Plate Infection Not Responding to Antibiotics Two Months Post Down-Graft

[eranthe]

Hello again.  As some of you know, I had a rather complex revision down-graft two months ago (will get around to writing a post about the results of this surgery at another time). 

When I woke up from surgery I could feel (as I always do) that my sinuses were full of blood.  Usually they drain at some stage in the first 5-7 days post-op ... but this didn't happen, and by week three it was clear that I had a sinus infection that had spread to the plates (or a plate infection that had spread to the sinus as has been suggested by my registrar).  This was confirmed on xray showing an almost full right sinus.  Since then, I've been on four courses of antibiotics (alternating each time to avoid antibiotic resistance) and I'm about to begin my fifth!!!  I've been told that the plates have to stay in for min three months - but preferably six months.  I'm in constant pain - even with the high dose of antibiotics, anti-inflammatories, nasal rinses and sprays, mucolytic liquids etc. have a constant headache and feel nauseous and miserable from all the antibiotics.

Today, the pain is intensifying and I'm waiting for a call from my surgeon, but it is pretty distressing as I can't imagine what happens next?

Has anyone else here been through similar?  And if so, how soon after downgraft surgery did they take out your plates?

Would the alternative now be to go back in, debride and re-plate?  Or is it more likely that they will put me on even higher doses of antibiotics for another month until the three month mark?  Just wondering what my options might be here.

Thanks

[Bobbit]

Do the cultures show which organisms are involved - -  to make sure they have the right antibiotics ?

[ghiggson90]

Eranthe, sorry you are experiencing this pain. It seems like an exploration of the area will give you a better answer as to the proper resolution. Some combination of debridement of tissue or bone, intravenous antibiotic and plate removal are possibilities. May I ask what grafting material was used and how large was your downgraft?

[eranthe]

No cultures have been taken! (something I will now request at my appointment on Wednesday)!
I had a 4mm advancement, and a 3mm downgraft. 
Grafting material used was Allograft and Bio-Oss.

Thanks guys.

[kavan]

Sorry to hear what you've been going through. I think it's more likely that they will keep with the anti-biotics until the 3 month mark. Because it would seem 'iffy' to do a surgery when you have an infection. You might want to think about going to the emergency room in the event you need to go on IV drip anti Bs and/or get admitted so all this can be monitored.

[Bobbit]

No cultures have been taken! (something I will now request at my appointment on Wednesday)!
I had a 4mm advancement, and a 3mm downgraft. 
Grafting material used was Allograft and Bio-Oss.

Thanks guys.

May be too late for cultures.  Normally they are taken just before they start the antibiotics - - as the antibiotics can suppress the cultures.

But maybe not in the case of a swab in a sinus infection.

[korvitz]

You should also know that the anti-imflammatories you are taking (corticosteroids or NSAIDs etc) may or may not impair bone healing by inhibiting prostaglandin production. On this topic Orthopaedic surgeons are far more advanced than maxfac surgeons are.

I would advise you to take some CBD oil/paste to help with the pain & cannabinoids also has some anti-septic properties. There are also some promising research done on cannabinoids & improved bone healing but alas CBD extracts are expensive in Australia but if you can afford it do get some.

[eranthe]

Thanks Kavan, yes I tend to agree that they will probably nurse me along with alternating courses of high-dose antibiotics for at least the next month (merry christmas) or even longer if possible to give the bone time to consolidate.  The problem is that the infection will never truly 'go away' so long as the infected plates are present, so they are going to have to do surgery whilst there is controlled active infection at some point.  Hopefully I'll get more info about their plan when I see them again on Friday (the team will be meeting to discuss my case between now and then).

Yes Bobbit, registrar said it might be too late, but was happy to do a nasal swab anyway to see if it can guide us in terms of choice of next antibiotic as we are running out of options there. 

Thanks Korvitz for that very useful piece of information.  I had no idea about the relationship between NSAIDs and bone healing impairment - but I do now!  I have been taking the ibuprofen to help reduce inflammation in the nasal passages in order to lessen the swelling and assist with drainage, but to be honest I don't know if they were really doing much in that regard, so I've stopped them today in light of your comment!

[dvfan]

How did this work out? Sounds stressful!