Oral Surgery/Severe jaw pain and stiffness
QUESTION: My husband is a head/neck cancer survivor and recently visited his dentist (also a head/neck cancer survivor) to eliminate some small bone/tooth particles that had surfaced in his lower right jaw area. Ten months ago, at the beginning of his cancer treatment, he had to have all back molars removed plus a wisdom tooth (9 teeth total removed). His recovery was very quick. A week ago, his dentist made two incisions in my husband's gum line and pulled up skin, covering up the exposed jaw area that was rubbing my husband's tongue raw. Since then, my husband has had severe jaw pain and can not open it wider than his pinky finger. He is unable to eat. Is this normal? What should he do to help his jaw open again? He is taking antibiotics as well as ibuprofen and/or naproxen.
ANSWER: Katherine - I would like to help you, but first, I need to know exactly the type of treatments for the cancer he underwent. Chemotherapy, radiation treatment and surgery.
It sounds, from your description of what is occurring in your husband's mouth, that your husband may be suffering from osteoradionecrosis if he had radiation. The limited opening, if he had radiation, could be caused by the radiation's effect on the nerves that control the jaw muscles that help open and close the mouth.
So if you could get back to me and let me know his treatments, I might have and answer for what is occurring and where he should now go to regain a more normal functioning.
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QUESTION: His treatment was through the University of Chicago and involved 6 weeks of chemotherapy (during January and into February), which was followed by 10 weeks (5 rounds) of combined chemotherapy and radiation. His treatment ended April 25, 2014. During the "combination" treatment, he was admitted into the hospital 5 separate times - staying 5 full days each time. He was administered chemo during the entire stay and then radiation twice a day (morning, afternoon). His tumor was located on the right side of his neck. He had surgery in late August - his ENT removed 31 lymph nodes from the tumor area. He is cancer-free. I hope this gives you the information you need. It has been 1 week since his oral surgery and his mouth is still only opening about 1".
Katherine - From your description of the treatments your husband underwent for the cancer, which ended about six months ago, your husband had the extractions done a short time before the cancer treatments. In this situation, if the area had not fully healed before the chemo and radiation began, the area of the extractions could easily break down. His limited opening is probably due to nerve damage from the radiation and the pain may be due to a lack of oxygen in the healing area.
Of course I cannot be sure without examining your husband, but it does sound like the lack of oxygen is what is producing a lack of healing in the extraction area and poor healing. I have seen others with similar problems from similar treatments. My recommendation is to see a knowledgeable board certified oral and maxillofacial surgeon. Initially, it sounds like your husband should undergo a hyperbaric oxygen treatment to help promote healing. True healing will go a long way to reduce the pain.
You need to speak with the doctors who performed the radiation and chemotherapy to ask for an oral and maxillofacial surgeon they have worked with previously. This situation is not totally uncommon, but only a doctor with the experience in treating patients who have undergone the chemo and radiation and subsequent bone osteoradionecrosis should oversee his treatment.
So initially speak with the doctors who did the treatments to eliminate the cancer and ask for a referral to an oral and maxillofacial surgeon. If for some reason they are unable to help or do not know of such a doctor, you can get back to me, tell me where you live and I will try to find and appropriate doctor near you to help your husband.