Muhammed Khalid, left, with Dr Renju Prem who treated him. Image Credit: Supplied

Dubai: The next time you feel exhausted, watch out.

A Dubai-based Pakistani expat, who went to sleep and woke up at night to go the washroom, suffered a grievous fall, went speechless for a while and ended up with multiple fractures in his face.

Speaking to Gulf News, Muhammed Khalid, the expat, said he had to be rushed to Emergency after he fell, not once, but twice. And strange as it may seem, the root cause of the fall was found to be fatigue.

Dr. Renju Prem, Specialist Oral & Maxillofacial Surgeon, Aster Hospital Mankhool, who worked on mending Khalid’s fractures, confirmed the diagnosis.

“Khalid had to go through a challenging medical journey following the bathroom fall due to fatigue. Upon his initial arrival at our hospital, he presented with speechlessness, extensive swelling and an inability to open his mouth because he had suffered multiple jaw fractures. To navigate this intricate situation while preserving both facial nerves, our surgical team opted for what we call open reduction and internal fixation surgery.”

Anesthesia-related risks

He said the nature of Khalid’s condition involved anesthesia-related risks because his jaw was broken on either side along the rounded projections on the jaw bone (bilateral temporomandibular joint (TMJ) fracture).

Dr Abhishek J Narayan, Specialist Anaesthesia, said, “He also suffered a mandibular symphysis fracture leading to a reduction in the opening of his mouth. As he explained, the mandible is the largest and strongest bone in the face and forms the lower jaw. It acts as a receptacle for the lower teeth.

Dr Abhishek J Narayan

A fracture here meant the use of an alternative procedure called submental intubation to administer anesthesia and ensure airway safety during the procedure, Dr Narayan added.

Broken tooth in hand

Khalid said he had no clue what happened to him after the second fall until he was in the ambulance. “I was unconscious when I fell and my wife had called the ambulance. Apparently, I had one broken tooth in the mouth, and another in my hand. It was only on the way to the hospital that I regained consciousness but could not speak as I could not open my mouth.”

The doctors said during the surgical procedure, the facial nerve on both sides of the face had to be carefully preserved. “This adds a significant level of complexity to the surgery owing to the degree of facial nerve weakness which can be temporary or prolonged in such cases,” said Dr Prem.

According to him, timely intervention is the key in such cases.

“If the patient had come to us later than he did, we may not have been able to do much,” he added.

The doctors said the way the surgery was undertaken was not very common for cases like these. They used a special approach that involves working near the facial nerves on both sides of the face, which could be tricky.

“Sometimes, patients can have temporary or lasting weakness in their facial nerves after this kind of surgery but in this case, the patient did well,” said Dr Prem.

What is fatigue?

The doctors said Khalid’s fall demonstrated how fatigue should not be taken lightly.

He said fatigue, which is extreme and prolonged tiredness, can have many causes and repercussions too, all of which must be thoroughly investigated.

“Luckily for Khalid, all his vital parameters were fine, including his blood pressure and blood sugar. Due examination was conducted and a scan of his brain also done to rule out any concerns,” said Dr Prem.

However, unaddressed fatigue, which could be physical, mental or both, can manifest itself in the unlikeliest ways and as such must be caught early and duly dealt with by enlisting professional help if necessary.

It is also good practice to leave a bed lamp on during night time.

Signs of fatigue

Constantly feeling tired


Feeling stressed

Lack of energy and motivation

Lack of focus

Difficulty in sleeping

Fainting, loss of consciousness