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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “Here we are now, how long has it been since the dog attack?”
Patient: “July, August, September, October, a month and a half only.”
Dr. Joel Aronowitz: “And you had a very severe dog bite to both sides of your face with multiple cuts on the left upper lid and multiple cuts on the right side of your face, this is all torn completely from your face and this part is torn down, and now we're looking at how your scars look and some of the problems from the injury, so I want to first show people what the facial nerve problem is, okay? And thank you for cooperating with us, we can teach others. So the facial nerve comes out of the stylo-masculoid frame and deep down here just below the ear, and it spreads across the face and one branch goes here and one branch goes to the eye and one branch goes to the smile and one branch goes to the sneer pulling the lip down and one branch goes to the neck, so if you raise your eyebrow for me, that's one branch and now squint really hard, close your eye really hard, this muscle to going around that closes, now relax and smile real and we have the zygomaticus muscle and then sneer like, show me your teeth, so the depressor of the lower lip here, that's one branch and then the last branch is this one in the neck, and you can see his platysma here, so that all looks good, but on this side where you had a injury up here to the facial nerve as it goes up into the forehead, raise your eyebrow, you can see on this side the frontalis muscle like a blind that lifts up like this, it works just fine, but on this side it doesn't, the reason is because that nerve has been crushed in the dog bite unfortunately.
Here's the scar and here's the scar from the injury out on the cheek and that's healing up very nicely and here we can see where the scar is where this was all torn up and it's actually healing beautifully, it's lucky your handsome man to start with. Now we're just talking about why does the, when he looks in the mirror he says I look scary sometimes and I made a joke that it's because of his bun, but it's not because of your bun is it, it's because when we look at you we're expecting to see the same opening of the eye on both sides, we call this the orbital fissure, so we should be about the same on both sides and we shouldn't see too much of the white, the sclera of the eye, and here the upper lid had several cuts which you can't even see now the scars have healed beautifully, but the scar tissue is pushing down a little bit, so this eye he has a little pushing down of the lid called ptosis where the eyelid is drooping a little too much over the pupil of the over the iris of the eye and over here he doesn't, so the upper lid on this side is in the correct spot and the upper lid on this side is a little too low and then over here the lower lid is too low looks up a little bit more and we see too much white here below on the lower and here we see the right amount of sclera or white, so when we see too much white of the eye that looks scary and that's why that looks a little bit scary to you and maybe and is why you look asymmetric and over time as that scar tissue softens and may require a little steroid injection, may require some other things that a oculoplastic surgeon may want to we may need him to help us with her to help us with later on, but right now at only this brief time after the injury what we're going to do is just give his own body time for that scar tissue to mature and for these things to take care of themselves, so and let me ask you still like dogs after all this?”
Patient: “Yeah, that's good.
Dr. Joel Aronowitz: “Good, well that's good to not hold any not hold any grudges in your heart, I think that's good advice.”
Patient: “I tested myself but I failed, the other day a pit bull passed by me and I was drinking coffee and my friend he took off and I said I want to test myself but as soon as the dog got too close to me I jumped and he attacked me.”
Dr. Joel Aronowitz: “Oh really?
Patient: “Yeah but he attacked me because he sensed fear.”
Dr. Joel Aronowitz: “Yeah, so maybe it's a little too soon to test yourself, it's a little too soon, but not with pit bull, but with chihuahuas, yeah start with chihuahuas and maybe start with cats and work your way up, but thank you for sharing your story and letting us show people what that looks like because I think it's it's helpful to kind of analyze the anatomy and every doctor I show him this, the ophthalmologist, he said this is a great job, I mean like my my Dr. Zaki he was questioning how we were able to do this this precise and it took like a lot of hours, I can't remember it was like six hours. It took a long time yeah, it took a long time and I'm pretty fast so.”
Patient: “Thank you so much doctor yeah.”
Dr. Joel Aronowitz: “But you're very welcome. Traumatic. This time next year you're gonna be a new man.”
Patient: “Thank you so much doctor.”
Dr. Joel Aronowitz: “Okay so we'll see you later from Aronowitz Land.”
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