UPDATE: IMF stands for inter maxillary fixation. The maxilla is the upper jaw bone (actually two bones fused together, I understand). It’s also the other location apart from the mandible where people get ameloblastoma, although it’s rarer.
We held out hope it couldn’t be an infection.
It seemed too far down the track. I didn’t have the other symptoms. And Dr P wasn’t worried.
But the swelling was sudden and worse two days in a row. The only thing that had changed was massaging my neck dissection scar with bio oil, ten minutes, twice a day. Could that have caused the swelling?
It might just have. Because it wasn’t an infection. Disruption of lymphatic flow, Dr P said.
During surgery, as we already knew, they removed the top two levels of lymph nodes in my neck. I gather this is usual during neck dissections to improve access, but it was also precautionary in case there was any malignancy. They also used micro surgery to connect up the artery and vein that formed part of the fibula flap. Now instead of flowing down, Dr P told us today, the blood flowed up and around then down.
The surgery disturbed both of the drainage systems in my neck and jaw: the blood and the lymphatic system. Together with the trauma of surgery, that adds up to a lot of swelling. The body adapts and gradually the swelling subsides.
Dr P didn’t offer a theory as to why the disruption of lymphatic flow caused the sudden explosion in swelling, so we’re sticking with our little theory about the scar massage. I haven’t massaged for the last two days, but will probably start again tomorrow. More gently this time. I want a flat white scar when this is all over, but the swelling has impacted my speech and got very uncomfortable there for a day or two.
The infection drama aside, it was a fun checkup. Two of the speech therapists came in for their meeting with Dr P as I was in the waiting room. F, who saw me in hospital and will continue with me once my jaw is unwired, and C, who saw me the night before surgery in hospital. (Too many Cs I know, just hang in here with me!)
I like getting to listen to specialists discussing me because you learn things you might not otherwise, like my braces are actually called an IMF. I must look that up.
Dr P looked through my CT and OPG scans from last Monday. We’d forgotten them for our last minute appointment last Friday. My new jaw looks to be healing well and shaped well. The titanium jaw is set a little outside the fibula-cum-jaw bone. If at some point the soft tissue settles so much that the titanium plate starts to show through as a bump on my jaw, they can remove the plate. (Another surgery I’ll be hoping to avoid!). The shape of the new bone is what counts and that is looking good.
Everyone has a look at my fibula flap too. Still pink and healthy. The wiring is looking well cleaned and cared for, they commented. A relief because I’d been feeling a bit guilty I may have contributed to my non-infection by not keeping my mouth scrupulously clean.
And this is where I feel a little embarrassed. It’s not like I don’t know people read this blog. I do. Quite a few people, though nothing like the number who read Darren’s posts while I was in hospital. But I write this as much for me as I do to share news. Sometimes more, sometimes less. It depends on what I’m writing about. Often I just get wrapped up in getting it out of my head.
I knew my speech pathologists had found the blog. (Hi.) But they mentioned it in front of Dr P today and he knew. Koala bear or something, he said. Close. I don’t know if he’s read any of it because he’s definitely a man in demand, but now I really am feeling the pressure to get my updates right!
As we left, we saw J in the waiting room and caught up. I’d met him while I was in for the second biopsy and he was three weeks post op for the same surgery. He told me about how he’d coped by challenging himself to stay calm and celebrating the removal of each tube. It was great to have the chance to tell him how much that had helped me.
Onwards and upwards from here on. My next appointment with Dr P is next Saturday and he may, just may, cut my wires. It will be two days short of five weeks post-op. My jaw won’t open much to begin with, but within days, it may open 10 to 15mm. Now that’s something to look forward to. What should be my first non-liquid meal?