Will Jake Paul follow doctor’s orders? Return to boxing at issue

Jake Paul insists he’ll box again despite suffering a broken jaw when he got knocked out by Anthony Joshua. How fast he returns to the ring could hinge on potential complications after recent jaw surgery, according to medical experts.

It does not take a medical expert to envision the potential challenge for the 28-year-old Paul.

People recovering from jaw surgery are supposed to avoid strenuous exercise, heavy lifting and hard, crunchy or chewy food. But Paul does not fit the profile of the average patient.

The same day he had surgery at the University of Miami hospital, he attended a party at a Miami mansion, according to photos and video published by TMZ.

He said during an interview with his brother, Logan, he might go snowboarding during his time off.

And, of course, he set aside concerns over his health in fighting Joshua, the former world heavyweight champion who broke Paul’s jaw in two places with a knockout punch.

Now Paul faces doctor’s orders.

“So this will require a lot of compliance from his standpoint,’’ Daria Hamrah, an oral and maxillofacial surgeon based in McLean, Virginia, told USA TODAY Sports.

Hamrah — who said he has done thousands of jaw surgeries — is not involved in Paul’s care. But he said he looked at the X-rays posted on social media by Paul, who disclosed he had two titanium plates and screws inserted on either side of his jaw.

“If he’s not compliant, (if) he starts clenching or biting on something that he shouldn’t, those plates and screws, they will break,’’ Hamrah said. “I would make sure I make it clear to him that at no point he should be chewing at anything harder than smoothies.’’ 

The worst-case scenario for Paul, Hamrah said, is the need for another surgery and losing a segment of his jaw that would have to be reconstructed. Not to mention delays in getting back into the boxing ring.

The complication rate for people recovering from jaw surgery could be as high as 20%, according to Omar Abubaker, Professor and Chairman of the Department of Oral and Maxillofacial Surgery at the Virginia Commonwealth University School of Dentistry and the Virginia Commonwealth University Medical Center.

Infection is the enemy

“The mouth is a sewer,’’ said Edward Ellis, Chair and Professor of the Department of Oral and Maxillofacial Surgery at the University of Texas Health Science Center in San Antonio.

He was not referring to the dirty words Paul uses at press conferences.

Instead, Ellis was referring to the high presence of bacteria in the mouth. “Fortunately,’’ Ellis said, “we also have a very good blood supply in and around the oral cavity, so that kind of helps with that.’’

Nonetheless, about 10 percent of patients have post-operative infection, according to Ellis, who said “so certainly there is a significant risk.’’

Treating the infection often requires the wound be reopened, and complications can involve “the hardware’’ — in Paul’s case, the two titanium plates and screws on either side of his mouth.

“If that happened in the first six weeks or so, one would need to remove the hardware and the dead bone and do a bone graft six to eight weeks later after sufficient healing had occurred to overcome the action,’’ Ellis said, adding “the jaw would not be as strong as a normal jaw for many months.’’

And, in Paul’s case, potentially slow his return to the boxing ring.

Surgeon questions Jake Paul’s procedure

Hamrah, the surgeon from Virginia, said more serious consequences could arise as a result of doctors having used miniplates and mini screws instead of a larger plate. That increases the importance of not biting or clenching something he shouldn’t, according to Hamrah.

“Those plates and screws, they will break … they’re fairly flimsy,’’ he said.

Hamrah said he usually puts a heavier plate on the right side of the jaw to make sure there is no mobility of the two segments of the bone.

“So given the fact that he had a tiny plate (inserted), that would make me as a surgeon a little bit more nervous,’’ he said.

Hamrah speculated that Paul might have opted for miniplates and mini screws because a larger plate would have required an incision on his neck and led to, a possible scar and longer recovery.

Ellis, the Chair in the Department of Oral and Maxillofacial Surgery at the University of Texas at San Antonio, said he thinks what was done with Paul’s procedure was ‘acceptable.’ He said the larger plates are much more difficult to apply than the miniplates.

“Different surgeons have different methods of treating these injuries, but the one that was done on this patient was an acceptable treatment,’’ Ellis said.

While the early stages of recovery are critical as the jaw bone fuses, the potential complications don’t suddenly disappear, according to Abubaker at Virginia Commonweath University.

‘We do a good job, but…’

‘Even in the long term, to be honest with you, the bone is not 100%, like, ‘Oh, that (fracture) never happened,’ ‘ Abubaker told USA TODAY Sports. ‘It takes a long, long time for that, that you could take an X-ray and say, ‘Oh my God, where is the broken bone? What happened?’

‘It takes months for the bone to be that solid, normally fused completely, and it doesn’t even show on the X-ray. Sometimes one of the screws come loose and we’re going to have to go and take it out. I mean, we do a good job, but unfortunately, not as perfect as the Lord put it together.’