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#194749 06-28-2017 06:53 AM
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Johnnie Offline OP
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Connie, you posted that your husband used cold laser successfully. Are you able to share the laser system you used? I have a wisdom tooth problem that has caused swelling and pain in my lower jaw. I am currently on antibiotics and seem to be responding. The oral surgeon wants to remove my tooth and possibly some bone. He did no tests. I am 80 years old and on a peg tube. My epiglottis was almost entirely destroyed by radiation in 2002 and I aspirate when swallowing. I had a radical neck on the left side. I do not want to do any more surgery.

I have several questions if anyone can answer them. I live in Florida.

Is Hyperbaric without surgery beneficial?

Who can give me an accurate diagnosis of whether I actually have osteoradionecrosis? I have have had CT's and blood tests which show no appreciable white blood count increase. The dentist thought the pain was just the impacted wisdom tooth pushing on the erupted molar but that was before my lower face swelled up and I could not open my mouth.

Can anyone suggest a laser system?

Did your husband, Connie go to UF Shands and if so were you satisfied?


Last edited by ChristineB; 06-28-2017 11:09 AM. Reason: moved to its own thread

Johnnie
Stage 4 cancer survivor 2002
RND
IMRT
Chemo
Joined: Jun 2007
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Johnnie, Ive sent you a PM explaining your post was moved to its own thread. I thought it would be best since this is about you and your situation that it deserved to have replies just for you and not for the original post. I did send it to the other member as well so she will hopefully see it soon. But, I do have to warn you she has not been here for months and the original thread you posted on was a year old.

Im not sure what the blood tests white counts have to do with osteoradionecrosis. ORN is part of the jawbone is dying and needs to be removed. If its not taken out the bone continues to get worse and will spread. Ive had this and mine was surgically removed in my oral surgeons office. I did 20 HBO prior to and 10 after the procedure. It took only about a minute for my oral surgeon to remove the small piece and put a couple stitches in it.

If your dentist is not a specialist who treats oral cancer patients I would be very careful allowing them to do anything. HBO (hyperbaric oxygen treatments) have been very helpful to me several times in helping me to heal areas that had bee radiated. Alone HBO might not be able to take care of the ORN. I suggest trying to contact the dental dept at Moffitt. They should have a dental oncologist or prostheodontist there who would be able to help you.

Good luck!!!


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
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I was dealing with impacted wisdom tooth, infections, teeth problems, extractions, ORN, and jaw replacement for about 6 years, and some of your ailments, and questions sound familiar.

I was on and off, and then on long term antibiotics, Augmentin, 800mg, 2x a day, and when I stopped sometimes the abscess returned, and then was on long term antibiotics once I had ORN after my teeth extractions in the 3rd molar. which is often associated with osteomyltitis too. I also used chlorhexidine rinse after each meal, and had weekly debridements at the dental oncologist's office.

For my tooth extractions, I had 20 HBOT before, and 10 after, following the Marx Protocol, to help in healing and help prevent ORN, which occurred anyway. Infection is not ORN. ORN is exposed bone, after radiation, for a period of three months, and there are different grades, l-lll with the Marx Protocol. Early ORN, stage l, can be treated conservatively, but late stage can only be treated surgically.

As far as tests, I've had a Panaramic dental scan, a dentascan, which is a dental CT, a regular CT with no contrast due to kidney issues, and a normally scheduled PET scan, which helped in diagnosing infection, ORN. A blood test could show an infection, but I think sometimes it doesn't, but it's good to have, and neither does a fever have to be present just going by past experience. You have to be careful with infections as they can go systemic, especially in the gums/teeth.

Yes, HBOT can be beneficial without surgery as I mentioned, and it's often used to treat early ORN conservatively with antibiotics, maybe with pentafoxiline and vitamin E to increase blood flow.

Only a doctor can give you an accurate diagnosis of ORN, which is exposed jaw bone for 3 months or longer after you had radiation. It's not an infection, but that may accompany it. ORN is radiation plus an injury like from an extraction, dentures, surgery.

I'm not familiar with or had cold laser therapy, but heard of it.

I hope this helps.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Johnnie Offline OP
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Thank you Paul. I think I learned more from your post than I have from the various doctors in three weeks. I am printing your response to read again.




