Oral Surgery/Pain/bleeding post-tongue biopsy
I had a tongue biopsy 6 days ago (Tuesday) for a lesion that I've had for a year. The lesion is on the ventral and lateral aspect of my tongue and is too large to excise, so the dentist/MD only took a small piece of it on the lateral side. He cauterized and then placed 4 stitches. I could see a line where the incision was made and the stitches appeared to be holding things together well. Of course, the tongue swelled significantly within a few hours and the first 2 days were fairly painful. I took ibuprofen for the first 2 days. I tried to be extremely careful eating to not disturb the site and I mostly had cold liquids for the first 2 days. The surgeon said it would likely be feeling better on the third day. It really wasn't- almost felt worse. Late Friday afternoon (of course, after their office closed for the weekend), I started getting a low grade fever (99, 100). I considered going to urgent care to see if I needed antibiotics, but the fever started going away this (Sunday) morning. I noticed, however, a divot was developing in my tongue at the incision site and all the stitches now appear to have failed. A pretty good hole has now formed and my tongue is bleeding. I don't appear to have any wound healing.
I have questions for both the short and long term:
1) I plan to call the doc's office in the morning. If they tell me to wait for my appt on Wed, should I or should I seek help elsewhere? If the stitches have failed, will they likely put them back in? Or is the standard of care to just remove the ones now inside the wound) and will I likely be left with a pretty large hole in my tongue to slowly fill in? (My appt on Wed was for removal of the stitches, so these are not the dissolving type.)
2) I am really having difficulty eating and have already lost 4 pounds. I have been largely unable to eat any solid food, even carefully on the other side of my mouth. I am a triathlete and don't have a lot of body weight to spare. I haven't worked out because I cannot fathom how I will get enough calories in. Even swallowing liquids is painful at this point. How long can the healing process really drag out? How common is it for the stitches to fail?
Thanks in advance for your thoughts.
Cyndi - First of all, because the tongue is mostly made of muscles, there is a constant pull force on any sutures placed in it. For that reason, many sutures areas break down and become open. For that reason it is very important that you need to keep the area clean to promote a proper and speedier healing by using warm salt water rinses for 1-2 minutes, 4-5 times a day.
A defect is not uncommon early on after tongue surgery, but with time there is often a recontouring of the area and it appears more normal and often completely normal.
As far as the eating, that is probably the most difficult aspect of the healing. Because the tongue is all muscle and to swallow we seal the tongue against the roof of the mouth, there really is no way to eat without some effect on the healing. Unfortunately, you will need to have a mostly liquid and very soft diet for 7-10 days after the surgery. There really is no way around this. The warm salt water rinses I earlier suggested will help to promote a speedier healing and should allow a shorter time until you can eat more normally. Be careful, acidic and spicy foods can irritate the healing area so bland is probably best.
I hope the area heals quickly and you feel better soon. If you have additional questions, feel free to contact me again.