Bone Scan vs. MRI for detecting osteomyelitis in jaw? And need help with jaw infection
My basic question is, when trying to detect an osteomyelitis (bone infection) which is the better tool, an MRI or a bone scan? Or a cat scan? Would a bone scan work on the jaw area?
But in addition to that question, I have a VERY complicated situation with this infection, so if anyone has any advice, please help - here is the shortest possible version of my whole story...
I've had a very serious dental infection for 6 months. A failed root canal left infected root in the tooth, which caused a major infection, an abscess, a need for another root canal on a nearby tooth, and eventually the extraction of both teeth. I have had a fever for 6 months, since the onset of this infection. I have no other underlying illnesses, no health problems, no inflammatory illness. Prior to this I was healthy. I don't drink or smoke. The only other thing that's popped up during all this is I have a small cyst on each side of my thyroid. But my thyroid hormones test normal.
Prior to having both teeth extracted, although I was sick from the onset of this infection, I got *extremely* sick for 4-6 weeks of it, when I was on no antibiotics. I was having horrible waves of severe flu-like illness, and I could barely walk, I was unable to even drive or talk on the phone. I had photophobia, mental confusion, memory loss, a rash on my arms and abdomen, and some vomiting. Thank God I was given antibiotics, and that phase finally ended after 4 weeks of oral clindamycin. No one has been able to tell me what that was - why I was SO sick during that time. If I had to guess, I think I had an inflammatory reaction to the infection, and this may have possibly caused something like an aseptic meningitis? But I was never given a lumbar puncture, so there's no way to tell.
Anyway, since then I've had both teeth extracted, under one the bone was mushy and some of it had to be scraped out. But, despite that fact, my MRI and cat scans didn't show any bone damage or bone loss. This has caused my infectious disease doctors to not treat this as seriously - since they couldn't see it on the MRI or cat scan therefore to them it doesn't exist. The 2nd tooth was pulled 3 weeks ago, and although that area on my jaw is definitely better, the other area of my jaw to which the infection spread (up towards my ear, concentrated in my jaw joint) still hurts VERY much. And I still have the fever. I do feel better overall, I no longer feel as ill as I did before having the 2 teeth pulled, but the painful ache in the jaw joint area really concerns me. And the fevers are really frustrating - they are low grade, never higher than 101 F, but when I get them I feel very weak and very tired, and have to drop whatever I'm doing, lay down, and apply ice packs. Otherwise I start to feel like I'm going to pass out and start to feel frantic with heat.
Bacteroides gracilis, strep viridans, haemophilus influenzae and parainfluenzae, and neisseria species were cultured from the actual surgical site in the jawbone. There was moderate growth of all 5 of these bacteria. I was started on Augmentin XR and have had some but very slow success, and I've been on it now for 22 days.
A new recent cat scan revealed "moderate flattening of the anterior superior aspect with anterior osteophyte formation" on the TMJ of the side with the infection. This osteophyte/bone spur is new, I didn't have one there in any of my other scans. From what I've read, a bone spur can be caused by progressed osteomyelitis. This also concerns me! But still (thankfully!) the scan shows no actual bone loss. But, because of that, the infectious disease doctors still aren't taking this seriously.
My infectious disease doctors have actually now suggested that I am having "phantom pains" and have basically blown me off. When I ask them about the fever they tell me "it's only low grade" and totally dismiss it. My oral surgeon who extracted the teeth thinks I probably have an osteomyelitis, but he's constantly contradicted by my infectious disease doctors, and I think at this point is even confused himself. Plus, he wants me to follow up with another medical professional in order to get appropriate antibiotic guidance, which I totally understand.
I am just overwhelmed by this situation. I don't know what kind of doctor to go see, or what to do. I just want to get well. I'd be so grateful for any suggestions, ideas, brainstorming, anything!
Keep researching and researching. You are on the right track. One article said a three med combination seemed most affective. Antibiotic, fungal, and viral. Also they may need to go back in surgically. Time for a second opinion and a better surgeon. Make sure they are a Maxillofacial surgeon and have experience with osteomyelitis.
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