Johnnie
Stage 4 cancer survivor 2002
RND
IMRT
Chemo
Joined: Jul 2012
Posts: 3,267
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I'm glad it helped! If you have any questions, just ask. Sometimes things I forget come to mind later on or I may forgot to include.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Posts: 18
Johnnie Offline OP
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Again-thanks and I will


Johnnie
Stage 4 cancer survivor 2002
RND
IMRT
Chemo
Joined: Oct 2005
Posts: 126
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Johnnie,

My wife had same type of swelling on the right side of the face on several occassions starting in 2010 or about 5 years after the end of the treatments. She had multiple MRI which were inconclusive. She saw an infectious disease specialist who pescribed 20 HBO treatment and port to connect a pump for antibiotices. She had the port and the pump for three months. After the HBO treatments and the 3 month long of antibiotics the swelling stopped but she still had pain on the right side. We went to go see and a maxillofacial dentist who did a Panorex which clearly showed a fracture on the lower jaw on the right side due to ORN. The right side frcature was stable though with no pain. In late 2015 she started havng pain on the left side of the lower jaw. Again we saw our ent and other surgeon and she had multiple MRI which were inconclusive. In October 2016, we went to go see the same maxillofacial dentist. He did another Panorex which showed another fracture of the left lower jaw. She was in pain constantly due to the left fracture. After seeing three surgenons/ENts at the USC Norris Cancer Center and also gettting a second opinion at the Stanford Medical Ceter we reluctantly decided in the full replacement of the lower mantible by a fibula free flap from the left leg. The fibula was removed along with tissue and blood vessel. The lower jaw was fully removed and then reconstructed using the transplant from the leg. The bllod vessel from the leg was sutered to the blodd vessel in the head to re-establish blood floow to the lower transplated jaw bone. The surgery was 10 hours long. Post surgery, because the tongue had to be released and the flap is really bulk, the tongue was pushed to the back of the throat and she could not longer eat or speak clearly. She has been on a J-tube since. The surgery is radical and witl post morbididty. At the Stanford Medica Center we were given the otion to reconstrcut the left lower jaw using a flap from the right and to place a titanium plate over the right jaw fracture. This was they would be able to save the chin and also the surgeon would not need to release the tongue. Our three surgeons/ENT at USC Norris whom we had seen and known for 10 years were advocating the fibula free flap from the leg. We went with the fibula free flap but revovery time was about a year and left the wife with the inability to eat or speak clearly.


CG to wife;
Jan 2005 DX SCC Tongue T2N1MO; RND surgery Mar 2005; 35 XRT and 4 cisplatin completed Jul 2005.
Dec 2006 tongue surgery, Scar tissue no cancer.
Feb 2010 neck node FNA - negative.
2010 ORN right jaw plus fracture
2015 ORN left jaw plus fracture
Feb 2016 Lower jaw reconstruction by Fibula free flap+titanium plate - Permanent G-tube
June 2016 Difficulty breathing - Permanent Trachea tube
Dec 2019 DX Cervical cancer - Stage 1 - Surgery Jan 16 2020.
15-20 esophagus/larynx dilations

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Johnnie Offline OP
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Your wife has really had a impossible ordeal. I am 80 and not in otherwise good health. In retrospect would your wife still opt for the surgery?


Johnnie
Stage 4 cancer survivor 2002
RND
IMRT
Chemo
Joined: Oct 2003
Posts: 89
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Hi Johnnie, Sorry to hear of your troubles.
I'm a long term survivor and don't visit OCF very often and have not posted in years (that's good news!)

I had successful rounds of HBO to treat recurring infections in mandible.
Initially (2004) the HBO was to prep for surgery and my doctor was not sure HBO would help, but decided to do it as a precaution/prep measure before surgery (proposed bone graft to mandible).
To the doctor's surprise the HBO worked so well that it completely eliminated the need for surgery!!!
About a year and a half after that I did another round of HBO.

So, I'm a case where HBO was successful without surgery.

I think for you it may depend on what the problem with the molar/wisdom tooth is. I am not a doctor or medical professional so this is just my impression & understanding, but if the issue is infection & healing then HBO is more likely an option, but if the problem is the physical impact of teeth & bone then HBO may not address the issue.



History of leukoplakia <2001-2004. SCC lateral tongue 9/03; left radical neck dissection & hemiglosectomy 10/03, T2-3,N0M0; 28 IMRT radiation completed 12/03. 30 HBO dives Oct-Nov 04 for infections and bone necrosis -mandible.
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Johnnie Offline OP
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Michelle,

Thank you so much for the post. It is a very uplifting one. I am scheduled for U of F next Friday for an evaluation and I am hoping they will agree to hyperbaric. I really feel I am too old to go through the surgery and would be happy to have a couple of pain free years. I will post again and let everyone know how I do with the hyperbaric.

Thank you again for posting.





Johnnie
Stage 4 cancer survivor 2002
RND
IMRT
Chemo
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