Chronic Pain

hi gang,
i wanted to see if any of you have had a christensen fossa plate put into your TMJ? instead of my previously posted thoughts of having a discectomy - that is no longer appropriate since i do not have a disc in the left side of my jaw anymore!!!! yikes!

so, the doc recommends that i have a christensen fossa eminence prosthesis put in.

having oodles of fun with the insurance (Cigna). so much fun that i've decided to drop them (my husb's coverage) and get BCBS through my employer.

Hi Lexi,
Ahh, fun with insurance... we've definitely all been there. May I ask where you live? This is important because some states have laws regarding TMJ surgery, and this would force your insurance to pay for any surgical procedures. Has your doctor written the insurance a letter of medical necessity? This is basically a letter stating why you need the treatment. The appeal process (once you are denied the surgery) sometimes works as well. Insurance companies figure that you will give up once they deny you once and don't expect you to fight. Sometimes if you do fight, you win. Although I would hardly call getting approval for a surgery winning, lol.
Anyway, regarding the fossa prosthesis... I have not personally had one of these, but have known those who have. I currently have bilateral TMJ Concepts joints, which are custom joints made to the patients exact anatomy.
It's obviously hard to say if the prosthesis will be successful for you, but I can tell you a couple concerns that I do have regarding metal fossas in general, and ask a few questions...
1. Your condyle will be rubbing against this metal for as long as it is in place - this can cause erosion of the condyle and another lovely condition called metalosis, which is where the metal erodes and emits particles of it throughout your bloodstream.
2. Did your doctor explain why he would choose the fossa prosthesis over a full joint replacement?
3. As of right now, there are 3 companies making FDA approved TMJ devices. Christensen, Lorenz, and TMJ Concepts. The Christensen and Lorenz joints are stock, meaning that they are not patient specific. They have several sizes of the joint replacements and choose the one appropriate for you. I urge you to do research about the company that will be making your joint. Here are some places to start:
The FDA: http://www.fda.gov
The FDA's Consumer Update on TMJ Implants: http://www.fda.gov/cdrh/tjmimpl.pdf
FDA's Maude database, which lists problems with devices: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm

There is a search box at the main FDA site (fda.gov) that is really great, so you can just enter whatever company you are looking for info on and it will return a lot of results. Look through those and make sure you know what's going on with the company you choose.
Also, check out the TMJ Association's site at www.tmj.org.. they have news relating to FDA approvals, warning letters, etc.
Anyway, I just wanted to give you that info and encourage you to do some research. Let me know your thoughts on my comments/questions and we'll go from there.
As far as fun with Cigna goes - I've been in your exact position with them. I don't have that insurance anymore... but they were quite good with paying for the hospital costs.. just not the actual surgical fees.
Hope this helped!
Sincerely,
Stacy

Thanks for the awesome feedback. I am in clinical research, and so doing a lot of reading and research on my part is easy

However, I'm reading coflicting studies on the Christensen vs. Concepts. The doc wants to put me on his research protocol for Christensen vs. Concepts, and have me fitted with a concepts. I was happy about this, considering that they are metal on poly instead of metal on metal (Christensen).

CIgna won't pay and I don't want to go through the ringer with them, so I'm dropping them and gettnig the insurance thru my employer, which is BCBS - I can't wait - August 1 and I'm covered with them. Then I'll just need the doc's office to put everything through and I can schedule my surg.

There are only 2 spots left on the clinical trial, as of 4 weeks ago - so if there aren't any left when I schedule surg, it's going to be the Christensen for me.

Right now, I have no disc left on the left side, and severe osteo arthritis. He thought, given this etiology, my best bet is the Christensen/Concepts prosthesis.

I'm excited, but also a little scared. I've had surg before, and I'm usually never gunshy about it, but this is the most invasive surgery I've had so far. I've seen pics of the procedure, in steps - live, and I can't believe that will be my jaw - but if I feel better afterwards, I'll be happy!

ok - PS - Stacy, I'm in MN

PS again - Stacy, I was just on your site, and saw your posting about MEdtronic - I used to work for them - like 2 months ago

By the way, the TMJA has been providing only one side of the story regarding TMJI or Christensen joints. I had Christensens for 13 years; they were the wrong size and seated improperly (the surgeon completely ignored the warnings about the joints PROVIDED by TMJI and the FDA), and, I have the letters ,to and from TMJI and the FDA. I do get fristrated with the TMJA as they seem to have a reason (??) to want to put TMJI out of business. IF you want to know more about these prostheses, you can go to the source; tmj.com. Dr. Bob Christensen pioneered the wholeof TMJ replacements, initially coming up with the idea when he was a corpman in WW11. Sorry, I just had to put my two cents in regarding a man who has really gone out of his way to be much more than decent to me. Don't get that from a LOT of oral surgeons!!