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Old 08-28-2015, 12:02 PM #41
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Bryanna Bryanna is offline
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ELna,

Please don't lose hope. The oral surgeon did the Wassmund-Rehrmann-lobe procedure because he could not leave the fistula into the sinus wide open. The reason to close it is because bacteria can get up inside and travel to you brain. So there has to be some attempt made to close it. This procedure is very difficult and tedious with no guarantees it's going to be completely successful. There is also no way to know how well the tissue will heal at the surgical site, especially if there is something else brewing in that area. If the fistula remains open, it may be related to bacteria stemming from an adjacent tooth which could prevent the hole from healing closed.

You may have told me.... but has anyone explained to you why there was a severe sinus communication in the first place?

Bryanna



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Originally Posted by ELna View Post
Update on my situation. Thank you for all the help again Bryanna. I'll update once in a while.

Last month: tried to heal, lost another 8 kg. Canker sores that I never had before appeared, healed, etc.

Went back to the hospital today. She said there's no way of knowing for sure whether the perforation is closed or not but as my nose still gets wet after I drink there must be still a communication. The site looks better but still red. I asked to wait another two months maybe it closes on its own she said ok. I didn't tell her that noone will operate on the fistula, I'll rather live with it from now on.

Do you remember how I was freaking out that something wrong was going on with the gum? Well, she said there's nothing that could be done to expand the oral cavity on the right side - now my inner cheek starts from right above my teeth 14-17, leaving me with a feeling of pulling on the right eye, pain when talking, ruined smile, a deep crease above the upper lip and not proper circulation in between the upper lip and the nose that leaves the area white and horselike. My speech is impaired, I thought it would get better but it doesn't and the stretching pulling either. She said the area can not stretch upwards so this is how it will be. And how I will be. I'm 38, lost my looks forever and cant talk normally - the sound of it is annoying, even hurts my own ears. She booked a consultation with another surgeon to see if it's worth at all to smoothen the surface with laser above tooth 14 - but she thinks not. On the left side the bone broke and the sharp bone piece sticking into my cheek will need to be done if does not settle - but that's nothing, I know.
ah yes and if as she thinks they'll have to close the fistula, the mouth cavity would get even smaller so I just won't have it done.

Also, there is no chance for implants on that side (that might be corrected, not easily though, if i wanted implants but I dont and wont).
It is absolutely sure that I'll never be able to wear dentures.
So let's just hope that I'll die before that - ergo pretty soon

Now I understand why the super(expensive) surgeon acted the way he did, pretending it didn't matter but in the review he wrote he hopes it will become 'acceptable' - he knew I was done just didn't want to say it. Whatever.

Today the surgeon said that I could eat on both sides so I came home and had some soft bread soaked in yoghurt, goat cheese and just a bit of smoked salmon, finally. Washed my teeth, checked with a photo and the site is more damaged than before - the gum broke open a bit along the next tooth. I think it is from the pulling as I moved my mouth. So back to liquids and baby food (1st phase) for a while longer I guess.

I've booked an appointment with the dentist Bryanna you helped me choose and will sort out my bite and try if I can have a partial denture on the left side.

Right now I feel like I don't want to live any longer, with RHS PHN and now this, I'm blaming myself for not saying no to the second surgery and that's the worst. But tomorrow I'll pull myself together and start to learn to live with this too, it could be so much worst it's not a brain tumour or anything like that after all. I can live decades, a long, uncomfortable, shitty life filled with pain and loneliness, since noone will want to be in the company of someone who looks bad, sounds bad and feels bad all the time. Yeeeeeah. Only joking. I'll learn just not starting today.
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Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-28-2015, 01:00 PM #42
ELna ELna is offline
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Oh no I think he could have and should have left it alone there and then since there's been a closing attempt just 2 days prior to that and the area was too damaged for anything further to do any good. Plus, he made me have the operation by scaring me how it would NEVER heal on its own and how I would need a major sinus surgery if it was left open.
Not true. The perforation was larger than ever before 5x5 mm 2 weekys post-surgery then after it recovered from whatever damage he did it it started to heal on its own and is almost fully closed - no air movement only some water still gets to wet my nose. But it DID heal on its own as it might have in the first place if it was left alone.
Plus, he said I might not be able to get an implant in the area but the the fact that I'll be ruined or that I'll be unable to have a denture ever was never mentioned because I think he didn't know what he was doing. No, there did not have to be am attempt to close it there and then and this way. If the procedure is knowingly so difficult with no guarantees should not I had been given a CHOICE? He acted like it was nothing.
There was nothing else brewing in the area only what he put there. The fistula is closing on its own now after the site recovered from the totally useless but absolutely destroying procedure he decided to force on me without my knowledge.

There wasn't a severe communication, it was a perforation that happens, left alone, I would be over the whole thing.
The fact that it might have been his first W-R lobe might have not helped as I found out along with how quickly he left his practice AND the country for good 2 weeks after the operation.

