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How Can A Swollen And Ulcerated Uvula Be Treated After Tooth Extraction?
Question: Hi there,
Merry Christmas!
My 18 year old son had his wisdom teeth extracted under general anesthesia on Friday. On Saturday, the lower half of his uvula was black, swollen, and more painful than the extractions themselves. I called the on call oral surgeon last night and he said he's never heard of that before and not to worry. Today, however, it is now white and still very painful. I can text you pictures of it.
How do I hear back from you? I appreciate that you're available for an opinion. I'm afraid that it has become necrotic tissue.
Thank you,
XXXXXXX XXXX
0000
Merry Christmas!
My 18 year old son had his wisdom teeth extracted under general anesthesia on Friday. On Saturday, the lower half of his uvula was black, swollen, and more painful than the extractions themselves. I called the on call oral surgeon last night and he said he's never heard of that before and not to worry. Today, however, it is now white and still very painful. I can text you pictures of it.
How do I hear back from you? I appreciate that you're available for an opinion. I'm afraid that it has become necrotic tissue.
Thank you,
XXXXXXX XXXX
0000
Brief Answer:
Please do provide clear images for my opinion, thanks :)
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. Please do attach pictures to our discussion here or email them to me at:
YYYY@YYYY
and please do mention "ATTN: DR. SHOAIB KHAN" in the subject line.
If at all the colour of the uvula has changed from black to white, then there is no concern relating to it being necrotic. But images would provide me with a more clear picture. Please do so, and we shall continue our discussion from there on.
Looking forward to being of assistance.
Best wishes.
Please do provide clear images for my opinion, thanks :)
Detailed Answer:
Hello and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. Please do attach pictures to our discussion here or email them to me at:
YYYY@YYYY
and please do mention "ATTN: DR. SHOAIB KHAN" in the subject line.
If at all the colour of the uvula has changed from black to white, then there is no concern relating to it being necrotic. But images would provide me with a more clear picture. Please do so, and we shall continue our discussion from there on.
Looking forward to being of assistance.
Best wishes.
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi,
I don't know if you received my pictures, but today the bottom half of his uvula fell off and he swallowed it. It looked necrotic to me since Saturday. He still has a lot of throat pain. He has more pain in his throat than the extractions themselves.
We've tried ice water, warm soup, and cepacol lozenges without much relief.
Any ideas or thoughts?
Thank you, XXXXXXX
I don't know if you received my pictures, but today the bottom half of his uvula fell off and he swallowed it. It looked necrotic to me since Saturday. He still has a lot of throat pain. He has more pain in his throat than the extractions themselves.
We've tried ice water, warm soup, and cepacol lozenges without much relief.
Any ideas or thoughts?
Thank you, XXXXXXX
Brief Answer:
A few points I could gather
Detailed Answer:
Hello once again XXXXXXX
This is really unheard of to me too, but his dentist should be able to provide an explanation for the same, as only he has details on the exact procedure conducted, whether he came in contact with the uvula during surgery or not, and so on. These are questions you need to ask his doctor.
In my opinion, if part of the uvula has already fallen then the only thing to be done now is for you to visit the dentist and start a course of antibiotics along with pain management medication in order to prevent secondary infections, and also make sure the region heals well.
Diet wise you can continue to give him liquids, but the confusion here is:
1. Cold liquids are usually advised after tooth/teeth extraction to prevent excessive bleeding
2. Warm fluids help increase blood flow to the region, which can increase a chance for a bleed, but at the same time would also prevent progression of the necrosis if any around the region of the uvula
So this is something you need to discuss with his dentist.
I did not receive the pictures XXXXXXX please do try to either attach them to our discussion here or email them to me at:
YYYY@YYYY
and mention 'ATTN: Dr. Shoaib Khan' in the subject line. I look forward to viewing them to see if I have an opinion after viewing them.
Best wishes.
A few points I could gather
Detailed Answer:
Hello once again XXXXXXX
This is really unheard of to me too, but his dentist should be able to provide an explanation for the same, as only he has details on the exact procedure conducted, whether he came in contact with the uvula during surgery or not, and so on. These are questions you need to ask his doctor.
In my opinion, if part of the uvula has already fallen then the only thing to be done now is for you to visit the dentist and start a course of antibiotics along with pain management medication in order to prevent secondary infections, and also make sure the region heals well.
