Sore Mouth/Tongue - Reconstructive Surgery: North London Oral Facial Treatments

What is burning mouth syndrome?

Burning mouth syndrome is a name given to discomfort or pain in the mouth. It often affects the tongue, lips and cheeks but other parts of the skin lining inside the mouth can also feel uncomfortable. Most people with the condition complain of a burning or scalded feeling.

Burning mouth syndrome is a common condition. It often affects women, particularly after the menopause, but men can sometimes get it too. Up to one in three older women report noticing a burning sensation in their mouth.

What is the cause?

The sensation of burning in the mouth can occasionally be the result of medical or dental problems. These include thrush infections and blood or vitamin deficiencies.

The hormonal changes around the menopause can be related to burning mouth syndrome. It can also occur or get worse when somebody is stressed, anxious or depressed, or going through a difficult time of life. Not knowing why your mouth is burning can also make you anxious.

What will happen to me?

If you describe a burning sensation in your mouth you will be examined thoroughly to make sure another medical or dental cause is not responsible. Some blood tests may be arranged for you to look for such a possible cause.

Sometimes people get worried that they may have mouth cancer. This is quite a common anxiety of people with burning mouth syndrome. Carrying out a thorough examination and any necessary tests will enable your doctor to reassure you that all is normal with no signs of cancer.

Is there any treatment?

Hormone replacement therapy hasn't been shown to improve the symptoms, and neither have vitamins if your blood tests are normal. Symptoms often improve following reassurance that there is no serious disease present in the mouth. The burning feelings can sometimes be worse at times of stress and go away when life is running more smoothly.

In the same way that low doses of antidepressants can help patients with neuralgia even if they are not depressed, sometimes low doses of antidepressants can relieve the symptoms of burning mouth syndrome.

What if I don't get better?

We know that we can't always make you better. Trying not to focus on the feeling, learning to live with the sensation, and remembering that no serious disease has been found can sometimes be the best way of managing this common problem.

Radial Forearm Free Flap

What is a radial forearm free flap?

A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed. It can be used to replace large parts of the mouth and has the advantage that when it heals it does not shrink so that hopefully speech and swallowing will not be greatly affected.

What does the surgery involve?

Your surgeon will take a piece of skin from the inside surface of your forearm near the wrist. The skin and fat layer in this region is removed (the flap) along with two blood vessels, one of which supplies blood to the flap (the artery) and one of which drains blood from it (the vein). The vessel which supplies blood to the flap is the artery which gives rise to the pulse at the wrist at the base of the thumb. Once the flap of skin is raised it is transferred to the head and neck and sewn into the hole created by the removal of your cancer. The blood vessels supplying and draining the flap are then joined to blood vessels in your neck under a microscope. These blood vessels then keep the flap alive while it heals into its new place.

Once the flap is removed from your forearm the hole created is covered with a graft of skin. This graft of skin can be taken from one of several places. Commonly a thin piece of skin is shaved from the arm above the elbow. Alternatively some skin will be borrowed from your tummy.

What will the arm be like afterwards?

Your forearm will be placed in a bandage and sometimes your arm held with the hand up in a special sling for a few days. The bandage is removed after around 10 days and replaced with a lighter dressing. The blood vessels lifted with the flap run from the inside of the wrist as far as the inside of the elbow so there will be a row of stitches along this line which will be taken out when the bandage is removed.

The nerve which supplies feeling to the skin over the base and side of the thumb is sometimes bruised when the flap is raised. This can mean that the area ends up tingly or numb for several months following surgery. Occasionally it can be permanent. Rarely a bruised nerve can give rise to feelings of pain. You may also notice that your hand does not feel as strong as it was after the operation and sometimes it will feel more cold than it used to in the winter months.

What are the possible problems?

In 2-3% of cases one of the blood vessels supplying or draining the flap can develop a blood clot. This means that the flap doesn't get any fresh blood or, if the drainage vein clots, the flap becomes very congested with old blood. If this occurs it usually happens within the first two days and means that you will have to return to the operating theatre to have the clot removed. Removing the clot is not always successful and on these occasions the flap "fails" and an alternative method of reconstruction sought.

DCIA Free Flap

What is a DCIA free flap?

A DCIA free flap is one way of filling a bony hole in either the upper or lower jaw. It is one of the common ways of replacing bone that has been removed for cancer treatment.

What does the surgery involve?

Your surgeon will take a piece of bone from your pelvis. The pelvis is the large block of bone that lies immediately above the hip joint. Pelvic bone (the flap) is removed along with two blood vessels, one of which supplies blood to the flap (the artery) and one of which drains blood from it (the vein). The artery supplying blood to the bone is called the deep circumflex iliac artery and hence the flap is usually known as the "DCIA" flap. Once the necessary piece of bone from the pelvis is removed it is transferred to the head and neck and secured in position with small plates and screws. The blood vessels supplying and draining the flap are then joined to blood vessels in your neck under a microscope. These blood vessels then keep the flap alive while it heals into its new place.

What happens to the hole in the pelvis?

The hole in the pelvic bone that is left after the flap is raised is left to heal on its own. It takes several months for the pelvis to heal completely but at the end of this time it will be as strong as it was before the surgery.

What can I expect after the operation?

The area of your pelvis where the bone has been removed is likely to be sore. Regular painkillers will be arranged for you. A small tube is also placed through the skin into the underlying wound to drain any blood that may collect. This "drain" is usually removed after a few days.

Will I have a scar?

All cuts made through the skin leave a scar but the majority if these fade with time. The scar on your tummy is usually around 9" long (23cm).

What are the possible problems?

There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

  • Bleeding - since a "drain" is inserted into your pelvic wound bleeding is unusual.
  • Infection - you will be given antibiotics through a vein whilst you are asleep and for the first few days after surgery. As a result infection is not normally a problem.
  • Numbness - occasionally a patch of skin over your thigh will feel numb and tingly after the operation. This numbness may take several months to disappear and in a minority of patients may last for ever.
  • Hernia - in addition to removing bone from your pelvis your surgeon may also remove a neighbouring muscle. This is necessary if some of the soft tissue lining inside your mouth has also to be replaced. If part of a tummy muscle is removed the area is usually strengthened with a synthetic plastic sheet when the wound is closed. Despite this the tummy muscles may be weakened. This can produce a bulge in the area. Rarely hernias may occur months or even years after surgery.
  • Flap failure - in 2 - 5% of cases one of the blood vessels supplying or draining the flap can develop a blood clot within it. This means that the flap doesn't get any fresh blood or, if the drainage vein clots, then the flap becomes very congested with old blood. If this occurs it usually happens within the first two days and means that you will have to return to the operating theatre to have the clot removed. Removing the clot is not always successful and on these occasions the flap "fails" and an alternative method of reconstruction sought.
Will my walking be affected?

You will be on bed rest for three or four days after surgery. Soon after you will start sitting out in a chair. With the help of physiotherapists you will start to walk at the end of the first week. You should be climbing stairs by about the third week after surgery.

Although you may need some help with walking when you leave hospital (eg a stick) most people end up walking normally after a few months.

*Information kindly provided by the British Association of Oral and Maxillofacial Surgeons www.baoms.org.uk