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Closed Mouth Cumshot [2021]


So, while Sweet might have been using her own explanations for what was happening to her face (no study points directly to forming a double chin), she might have been on the right track that mouth breathing can cause structural changes.




closed mouth cumshot



On exam, the physician should bimanually palpate the fracture site to check for fragment mobility. A lack of mobility indicates a stable fracture that may be amenable to conservative management, provided the occlusion has not been altered. Intraoral lacerations, injuries of the soft tissues, and hematomas at the fracture site are also important to note as these may lead to an increased risk of infection. Ecchymosis of the floor of the mouth is classically pathognomonic for mandibular fractures.


The dental status of the patient should also be evaluated. Loose teeth are extremely common following facial trauma and should be noted during the initial assessment. Exceedingly carious or damaged teeth, particularly at the fracture site, should prompt consideration of extraction. Tooth extraction is recommended if the tooth is (1) luxated from its socket and/or interfering with fracture reduction, (2) fractured, (3) has advanced dental caries carrying a significant risk of abscess, (4) has advanced periodontal disease with mobility that would not contribute to establishing stable occlusion, or (5) has existing pathology such as cyst formation and pericoronitis.18 There are certain situations in which teeth in the fracture line can be left in place as they can provide a larger repositioning surface. They can also be used for the application of tension bands in certain cases19 and do not cause delayed healing when treated with a closed reduction.20


It is important to distinguish between fractures of the condyle itself (intracapsular) and fractures of the condylar neck (extracapsular). Fractures of the head of the condyle are generally treated closed because the fracture fragments are typically insufficient for fixation and the location within the temporomandibular joint (TMJ) places the patient at risk for ankylosis. Patients with no malocclusion can usually forgo MMF and be placed on a soft diet with close follow-up. If malocclusion is present, MMF is necessary, and occlusion is controlled with elastics.


Fractures of the condylar neck and subcondylar region can result in more serious occlusal disturbances. Management options include closed or open treatment, by either a direct approach or endoscopically. Previous studies have supported a more conservative approach because conservative treatment produced similar occlusal and functional outcomes to those treated with ORIF,4344 and there is an alleged risk of devascularization of the fractured segment in addition to the visibility of external scars with the open approach.454647 Facial nerve injury is also a purported risk of ORIF, but cases seem to be largely temporary with total recovery in less than 6 months.45


Advocates for ORIF report improved pain control, occlusion, and the restoration of posterior ramus height with the open approach.484950 Additionally, long-term complications such as pain, arthritis, malocclusion, TMJ dysfunction, facial asymmetry, and ankylosis are reported in patients with condylar injuries treated in a closed fashion.515253 A meta-analysis by Al-Moraissi and Ellis51 in 2015 found that ORIF provided superior functional clinical outcomes, such as MIO, protrusion, and a lack of chin deviation, compared with a closed treatment. The authors also found improvements in postoperative pain reduction and occlusion in those treated in an open manner.51 Although objective outcome measures do appear to vary with treatment selection, some authorities42 feel that the management of these fractures should ultimately depend on the skill and comfort level of the surgeon, and whether they feel they can achieve the goals of treatment better with open versus closed treatment.


Similar to the adult literature, the management of pediatric condylar fractures is a contentious topic. Three main treatment modalities have been described, including mandibular physical therapy consisting of ranging exercises without MMF, a short period of MMF followed by mandibular physical therapy, and ORIF. In general, these injuries rarely require operative management as children usually have good ROM and occlusion. Long-term favorable facial growth outcomes have been described with the closed treatment of condylar fractures.8384


What It Means: A closed-mouth smile is often considered in the primate world as a submissive display. People who are particularly shy about their teeth will often do the closed-mouth smile.


You might also see a tight smile is formed when the central part of your lips is strongly pursed, with the mouth corners pulled back as in an ordinary smile3. This may indicate a person is holding back tension and anger but is trying to appear happy.


Henry VIII was also famous for this pursed-lip expression. You can see that in many of his portraits. The small-mouth gesture used to signify superiority among English aristocrats in the 16th Century.