Diet wise you can continue to give him liquids, but the confusion here is:
1. Cold liquids are usually advised after tooth/teeth extraction to prevent excessive bleeding
2. Warm fluids help increase blood flow to the region, which can increase a chance for a bleed, but at the same time would also prevent progression of the necrosis if any around the region of the uvula
So this is something you need to discuss with his dentist.
I did not receive the pictures XXXXXXX please do try to either attach them to our discussion here or email them to me at:
YYYY@YYYY
and mention 'ATTN: Dr. Shoaib Khan' in the subject line. I look forward to viewing them to see if I have an opinion after viewing them.
Best wishes.
Above answer was peer-reviewed by :
Dr. Prasad
These are the photos of his uvula after most of it became necrotic and sloughed off and he swallowed it
I just sent pictures of my son's uvula that had a definite line of demarcation and looked necrotic
following wisdom teeth removal that were impacted. They were removed December 23rd and he was nasally intubated.
IMG _2973.mov is a short video from Saturday December 24th
IMG 2974 and IMG 2977 are images from Saturday all of which I offered to send to the oral surgeon on call. I told him about the transverse line of demarcation and that it looked necrotic. He declined my offer to send pictures and told me that he had never heard of a uvula falling off and told me that he would be fine.
IMG 2955 is from Sunday after an urgent care dr said he didn't know what it was, had never seen anything like it before, but to contact the oral surgeon on Monday December 26th. He ruled out thrush. At this point, my son had very little if no pain from the extractions. He had an extremely painful throat. The urgent care dr gave him prednisone 40mg po qd for 5 days and a magic mouthwash of lidocaine, diphenhydramine, and maalox to swish and spit 10 mls q 4 hours prn. I am a pharmacist and made the magic mouthwash on Christmas Day and gave it an extra shot of lidocaine. We had tried cepacol lozenges and spray with little relief. He was also gargling with warm salt water and taking amox 500mg po tid since the surgery on December 23rd.
On Monday December 26th I called the on call oral surgeon, expressed my concern that there was a definite transverse line of demarcation and that it smelled and looked necrotic. He said it was probably bruised, had never heard of a uvula falling off, declined my offer to send pictures and told me that he would be fine.
I got home from work and asked XXXXXXX if I could look in his throat. He is 6'4" tall so he had to kind of squat down so I could see it. He cleared his throat and told me that it felt as if he had just swallowed it. IMG 2979 is right after it sloughed off and he swallowed it.
He has had extreme throat pain, very little dental pain.
Tuesday December 27 he saw the actual oral surgeon who did the procedure and he said he's never seen it before. His RN allowed me to send her pictures on her phone and told him to come in immediately.
I have yet to be given an answer as to why his uvula became necrotic and fell off. The oral surgeon thinks that another small part of it might fall off again.
He was nasally intubated; do you think that the tube compressed his uvula and deprived it of oxygen long enough for it to die?
Thank you so much Dr. XXXXXXX
I just sent pictures of my son's uvula that had a definite line of demarcation and looked necrotic
following wisdom teeth removal that were impacted. They were removed December 23rd and he was nasally intubated.
IMG _2973.mov is a short video from Saturday December 24th
IMG 2974 and IMG 2977 are images from Saturday all of which I offered to send to the oral surgeon on call. I told him about the transverse line of demarcation and that it looked necrotic. He declined my offer to send pictures and told me that he had never heard of a uvula falling off and told me that he would be fine.
IMG 2955 is from Sunday after an urgent care dr said he didn't know what it was, had never seen anything like it before, but to contact the oral surgeon on Monday December 26th. He ruled out thrush. At this point, my son had very little if no pain from the extractions. He had an extremely painful throat. The urgent care dr gave him prednisone 40mg po qd for 5 days and a magic mouthwash of lidocaine, diphenhydramine, and maalox to swish and spit 10 mls q 4 hours prn. I am a pharmacist and made the magic mouthwash on Christmas Day and gave it an extra shot of lidocaine. We had tried cepacol lozenges and spray with little relief. He was also gargling with warm salt water and taking amox 500mg po tid since the surgery on December 23rd.
On Monday December 26th I called the on call oral surgeon, expressed my concern that there was a definite transverse line of demarcation and that it smelled and looked necrotic. He said it was probably bruised, had never heard of a uvula falling off, declined my offer to send pictures and told me that he would be fine.
