Laughter,
Thank you for the kind words
I didn't mean to imply that you were being a chicken.... it's okay to be a chicken
My intention was for you to take a hold of the situation as I felt you were being jerked around a bit.
I am re posting the biopsy report and answering in bold type.
<<"Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious.">>
INTERPRETATION:
AN EXTENDED OR EXPANDED AREA OF THE LOWER JAW BONE AND TOOTH SOCKET IN THE 3RD MOLAR REGION. CONTAINING DEAD CELLS AND A HOLEY APPEARANCE WITH UNDEFINED MARGINS OF THE MEMBRANE COVERING THE BONE. IN OTHER WORDS YOU HAD A TOOTH OR TWO REMOVED, IT WAS A TRAUMATIC EXTRACTION MEANING FORCEFUL AND THE SOCKET WAS NOT DEBRIDED THOROUGHLY.
THIS BIOPSY CONFIRMS INFECTION AND INFLAMMATION REFERRED TO AS OSTEOMYELITIS AND MYOSITIS.
IT ALSO INDICATES THAT YOUR MASSETER MUSCLE, THIS MUSCLE IS USED TO OPEN AND CLOSE YOUR JAW, IS ALSO INFLAMED. THIS COULD BE FROM THE SURGERY, THE INFECTION AND/OR YOU ARE GRINDING YOUR TEETH.
<<It also said "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension.">>
INTERPRETATION:
YOU HAVE SWOLLEN LYMPH NODES SCATTERED ON BOTH SIDE OF YOUR NECK. LARGER ONES ON THE LEFT SIDE WITH 2 OF THEM BEING PREDOMINANTLY LARGER THAN THE OTHERS.
IN OTHER WORDS, YOU HAVE AN INFECTION AND YOUR LYMPHATIC SYSTEM IS TRYING TO DEAL WITH IT. THE INFECTION WAS LIKELY PRESENT LONGER THAN YOU MAY HAD REALIZED PRIOR TO HAVING THOSE TEETH REMOVED. SO THIS WILL TAKE TIME TO SUBSIDE COMPLETELY.
<<The biopsy results were also in and here is what it says:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.>>
EXACTLY, OSTEOMYELITIS MOST LIKELY DUE TO LONG TERM INFECTION AND INFERIOR DEBRIDEMENT OF THE BONY SOCKET WHEN THE TOOTH WAS REMOVED.
THIS IS WHY I CANNOT STRESS ENOUGH TO EVERYONE.... MAKE SURE YOU TELL YOUR ORAL SURGEON TO BE THOROUGH WITH THE DEBRIDEMENT!
<<Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.>>
INTERPRETATION:
LOWER MANDIBLE 2ND AND 3RD MOLAR REGION.
SEVERAL SPECIMENS OF VARIOUS TEXTURE, COLOR AND SIZE WITH SOME BONE ATTACHED TO THEM.
IN OTHER WORDS... DEEP BONE INFECTION WITH BUMPY GRANULATION TISSUE AND INFLAMMATION OUT THE YING YANG!
So you had a severe infection brewing in that area prior to the extractions and even after the extraction due to an incomplete debridement of the bone. The cause of the infection, the teeth, were removed but the site was not able to heal properly because the infected tissue had not been removed. Given the lapse of time before the site was finally debrided, the infection went deeper. Hopefully you are on the mend now. Another thing that disturbs me is that there was no bacterial culture taken according to this biopsy report. Which is just plain irresponsible because that would have determined the proper strain of antibiotic to use. Were there any other reports with this one?
<<Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.>>
FORGET SURGEON #1.... HE COULD HAVE DONE A BETTER JOB. BEING IN A HURRY WHEN PERFORMING ROUTINE ORAL SURGERY IS NOT ACCEPTABLE AS FAR AS I AM CONCERNED. THE HEADACHES, RANDOM ACHES AND PAINS COULD BE DUE TO THE INFLAMMATION FROM THE BONE AND MASSETER MUSCLE. ARE YOU GRINDING YOUR TEETH?? IF SO, I SUGGEST THAT YOU APPLY WARM MOIST HEAT ON THE LEFT SIDE OF YOUR FACE, HEAD AND NECK TO ENCOURAGE BLOOD FLOW AND REDUCE INFLAMMATION. ESPECIALLY BEFORE YOU GO TO SLEEP AT NIGHT.
THE LYMPH NODES CAN REMAIN TENDER FOR SEVERAL WEEKS. THE LYMPHATIC SYSTEM IS DOING ITS JOB OF RIDDING YOUR BODY OF THE TOXINS FROM THE INFECTION. HOWEVER, YOU NEED TO MONITOR THE SEVERITY OF THE TENDERNESS AS TO IF IT IS GETTING BETTER OR NOT. IT SHOULD GRADUALLY IMPROVE UNTIL COMPLETE DISSIPATION. IF IT SEEMS LIKE IT'S NOT IMPROVING OR IT'S GETTING WORSE THEN SEE YOUR ORAL SURGEON #2, NOT OS #1, AND POSSIBLY YOUR PHYSICIAN FOR A WBC AND SED RATE BLOOD TEST.
Hope this info helps. Please keep us posted...
Bryanna
Quote:
Originally Posted by Laughter222
Hello Bryanna,
I first have to say that I sincerely appreciate the expertise, time and energy that it took to post your reply to my original questions. It's a rarity to find someone like yourself who is so giving of their time and energy in order to make such a difference in other people's lives. Thank you for being Y-O-U.
A bit more detail is needed---Surgeon A did the original extractions. He was booked solid and in a super hurry; my procedure took a total of 15 minutes, which shocked my designated driver.
When I followed up with him a week later to check the surgery site and to look at what I knew was a dry socket, he said that he felt I had a blocked submandibular gland. He said for me to suck on tart candy and to massage the jaw/neck area in order to convince the gland to begin flowing once again. He also said that he "wanted to keep an eye on it" and that he was leaving for a month the next day. He said I would be fine in his partner Surgeon 2's hands.
I came back in pain and saw surgeon 2. He determined that I in no way had a blocked salivary gland; that he didn't see any evidence of why I was having such pain (the granulation wasn't visible) besides being related to the dry socket so he sent me for a CT scan.
By the next time I saw Surgeon 2, the granulated tissue was visibly running wild and he determined that I needed to return to have that debrided and biopsied. We were still waiting on the CT results.
After a week of waiting, I had the second surgery done by Surgeon 2. He said that I would owe $0.00 for this entire procedure and he'd only collect whatever my insurance was willing to pay.
I returned to Surgeon 2 for a check up about 10 days after the surgery and things had finally taken a turn for the better. A day or so prior to the appointment, I began feeling better than I had in what seemed like a long, long time. So, I let him know that I was actually beginning to feel like my old self and felt as if I was gradually on the mend. The CT results were in and they stated:
"Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious."
It also said "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension."
The biopsy results were also in and here is what it says:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.
Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.
Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.
Bryanna, you hit the nail on the head when you said that basically I was being a passive, wimpy chicken. lol Well, in all fairness, you did word things a bit differently. To be candid, I am petrified of dentistry in general, so when these issues began to rear their ugly head, I just did what I had to do and tried to go with the flow. My focus was to be done with everything….yesterday!
I did not have a copy of the X-ray that showed that little vertical image-----however, do you think that the description of the biopsy results reflect what was visible on my dentist's X-ray?
I'll wrap this up for now. Thank you again, Bryanna. I appreciate you!
~Laughter
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