Bilateral arthroscopy, now condylotomy, then orthognathic surgey!

[Guest guest]

Please help me. I need advice. I had a bilateral arthroscopy with

suture plication in October 2003. I was doing great until december

2003. It's been downhill from there. I have been in the worst

pain. It's depressing and it's has affected my whole life. Now, my

doctor wants to make an incision around my condyles and wire my jaw

shit for 10 days. I am scared and I have little faith that this

proceedure will actually work.

The original plan when I began seeing these surgeons was to have the

orthognathic surgery, not it keeps being put off because of all of

the treatment I have had regarding my joint.

I guess I just dont understand how the orthognathic surgery wouldn't

help my joint, but the surgeons tell me that it is all seperate.

Can anyone give me some advice?

I really need it.

Thank you,

Lari

lamibu13@...

[Guest guest]

Well, I'll do my best to share what knowledge I have.

I've had an arthroscopy on my left TMJ, so I can relate to that.

I'm not sure what a suture plication is, but I'm guessing the docs

tried to stitch your discs into place. From discussions I've had

with my own oral surgeon, he doesn't do this procedure because it is

rarely successful. He believes the stitches are too easy to break.

My arthroscopy was successful in that it stopped my left joint from

locking shut every time I feel asleep. I had that procedure in May

2001.

Once my bite settled, my oral surgeon took one look at my occlusion

and recommended I consider orthognathic surgery. The idea behind it

was to correct my bite so my joints had a better foundation, so to

speak. There are no guarantees with orthognathic surgery, and mine

proved that. I had upper (to widen) and lower advancement in March

2003. During recovery when I was finally permitted to sleep lying

down, I found I couldn't sleep through the night because I'd wake up

feeling like someone was sticking an ice pick into my left joint.

It was awful. So I had an arthrocentisis on that joint when I was

seven weeks post-op. Forgive me if you already know this, but an

arthrocentisis is a procedure where they flush out the joint with

saline and then inject anti-inflammatory steroids around the joint.

I've actually had two of these, and both were done in my surgeon's

office while under anesthesia (not the big surgery kind where they

intubate you). It helped, and I've been okay since then, though jaw

pain has become a way of life for me. My left joint is now

considered moderate (it was mild when I had the arthroscopy) and I

had no problems with my right joint pre-op, though it is now nearly

in the same shape as my left joint was three years ago. So,

orthognathic surgery is somewhat separate from the joints.

From what I know, there are two schools of thought among

maxillofacial surgeons regarding how to treat TMJ dysfunction. Some

do everything they can to get a joint as normal as possible before

doing orthognathic surgery. Others try to get the joints tolerable

for their patients before orthognathic surgery. My surgeon is from

the latter group.

Given the continued problems I'm now having with both joints, he has

discussed open joint surgery with me, which is what it sounds like

your surgeon(s) want to do with you. It would be a three inch

incission in front of my ear. My disc would likely be removed going

by results of a recent MRI, but were it in decent enough shape, my

surgeon told me about a titanium harpoon-like device that doctors

are now using to secure the dics where it's supposed to be. This is

apparently much more successful than stitching the discs back into

place.

I'm opting not to have open joint surgery for now. I take Vioxx

every day to help with the pain. After all, I've been diagnosed

with osteoarthritis in my left joint since I was 24. I'm now 27 and

consider myself lucky that the pain is mostly tolerable. I don't

eat foods that are too hard to chew, and I don't chew gum either. I

do ice my joints relatively regularly and just generally try to live

with this until I get worse... and it is likely that I will get

worse and have to have more surgery or surgeries in the future.

So, I feel for you. I know what the pain is like, and I can also

understand why your surgeons may be delaying orthognathic surgery

while they get your joints calmed down. It may be likely that they

feel they need to get them calmed down so they can see how your bite

falls right now. With all that inflammation in your joints,

orthognathic surgery may be more likely to be unsuccessful because

the docs correct the jaws based on how your teeth come together, and

your teeth aren't meeting under normal circumstances if you have all

this joint pain.

Hang in there. Remember that you are the customer and every doctor

has the responsibility to answer any questions you ask. Many of us

have had success with Vioxx. If you are not already on something

like it, it may be helpful to ask your docs about whether or not

using it would be right for you.

I do wish you the best.

> Please help me. I need advice. I had a bilateral arthroscopy

with

> suture plication in October 2003. I was doing great until

december

> 2003. It's been downhill from there. I have been in the worst

> pain. It's depressing and it's has affected my whole life. Now,

my

> doctor wants to make an incision around my condyles and wire my

jaw

> shit for 10 days. I am scared and I have little faith that this

> proceedure will actually work.

