To Penny

[Guest guest]

Hi Penny,

It is nice to finally have a joint replacement and orthognathic

surgery buddy although it is bad for both of us to have this

problem. How long ago was your joint replacement? Mine was in

January 2004 so I'm a little over a year out. So far the joints are

holding up well.

I'll be having my sixth jaw surgery on May 11. Previously, before my

joint surgeries, I had orthognathic surgery to correct my

open/overbite. The hope was that by correcting by bite, we could

stop the deterioration of my joints. My surgeon did it in two

stages. First, he used distraction to advance my lower jaw 17 mm and

in the second, he did a Lefort I to move my upper jaw 5 mm so I had

a total of 22 mm movement. Unfortunately, the joints did continue to

deteriorate so I had more surgery. The next one was bilateral

arthoplasty with temporalis muscle grafts to replace the cartilage

(the discs were long gone). The cartilage held up but the bone

continued to disintegrate. Therefore the bilat joint reconstruction.

We grew about 15 mm of bone on each side to make condyles. So I had

a total of 32 mm of new bone on each side or 64 mm total of new bone

in my lower jaw. Surgery #5 was to remove the distractors and mold

the new bone into position.

However, after all that, with my new joints and condyles, my bite

doesn't line up anymore. Now I have about a 6-7 mm anterior open

bite so in May, I'll have another Lefort procedure to close the

bite. I do have some assymetry of the lower jaw as well so they will

align the upper jaw with the lower. To achieve a perfect bite, they

(I have two surgeons - one orthognathic and one for the TMJ) would

have to do both upper and lower jaw surgery but both surgeons agree

it's too risky to cut into my lower jaw again. We're going for

functional.

I'm a little nervous (okay, a lot nervous) about going through

surgery again and worried about the joints. But if we don't do

anything, they're worried the jaw imbalance will put too much stress

on the joints and cause them to fall apart again. I can't wait for

this next surgery to be over with. Since I've gone through it

before, at least I know what to expect.

You're right. There are only a few surgeons that perform these

surgeries. I'm in Charlotte, NC. Where are you and your surgeon? I

wish I could have been at the major oral surgery conference

recently. There was a panel discussion on TMJ joint reconstruction.

One surgeon discussed using bone grafts (ribs), one discussed

artficial joints and one (mine) discussed distraction using me as

his case study.

Definitely email me minirascal@... . I want to hear more about

your experiences too.

>

> I am a 39 year old who just had bilateral joint replacements. I

> could not have the distraction osteogenesis because of asymmetry

> issues. Down the road I maybe able to to the distraction when the

> joints need to be replaced. I had the asymmetry fixed with a

LeFort

> I on Jan 12. I have been getting lots of info from this group. I

am

> also in physical therapy with an experienced TMJ therapist. I am

> curious as to where and what surgeon did your bilateral joint

> replacements. From the info you have shared, sounds alot like my

> surgeon and some of the procedures he uses. I know there are only

a

> select few surgeons in the US that perform this surgery. You can

> email me directly at pennycraig@c... if you like. I would

> love to hear your experiences. I have had a difficult time in

> finding another bilateral TMJ joint replacement buddy, also one

that

> has experienced orthognathic surgery as well.

>

>