Osteoradionecrosis (ORN) and Fractured Jaw

Hi,  

I had cancer of the Tonsils treated by radiotherapy and chemo in 2005. Due to my age (45) I got high doses of both.

15 years on, living the dream in Cornwall, I had an abscess under a molar that just wouldn't heal. After unsuccessful root canal treatment my (private) dentist decided to do an extraction.  He had to "excavate" to remove the abscess from my jaw.  I returned after a few days as the scab had fallen out of the cavity, and again later as it was not healing. I was disappointed that my dentist had not sent samples of the abscess for examination considering my history, I had assumed that this would have been done.

I went to the states to my son's wedding, and luckily made it through the ceremony and reception eating cautiously. Just before I flew home I was eating some extremely hard pretzel snacks when one got jammed in the cavity and as I bit down on it I heard an awful crack. I was convinced I had broken my jaw! I flew home later that day, but by the time I landed my jaw has swollen up dramatically. After reaching my sisters house I went immediately to see her dentist who checked my jaw but could not see any damage on the X-ray he took. Returning home I visited my doctor and my dentist, as I was in increasing pain. Scarily. when I asked my dentist  if my socket hadn't healed because of my cancer treatment my dentist gave me a surprised look and went into a back room to check on something. This was disappointing as I had given my history when I joined the dentist, ad expected it to be emblazoned on the top of my notes. I even went to A&E in Cornwall and had an X-Ray but still no=one could see what was causing me so much pain. 

Eventually I managed to get referred to the hospital, where I was told that my dentist should not have attempted an extraction on a patient with a history of radiotherapy and that this should have been carried out in hospital! The radio therapy I had to treat my cancer had caused osteoradionecrosis in my jaw.  By then I had an infection inside my jawbone (osteomyelitis). On the X-rays I could see the bone was bent around a central infection. 

On Christmas Eve I was given some antibiotics (Clindamycin) and some mouthwash and gel by the consultant, and thankfully my doctor prescribed some heavy duty painkillers.

My consultant wanted to put me on a trial for a new treatment, but was overruled by his boss. I spent about a year on the maximum dose of tramadol and prcegablin, and on slowly reducing doses of the antibiotic. The infection was persistent, I could feel strings of gunge coming out of the socket for months. As the infection and swelling decreased further X-Rays showed an obvious fracture in my jaw. 

Because of the radiotherapy my consultant feels that the normal treatments for a fractured jaw; i.e. screwing a plate to the adjacent bone, or transplanting some healthy bone in between the two sections. My dentist thinks I must have a sliver of bone around the nerve as I still have feeling on both sides of my jaw, but I’m worried that this may go if I bite on something hard.  

So I’m at a loss - do I have to live the rest of my life eating sloppy food, or is there anything that could be done to give me a better quality of life. I’d love to hear from anyone else who has the same issue, and any treatment you’ve had for it.  

Love to you all

Jenni