodontics to reverse things in order to get an optimal result.

A neuropsychology report found a mild traumatic brain injury with a noted acute intracranial abnormality due to Ms. Client’s inferior right basal ganglia hemorrhage. She had a full and complete recovery of this and did not need any additional treatment.

Ms. Client has no jaw pain but has a marked degeneration of her left TMJ structure. Ms. Client’s injuries left her prone to having a higher degree of TMD onset due to her jaw disharmony not being surgically corrected.

Ms. Client is a unique plaintiff in that her ongoing complaints are almost non-existent. She claims to have no pain; she said the braces hurt somewhat after adjustments were made but were mainly just a hassle. Her nose is crooked and occasionally feels stuffy. She has never gone to any chiro, physio, massage, or counselling. Ms. Client stated she had occasional clicking tissue displacement in her right TMJ, but no pain. She has no ongoing pain, no headaches, and sleeps well.

 

CONCLUSION:

There are several cases that are analogous to Ms. Client’s situation.

The most analogous case overall is Latek v. Krol, 2013 BCSC 1884. The 28-year old male plaintiff was injured in a motor vehicle accident; prior to the accident, he had been very healthy and active. The plaintiff suffered bruises, lacerations, and soft tissue injuries; he had significant jaw pain and 16 teeth were loosened and mobile. The plaintiff required braces to correct the misalignment of his jaw, and there was the possibility he would require surgery in the future. The court held that his injuries were extensive but not severe or life threatening, and most had resolved by the time of trial. Sewell J awarded general damages of $91,205 (inflation adjusted).

The most analogous Alberta case is Chisholm v. Lindsay, 2012 ABQB 81, additional reasons in 2013 ABQB 589, affirmed in 2015 ABCA179.        The 31-year old female plaintiff suffered a WAD II injury with pain in her neck and back, as well as headache, sore teeth, and facial swelling. She suffered a TMJ sprain/strain, among her other injuries, that led to pain that was chronic and persistent. Kenny J awarded $97,470 in general damages.

Other analogous cases set the damage award for plaintiffs with similar injuries to Ms. Client’s, inflation adjusted, from a high of $188,580 to a low of $62,460, with an overall average amount of general damages awarded of $111,000. The average amount of damages awarded in similar Alberta cases was $87,240, inflation adjusted. Therefore, it seems likely that Ms. Client’s general damage award will range around $90,000 – $110,000.