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Today I have my second surgery to remove the titanium mesh installed during the first surgery. The mesh was put in place to give the bone a space to grow into. It has since dehisced (uncovered itself) on both the buccal (cheek) and lingual (tongue) sides. The lingual dehiscence is the most pronounced. My body has regrown gum tissue on the underside of at least this part of the mesh. Here are photos before I go to get this removed today. The black stain on my teeth is due to the chlorhexidine gluconate mouth wash I’ve been using to keep things clean and sterile.


Pano

Panoramic radiograph of my jaw (from today), 6.5 months after surgery.

Update

Thank you everybody who left comments on my blog. I had my wires cut yesterday and am now on 2-3 weeks of rubber banding. I can open my mouth a whole 7mm today! Yay! When I open my mouth, it actually feels like I’m opening it all the way … but only 7mm. Just enough to shove a butter knife with refried beans in, with the help of a teaspoon, which I used to push the beans in while pulling the knife out. Then wipe off the excess. Incredibly graceful :) And time consuming.

I have a little more energy than I’ve had the last 2 weeks or so … which I guess is good, since I’m going back to work tomorrow. The swelling has gone down quite a bit … it was scary and a bit unnerving for awhile, especially when it was around my clavicle and around my adam’s apple (there was no swelling in between). That lasted for 2-3 days and then it started going down. Now, it isn’t all that bad.

My submandibular muscle under my chin feels like a rock and the swelling extends up the left side of the jaw (and stops where the maxilla begins), around the occlusal plane. My left cheek is hypersensitive, which makes shaving interesting – it feels like the razor is actually tearing the hairs out one by one. Even with a brand new razor.

My surgeon says that the inside wound is healing up well, the color is good and I need to stay on soft foods for awhile till the underside of the wound finishes healing. He actually said that attempting to eat solid foods could cause it to tear open and that would be the “kiss of death” to my graft.

The external incision is pretty much healed up and the scab having fallen off, with the last stitch being removed yesterday (the rest of the wound was superglued together and that became “rubbery” and eventually fell off with the scab).

I was fairly consistent about keeping my mouth clean (all things considered). Brush then rinse with peridex. I used a Crest rotating spin-brush (about $6 USD) and Colgate toothpaste with triclosan. I’d start at the midline, brush upper and lower all the way over too the right and just the upper on the left (I didn’t want to interfere with the wound). Brushing would push toothpaste through my teeth and then I’d take my tongue and rub it around on the inside of my teeth. Despite this, when unwired yesterday, I still have pieces of “unrecognized biomass” in my mouth. Yuck.

I have daily pictures and notes, which I’ll transcribe back-post later on.

I also have intra-operative surgical photos, if anybody’s interested over on Flickr. I attempted to post here, but Photobucket decided to randomly censor them … uggh. Warning, they contain everything you’d expect in a surgery … blood, muscle tissue, bone, etc. These are available here:

http://www.flickr.com/photos/atxameloguy/sets/72157617479878682

Photos from surgery

WARNING: This particular post contains surgical photos, depicting blood, body tissues, bone, etc. If you are squeamish, don’t view this full article.

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Day 4 After Surgery

Photos from day 4 after surgery. The swelling is quite “remarkable”. There is also “poofyness” around my collar bone. Apparently this is a well-known effect of the INFUSE and the swelling takes about a week to go away.

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Day 2 After Surgery

This is the second day post surgery. The swelling isn’t too bad, but they’ve been giving me 2 steroids via IV.






After Surgery

Today I woke up after surgery. I spent most of yesterday asleep, drifting in and out of sleep. They’re been controlling the pain fairly well, although there is swelling. I have a scopolamine patch behind my right eye, cephalosporins on IV, dilaudid on IV as a PCA (with 10 minute self-administration interval), pepsid injection and some other anti-nausea drug. And some vicodine which I took in liquid form with breakfast.

This what I looked like when I woke up this morning around 730A.

This is the 60 mL syringe with flexible tubing that I’m using to feed myself.

This is me trying to hold my lips open so you can see my teeth. My lips are hard to control and the lower left lip and part of my chin are numb, because the inferior alveolar nerve (IAN) had to be removed to remove the ameloblastoma. It was pulled out using the “pull out” approach described by Dr. Marx in his book (see the earlier post that I’m holding the book up in).

I can feel a little bit of pressure in that part of my lip. Each side of the jaw has its own IAN, and they go through the bone and come out of the bones around the canine. There is a bit of cross over on each side, so the left innervates part of the right side and vice versa. Maybe that’s how I feel pressume? Another odd thing though is that earlier today the left lower lip and chin just below it was itching, but scratching did no good! A phantom itch? Weird.

I went back to sleep after this and work up around 1015A. This is what I had for my breakfast around 1030A this morning. I had a smooth (banana and strawberry I think), chicken broth and a glass of apple juice. All given to myself with the syringe with tubing, put to the back of the right side of my mouth (opposite). I tried to put my tongue over the left side as to not contaminate it. I rinse with peridex (chlorhexidine) after eating anyways.

And this is my IV in my left arm. It hurt going in first yesterday and there was some pinkness around the entry point, but is doesn’t bother me now.

And this is what the incision looks like with the gauss off. Doesn’t hurt just poofy.



This afternoon, I had a little blood spillage as well. This kinda freaked me out, but the nurse told me it wasn’t anything to worry about.

The braces I had on were wired shut. The front 4 teeth by default don’t have tabs. The ortho put K-hooks on the canines. Then the hooks and tab on the brackets were used to wire my jaw shut.

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