Tuesday, 19 February 2013

Sinus Infections after Surgery

Sinus Infections and Orthognathic / Maxillofacial / Jaw Surgery

As previously discussed in my recovery notes, I started to suffer from sinus infections from 5 months post orthognathic surgery. However, I had symptoms from 3 months post-surgery. When I first expressed to my surgical team I was having pain in my face and I still had visible swelling, they gave me an x-ray to makes sure the jaws were not infected. The x-ray came back clear and it was advised that I continue with the anti-inflammatories and rest.  Due to the jaw pain and swelling left behind from the surgery it took a while before my sinus infections were treated with antibiotics. I had never experienced a sinus infection before surgery and I had hoped that this would be a one off. Unfortunately, after I finished my first batch of antibiotics in January 2012 I continued to get sinus infections every few weeks.

So what is a sinus infection?

Most often, sinus infections develop after a cold. Sinus infections are the result of inflammation or swelling of your sinuses. When your sinuses become filled with fluid or clogged, bacteria can grow causing an infection.

Other than colds, sinus infections can be caused by other methods:

  • Exposure to dust, dirt, pollen or any other irritants in the air
  • Excessive mucus production
  • Blockage in the drainage duct due to an obstruction
  • Bacteria travelling from the respiratory tract or other bacteria such as streptococcus pneumoniae

What are the symptoms of a sinus infection?

  • Yellow, foul smelling nasal discharge
  • Pressure and pain in the face
  • Headaches
  • Fever
  • Nasal obstruction
  • Congestion
  • Cold symptoms that seem to get worse and do not improve
  • Sometimes sinus infections may be accompanied by a cough

Generally, if your cold symptoms last for more than 10 days, it is best to see a doctor to make sure you do not have a sinus infection.

My Case

After the first few days of taking antibiotics the swelling in my face greatly decreased and my pain levels were reduced. By the time I had finished the first course of antibiotics the infection appeared to have gone. However, this was short lived. Within a week of finishing my antibiotics the face pain and pressure returned. This was a continuous cycle and I was taking a course of antibiotics every other week. As I am quite sensitive to a lot of drugs, I find it difficult to take most antibiotics and I have an allergy to penicillin. This was a problem for my doctor when attempting to prescribe an antibiotic to treat my infections. After trying and being unsuccessful with a few different pills, I eventually started to take Doxycycline. Each time I started a course of antibiotics with 2/3 days my pain was minimal and my breathing was a lot better. My asthma which is usually quiet mild, had been playing up since the operation and was exuberated when I had the sinus infections.

When I was next reviewed by my surgeon at King’s in May 2012, he advised that I had a nasal cavity scan. This was essentially, a CT scan of my sinuses. This was conducted on 28th May 2012. I went back for the results on 2nd July and was referred to Ear, Nose and Throat at Guy’s hospital. The results showed some soft tissue in the nasal cavity but no obstruction of the drainage ducts. My surgeon suggested that I could have the titanium plates and screws removed as I was experiencing pain in the lower jaw. Mr Matthews wanted to rule out any other causes for the sinus infections and advised that I saw an ENT specialist before proceeding with the plate removal.

After being on and off of antibiotics since January, my GP suggested I could try and blast out the infection with a one month course. This would hopefully kill any lingering bacteria. I was apprehensive as I had conducted some research into the long term effects of using antibiotics and knew that I could end up becoming “immune” to Doxycycline and this would mean I would have no other antibiotics to cure my infections.  I was a little desperate and wanted so bad to be “normal” so I agreed with the doctor’s advice and was put on a 30 day course of Doxycycline. I remember feeling so drained and tired but I was relieved to have less pain and pressure in my face.

I saw Mr Roberts the ENT specialist on 1st October 2012. After explaining my problems with pain and breathing, Mr Roberts examined me using an endoscope. This is a small tube like device which was placed through the nostril into the nasal cavity. It was quite uncomfortable and hurt a little when it touched my soft tissue. He advised that there was nothing he could do for the moment and suggested that my surgeon should remove my maxilla plates and screws. As I was having pain and muscle issues around my mandibular plates, I decided I would like all my plates and screws removed from my face.

I saw Mr Mathews on the 29th October and was still taking course of antibiotics every couple of weeks.  After discussing the risks of the operation I was booked in for plate removal surgery at King’s on 6th December 2012.

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