The countdown continues. Two days to go.
I’ll be admitted to hospital tomorrow (Sunday) at 2pm. I have a sneaking suspicion they’ll want to jab me a few more times just for fun. I’m considering taking a sign, Frazzled Patient: Do Not Approach Without Emla. Too much?
We had our last consultation with Dr P yesterday. He’s grown on me, you know. He’s been terribly thoughtful in his own way.
We took along the MRI and OPG scans that we’d picked up on the way.
(In a little episode typical of our experience of the hospital’s administrative prowess, they hadn’t packed the scans for me to take and then the receptionist told us the radiologist’s report wasn’t done. That was fine, she assured us, she’d post it out to me next week. Seriously? But I digress.)
He took a quick squiz at the scans. He’ll study them over the weekend, he said, as will Dr A. He expects to remove my mandible (lower jaw bone) all the way up to the occipital condyle, just under my cheek bone, and all the way down to my left bottom canine tooth. He’d like me to keep the canine, but he thinks I probably won’t.
It sounds ugly, but really that’s only another two teeth to go now. I didn’t have a lower left wisdom tooth. The next tooth was sacrificed on the orthodontic altar for braces when I was 14 or 15. Another molar required only a little encouragement to go during my first biopsy because Blaster had eaten its roots.
He very much doubts he’ll need to do a lip split. My neck dissection will run from my ear under my jaw to my chin. That should give him enough access, as well as removing the first two levels of lymph nodes.
Another patient from the waiting room kindly came in to demonstrate Dr P’s fine needlework. He’d had similar surgery nine or so months ago. The scar was visible and the skin a little saggy around the jaw, but didn’t look too bad. He couldn’t open his jaw more than 2cm and that’s usual after surgery, said Dr P. Most people, but not all, can open their mouths 3.5cm, so it takes some adjustment.
I will definitely lose the inferior alveolar nerve, he clarified, but I may also lose the mandibular branch of the facial nerve. The IAN is responsible for sensation in my lower lip and chin. The mandibular branch of facial nerve communicates with the muscles for movement. A quick google reveals this nerve may be injured during neck dissections. A good one to keep your fingers crossed on.
What makes my surgery trickier though is my size, for a couple of reasons.
First, he told us while squeezing my cheeks, I have a small facial structure and there’s very little flesh on my facial bones. They’ll bulk it up as much as they can with the fibula flap. Removing some later (debulking) is an option, but adding is not. It also means the titanium plate will leave me with a slightly squarer jaw and I’m more likely than most to feel it when I press my face.
Second, my fibula will be slighter than most. Seeing it on the scans is not the same as holding it in his hands. It’s a call for the day whether they take more of the fibula bone and do some complex doubling over trick to make the reconstructed jaw sufficiently solid. It will just be hanging around in my leg with no purpose anyway.
Third, my internal plumbing will be fiddly. They’ll have it blown up on the big screen, but my veins and arteries will be more fine and the micro surgery more precise.
Fourth, and this was no more than a passing comment as we had one foot out the door and mentioned my chat about blood transfusion with Dr K, I’m more likely to need a blood transfusion. Indeed, we left with the impression that a transfusion is more likely than not. On a person of my size, it doesn’t take a large blood loss to be a good percentage of my blood volume. Yippee.
He seems cheerful and ready to go. As am I… almost…