Redundant Tissue in Oral Cavity after TORS surgery of SCC-II of tonsil resulting in problems chewing

rjmeyers1
rjmeyers1 Member Posts: 9
in Head and Neck Cancer #1

My wife had a successful removal of her cancerous tonsil with good negative margins and a clear follow-up Pet/CT Scan recently.

She still cannot eat normally however due to a ridge of excess ("redundant tissue") that is on the inside of her mouth interferring with her bite (if she tries to chew she chews on the tissue). She had her upper wisdom tooth removed as an initial effort to correct problem but it did not work. The bottom wisdom tooth has been discussed for removal but I am not sure that it will be enough to correct the problem either. Her surgeon said that removing the tissue surgically (non laser) would result in a further restriction on the cavity area. Has anyone had any experience with this and if so where you able to acheive a good result somehow? Thanks!

Comments

  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #2
    How long has it been now?

    I had enough swelling after my radical surgery that I had a flap of tissue that got into my bite for a few months afterwards, but it eventually resolved on its own.  It is confusing to me when the say that resection of redundant tissue would restrict cavity.  This seems like a contradiction in terms.  If the tissue is redundant, and only the redundant tissue is removed, it would seem that a perfect solution would be the expected outcome.  Where does the redundancy arise?  Mine was from the buccal mucosa, flapping in from the outside between the back molars.

     

    Pat 

  • rjmeyers1
    rjmeyers1 Member Posts: 9
    #3

    Hi Pat!

    Nice to hear from you. It has been three and a half months since the surgery. The redundancy is like a tootsie roll size horizontal ledge of tissue emanating from the surgical site (tonsil) going forward towards the front of the mouth. Due to her biting it has extended forward on her inside cheek. The removal of her upper wisdon tooth last week is probably still causing some swelling so we need to give it some time I guess. The oral surgeon is not anxious to remove the bottom wisdom tooth (he will of course if asked) as he said it will be a difficult extraction.

    I'm not sure why the oral cavity would be restricted further if it was removed and have that question in to the doctor and waiting for a reply (just accepted what he said when he said it). I suppose if he has to cut around it into the margins to remove it and  the closing of that excision would result in more scar tissue, flexibility, etc causing the increased restriction. I was thinking that maybe laser surgery to "shave it down" instead of excising it might be an option but have gotten conflicting answers from two physician friends (one a urologist and the other a retina specialist) who both acknowledged that this was not in their area of expertise.

    Hope you are well and planning for your next hike!

    Rudy

  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #4
    rjmeyers1 said:

    Hi Pat!

    Nice to hear from you. It has been three and a half months since the surgery. The redundancy is like a tootsie roll size horizontal ledge of tissue emanating from the surgical site (tonsil) going forward towards the front of the mouth. Due to her biting it has extended forward on her inside cheek. The removal of her upper wisdon tooth last week is probably still causing some swelling so we need to give it some time I guess. The oral surgeon is not anxious to remove the bottom wisdom tooth (he will of course if asked) as he said it will be a difficult extraction.

    I'm not sure why the oral cavity would be restricted further if it was removed and have that question in to the doctor and waiting for a reply (just accepted what he said when he said it). I suppose if he has to cut around it into the margins to remove it and  the closing of that excision would result in more scar tissue, flexibility, etc causing the increased restriction. I was thinking that maybe laser surgery to "shave it down" instead of excising it might be an option but have gotten conflicting answers from two physician friends (one a urologist and the other a retina specialist) who both acknowledged that this was not in their area of expertise.

    Hope you are well and planning for your next hike!

    Rudy

    Yup

    I did pack the entire Ozark Highlands Trail, a total of 185 miles.  It was a strenuous endeavor, but a very enjoyable experience.  My eating restrictions really were a bit of a problem on the hike.  In cold weather, my ability to swallow is so curtailed that solid food is completely out.  Burning 7000 calories a day, the weight loss was calculable in advance.  I wound up being pretty skinny by the end of the hike.  I'm going back in just a few days, to one of the Wilderness areas I encountered along the trail.  Termed the Hurricane Creek Wilderness, it is quite remote, and every step is a photo out of National Geographic.  This trip is more hunting waterfalls up the various drainages into Hurricane Creek, a real photo safari....

     Oops, Rudy this is a pdf file, so you will have to paste it into google to have it pop up.

    I would think waiting quite awhile is in order on this.  My swelling took literally 4 or 5 months to subside to where I wasn't biting down on myself.  And especially if she just had an extraction, this may go on for half a year and then resolve.  The good news is that oral mucosa does not form hypertrophic scar like outside skin does, so the chances are this reflects continued swelling, not an  abnormal healing response.  Here's a reference, it's long but the point is made on either the first or second page:  http://www.wounds-uk.com/pdf/content_9260.pdf

     

    Glad to hear from you Rudy.

