Posted by dirtywater on January 05, 2009 at 18:05:27:In Reply to: Geniotubercle screw loose? posted by dirtywater on November 27, 2008 at 21:09:20:
Finally I have an update. The piece of bone, or screw, or whatever it is in my chin, is still loose. I can wiggle it up and down but it is usually not painful. The only time it happens unintentionally is when I roll onto my face in bed.
The hospital lost my request for a copy of the CT scan. I put in another request and got the copy today on CD. Either the copy is lower resolution than what they use in-house, or I just don't know how to read a CT (which is very likely), because the radiologist drew all sorts of conclusions about the bone screw, when all I can see on my screen is a blur that looks kind of like a screw :-) But the CD did have detailed interpretive notes, which I will paste below.
I hadn't heard anything from the surgeon, so I left a message and her assistant called me back today. She said that according to my chart, the CT showed some bone resorption around the screw, but it was within the "normal range" of what would be expected to happen during recovery. Doesn't feel very "normal" to me, so I'm going to meet w/ the surgeon next Monday to discuss.
Here are the radiologist's notes. I've read through them quickly, but I don't have enough expertise to know whether these findings explain the movement in my chin. Maybe the "prominent soft tissue" is what I am feeling?
----------
HISTORY: Status post Le Fort I osteotomy and bilateral mandibular
sagittal split osteotomies, now with movement felt in the chin.COMPARISON: Facial bone CT dated 1/17/2008.
TECHNIQUE: Facial bone CT WITHOUT contrast.
FINDINGS:
The patient is status post LeFort 1 osteotomy with maxillary advancement and internal fixation by means of flexible plates and multiple screws. The plates are flush with the bones, and the screws appear well seated and stable in position since the prior examination. There has been interval healing of the minimally displaced fracture of the left lateral pterygoid plate. The maxillary teeth and alveolar ridge remain anteriorly displaced with regard to the maxillary sinuses, without bony bridging.
The patient is also status post bilateral mandibular sagittal split osteotomy, with internal fixation by means of plates and
multiple screws. There has been interval bony healing of the osteotomies with the plates flush with the bone, and the screws well seated and stable in position. The right second most distal screw abuts and possibly encroaches on the right mandibular canal, stable since the prior examination. On the left, the two most anterior screws and the most distal screw abut and possibly encroach on the mandibular canal.The left mandible, including the left mandibular condyle, remains hypoplastic.
The mental spine has been advanced anteriorly with internal fixation by means of a single screw. Since the prior examination, there has been bone resorption at the anterior margin of the screw. The bone around the posterior aspect of the screw demonstrates incorporation with the adjacent bone posterolaterally. The bone measures 0.9 AP cm compared with 1.3 AP cm on the prior study. The portion of the screw within bone appears well positioned with no evidence of loosening. Adjacent to the head of the screw, there is prominent soft tissue which has increased in size compared with the prior examination.
The sinuses are clear with interval improvement since the prior examination. The remainder of the bones and soft tissues are stable and unremarkable.
Impressions:
IMPRESSION:
1. Post-operative changes as detailed above status post Le Fort 1 osteotomy and mandibular bilateral sagittal split osteotomies,
without evidence of hardware failure.2. Interval bone resorption around the head of a screw fixating the mental spine with an increase in the soft tissues adjacent to the head of the screw, which may represent granulation tissue or less likely edema. There has been bony healing of the residual posterior bone of the mental spine, with no evidence of loosening around the screw.
---------