I got home from work and asked XXXXXXX if I could look in his throat. He is 6'4" tall so he had to kind of squat down so I could see it. He cleared his throat and told me that it felt as if he had just swallowed it. IMG 2979 is right after it sloughed off and he swallowed it.
He has had extreme throat pain, very little dental pain.
Tuesday December 27 he saw the actual oral surgeon who did the procedure and he said he's never seen it before. His RN allowed me to send her pictures on her phone and told him to come in immediately.
I have yet to be given an answer as to why his uvula became necrotic and fell off. The oral surgeon thinks that another small part of it might fall off again.
He was nasally intubated; do you think that the tube compressed his uvula and deprived it of oxygen long enough for it to die?
Thank you so much Dr. XXXXXXX
Brief Answer:
Most certainly intubation related; seen similar cases previously
Detailed Answer:
Hello and welcome.
I wasn't aware about his intubation prior to your last response. A few years ago I ready about a case wherein a 30+ year old woman was intubated for a procedure, which was then followed by a throat infection.
This throat infection was accompanied by necrosis of her uvula. She reported to her doctor immediately and was monitored continuously. Over the next few days a team of doctors monitored her strenouosly and came to the conclusion that the midline intubation was the cause for the necrosis that caused a certain amount of pressure on her uvula causing it to necrotise and eventually fall off.
This was a previously unheard of complication, and is extremely rare, which is why in most cases no necessary precautions are taken, but after this case, there were a few other reported cases which is why a fixed protocol for treatment has been employed. It includes:
+Antihistamines
+ i.v. steroids (as the patient is usually admitted and treated, oral steroids can be used if the patient is treated at home)
+Antibiotics (mainstay): Prefered through an i.v. rpute as it is more rapidly and efficiently delivered, and thus more effective
+Adrenaline: Topically applied
Please speak to your doctor to help initiate the same for your son, albeit most of the recovery and healing has already occured from the last image attached.
I hope I have explained things in a manner best understood by you. Please do not hesitate to write to me for any further clarifications, guidance or information; I am always here to help.
Best wishes.
Most certainly intubation related; seen similar cases previously
Detailed Answer:
Hello and welcome.
I wasn't aware about his intubation prior to your last response. A few years ago I ready about a case wherein a 30+ year old woman was intubated for a procedure, which was then followed by a throat infection.
This throat infection was accompanied by necrosis of her uvula. She reported to her doctor immediately and was monitored continuously. Over the next few days a team of doctors monitored her strenouosly and came to the conclusion that the midline intubation was the cause for the necrosis that caused a certain amount of pressure on her uvula causing it to necrotise and eventually fall off.
This was a previously unheard of complication, and is extremely rare, which is why in most cases no necessary precautions are taken, but after this case, there were a few other reported cases which is why a fixed protocol for treatment has been employed. It includes:
+Antihistamines
+ i.v. steroids (as the patient is usually admitted and treated, oral steroids can be used if the patient is treated at home)
+Antibiotics (mainstay): Prefered through an i.v. rpute as it is more rapidly and efficiently delivered, and thus more effective
+Adrenaline: Topically applied
Please speak to your doctor to help initiate the same for your son, albeit most of the recovery and healing has already occured from the last image attached.
I hope I have explained things in a manner best understood by you. Please do not hesitate to write to me for any further clarifications, guidance or information; I am always here to help.
Best wishes.
Above answer was peer-reviewed by :
Dr. Raju A.T
My concern is that he finished the 7 day amox 500mg po tid and still has a severe sore throat and it smells. We saw the oral surgeon last Friday and he didn't seem concerned. I am also upset at how dismissive the on call oral surgeons were of my concerns. I told them it had a definite transverse line of demarcation and looked necrotic. It was black within 24 hours of surgery and the on call oral surgeon said that he's never heard of that, but he should be fine. Should something have been done at that point and half of his uvula would not have necrotized and fallen off? What are the disadvantages of not having a uvula? Or only part of a uvula? I asked, at his appointment with the oral surgeon who did the extractions, if it could be from the nasal intubation and he said he didn't know. I think his uvula became compressed at some point during the extractions, went without oxygen, and was no longer viable at that point. We were never warned that this could be a complication of wisdom teeth extraction with nasal intubation. What should we do? Do you feel that I should be financially responsible for the hospital setting, anesthesia, and extractions? What are the long term effects of only having part of your uvula?
