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Jaw Infection

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meshell77
meshell77

Underwent wisdom tooth extraction. Developed an infection. Was treated with surgical debridement and 4 wks of IV antibiotics (ertapenem). Two weeks into IV and MRI revealed inflammation, no infection, thus no osteo. However, treatment continued for 2 more weeks. Bone biopsy came back and was not necrotic so was not diagnosed with osteo. Just “chronic inflammation”. Has been 2 months since debridement and 1 month since cessation of IV antibiotics. Tongue is still numb on side of surgery. Sensation and slight pain is developing again at suspected sites of previous infection. Cone scan shows bone healing. Is it normal to experience new pain and sensation during “healing” or is this a possible flare? OS says my scan looks good and is likely just healing pains. No new swelling or drainage. Just increased sensation. 

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5 Replies

  • melindasmakeup
    melindasmakeup meshell77

    Posted

    Hi Meshell! I’m so glad I can help you because I’ve had 5 jaw bone debridement surgeries for my osteomyelitis each with a course of it antibiotics. I was also on ertapenem. My last surgery was in November of 2014. Since then I’ve had numerous flare ups with excruciating pain and some swelling.  I was put on oral antibiotics for about a year to suppress any returning infection but my ID doc and surgeon said he didn’t want me to go through another surgery since my jaw bone was so fragile from all the previous infection and debridements. I felt really alone because they basically said it was probably nerve pain and all they could do is refer me to a neurologist and she would prescribe nerve pain meds (which I will not go on!! I hate that medication it’s like a horse tranquilizer). So I finally went to a physical therapist because my pain was radiating into my neck and I was getting intense muscle spasms and pain. And VOILA! My pain has subsided DRASTICALLY. I sometimes have pain around the week before my period due to hormones fluctuating. But overall I am leading a normal life again without sleepless nights of crying in pain. The physical therapist I go to has a PhD in physical therapy so he is actually a doctor. He was very very knowledgeable about jaw muscle pain and actually did some  massage on the inside of my mouth over the jaw muscles and I can’t tell you how good that felt. Sometimes it was painful but overall it was very relaxing. I know for sure I have extensive nerve damage and major scar tissue and muscular injury due to all the trauma from surgery and infection. I wish my doctors would have prescribed physical therapy sooner!!! I’m not sure how much of your pain is due to infection inflammation or damage from surgery but it’s worth talking to your id doctor or surgeon about. Sometimes they worry about massaging directly on the infected area but if they’re sure the infection is subsided and your current pain is nerve related and causing inflammation on the surrounding tissue and nerves, you might look into physical therapy. If anything, have them just work on your shoulders in the beginning! You need to focus on relaxation and pain relief right now. Take care of yourself! If you can, let me know more specifics about the pain you’re experiencing, persistence of pain, burning feeling or dull, stabbing, etc. how is facial swelling? I hope this helps! I don’t know where you live but I do know my physical therapist does free phone consultations and can probably answer your questions and see about finding you a therapist in your area! 
    • meshell77
      meshell77 melindasmakeup

      Posted

      That’s really the big question. How will I know the infection has subsided.  there has to be inflammation no doubt. All of a sudden, two months after the debridement and one month after IV meds it’s like a switch got flipped and I started having sensation in that area again. It feels like the beginning of the way it started last time.  Feel swollen but doesn’t look swollen. Somewhat tender to touch jar area were third molar was removed. Which was the original infection site. The pain sort of radiates it times  halfway down the mandible between the Jaw and Chin  to the site where I had the really hard nodule develop that was removed during debridement.  I never had an active sinus tract that I’m aware of.   But can it go down like that?  I’ve been feeling this way for a week and a half without it getting intensely worse necessarily.  And it’s not excruciating pain or anything it’s just inflamed feeling  with occasional sharp pains and worse upon eating or talking a lot. 
    • melindasmakeup
      melindasmakeup meshell77

      Posted

      It really sounds like nerve pain. I totally know exactly what you are talking about with the “swollen feeling” without being swollen. I’ve had that same feeling so many times. You’ve had a lot of trauma around the trigeminal nerve and that can cause sharp pains and a feeling of inflammation. And all that tissue around the infection site is trying to heal, so the pulling, tight, swollen feeling is normal. I wish there was an instructional manual for healing after bone debridements and mouth surgery!! It’s like the doctors just send us home and don’t tell us what to expect or if we are going to get better! Unfortunately with osteomyelitis, there’s too many unknowns and it’s kind of a wait-and-see game. It really sucks. My doctor always said,  “If the pain lasts for longer than three months, then come and see me and we might do a bone scan and more antibiotics or surgery.” This is a terrible way to have to gauge the necessity for action, but that seems to be the protocol for recurring chronic osteomyelitis. 

      Sometimes it’s just a healing pattern and it feels very similar to how the active infection feels. If the pain isn’t keeping you up at night, causing major swelling or heat at the site, nausea, fever, or oozing sinus, then I wouldn’t panic. See what you can do about easing your nerve pain for now and keep an eye on the swelling. 

    • melindasmakeup
      melindasmakeup

      Posted

      P.S. And to answer your question about pain extending past the surgery site, yes. When having any kind of jaw/tooth/mouth surgery, it is very likely the trigeminal nerve will get nicked and cause lots of “referred nerve pain” (look that up online). I also had a condensed area of infection about two inches away from my chin on my right side of my jaw and the surgery really messed with my trigeminal nerve. I’ve had numbness and tingling for over four years and some random shooting pains in that area. I know it’s healed quite a bit though, which is reassuring. But it’s a long road and I’ve had to be really patient even when I feel like the pain is an emergency. When it’s just an inflamed swollen and tender feeling, i try to ice the area a little. But if the nerves feel like they’re on fire, I only use moist heat. Advil seems help the best but some people prefer Tylenol. Try not to take prescription pain pills. That’s a hard road to go down. Been there done that and it was awful. 
    • meshell77
      meshell77 melindasmakeup

      Posted

      Thank you so much. This gives me some comfort. You are so right about not having enough information about what to expect of  bone healing. So I actually met with my 2nd opinion OS today. He reviewed the CBS that was taken prior to my debridement and clearly identified a slow healing bone (compared to the other extraction site) and the area of sequestra. He confirmed that he would have considered this osteomyelitis based upon my storyline and the CBS. Even when I showed him the Path results saying no necrosis, he was non- plussed. That said, he did a scan today to compare and said that my bone is definitely healing and filling in. He saw that there was some muscular inflammation on the side that was healing. So, like you suggested, assumed it to be healing pains and changes. Sure hope so. Thank you so much for your response. Again, super helpful to read about your experience. Hope you continue to progress well! 
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