Mid 2010: Mr. Spaghetti, it appears that you’ve got a rather large cancerous tumor on the base of your tongue, and, it’s metastasized to the lymph node in your neck. The good news is, we have a very good success rate with a series of therapies which should get rid of the cancer: external beam radiation, chemo, followed up by brachy (tying your tongue down with spaghetti wires for more focused radiation).
Mid 2012: Mr. Spaghetti, the good news is, it appears the therapies used to eliminate your cancer have worked. You are, so far, cancer free. However…err, in the process, the therapies kind of destroyed your left mandible. We have though, a very good success rate cutting out part of the jaw and replacing it with a piece of bone from the leg.
Or course, the medical team who attended me throughout the therapies were doing the best they could do. In fact, I’m extremely grateful, humbled and thankful. It’s only a coincidence that the DNA in my bone didn’t resist the amount of beamage doused in said area.
Twice over the last six weeks my jaw/face has swollen due most probably to an underlying problem that is more suspicious than first anticipated. More serious though has been the accompanying trismus. Given that I’m keeping myself full of augmentin (antibiotic) to prevent another swelling episode, I need to get this taken care of sooner rather than later. I’m starting to feel the effects of being on this antibiotic for so long.
Submitting to option 1 — which is a scraping the dead bone and covering over with gum tissue most probably won’t work. Option 2 — is a semi-major operation, which would have meant taking out a vein from my arm, taking out teeth and some bone and patching over with a skin graft and hoping for the best. Option 2 is a seven day hospital stay and a six week recovery.
The third and final option, the option I was hoping to avoid, looks to be the most definitive solution. In other words, if I’m going in for a semi-major operation, why not just make it a major and try to take care of the problem definitively. It appears now that option 2 would be a gamble and if it didn’t work I’d still need to do option 3.
The bottom line? Option 3 is scheduled for August 22. I’ll be in the hospital for 10-14 days. The operation itself could take 6-8 hours. It involves taking out a section of the jaw and replacing it with a section of the fibula, complete with vein and artery from the fib area, as well as skin from the leg. To sure this up, the jaw will also be outfitted with a titanium plate.
The operation will be preformed by a team led by a chief surgeon and specialist in otolaryngology and a maxillofacial reconstruction specialist.
The amount of jaw that needs to come out won’t be clear until they start digging. They cut down at the known area and saw out both directions until they get to bleeding bone. It’s a delicate balance of taking enough but not too much. Still, it’s no guarantee.
The tricky part is re-wiring the vein and artery and making sure the piece of calf bone successfully takes to its new home in my mouth. Hence, after the operation, I’ll be spending at least a couple of days in intensive care, where they need to keep constant check on the status. After that, I’ll spend another couple of days in a step-down unit, then moved to a private room until I’m ready to do (mental) cartwheels.
Supposedly the fibula is non-weight bearing so after healing, there should be no issues with walking, running, cycling, or giving the dog a good swift kick. It’s been said that people have run marathons with part of the fibula taken out.
What I don’t look forward to is another tracheostomy. They will cut another hole in my throat (actually open old hole) for security in case the throat swells and I need to breath. The ugly about the trachea is that mucus automatically forms as the body’s protective mechanism and needs to be constantly cleared out to breathe by shoving a suction hose down the hole.
If there is good news to this, and there is, it’s that hopefully I’ll be ridding myself of a literal pain in the neck. But more importantly, option 3 allows a platform for building a prosthesis for however many teeth I’ll need on the bottom row (4 maybe?). This will help functionally allowing use of the left side for chewing and also save the upper teeth (keeping them in place).
The prosthesis will be possible sometime over the next 6-12 months and will be somewhat costly as dental work is not covered by insurance. (Insurance companies don’t consider teeth a necessity).
Because I’ll be under anesthesia for so long I had to get a cardiac clearance. So this week I saw a cardiologist and took a stress test. During the interview I didn’t realize that I told an unknowing fib. When the cardiologist asked if there was any heart disease issues in the family I said no. Then afterwards I remembered that my mother’s brothers, (they would be my uncles right?), all died from heart problems. The girls in the family all live to be close to 100, but the men have checked out much earlier due to heart stoppage. Oh well, I can’t let a little fib get in the way of the fibula. Still, it was an interesting battery of tests. Luckily, I passed.
During the initial recovery, I’ve got to be zealous about keeping the mouth cleaned, even though I won’t be eating through it (tube down nose). Even under normal conditions, more than most, I’ve got to be super-viligant about teeth and gum cleanliness. Fortunately, several years ago I found a couple of excellent professionals and specialists in Colombia who help keep me up-to-date with judicious oral hygiene. Both split their time between teaching and practicing and are my ‘go to’ doctors for dental service. But it will be at least three months until I’m able to get back down there.
Until the 22nd, I’ll relish any relish I can find, and afterwards, bide my time until there is even more to relish. But it’s anything but a done deal. Even when it’s done it won’t be done. The exact result will be up in the air until they go in and dig, saw, cut, paste and sew.