Shanksteps #121
She sat down on the bench in my office and grinned, or at least did that motion with her lips. Something was in front of her teeth. She was three and her father had brought her in from a far village to be seen. About five months earlier she had developed a toothache and then a hole started under her right mandible and draining pus from the hole. The father was away for a few months with some work and her mother was afraid to come in without his permission. He returned from his 4 month trip and
after a few weeks brought her in.
I look into her mouth and see what appears to be bone in front of her front teeth. It appears to be coming from the left side and somewhat mobile. She is calm and so I decide to wait and evaluate it in the OR under anesthesia. I suspect it is osteomyelitis. She has a 0.5cm hole under her mandible with foul smelling saliva draining from it.
In the operating room I peer into her mouth and see her mandible exposed with one tooth remaining in the section from the angle of her mandible to nearly where the incisors would have been. She is asleep with Ketamine and I tug on the bone. It comes out easily and I have half her mandible in my gloved hand. God created our bodies incredibly! Her bone had become infected; her body had pushed up the necrotic bone through the gums and healed behind it. So she is still draining saliva from the
hole, but no more foul smell. What I think she needs is a free graft fibula implant to the area! This would give tissue and structure to her mandible and face. This is apparently done by transferring artery and vein to the carotid and jugular (sounds microscopic). I suppose this is usually done with anticoagulants that I do not have.
Again, as often, I do not have the expertise, materials, tests needed for this situation. God help me know what to do!
I was recently showing pictures to the visiting PA students from the south, that are doing a rotation with us. I am amazed again at the number of peculiar and advanced diseases that we treat here. We are usually beyond or way out on some tangent to what we were trained to do. We pray often for guidance when tests and our knowledge are lacking for the patient before us.
Please continue to pray for wisdom, perseverance, ingenuity, and more love for the people we serve. In His Service, Greg
Shanksteps #121