>

> The original plan when I began seeing these surgeons was to have

the

> orthognathic surgery, not it keeps being put off because of all of

> the treatment I have had regarding my joint.

>

> I guess I just dont understand how the orthognathic surgery

wouldn't

> help my joint, but the surgeons tell me that it is all seperate.

>

> Can anyone give me some advice?

>

> I really need it.

>

> Thank you,

> Lari

> lamibu13@y...

[Guest guest]

Hi Lari,

I've had several TMJ surgeries as well as orthognathic surgeries, so

far a total of 5 jaw surgeries in the last two years. I was born

with unusually small condyles so I had TMJ problems for most of my

life. My joints started dislocating when I was 9 or 10 years old. My

orthodontist didn't believe me at the time so I actually didn't get

any treatment for my joints until I was 14. Then I was treated with

splints, arthrocentesis and joint manipulations. After I turned 20,

I had years where I had very little pain despite a CT showing severe

degeneration of the joints. The TMJ specialists recommended I

undergo orthognathic surgery to correct my ~20 mm overbite to

minimize stress on the joints and prevent my joints from

deteriorating further. Since I wasn't really having joint pains at

the time, they recommended we leave them alone since joint surgery

can be risky. At the time, I was told that about 85-90% of TMJ

patients get improvements in their symptoms after orthognathic

surgery but I was also warned that the TMJ could get worse.

My orthognathic surgery was planned in two stages because of the

large movements involved and to minimize stress on the joints. In

Sept 2002, my lower jaw was gradually advanced 17 mm using

distraction osteogenesis. Two months later, the distractors were

removed and the upper was moved 5 mm. Afterwards my bite was perfect

but I could only open 6 mm 3 months post-op despite aggressive

stretching exercises. I ended being one of those whose joints got

worse, much much worse.

My first surgeon (who does orthognathic surgery exclusively) then

referred me to a TMJ surgeon. After reviewing my MRI, which showed

that my discs were completely gone and had been gone for years, the

surgeon tried to be as conservative as possible and did

arthoplasties. He took part of the scalp muscle and grafted it into

the joints to replace the missing cartilage and discs. Again we were

hoping that this would prevent the bones from deteriorating. This

worked for a few months and then, like you, the pain came back. More

scans now showed that the little stub of a condyle I had had on the

left was gone and the right condyle had avascular necrosis (dead

bone). We had no choice but to pursue more aggressive surgery. My

choices were bilat artificial joints or joint reconstruction using

distraction osteogenesis.

I chose the distraction again. Last January, I underwent bilateral

condylectomies, coronoidectomies and placement of the distractors.

Over a two week period, we rebuilt the condyles 15 mm. So far the

surgery has been a success. I can now finally chew soft foods like

chicken or fish which is a huge accomplishment for me. The pain is

much less than before and I can control it by taking Celebrex two or

three times a day. I don't ever expect to be normal but I feel a

thousand times better than I did before.

The main problem I have now is that I have an open bite. After the

condyles were reconstructed, my upper jaw no longer matches the

lower. I will need to have one additional surgery to correct that.

We are putting that off at least a year to make sure that the joints

are completely healed and stabilized.

I am not familiar with the procedure you're having but it sounds

like your surgeon wants to get your joints in the best shape

possible before the orthognathic surgery. The orthognathic surgery

puts a lot of stress on the joints so you want the joints to be as

stable as possible beforehand. Also the joint surgery itself can

change your bite so it makes sense that your surgeon would want to

do the surgeries separately. Good luck with your procedure. I hope

it helps.

> Please help me. I need advice. I had a bilateral arthroscopy

with

> suture plication in October 2003. I was doing great until

december

> 2003. It's been downhill from there. I have been in the worst

> pain. It's depressing and it's has affected my whole life. Now,

my

> doctor wants to make an incision around my condyles and wire my

jaw

> shit for 10 days. I am scared and I have little faith that this

> proceedure will actually work.

>

> The original plan when I began seeing these surgeons was to have

the

> orthognathic surgery, not it keeps being put off because of all of

> the treatment I have had regarding my joint.

>

> I guess I just dont understand how the orthognathic surgery

wouldn't

> help my joint, but the surgeons tell me that it is all seperate.

>

> Can anyone give me some advice?

>

> I really need it.

>

> Thank you,

> Lari

> lamibu13@y...