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Dr. Andrew Rynne

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What does this CT scan report indicate?

Answered by
Dr.
Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

Answered : 2412 Questions

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Posted on Tue, 27 Oct 2015 in General Health
Question:

(Hello - i have an issue -
I had an orbital break in
march 2015
Since then the hospital neglected me medical treatment - the titanium plate surgery to put in place where the missing bone was - i waited 8 weeks for a inital CT scan , during this time
I was healing on my own -
My sinuses have never been the same and i have issues everyday now with all aspects of my face. - i feel i have a gaping hole from my nostral to my lung and i get alsorts stuck in the back of my throat and nose and i have to blast a shower down my sinuses to clear them- very time consuming for
Me and getting me very stressed out.
Every 15minutes im clearing my sinuses
I still think to this day
If i was treated properly at the hospital and they closed up
My break in my face
Everything would be fine
But because they left it so long and made me heal on my own - (sending me home without xrays and things saying ide be fine after the swelling went down -)
Well now i have issues ive never had before.
Breathing through my nose causes things to get to the back of my throat and nose wen i clear it
Theres black dots in my saliva

Sorry for the not nice pictures but honestly feel
Somethings really wrong. )



doctor
Answered by Dr. Naveen Kumar 48 minutes later
Brief Answer:
If any gap or malalignment is noticed in CT scan... fixation is required...

Detailed Answer:
Hi

Thanks for posting the query

As you have rightly said, eight weeks is too long a time for the repair to be done. Meanwhile, the fractured segments start healing by secondary intention. In the CT scan if the gap is still seen or any malalignment noticed, then it would be wiser to go for a surgical repair and plating of the fractured segments.

Meanwhile, there will be issues in the maxillary sinus mucosa which can lead to altered drainage. My suggestions to you are:
1. Use saline nasal spray as frequently as possible. This helps in clearing of the sinus secretions.
2. Try taking mucolytics such as ambroxol or bromhexine to reduce the consistency of secretions; thus aiding in easy clearance.
3. Intranasal steroids can be beneficial in reducing the mucosal inflammation.

Hope this answers your query; I'll be available for the follow up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon



Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Naveen Kumar 1 hour later
Yes - as an expert i would like your proffessional opinion please.
Do you think this could be classed as medical negligence?
Here -
March 6th 2015 @ 12:00noon- orbital break/fracture
March 6th 2015 @ 3pm - visited A&E - blew my nose and my eye almost exploded. A Big bubble came to my eyelid.
March 6th @ 10pm - was seen by a doctor/nurse
He said to go home and within a week ide be fine - i asked to XRAY me - he said no.
March 7th @ 2am - i went back to A&E and demanded XRAYS as i was in AGONY.
My teeth my face my eye everything was in agonising pulses and pains. Ide torn my orbital nerve as my face was broken.
Had an XRAY that night and they noticed something -
They told me to go wait too see a XXXXXXX doctor or surgeon - i waited a while and he came and looked at me and my xrays and told
The staff he wanted a CT Scan done within the next 3 days. Otherwise ide be waiting weeks. He wanted to see how big the break was - as i was a mess!
Anyway as soon as he left the room
The other nurse told me ide be put on a waiting list and would be called in for a CT Scan.
Which already wasnt what that XXXXXXX just told me and the staff.
Anyway i just nodded and agreed
Took my co-codamol prescription and went home - i then waited 8 full weeks for a CT scan -
During this time i was put out of work and scared to even walk the streets - thinking if i was hit again in the same place - ide be blinded or worse.
So since then i dont walk anywhere and i spend an awful lot on taxi fares. Even just to the shop. Im that scared of more injury.
Anyway - after the CT scan was done
I waited a futhur month for a consultant to contact me to call me in to discuss fixture options.
She suggested a titanium
Plate as the CT scan At 8 weeks still shown the break. (Photo attatched)
The titanium plate was suggested for my own safety in the future and also that they wernt just going to leave it. And it would be fixed.
Anyway -
I was booked into surgery - i was nil by mouth by midnight the night before i was supposed to go for my surgery and i went to the hospital - i arrived and was told they had put the wront date on the letter to me - infact my surgery wasnt until
The day after.
So i accepted the mistake and went home again.
I was nil by mouth by that midnight again
And went to the hospital again in the morning -
(ALL THIS HAS EFFECTED MY ANXIETIES AND DEPRESSION MORE TOO)!
As i got there
I was told to wait in a waiting room - a woman came round explaining the risks etc. As they have to by law.
And drew an arrow on my face for surgery.
20minutes later a surgeon came
To me - he sat me down and told me he didnt want to operate because it had been 8'weeks and he called It a 'LATE REPAIR' - because it was 8
Weeks after the injury occured he told me that ide already done the healing myself FACIAL NERVE wise. And that the bone would
Heal Eventually but like any broken bone - it would heal deformed. - i QUOTE -
He said if i make an incision on your face
I'll take you straight back 8 weeks healing time and youll be in more pain and have to go through the healing process again.
He said with no repair at this stage
It could lead to
Eye sagging
Loss of sight in the future
Allsorts.
But he said if he operated he could send me back 8'weeks healing time or even worse blind me - as there was a certain percentage that he could possible cut my optical nerve a blind me - he said.
So the risk was greater in surgery than it was to leave me to heal.


