Oral and Maxillofacial Surgery Expert Forum
Radicular Cyst removal - now hematoma infection
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Radicular Cyst removal - now hematoma infection

Hello.   Thanks in advance for your time.  I am writing because a 8 days ago I had a radicular cyst (biopsy confirmed) removed from my mandible.  It was (theory) from a failed root canal 7 months ago.  However, it grew quite large.  The oral surgeon said it was the size of a half dollar.  When he removed the cyst he was not sure if it was indeed a radicular cyst (as he expected) so he did not fill it with the bovine bone graft -  for fear it was a more aggressive cyst/tumor.  Well,   all was fine in the recovery until day 4.  I started to swell.  I called and asked about it and they said just continue using heat packs and take your clindamycin antibiotic.  Well,  by that afternoon - I could see this was about to be an abscess.  It began to drain blood and awful discharge.  I got right into the doctor and he looked at it and said that I had a hematoma and the nurse gave me bad information and I drew the infection into the area.  He cleaned it and told me to continue cleaning it with a syringe and antiseptic.   He also taped the exterior of my jaw to prevent the area from becoming saturated again.  I wore that tape for 3 days and returned.  I told him it was still draining some,  even with the tape on - but it was greatly reduced.  He said great.  He removed the tape and said you should be fine...come back in 4 days for another check.  He just said I needed to continue a liquid diet.  I have. But, about 4 hours after I left his office the area began to ooze again.  He told me to press on it a little and allow it to drain and to keep cleaning it.  I have... but now it's day 9 (5 days since the hematoma issue ) and it's still oozing.  He says I just need to keep taking the antibiotics and let it run its course.   I tape it up on my own, since I'm fearful of the area swelling so badly again.  

Is he right?  Is this the way it normally goes?  He did tell me he thought I needed 2 more root canals on teeth surrounding the cyst removal....because they were "involved".  
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What you have described is consistent with an infection.  I would have hoped that the surgeon obtain cultures of the drainage to determine exactly what bacteria are involved.  Once the organisms are known, then an antibiotic can be selected that is best to handle that specific bacteria.

It is also possible the source of the infection remains in the jaw bone and this would require treatment other than antibiotics in order to obtain complete resolution of the infection.  

Infections of the jaws can take several weeks to complete cure, however one must be closely followed by a surgeon to insure the infection is resolving.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
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Thank you for your valuable insight and time.  I wanted to let you know I returned to the surgeon on Friday and he inserted a drainage tube in my jaw for the weekend and I'm supposed to have it removed today (Tuesday).  He also changed my antibiotics (never performed culture).  I am on Flagyl and Amoxicillin now.  The flagyl is tearing up my stomach.  

I am still concerned because the drainage has slowed but it's still present in the morning, especially.  I am so anxious about this situation.  I will insist on a culture today when I return.  Is it possible that the antibiotics ARE working since the drainage has slowed or should it be gone (with the drain) by now?  It is improved - but i'm scared that once the drain comes out I'm going to end up in the same position again.

I also realize I need root canals.  How long before I can safely have them performed?  Could THAT be necessary to stop all of the infection?   You mentioned the infection could be in the jaw bone, itself.  I will ask today but I assume the biopsy revealed the infection was not in the bone ....since he did take some for biopsy and cleaning when he removed the cyst.  I know from the CT scan that the cyst had invaded the bone.  

What else can I ask for at this point?  I want to get better.  Should I find another oral surgeon or does it sound like all of the right things are being done?  

Thanks so much!  I'm grateful for your insight.    
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Michael H Kirsch, DDSBlank
Dr. Michael H. Kirsch
Caldwell, NJ
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