Clenched teeth can sometimes be seen even when the mouth is closed. For example, you might notice a tiny movement on the jaw area or side of the face that pushes the jaw up and slightly widens it2. Additionally, teeth tapping shows signs of stress, boredom, or frustration. Some people might even shift their jaws and tap their canine teeth as a way to soothe themselves2.


It may also be a self-soothing gesture, similar to how babies put objects in their mouths when they are exploring things in the world for the first time, or how a toddler sucks on their thumb. This could carry over to adulthood when someone is thinking or in response to a question.


What It Means: When someone covers their mouth, it can mean that they are trying to pacify themselves2. This may be because they feel high amounts of stress or are uncertain about a situation.


Check out this video of a little girl in Russia. As she walks into a building, alone, a sketchy man observes her outside the building and decides to follow her in. As the man goes in, watch as he touches his mouth in a pacifying gesture (timestamp 0:52). Luckily, the girl catches on and escapes the building without a scratch!


What It Means: Fingers above the mouth in the philtrum area (that area of skin right above the lip) can mean low confidence, anxiety, or shyness. This is also a blocking behavior that covers the mouth, which may mean someone is hesitant to speak.


What It Means: The palm-over-mouth gesture indicates surprise. You might see this if someone receives bad news over the phone. In some Eastern cultures, especially Japanese cultures, covering the mouth when talking is polite if they are laughing or eating, etc.


How many times does air come in and out of your mouth? Most of us are nose breathers, but those times air does come out of our mouth can mean relief, fear, defeat, or accomplishment, among other things. Watch for duration and length to identify these cues:


What It Means: If someone suddenly opens their mouth just wide enough for some air to come in, they might be upset or feeling defeated and frustrated. You might also hear an audible gasp or notice air being sucked from the corner of their mouth, which can indicate pain.


In the presidential debate between Al Gore and George W. Bush, Al Gore can be seen repeatedly sighing throughout the debate. This becomes negative. The exasperated sigh is only exaggerated with the microphone close to his mouth (timestamp 2:30):


Over time, these muscle spasms and contractions may happen more often, and cause your eyelids to close, making it harder to keep your eyes open. Those with Meige syndrome can essentially become blind since their eyes are closed, though their vision is unaffected. You may also have dry eyes. The initial symptom can feel like sand in the eye."


Oromandibular dystonia, another symptom of Meige syndrome, is a term that means you have forced contractions of your jaw and tongue, making it difficult to open or close your mouth. A clenched mouth and teeth grinding (bruxism) can also occur. Other jaw-related symptoms you might experience include:


Incomplete recovery can take many forms. For some this means that a portion of the face does not move as much as the other side. Others will feel their face tighten, often in the cheek, around the mouth, or in the neck. Some develop synkinesis which is dis-coordinated movement of different regions of the face such as eye closure with mouth movement. Some people develop a combination of these issues. The best way to minimize these complications is to prevent them from developing in the first place. Early treatment with steroids and antiviral therapy can help improve the odds of normal facial function and minimize the development of facial tightness and synkinesis. Once facial function has begun to recover, a personalized plan of facial massage and facial retraining may also improve outcomes for certain individuals. If facial tightness or synkinesis has developed, targeted chemodenervation with Botox injections can be helpful to restore facial balance and minimize these symptoms. Some people may ultimately require surgical intervention if their face does not recover adequately. There are many surgical procedures utilized and often times a combination of procedures is recommended to achieve the most balanced results. These are discussed in more detail below but include procedures to restore eye brow symmetry, assist with eye closure, improve nasal breathing, and improve smile production and lip movement.


Injectable filler comes in many forms and these are described in more detail in the Filler section. Filler injection helps restore volume to various parts of the face and have been used for years in both cosmetic and reconstructive applications. Some patients with facial paralysis have a lot of difficulty with lip weakness and have to alter their eating habits to avoid spilling liquids out of the corner of their mouth. Lip strength can be measured easily by speech and language pathologists and if found to be weak on the affected side, a small amount of filler injected into the lips around the corner of the mouth can significantly improve these symptoms. The goal of this treatment is not to make the lips look bigger, but simply to restore some volume and provide more of a barrier to liquids escaping. 041b061a72


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