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Thursday, May 23, 2013
Face and Jaw Surgery
Cancer survivor and radiation issues
I had cancer of the parotid (left side) which went undetected for 6 years. Misdiagnosed w/Bells ... long story. The cancer burst through the tumor, advanced into facial nerves and mastoid. Had BIG radiation on left side, many corrective surgeries, still looks impaired to an extent. Recent years have had tooth loss and bone "compromise in left mandible. Sent to hyper baric - one month, teeth extracted, began to rebuild with bridges. Lots of stress causing me to clench and grind, sleep apnea, etc. Always have chewed gum to keep moisture in mouth - double edged sword - I know. I teach so talking is a function of my workday as well. Now I am having severe pain with chewing. And if it is quiet enough the screaming I can hear in my ear can be heard by everyone else at the table. The pain is tremendous. Dentist did panorex and very clearly the jaw on the left looks a mess compared to the healthy right side. Where to go from here? Back to hyper baric and then surgery to rebuild the jaw? Would wiring the jaw be reasonable prior to returning to hyper baric? Would wiring be helpful in realigning? Do I plunge right into jaw replacement or could wiring be a "worth a try" type procedure? I am plump - so weight loss would not be a huge risk - actually it could be quite pleasent since I am 50 and those extra pounds are tough to lose. Your thoughts are very important to me as I don`t like to go into my docs without some knowledge of what the possibilities may be. I have many trust issues since the original TWO docs that took my cancer for Bells and me being a hypochondriac.
Is your concern the jaw pain, ill-fitting dentures, inability to chew due to pain, loss of bone, or malalignment of jaws? Also, when and what kind of surgery did you have? When did you have the radiation treatment? I will not be able to give you any treatment advice without answers to the above questions and without a clinical examination.
However, wiring of the jaws has no value and will not help with any of the above mentioned problems in your case. Rather it will be counter-productive if wired long-term as the scarring from radiation might make the opening of your mouth more difficult.
It is not surprising that the jaw bone on the left is different than the right side. This could be due to surgical removal of bone along with the cancer, scarring of the tissues due to radiation, and secondary changes could have also contributed to it.
If you are uncomfortable with your surgeon, you need to see others for a second opinion so you can make an appropriate choice. I suggest you need to develop confidence in your surgeon or see another with whom you are comfortable.
Likith V Reddy, MD, DDS, FACS
College of Medicine
University of Cincinnati