  • Rick2924
    Rick2924 Member Posts: 23
    #5
    rjmeyers1 said:

    Hi Pat!

    Nice to hear from you. It has been three and a half months since the surgery. The redundancy is like a tootsie roll size horizontal ledge of tissue emanating from the surgical site (tonsil) going forward towards the front of the mouth. Due to her biting it has extended forward on her inside cheek. The removal of her upper wisdon tooth last week is probably still causing some swelling so we need to give it some time I guess. The oral surgeon is not anxious to remove the bottom wisdom tooth (he will of course if asked) as he said it will be a difficult extraction.

    I'm not sure why the oral cavity would be restricted further if it was removed and have that question in to the doctor and waiting for a reply (just accepted what he said when he said it). I suppose if he has to cut around it into the margins to remove it and  the closing of that excision would result in more scar tissue, flexibility, etc causing the increased restriction. I was thinking that maybe laser surgery to "shave it down" instead of excising it might be an option but have gotten conflicting answers from two physician friends (one a urologist and the other a retina specialist) who both acknowledged that this was not in their area of expertise.

    Hope you are well and planning for your next hike!

    Rudy

    Buccal Flap Probem

    Rudy:

    For what it's worth, I'll relate my experience. I had a similar issue after my TORS 1 1/2 years ago for a tongue base resection and radical tonsilectomy. They made a buccal (inside of the cheek)  flap to cover exposed bone. The flap tissue was very large and was between my back teeth when I attempted  to close my mouth or chew. I know how miserable she must be. Initially, my dentist made me a splint called a NTI which fit between my front teeth  and held my mouth open enough so I wouldn't bite the tissue at night. That helped me get some sleep. (the more I bit it, the more swollen it got). Sometimes I would put it in during the day just to get some relief and relax my jaws.  After 3 months of not much improvement an oral surgeon who was affiliated with MD Anderson used a cautery knife to remove some of the tissue. That still wasn't enough so I had another procedure using a laser to remove more. It was better after that, but not great. Eventually I had to have 3 molars extracted (1 one top and 2 on the bottom) to solve the problem. Of course if she had radiation treatment, then there is the ORN issue with the extractions. In my case, I did 40 hyperbaric sessions before the extractions and 10 after. My wisdom teeth had been removed long ago so I really have no experience as to how that complicates matters.

    Even though I can now close my jaws together with no problems, the flap tissue remains very tender and gets very sore when chewing food.

    I hope things work out soon.

    Rick

  • rjmeyers1
    rjmeyers1 Member Posts: 9
    #6
    Rick2924 said:

    Buccal Flap Probem

    Rudy:

    For what it's worth, I'll relate my experience. I had a similar issue after my TORS 1 1/2 years ago for a tongue base resection and radical tonsilectomy. They made a buccal (inside of the cheek)  flap to cover exposed bone. The flap tissue was very large and was between my back teeth when I attempted  to close my mouth or chew. I know how miserable she must be. Initially, my dentist made me a splint called a NTI which fit between my front teeth  and held my mouth open enough so I wouldn't bite the tissue at night. That helped me get some sleep. (the more I bit it, the more swollen it got). Sometimes I would put it in during the day just to get some relief and relax my jaws.  After 3 months of not much improvement an oral surgeon who was affiliated with MD Anderson used a cautery knife to remove some of the tissue. That still wasn't enough so I had another procedure using a laser to remove more. It was better after that, but not great. Eventually I had to have 3 molars extracted (1 one top and 2 on the bottom) to solve the problem. Of course if she had radiation treatment, then there is the ORN issue with the extractions. In my case, I did 40 hyperbaric sessions before the extractions and 10 after. My wisdom teeth had been removed long ago so I really have no experience as to how that complicates matters.

    Even though I can now close my jaws together with no problems, the flap tissue remains very tender and gets very sore when chewing food.

    I hope things work out soon.

    Rick

    Redundant Tissue in Oral Cavity after TORS surgery of SCC-II of

    Dear Pat and Rick,

    Thanks for the info which is very helpful.

    Bev has actually just noticed an incremental improvement brought about by packing a small piece of gauze against the flap at night which has caused the swelling to go down...very little, but enough to comment upon. I thought that there might be a dental device that could help but none of the doctors ( or even the oral surgeon who took out the first wisdome tooth mentioned one...another example of the importance and helpfullness of this site!).

    I will advise her to hang tough to give the long term swelling a chance to further improve. I will also look into the NTI dental splint to help that along. If that doesn't work over time then the bottom wisdom tooth will have to go, and if no help there, then I guess the excision of the tissue will be the last resort. I am encouraged and I know that she will be as well. Pat, thanks for the extra info as well as the results of your hike. And Rick, that fish in your photo is quite impressive! You guys are living large and I love seeing that. Best wishes.

    Rudy

     

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