Brief Answer:
All queries addressed ma'am :)
Detailed Answer:
Hello once again.
If he underwent a 7 day course of amoxicillin, all possible infections should be taken case of, and no further antibiotics should be required. He can however request for antihistamines, pain management medication, steroids, etc; which can all ease his discomfort and help with the healing process as well.
If at all necrosis did ensue from the compression that took place during the intubation, then it would have eventually resulted in it necrotising and falling off, unfortunately nothing could have been done at that point other than the early initiation of the treatment regimen.
The main function of the uvula is the prevention of food from entering the nasal cavity, and if at all his uvula does not have the required size to help serve that function, then there is a risk for regurgitation of food into the nasal cavity.
As I mentioned earlier ma'am, this is an extremely rare complication and unfortunately because it has only been encountered a handful number of times, it is usually not mentioned prior to intubation. But if you wish to hold the hospital liable for this, then you can, primarily because it was not mentioned to you in the consent form given prior to surgery or verbally, so you can give it a shot. The hospital should at the least, bare the expenses for this complication in my opinion.
I hope I have explained things in a manner best understood by you ma'am. Please do not hesitate to write to me for any further clarifications, I am always here to help.
Best wishes.
All queries addressed ma'am :)
Detailed Answer:
Hello once again.
If he underwent a 7 day course of amoxicillin, all possible infections should be taken case of, and no further antibiotics should be required. He can however request for antihistamines, pain management medication, steroids, etc; which can all ease his discomfort and help with the healing process as well.
If at all necrosis did ensue from the compression that took place during the intubation, then it would have eventually resulted in it necrotising and falling off, unfortunately nothing could have been done at that point other than the early initiation of the treatment regimen.
The main function of the uvula is the prevention of food from entering the nasal cavity, and if at all his uvula does not have the required size to help serve that function, then there is a risk for regurgitation of food into the nasal cavity.
As I mentioned earlier ma'am, this is an extremely rare complication and unfortunately because it has only been encountered a handful number of times, it is usually not mentioned prior to intubation. But if you wish to hold the hospital liable for this, then you can, primarily because it was not mentioned to you in the consent form given prior to surgery or verbally, so you can give it a shot. The hospital should at the least, bare the expenses for this complication in my opinion.
I hope I have explained things in a manner best understood by you ma'am. Please do not hesitate to write to me for any further clarifications, I am always here to help.
Best wishes.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I guess I am upset at the dissmissiveness of the two on call oral surgeons that I talked to, who declined to see pictures and told me that he would be fine. Especially the oral surgeon that I spoke to the day after surgery when his uvula was black. Perhaps some type of therapy could have been initiated to prevent complete necrosis. And he was a little "freaked out" when he swallowed his rotten uvula! I could smell infection
Brief Answer:
I am really sorry to hear about what both of you had to endure
Detailed Answer:
Hello once again.
I too am disappointed at their approach, from my experience medical staff who are unaware about the happenings tend to panic and can be dismissive as a result of this. But this is no excuse for such behaviour at all, I wish to apologise for such behaviour on their behalf ma'am.
I wish they would have at least informed you or learned more about the situation, or at least just pacified you and your son.
As for the swallowed necrotic uvula, it will be passed in his stool without having any implications, so you need not worry about that in case you were ma'am. Right now you should try to make your son feel as secure and comfortable as possible, and I am sure he will soon recover from the emotional trauma.
My prayers are with both of you. And please do not hesitate to write to me about anything, I am always hr=ere to help.
Best wishes.
I am really sorry to hear about what both of you had to endure
Detailed Answer:
Hello once again.
I too am disappointed at their approach, from my experience medical staff who are unaware about the happenings tend to panic and can be dismissive as a result of this. But this is no excuse for such behaviour at all, I wish to apologise for such behaviour on their behalf ma'am.
I wish they would have at least informed you or learned more about the situation, or at least just pacified you and your son.
As for the swallowed necrotic uvula, it will be passed in his stool without having any implications, so you need not worry about that in case you were ma'am. Right now you should try to make your son feel as secure and comfortable as possible, and I am sure he will soon recover from the emotional trauma.
My prayers are with both of you. And please do not hesitate to write to me about anything, I am always hr=ere to help.
Best wishes.
Note: Find out which dental treatment will work best for your teeth. Ask here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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