Re: Relapse problems (TMJ resorption) PLEASE HELP!!! - to Julz

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Hi Julz,

Sorry for the delay in replying but I'm still recovering from my

last (and final, I hope) surgery 5 days ago. I had condylar

resorption as well which caused my overbite to relapse 8 mm although

it never got to the almost 20 mm overbite I had originally. My

original surgeon did everything he could to minimize the stress on

the joints which were already in bad shape since childhood. No one

can say for sure why it happens but we are fortunately in the

minority. Have you had a complete physical by your primary care

doctor? My TMJ surgeon insisted on that to rule out any other

rheumatological disorder such as lupus or rheumatoid arthritis which

could cause continued destruction of the joints.

Get as many opinions as you can and pick someone you are comfortable

with. There are various approaches to treating severe arthritis to

the TMJ joints. My surgeon was recently part of a panel that debated

at a large TMJ conference. He discussed distraction osteogenesis

(using me as his most recent example), another discussed artificial

joints (made out of the same material as artificial hips) and

another argued for using rib grafts. Hopefully you won't need

anything as drastic.

My surgeon initially used a more conservative approach using a

temporalis muscle (one of the scalp muscles) graft into the joint to

create cartilage and replace missing bone. Others here (including

) have had this done with great success. Only when that failed

did my surgeon want to do more radical surgery. He gave me the

option between artificial joints and distraction osteogenesis and I

chose distraction because my own bone was used to recreate condyles.

Many times artificial joints have to replaced after 10-15 years at

best. Since I'm only 37 that would mean many more surgeries in my

future which I most definitely don't want.

Here is a website that diagrams distraction. By the time of surgery,

my mandible looked like the class II-b but on both sides. We ended

up with 15 mm of new bone growth to create condyles.

http://www.klsmartin.com/MOD-line/molina.htm#Distraction%20Technique

Good luck. I hope you can find someone who can help you. Make sure

that person is very experienced and someone you feel comfortable

with. Hopefully you can benefit from a more conservative approach.

> > Hi

> > I went to see the maxillofacial surgeon today regarding my

relapse

> (

> > I had upper and lower advancements in March 2002). The xrays

> showed

> > up the problem, I've had bone resorption at the TMJ's. The

plate

> > and screws are in place (lower jaw) but because my muscles were

> > pulling and wanting to go back to their original position it has

> > caused my bottom jaw to pull back and up causing the TMJ bone

> > resorption. My bottom jaw is pretty well back to its pre

surgical

> > position and another surgery on the bottom is out of the

question

> as

> > I will most likely have more bone resorption and there will be

more

> > pressure at the TMJ's. They are going to put my case to about 10

> > maxillofacial surgeons and get opinions and find out what the

best

> > option is.

> > Also my maxilla has dropped a couple of mm (may be because of

all

> > the pressure on my TMJ's), so basically surgery again to the

upper

> > to help compensate might be the only option. I have to go back

in

> a

> > week, get more moulds done and some TMJ xrays. I'm so upset, my

> > main problem initally was my bottom jaw. I hated how I had an

> > underbite. They gave me the option to have the upper done as

> > getting them both done would give me optimal results. So now I

> have

> > problems with both jaws, I have an underbite again and severe

pain

> > in my TMJ's.

> >

> > I would really love any advice or opinions on what I should do.

> >

> > Thanks so much

> > Julz