I feel
I should of had a titanium plate
Because of my history of being hit in the streets by strangers for my possessions and if
It happend again i wouldnt be that injured as in if i was to be hit again in the future without the titanium plate in - it would probably blind me or cause furthur injury.
-
I have sinus problems everyday and feel they even missed my base of my nose being broken - but when i told them they told me
nooo- with nerve damage it can feel like allkinds of things - pains tingles sensations - whilst it heals - but they wouldnt take in the face even to this day
The base of my nose where my nostrals are
Are extremely sore and my right nostral - under it - the bone is sticking out abit - i cant feel
The left side atall its not even sore - but my right bit is still sore if i push on it or move it left or right. And cracks.
- i just need your proffessional
Opinion.
As i feel ive been neglected and now i wont go anywhere because they didnt fix me.
Which is ashame.
Anyone else whos has a facial break

Have had surgery to fix it - in most cases.
But me - not.
And even at 8'weeks the break was very clear.
(As below)
He just chose not to operate due to the fact
Ide been left 8'weeks already.

If my scan was done when the XXXXXXX told them
And me initally - ide of probably had it fixed.

Dont you think that the 8
Weeks wait for a scan was wrong?
When they was told to bump
Me up and have one ASAP!
Within 3 days
So he could see the results and sort me
Out?

Thankyou XXXXXXX
Photos below show
Plan for surgery and just normal ct scan at 8 weeks.
Please respond
Thankyou
doctor
Answered by Dr. Naveen Kumar 20 hours later
Brief Answer:
Consult a good maxillofacial or head & neck surgeon...

Detailed Answer:
Hi XXXXXXX

Thanks for writing back

1. I have gone through the CT images thoroughly and I do see a displaced fracture in the floor of the orbit.

2. I'm surprised as to why they did not repair the fractured segment immediately. Eight weeks is too long a period for them to wait. Fortunately, you don't seem to have any entrapment of the delicate nerves or double vision.

3. By this time fracture would have healed by secondary intention and lots of fibrosis would have set in. But, this remains a potential source of infection for the eye via the sinuses.

4. My suggestion to you is to consult either a Maxillofacial Surgeon or a Head & Neck Surgeon. They can help you in rectifying the defect. Blindness because of this surgery is very rare. If done by an experienced doctor the success rates are high.

Hope this clarifies your doubts. Wish you good health.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Naveen Kumar 19 days later
hello - no my face has seem to have gotten worse now -
its getting to winter and the Ache-ing i am
getting throughout my face is just absolutley astounding.
i have problems
everyday - my front left tooth and my left canine (the vampire-like one) tooth
and then the corresponding tooth next to that / i have lost complete feeling too - my face feels like its hanging on by a thread. - is the best way to describe it.
my eye socket is still quite sore at times
and i cant even itch my left side of my nose or face as if i do i feel a bigger itching/pinning sensation all the way up, under and behind my eyeball. in the mornings im
very blocked in my left sinus - and after an hour in the shower of blowing my nose and clearing my sinus with water and steam - its then fine - but its always different to my right side; by the extremes - meaning my right side is normal and then my left sinus is like i have a gape-ing hole from my nostrel to my lung and air passing through it seems
very powerful
as if my sinus is completely clear and theres a hole somewhere - its
hard to explain but
i can pass alot
more air through my left nostrel than my right.
as i type
this message im
getting sensations along my left side of my face - and its been
almost 7 months since my accident.
so its a no win situation i have -
and i feel
like screaming , crying, or smashing my face up
myself!

i want it
to be back
to normal
as my left side feels extremely prominent compared to
my right.
!
doctor
Answered by Dr. Naveen Kumar 24 hours later
Brief Answer:
You need surgical correction... Consult an apt maxillo-facial surgeon...

Detailed Answer:
Hi

Welcome back

I do understand your concern and feel extremely sorry for your condition.

My sincere advice to you is to consult an apt maxillo-facial surgeon who will be expertized in dealing these type of cases. Normally, in the case of non-reduction of orbital fracture, there may be presence of granulations or mucocle around the fractured site which could be trapping the surrounding nerves causing the loss of sensation.

Surgical correction at experienced hands can relive most your symptoms as well as the cosmetic deformity. Symptomatic treatment doesn't have much role to play in this situation.

Meanwhile, you can try using saline nasal spray available over the counter, to clear the sinuses and keep the mucosa moist and granulation free.

Hope this clarifies your doubts. Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Naveen Kumar 11 hours later
i woke up this morning at 4am
and my left side was completely blocked up with a really sticky saliva.
and has took me til now to get my sinus to clear and be normal -

in your professional opinion
should:would; an operation correct my issues now - would you say the operation is the best way forward to rectifying the problems?
And Would you say in your
proffessional opinion that the NHS have caused these issues to
be prolonged due to insufficient care?
thanks XXXXXXX
doctor
Answered by Dr. Naveen Kumar 26 hours later
Brief Answer:
Surgery can curtail most of your problems...

Detailed Answer:
Dear XXXXXXX

Thanks for writing back

1. Yes, most of your symptoms should reduce with surgery. Before planning for the surgery we need to re-evaluate the sinuses and the status of the orbit with a repeat CT scan. With surgery even your cosmetic issues can also be solved.

2. Yes, NHS has taken your case very lightly without understanding the gravity of the situation. Any trauma to the face or the head should be evaluated with a CT scan, at the earliest. At least, if they had acted upon the orders given by the XXXXXXX consultant you would not have suffered to this extent.

3. Try consulting an apt maxillofacial surgeon for further management.

4. Meanwhile, try using saline nasal spray for easy clearance of sinus secretions.

Wish you good luck and good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon


Above answer was peer-reviewed by : Dr. Prasad
doctor
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