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#148807 - 04/27/12 08:48 PM Fistula
AnitaFrances Offline
"Above & Beyond" Member (500+ posts)

Registered: 09/25/09
Posts: 695
Loc: Media, PA
Clark had surgery last Monday to locate and treat a recurring infectious process in his cheek, and to debulk his flap. What was thought to be a possible infection in his jaw turned out to be a fistula between the floor of his mouth and his cheek. The fistula also has a branch that extends to the top of his throat. After surgery, he had significant pain, swelling, and warm, hard, red skin. Drainage in the JP went from clear yellow to cloudy latte color. He could not swallow efficiently or talk at all.

Last night, he had a fever of 101.6. We controlled the fever and pain with Percoset and then saw the surgeon at 11 am. The PS removed the stitches, and the JP drain and left an opening of 1.5 inches to allow the wound to drain and heal on its own. Clark is on Cipro. The bottom line is this: this might work and it might not. Fistulas are difficult to manage and very challenging to close. It requires reaming the the inside tunnel to roughen it up, which the PS did, and then hopefully it closes. But fistulas are known to reform.

In the wake of post radiation, this infection is a lingering side effect. Clark now has Magic Mouthwash to help with the pain since the one opening is near his throat and feels like a large canker sore. Wow, we thought this would be the LAST surgical procedure. The goal was clearly to get to the root of the problem only now we realize that may not be possible. So, he has gauze packing the wound, and whatever happens next is a BIG HUGE GUESS.

No evidence of disease is a wonderful thing to hear. On the flip side, dealing with repeated infection and now more swallowing issues is disheartening to say the least. Clark was going to have a swallow study and get into dysphagia and speech therapy within the next couple of weeks. I still think he will pursue this though at a later date.

Has anyone else had persistent fistula(s)? How are you managing it/them? I am wondering if there is a person out there who specializes in fistula repair in the oral cavity. If you know of someone, please let me know.

Anita (62)
CG to husband, Clark, 73,
DX SCC 11/07, T4N0Mx, PEG 1/08, RAD, post rad infection 3/08,
HBOT 40 dives, ORN, Surg 11/09 mandibulectomy w/fibular graft.
Plastic Surg 4/10, 12/10, 3/11, 10/11, 4/12, 10/12. All PETS clear,
PEG out 1/11. 6/11 non union jaw fracture
Fractured jaw w/surgery 7/14

#148809 - 04/28/12 03:13 AM Re: Fistula [Re: AnitaFrances]
ChristineB Online   content
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Registered: 06/23/07
Posts: 9435
Loc: PA
Im so sorry to hear Clark's surgery didnt go as planned. Poor guy has been thru so much already. I hope the antibitoics help with the infection and that this will heal easily. I know nothing is easy after having rads.

I wish Pete D was here, I think he had been thru fistulas if I remember correctly. I had a tunnel that was about 3" long that refused to close. I ended up going to wound care specialists at the hospital where they worked on it for about 9 months. I had used a wound vacuum for about 2 months without success. It was awful hearing that machine run right next to my ear all day and all night. What finally worked was a picc line with IV antibiotics and HBO. My wound specialists and ENT would use the the medicated sticks to clean up and stimulate the wound(cant remember what they were but I hated them!). It took 8 months of this before the wound finally closed. This was in 2009 after the long hospital stay, it took me a full year to recover from everything.

I sure hope Clark does better than I did. I know he has excellent doctors. Good luck!!!!
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07, no caregiver
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 extended hospital stay, ICU & burn unit
PICC line w/ IV antibiotics 8 mo
10/4/10, 2/14/11 reconst surg
OC 3 times in 3 years
very happy to be alive smile

#148833 - 04/29/12 01:55 AM Re: Fistula [Re: ChristineB]
Cheryld Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Registered: 12/22/10
Posts: 5260
Loc: Toronto canada
I wish I could e o some hlp! Bu christin is awesome... I just wanted to say I hope he feels better an recovers quickly. Hugs!
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan


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