So yes, maybe it's all my fault and my body's fault but I surely would have said no if I knew the risks and the certainties. I'm not worried about the communication because I trust it will fully heal on its own now, I'm worried about the damage done.
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Old 08-28-2015, 02:05 PM #43
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ELna,

That procedure is done in extreme cases where there is a large opening from the jaw bone into the sinus. It is not done on small perforations. I think the first attempt at closing the opening was ineffective for whatever reason, possibly poor technique or inexperience or the dentist did not realize the actual severity of the opening. Also, some ora-antral fistulas do not actually form completely until a few days post op. Which could also be a factor in your case. These communications between the mouth and the sinus can be very complicated and difficult to treat especially if there is other pathology going on in or near that area.

From the way you have described this, I feel it would have been unethical for him not to attempt to close the opening. But I was not there and did not see the actual OAC or OAF. I do think he should have explained the situation to you much better prior to doing the surgery and in that explanation told you why this opening occurred in the first place. I think part of your frustration is over the way you were treated at the beginning by not just him but the other dentist as well. Which is totally understandable.

Here is a link that describes the procedure. It's a bit technical but you may get something worthwhile out of it.
http://www.medfak.ni.ac.rs/ASN/BROJ-...ull%20text.htm

When you say it has healed on it's own. Are you referring to the hole in the gum tissue and/or the hole in the bone into the sinus?

Bryanna






Quote:
Originally Posted by ELna View Post
Oh no I think he could have and should have left it alone there and then since there's been a closing attempt just 2 days prior to that and the area was too damaged for anything further to do any good. Plus, he made me have the operation by scaring me how it would NEVER heal on its own and how I would need a major sinus surgery if it was left open.
Not true. The perforation was larger than ever before 5x5 mm 2 weekys post-surgery then after it recovered from whatever damage he did it it started to heal on its own and is almost fully closed - no air movement only some water still gets to wet my nose. But it DID heal on its own as it might have in the first place if it was left alone.
Plus, he said I might not be able to get an implant in the area but the the fact that I'll be ruined or that I'll be unable to have a denture ever was never mentioned because I think he didn't know what he was doing. No, there did not have to be am attempt to close it there and then and this way. If the procedure is knowingly so difficult with no guarantees should not I had been given a CHOICE? He acted like it was nothing.
There was nothing else brewing in the area only what he put there. The fistula is closing on its own now after the site recovered from the totally useless but absolutely destroying procedure he decided to force on me without my knowledge.

There wasn't a severe communication, it was a perforation that happens, left alone, I would be over the whole thing.
The fact that it might have been his first W-R lobe might have not helped as I found out along with how quickly he left his practice AND the country for good 2 weeks after the operation.

So yes, maybe it's all my fault and my body's fault but I surely would have said no if I knew the risks and the certainties. I'm not worried about the communication because I trust it will fully heal on its own now, I'm worried about the damage done.
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Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-28-2015, 05:40 PM #44
ELna ELna is offline
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Exactly. There wasn't an extreme case. There was an overly eager surgeon who actually said before the operation hmmm where should I take the gum from and he chose the procedure because he remembered he could take gum from there not because of the hole itself. According to him the only reason the first operation wasn't successful might be because of a piece of sharp bone around the area where the gum tissue used during the first surgery might have broke so he took care of that. He had no idea of the consequences he would be causing. There is a reason he left. It wasn't an extreme hole or anything else going on he clearly chose an unnecessary procedure. Thank you for clearing that up for me. I also wish everyone was like you but they are not Bryanna. There might not be a good, noble reason behind his actions. He simply might not be good. Thank you again, for everything.
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Old 08-28-2015, 05:58 PM #45
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ELna,

I am not defending his technique as I was not there to see the surgery. I've never witnessed this closure technique unless the situation warranted it. I have seen, too many times, botched up closures :/ Even simple ones. So I unfortunately know that does happen :/

Here is another link that explains the buccal fat pad that is used for the closure. It also gives photos... warning, they are explicit.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510921/

Bryanna





Quote:
Originally Posted by ELna View Post
Exactly. There wasn't an extreme case. There was an overly eager surgeon who actually said before the operation hmmm where should I take the gum from and he chose the procedure because he remembered he could take gum from there not because of the hole itself. According to him the only reason the first operation wasn't successful might be because of a piece of sharp bone around the area where the gum tissue used during the first surgery might have broke so he took care of that. He had no idea of the consequences he would be causing. There is a reason he left. It wasn't an extreme hole or anything else going on he clearly chose an unnecessary procedure. Thank you for clearing that up for me. I also wish everyone was like you but they are not Bryanna. There might not be a good, noble reason behind his actions. He simply might not be good. Thank you again, for everything.
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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