Hello,
9 weeks ago my daughter had 4 impacted wisdom teeth removed. It was a difficult extraction followed by dry socket.

just when we thought we were on the road to recovery she woke up with pain in her jaw/cheek and a swollen cheek (about 5 plus weeks ago).

She received three courses of antibiotics which seemed to help or cure the infection but the swelling was not a all reduced.

The oral surgeon offered two-or one confusing-explanation of the swelling. First he said it was due to the infection filling up the area that would normally provide a drainage route (for what?) , so instead, whatever should be draining was draining into her cheek and causing the swelling. then he also said that she had a hematoma/blood clot in her cheek and that was causing the swelling (sounds like two different explanations but maybe I am confused-I sought clarity but really did not get any).

Anyhow, today he opened up the gum tissue to get rid of any infection and check for bone fragments-he did not find any signs of infection or bone fragments or anything but still told me he thought it would 'cure ' the swelling.

Of course she is so swollen form this second procedure I can't tell any thing-and he said she would stay swollen for the next 5 days.

Help-what caused the swelling in the first place-why was it not showing any signs of subsiding even after 5 weeks and no real infection left-was it a blood clot or hematoma-is it gone? What are you supposed to do to treat a clot/hematoma-ws it scar tissue-is she going to be always swollen?

Just talked to dentist again and he was clear that there were no bone fragments and no infection. he did say there was some dead tissue and that he really cleaned out the area nicely. he clearly does not know why she had the swelling and hopes that it was due to a blood clot which he 'cleaned out' and hopes that it will go away. Any suggestions on what to do if its still there in a week?

Hi Lolla,

The continued swelling prior to this debridement could have occurred from necrotic tissue that had not been removed during the extraction. Having this second surgery would of course cause additional swelling at this point.

If it were a hematoma, it would have seen that upon clinical examination and if not then when he opened up the site.

Starting 24 hrs after this surgery she should rinse with warm salt water several times a day for at least 2 weeks. No mouthwash what so ever as it will only irritate the surgical wound and slow down the healing. Soft food nutritional diet for 2 weeks or until the site closes over. Warm moist compresses to that area of her face will bring blood flow into the area and that can reduce the swelling. They should be done in the am and just before bed time. Also sleeping with the head elevated will also help keep the swelling from migrating further into the face and cheek area.

It sounds like she had residual tissue that needed to be removed.... and if that is the case, then it should heal now that that has been removed. Some people stay swollen for several weeks after wisdom teeth removal and not necessarily in all four quadrants.

Hope this info helps..
Bryanna









QUOTE=Lolla C;1002276]Just talked to dentist again and he was clear that there were no bone fragments and no infection. he did say there was some dead tissue and that he really cleaned out the area nicely. he clearly does not know why she had the swelling and hopes that it was due to a blood clot which he 'cleaned out' and hopes that it will go away. Any suggestions on what to do if its still there in a week?[/QUOTE]

Hi Bryanna,

thank you for the reassurance. We are hoping (somewhat desparetly) that this is/was the case and that the swelling will be gone after she 'settles' from this procedure. We are doing the warm rinses and moist heat-she goes back to college August 17 and does not want to go with a swollen face! Hopefully 4 weeks will do it.

Two quick questions 1) Would it be at all helpful if she gently massages it when it is comfortable to do so, and 2) if the swelling is still present after say three more weeks would ultrasound possibly help?

Lolla

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Hi Lolla,

Yea, it is ideal for this to be a whole lot better before she goes back to college.

In about a week, she can start to gently massage the outside of her cheek/jaw. Gently and not for long periods of time. This will keep the blood flowing there which is what you want.

An ultrasound will probably not show much of anything. She can have a dental periapical xray (one small film) done just before she leaves for college to see what the bone looks like. It will still be far from healed as that will take at least a year. But it may show if there is any residual infection or concern.

I'm sure she is not a happy camper and feels like.... why did I have to do this!!!! Oye :/

Let me know if you have any further questions.

Bryanna


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ok-I will encourage her to star massage in a few more days.

my final question-could the swelling be due to a broken jaw and could the oral surgeon have completely missed that possibility-he did not mention it as a possibility and has not taken any exrays since the original surgery-should I request X-rays when we next go in-and what is the treatment-will she have to have her jaw wired shut? How I wish we had never had this surgery!

Lolla.

What makes you think she could have a broken jaw?

Regarding a broken jaw...... depending on where and how large the break or fracture is or if the bone is displaced or not.... determines the course of treatment. For example.... you can have a fractured jaw bone where the bone has not displaced (become misaligned) and there would most likely be minimal swelling, minimal pain and no invasive treatment would be warranted so long as the person followed a restricted diet and chewing protocol for several weeks. The bone would actually fuse back together fairly quickly.

So why the concern about this?

Bryanna

Just because the doctor has not offered any explanation for her face being significantly swollen at the jaw/lower cheek area on one side 10 weeks post extraction-and he said the extraction was difficult

just trying to deal with the noticeable swollen area