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Reconstruction of Maxilla - How long until we know if bone graft will succeed?
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pdurant
medicine forum beginner


Joined: 02 Nov 2005
Posts: 13

PostPosted: Mon Jul 10, 2006 12:29 am    Post subject: Reconstruction of Maxilla - How long until we know if bone graft will succeed? Reply with quote

My (then 20, now 21 year old) son had reconstructive surgery on his
upper right maxilla on May 5th to try to replace the 1/3rd of his
maxilla he lost 3 years ago in surgery for an ameloblastoma tumor. A
6-inch piece of his 5th rib was harvested, cut in half and layered,
along with demineralized bone, fit into position and screwed into other
bones to form a new maxilla. Cheek tissue was taken to cover the bone.

The surgery went better than expected but in the first week after
surgery, a portion (about 1/2 inch in diameter) of the soft tissue
covering the newly placed bone began to turn gray, became necrotic and
sloughed off - leaving bone exposed.

The surgeon didn't seem too concerned about this at the time. My son
was on a total liquid diet, had special antibiotic mouthwash he used
many times a day - always after "drinking" his meals and was on
antibiotics. We thought everything was OK for almost a month....until
on June 2nd when he woke up with a swollen jaw. Coincidentially, he
had an appointment that day with the surgeon who discovered he had
developed an infection. He drained the pus, inserted a latex drain and
gave my son a stronger antibiotic. The surgeon told us that he thought
the graft was failing and that at least half of it would work its way
out of my son's mouth or would have to be removed.

A week later, the surgeon took the drain out as the infection seemed to
be cleared up. A week after that, he took the screws out that were
securing the bone grafts in place. My son continues on antibiotics,
the bone is still exposed, there has been no further infection but we
still don't know if the graft will succeed, partially succeed or
totally fail. The surgeon says all we can do is wait. The bone is
still solid as of a week ago (next appointment is not until the end of
the month unless something else happens) but according to the oral
surgeon, there is no way to tell if the bone graft is being integrated.

I don't know anything about length of time needed to know if bone
grafts are going to succeed or fail. The prosthodontist who referred
us to this oral surgeon says he has utmost confidence in him as he has
worked with him for many years. The oral surgeon has a string of
credentials a mile long but is a man of few words.

My questions are these - Is there anything else that could be done -
other than wait? What happens if the bone graft does take but the bone
remains exposed? How long is it likely to take before we know one way
or the other as to the probable failure or success of the procedure?
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Dave King
medicine forum addict


Joined: 05 May 2005
Posts: 92

PostPosted: Mon Jul 10, 2006 4:11 pm    Post subject: Re: Reconstruction of Maxilla - How long until we know if bone graft will succeed? Reply with quote

On 9 Jul 2006 17:29:43 -0700, "pdurant" <pdurant@atlanticbb.net>
wrote:

Quote:
My (then 20, now 21 year old) son had reconstructive surgery on his
upper right maxilla on May 5th to try to replace the 1/3rd of his
maxilla he lost 3 years ago in surgery for an ameloblastoma tumor. A
6-inch piece of his 5th rib was harvested, cut in half and layered,
along with demineralized bone, fit into position and screwed into other
bones to form a new maxilla. Cheek tissue was taken to cover the bone.

The surgery went better than expected but in the first week after
surgery, a portion (about 1/2 inch in diameter) of the soft tissue
covering the newly placed bone began to turn gray, became necrotic and
sloughed off - leaving bone exposed.

The surgeon didn't seem too concerned about this at the time. My son
was on a total liquid diet, had special antibiotic mouthwash he used
many times a day - always after "drinking" his meals and was on
antibiotics. We thought everything was OK for almost a month....until
on June 2nd when he woke up with a swollen jaw. Coincidentially, he
had an appointment that day with the surgeon who discovered he had
developed an infection. He drained the pus, inserted a latex drain and
gave my son a stronger antibiotic. The surgeon told us that he thought
the graft was failing and that at least half of it would work its way
out of my son's mouth or would have to be removed.

A week later, the surgeon took the drain out as the infection seemed to
be cleared up. A week after that, he took the screws out that were
securing the bone grafts in place. My son continues on antibiotics,
the bone is still exposed, there has been no further infection but we
still don't know if the graft will succeed, partially succeed or
totally fail. The surgeon says all we can do is wait. The bone is
still solid as of a week ago (next appointment is not until the end of
the month unless something else happens) but according to the oral
surgeon, there is no way to tell if the bone graft is being integrated.

I don't know anything about length of time needed to know if bone
grafts are going to succeed or fail. The prosthodontist who referred
us to this oral surgeon says he has utmost confidence in him as he has
worked with him for many years. The oral surgeon has a string of
credentials a mile long but is a man of few words.

My questions are these - Is there anything else that could be done -
other than wait? What happens if the bone graft does take but the bone
remains exposed? How long is it likely to take before we know one way
or the other as to the probable failure or success of the procedure?

I would recommend time and patience. These are complicated
reconstructions in areas that are harboring many bacteria. As long as
the infection does not return, he should be in good shape.
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pdurant
medicine forum beginner


Joined: 02 Nov 2005
Posts: 13

PostPosted: Sun Jul 16, 2006 1:40 am    Post subject: Re: Reconstruction of Maxilla - How long until we know if bone graft will succeed? Reply with quote

The past few days little pieces of bone are breaking off and coming out
of his jaw but my son thinks gum may be forming where the bone is
coming out. Hopefully, the upper layer of rib is integrating and it
is only the lower layer (nearest the surface of his upper jaw) that is
breaking up. Two and one-half months after the surgery, I am
realizing how right you are about time and patience - I just didn't
think it would take so much time and so much patience! Thanks for the
response.


Dave King wrote:

Quote:

I would recommend time and patience. These are complicated
reconstructions in areas that are harboring many bacteria. As long as
the infection does not return, he should be in good shape.
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Dave King
medicine forum addict


Joined: 05 May 2005
Posts: 92

PostPosted: Sun Jul 16, 2006 11:05 pm    Post subject: Re: Reconstruction of Maxilla - How long until we know if bone graft will succeed? Reply with quote

On 15 Jul 2006 18:40:59 -0700, "pdurant" <pdurant@atlanticbb.net>
wrote:

Quote:
The past few days little pieces of bone are breaking off and coming out
of his jaw but my son thinks gum may be forming where the bone is
coming out. Hopefully, the upper layer of rib is integrating and it
is only the lower layer (nearest the surface of his upper jaw) that is
breaking up. Two and one-half months after the surgery, I am
realizing how right you are about time and patience - I just didn't
think it would take so much time and so much patience! Thanks for the
response.


Your welcome. Your 'hopefully' is what to expect in this situation. He
may need some augmentation but now with a better foundation.


Quote:

Dave King wrote:


I would recommend time and patience. These are complicated
reconstructions in areas that are harboring many bacteria. As long as
the infection does not return, he should be in good shape.
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