This is the second in the three part Q&A series with my oral & maxillofacial surgeon, Dr P.
I have excluded the questions about costs and invoices. In case anyone wonders about my ability to count to 45.
Will I need more tests or scans before admission to hospital?
It would be required to meet Dr L (Physician) to establish baseline Respiratory and Cardiac Function. The Anaesthetist will be advised of your admission and will view your results. Generally you will,have daily blood tests, ECG and Chest x ray in ICU. Thereafter daily or 2nd daily blood tests on the ward. [Yippee]
When will the blood tests, chest x-ray and ECG noted in my hospital admission paperwork take place? Before or after surgery?
The pre op tests will be done approximately 1 week before in the University Preadmission clinic.
Is there anything else I should be doing to prepare for surgery?
Refrain from Smoking, Alcohol, The use of blood thinning agents like anti inflammatories and Aspirin. Advise the medical staff if you have any unusual medical conditions, taking drugs or pills and any allergies. Exercise prior to surgery is OK. Do not chew hard food lest the mandible fracture and get infected.
How will my surgery be affected if I lose too much more weight?
It is not unusual to be catabolic after surgery. We would suggest pre operatively to put on weight by a high caloric diet.
Is there anyone else on my medical team that I could/should meet before my surgery?
I think he missed this one.
Who will be involved in the surgery other than Dr P (oral & maxillofacial surgeon) and Dr A (plastic & reconstructive surgeon)? What is their role?
Dr XX may be involved in the surgery. He is a Head and Neck Surgeon and I will advise you of his availability. Dr XX is the Advanced Fellow in Surgery. Dr XX and Dr XX are members of The University Cosmetic and Plastic Surgery Unit and may be involved. Our roles are multi disciplinary in that we all look after you in respect of your surgery and progress.
Who does the tracheostomy?
Dr XX, myself or Dr XX will do the tracheostomy. All the surgeons above can also do the tracheostomy as required.
Fibulectomy and fibula flap
What do you learn from my doppler ultrasounds on the artery and vein in my legs?
The Dopplers and Ultrasound are done to exclude that the Peroneal artery is separate and stand alone from the Posterior Tibial Artery.
Do you take the whole fibula? What happens to the joints or bone parts that remain? Do you take muscle with the fibula?
We take the whole fibula but preserve the distal 10 cm’s otherwise you could develop an unstable ankle joint. We take muscle with the fibula.
How will you know if the fibula flap is failing?
If the fibula flap is failing we see a change in colour of the flap, associated blood indcators like elevated white cell count, high temperature ad tachycardia. You will be unwell if infection sets in. We may organise a Technecium 99 Bone scan 3-4 days after surgery to confirm blood flow to the flap.
How much will I be able to move with my jaw wired?
We wire the jaw for 3-4 weeks for assistance with the healing process. Following this we place elastic bands for 2-4 weeks for partial assistance with mastication and occlusion. You will be fed by a Naso gastric tube for 1-2 weeks. Thereafter a full fluid diet, then a soft diet.
How will you know if you have removed all the tumour?
We would suggest a repeat MRI 1 week before the surgery to give maximum information regarding bony infitration of the tumour. MRI’s do not produce radiation but give exact localisation of the tumour. [This doesn’t quite answer my question.]
What will you do if you can’t remove all the tumour?
Your preliminary findings suggest we can remove all the tumour. If the “final” pathology margins suggest we are not clear then we will advise you of a wider clearance needed as a separate surgery.
How much of my soft tissue will you remove? What will be the effect on my face?
Soft tissue includes,
- Free and attached mucosa (Gum)
- Buccinator muscle (part)
- Mylohyoid muscle (part)
- Associated nerves, blood vessels.
- Important nerves include Inferior Alveolar Nerve, Possible facial nerve branches including Marginal Mandibular and Buccal nerve
You will have scarring, fullness or depression of facial aesthetic units, alteration of symmetry of face, compromised jaw opening, sensation or movement of the face.
We over correct the deformity and aim to give more fullness than depression of tissue. We may need to undertake repair/revision/reconstruction of tissue or jaw/teeth at a later date.
When will you get the results of the pathology on the removed tumour and mandible? What will you do if you find malignancy? What will you do if the tumour is not clearly benign?
The pathology will take about 1-2 weeks before the jawbone is “decalcified” to enable the patholoist to advise on margin clearance. We reserve the right to advise you on this and also the need for wider excision.
Will you do follow up checks with me in hospital? Will other doctors do follow up checks? For what and how often?
We will do daily follow up checks on you, this includes myself, Dr A, Dr XX, Intensive Care Specialists, Dr L (Consultant Physician) and other Doctors.
Nursing, Dietitian, Speech pathology, Physiotherapy also.
*Disclaimer: He did not have access to my files and his answers are indicative only.