TMJ surgery after orthognathic surgery?

[Guest guest]

Hi all,

On July 22nd of this year I had a bilateral sagittal split to

correct assymetry, a bad bite, and TMJ symptoms. We knew it was a

possibility it would not help the TMJ, and could even aggravate it,

but without the surgery to correct my bite, there was no possibility

of improving the TMJ at that time.

Now at 12 weeks postop it may be possible that I could be facing

having TMJ surgery since the BSSO didn't correct the problem (it did

a beautiful job on my bite though. My teeth are aligned

perfectly!). My OS has concerns that my jaw is locked on one side,

and has sent me to physical therapy to see if that will help before

he does an MRI.

My question is this. Has anyone else had TMJ surgery along with

orthognathic surgery? Which did they have performed first? Also,

what is the recovery like from TMJ surgery? Is it similar to

orthognathic surgery? Also, I had a friend who had TMJ surgery, and

she said she had to wear a splint for a year prior to surgery. Is

that common?

Any and all comments would be greatly appreciated. Thanks for all

of your time.

Connie

[Guest guest]

Hi Connie,

I'm sorry to hear about your TMJ problems. My TMJ got worse after

orthognathic surgery, too. I had read in one of your previous posts

about your opening and being able to chew soft foods. Three months

after my surgery, I was only able to force my jaw open 6 mm. My

surgeon tried doing arthrocentesis (flushing out the joints and

injecting steroids) first to try to free up my joints but it didn't

work. Then I had an MRI that showed my left condyle had completely

eroded away and the right joint was fused (ankylosed). I ended up

having four TMJ surgeries after that with the last one being

bilateral total joint replacements.

I've also had numerous courses of physical therapy after the

surgeries which helped a lot. I did have to wear a splint and have

been told that I will continue to have to do so to protect the

joints. I didn't have to wear the splint before any of my TMJ

surgeries. Maybe your friend's surgeon wanted her to wear the splint

first for a year to see if that would help her TMJ and possibly

avoid surgery?

My first TMJ surgery, arthroplasty, wasn't bad at all. My surgeon

took part of my temporalis muscle from my scalp and grafted it into

the joint to replace the cartilage. My discs were already long gone.

I felt so much better immediately after the surgery because I was

finally able to open and the constant pain was almost completely

gone. I went back to work after two weeks. The other TMJ surgeries

were much more painful and more difficult from than my orthognathic

surgeries. The good thing about TMJ surgery vs orthognathic surgery

is that you are able to and supposed to start opening exercises

immediately post-op to rehabilitate the joints instead of being

banded or wired shut. You're usually able to progress to a soft chew

diet pretty quickly.

I hope the physical therapy does the trick for you. Keep us updated.

>

> Hi all,

>

> On July 22nd of this year I had a bilateral sagittal split to

> correct assymetry, a bad bite, and TMJ symptoms. We knew it was a

> possibility it would not help the TMJ, and could even aggravate

it,

> but without the surgery to correct my bite, there was no

possibility

> of improving the TMJ at that time.

>

> Now at 12 weeks postop it may be possible that I could be facing

> having TMJ surgery since the BSSO didn't correct the problem (it

did

> a beautiful job on my bite though. My teeth are aligned

> perfectly!). My OS has concerns that my jaw is locked on one

side,

> and has sent me to physical therapy to see if that will help

before

> he does an MRI.

>

> My question is this. Has anyone else had TMJ surgery along with

> orthognathic surgery? Which did they have performed first? Also,

> what is the recovery like from TMJ surgery? Is it similar to

> orthognathic surgery? Also, I had a friend who had TMJ surgery,

and

> she said she had to wear a splint for a year prior to surgery. Is

> that common?

>

> Any and all comments would be greatly appreciated. Thanks for all

> of your time.

>

> Connie

>

[Guest guest]

,

Thanks so much for your reply so quickly. The main thing that

concerned me with this was that my OS started to tell me what the

surgery would involve, and then he stopped himself and said, " Well,

let's just wait to see if it's necessary before I describe what's

involved. " It got me a little worked up since he always explains

possible procedures and complications in detail, and didn't in this

case.

I'm actually not too upset with the possibility of needing this

done. I see such great results from my orthognathic surgery and

would do it again in a heartbeat. So, I figure if this is something

that is necessary, that after it's all said and done, in the future

I'll be glad I had it done. It's just one more step in my process

of trying to live a painfree life.

Over the course of how many years did they do your four surgeries?

Did they ever think in the beginning things would be that severe?

