Dentist & Plastic Surgeon

Tuesday, January 19, 2010

Dr. Jack Martin, Dental Oncology
I met with Dr. Martin. He just did a quick oral exam and cleared me for surgery. I'm going to see Dr. Chambers before I start radiation to get more information on the effects to my teeth & mouth. Dr. Martin did say that before radiation I would need to start using fluoride...forever. He said there was a chance that my dental implant would "scatter" the radiation which could cause sores inside my mouth. He also told me that if I ever need to have dental surgery or extractions, that I should go back to MDA to get it done. Ever.

Dr. Roman Skoracki, Reconstructive Surgery
We started out by discussing what happens if I have to have a nerve graft. (I made him repeat several times that we are hoping this is NOT necessary, but I have to be prepared just in case.) First, if they cut the nerve, they will use a nerve from my thigh to re-connect the nerve. This is not like splicing wires, more like a conduit so that they two ends can eventually grow together. This would take at least 6 months. In the meantime, with no nerve function, everthing starts to sag. In order to keep my lower eyelid from sagging, they would perform a tarsorrhaphy and canthopexy (look it up). I would also have a gold weight placed in my eyelid to help with blinking. My eyelid would not stay closed when sleeping so I'd have to tape it closed. Then to keep my mouth from sagging, a fascial static sling -- that's where they pull fascia from my thigh and use it to pull up the corner of my mouth. (It sounds positively lovely... too bad I can't describe it better. Again, google it.)
Let's move on to the free tissue transfer. We're pretty sure this will have to be done. Some skin will probably need to be removed because the tumors are so close that they can't be separated. That skin needs to be replaced so again, back to my thigh. They'll pull skin and tissue from my thigh to fill in the new hole on the side of my face. The tissue has to be "connected" to my face by attaching the blood vessels. Apparently, there's a risk of blood clots which could be really ugly. If that was going to happen, it would happen in the first 5 days so I'll be staying put for at least that long. (By the way, that's called an anterolateral thigh flap (ALT).) Ideally, they will be able to close up my thigh without a problem, but if there's not enough skin to close up, they do a skin graft from either my other thigh or forearm. With all this digging around in my thigh, there will be a scar from almost hip to knee.
Back to surgery time - Last I heard, each of the ear doctors will take about 3 hours. Plastics will take 5-8 hours if just skin flap, 8-10 if nerve graft too. 3+3+6=12 hours! The plastic surgeon said he come by before surgery to make sure everything he needs is good to go. Then the other surgeons will keep in contact with him throughout the day and let him know when to come in and get started on his part. There's supposed to be a surgery liasion that comes out every 2 hours to let my family know how I'm doing.
This surgery is obviously a bit more involved than the previous two. Sounds like the thigh part is going to slow me down the most. I was told to expect to be down for at least 3-4 weeks. Of course, once I recover from that, radiation therapy starts. Still not sure exactly what to expect with that.
I'm asking that everyone pray for my daughter. She's having surgery the week before me and she has to be 100% before I go under!!!

Dentist appt

I called my local dentist this week to ask about getting a night guard. Apparently I'm a long-time teeth grinder. I got a night guard several years ago, but it broke about two years ago. Because it was no longer covered on my insurance, I never had it replaced. Well, now I thought it might be worth looking into since I'm hearing that radiation will make my teeth more brittle. My dentist agreed that grinding my teeth would probably do even more damage after radiation. So, I went in yesterday to get the impressions made. I go back on Feb 1 to get fitted. Good timing since my daughter's surgery is scheduled for Feb 3. My dentist also recommended getting fluoride trays so he threw that in, as well. I'll find out what the dental oncologist recommends on Tuesday.