I'm very glad I did all my research in the beginning, and had a

doctor who told me all the risks of further TMJ problems. I did not

go into orthognathic surgery believing it would be a cure all for

all my problems, I just " hoped " it would be. Maybe after physical

therapy I'll find that my first surgery did cure it all. That'd be

nice, wouldn't it?

Connie

> >

> > Hi all,

> >

> > On July 22nd of this year I had a bilateral sagittal split to

> > correct assymetry, a bad bite, and TMJ symptoms. We knew it was

a

> > possibility it would not help the TMJ, and could even aggravate

> it,

> > but without the surgery to correct my bite, there was no

> possibility

> > of improving the TMJ at that time.

> >

> > Now at 12 weeks postop it may be possible that I could be facing

> > having TMJ surgery since the BSSO didn't correct the problem (it

> did

> > a beautiful job on my bite though. My teeth are aligned

> > perfectly!). My OS has concerns that my jaw is locked on one

> side,

> > and has sent me to physical therapy to see if that will help

> before

> > he does an MRI.

> >

> > My question is this. Has anyone else had TMJ surgery along with

> > orthognathic surgery? Which did they have performed first?

Also,

> > what is the recovery like from TMJ surgery? Is it similar to

> > orthognathic surgery? Also, I had a friend who had TMJ surgery,

> and

> > she said she had to wear a splint for a year prior to surgery.

Is

> > that common?

> >

> > Any and all comments would be greatly appreciated. Thanks for

all

> > of your time.

> >

> > Connie

> >

>

[Guest guest]

Hi Connie,

Yeah, we were very aware of the risks going into this surgery. I

have had joint problems since early childhood and had braces for 7

years back then. I was finally diagnosed and started treatment for

my TMJ when I was 14. However, other than splints and arthrocentesis

every time my jaw locked, there were no surgical options then in the

early 80's.

I finally started on this orthognathic journey when I went on active

duty in the military in 1994. The TMJ specialists and the surgeons

felt that surgery was the best option for me to try to preserve my

joints and my teeth. I was turned down by two orthodontists who only

treated surgical cases because they felt my case was too risky.

Since I was active duty, they were the only OD I could go to.

Finally after a lot of convincing from the TMJ specialist, the

surgeons, an endodontist and a periodontist, one of them finally

agreed to take me on. I had my braces put on in May 1996 starting

with just lowers for a year to reduce stress on my joints and teeth.

No one ever promised me a cure, just a chance to preserve my teeth

and joints.

I finally had the orthognathic surgery in 2002. It was done in two

stages to reduce the stress on the joints. My lower jaw was advanced

gradually using distraction osteogenesis and the upper jaw surgery

was two months later. Despite the precautions, my joints only got

worse. I had six surgeries in less than three years.

I don't regret the orthognathic surgery. I think if I hadn't had it

done, my joints would still have ended up deteriorating. My bite had

already shifted a lot from the mainly open bite I had in college to

the 17+ mm overbite I had at the time of surgery. That was because

of bone loss in the joints.

The only thing I would have done differently if I had had a crystal

ball would be to go to the artificial joints directly instead of the

other TMJ surgeries first. My surgeon was very reluctant to put in

artificial joints because of my age and because they will never be

fully functional. With joint replacement, you lose the ability to

move your jaw forward and back and side to side so it makes it

nearly imposssible to grind food. I hope it never comes to that for

you.

Here's to physical therapy!

> > >

> > > Hi all,

> > >

> > > On July 22nd of this year I had a bilateral sagittal split to

> > > correct assymetry, a bad bite, and TMJ symptoms. We knew it

was

> a

> > > possibility it would not help the TMJ, and could even

aggravate

> > it,

> > > but without the surgery to correct my bite, there was no

> > possibility

> > > of improving the TMJ at that time.

> > >

> > > Now at 12 weeks postop it may be possible that I could be

facing

> > > having TMJ surgery since the BSSO didn't correct the problem

(it

> > did

> > > a beautiful job on my bite though. My teeth are aligned

> > > perfectly!). My OS has concerns that my jaw is locked on one

> > side,

> > > and has sent me to physical therapy to see if that will help

> > before

> > > he does an MRI.

> > >

> > > My question is this. Has anyone else had TMJ surgery along

with

> > > orthognathic surgery? Which did they have performed first?

> Also,

> > > what is the recovery like from TMJ surgery? Is it similar to

> > > orthognathic surgery? Also, I had a friend who had TMJ

surgery,

> > and

> > > she said she had to wear a splint for a year prior to

surgery.

> Is

> > > that common?

> > >

> > > Any and all comments would be greatly appreciated. Thanks for

> all

> > > of your time.

> > >

> > > Connie

> > >

> >

>