Chronic Pain

Good afternoon. I used to write back on tmjfriends and haven't checked in for a while. I have had left jaw joint problems and have always known it was a problem but didn't want to deal with it. Well, I have now decided to deal with it and feel pretty good. I got my insurance to help me out after letter after letter of help and appeals. I have listed below the letter from my Dr. on my upcoming surgery in a few weeks. Can anyone help me out and let me know what is going to happen? Will it help? Could it cause more problems?

Underone idiopathic left condylar resorption. The mandibular condyle on the left side is almost completely gone as evidenced by the enclosed radiographs. Jaw has settled back to the left side and the upper jaw has tilted downhill to the right to accommodate the poor position of the lower jaw. There is not a non-surgical treatment available.

MRI Results:
On the left the mandibular condyle is seated within the temporal fossa on closed mouth views. There is significant deformity of the mandibular condyle suggesting degenerative change. There is marrow edema within the condyle. There does apear to be a shallow and broad temporal fossa on the left. There is anterior displacement of the articular disc on closed mouth view. With opening there is limited anterior transitional movement of the condyle to a point inferior to the temporal eminence. There is no significant reduction of articular disc. There is a moderate sized effusion on the left.

CORRECTION will require a Le Fort I osteotomy as well as a mandibular sagittal split osteotomy and bilateral reconstructive arthroplasties of his temporomandibular joints. The services of an assistant surgeion as well as the use of prefabricated acrylic splints will be necessary. Unless problems arise, he will be able to be treated on a 23 hour observation basis. This treatment is entirely rendered to correct the underlying bony abnormalities and has no cosmetic or dental component involved. Patient does understand that he may be required for a full joint replacement if this does not hold up.

Sorry for the novel but I need some help. I happy to get this process underway now that I have accepted it. Anyone have any experience with this? What are the odds this works?

Thank you all so much,

Michael

quote:

CORRECTION will require a Le Fort I osteotomy as well as a mandibular sagittal split osteotomy and bilateral reconstructive arthroplasties of his temporomandibular joints. The services of an assistant surgeion as well as the use of prefabricated acrylic splints will be necessary. Unless problems arise, he will be able to be treated on a 23 hour observation basis. This treatment is entirely rendered to correct the underlying bony abnormalities and has no cosmetic or dental component involved. Patient does understand that he may be required for a full joint replacement if this does not hold up.

Hi Michael,
I'm sorry to hear of your problems with your jaw, however, I am really happy to hear that you have decided to go forward with treatment and accept your condition. This is great, as hopefully you will feel much better once it's over with!
As I go through your doctor's letter (thank you for posting this, by the way - it makes my reply easy when I have all the info!), I notice that you will have these surgeries:
1. Le Fort 1 Osteotomy
2. Mandibular Sagittal Split Osteotomy
3. Bilateral Reconstructive Arthroplasties

A Le Fort 1 Osteotomy is when your doctor makes a cut to separate the maxilla and the palate from the skull above the upper teeth. The incision is made inside the upper lip, and then the maxilla is screwed in place. This normally takes about 3 hours.
Sometimes, the Le Fort 1 Osteotomy is also done with a Sagittal Split Osteotomy, like in your case. This is called a "Bimaxillary Osteotomy."
A Sagittal split osteotomy is when the lower jaw is cut by the wisdom teeth. This allows the jaw to be pushed forward or back depending on your specific issues. After that it is fixed in it's new position with screws/plates, like the Le Fort.
As far as the arthroplasties go, arthroplasty literally means "open joint." The incisions will be down your ear, like a face lift incision. During the arthroplasty, the doctor will take a look at the joint. This allows him to remove any adhesions (scar tissue), osteophytes (bone spurs), or bony ankylosis (fusion of the joint), etc. The disc, if present, is examined. It's position, thickness, smoothness, and flexibility is noted. The bony surfaces of the TMJ are examined, and special care is taken to identify rough surfaces, sharp edges, cavities, or other anatomical abnormalities. The surgeon can then repair discs if they are healthy by suturing them into place. If the disc(s) are damaged beyond repair, they must be removed. This type of arthroplasty is called a discectomy. The surgeon can then implant something to replace the disc, which can include anything from temporalis muscle (temple muscle) to ear cartilage or other tissue.

As far as recovery goes, I have not had either a Le Fort Osteotomy or Sagittal Split Osteotomy. I however, have had several types of arthroplasties. The recovery for an arthroplasty has varied among the type of arthroplasty I have had, but it can be anywhere from 2 weeks to 6 weeks.

I do like that your doctor includes that you will be staying in the hospital overnight. As a patient, I highly recommend this. When I have stayed in the hospital following surgery, my recovery has been significantly shortened compared to the arthroplasties without hospital stay. I think this has to do with focusing on recovery and having adequate pain relief.

As far as odds of these procedures working, it is difficult to say. The orthognathic procedures (osteotomies) you will be having are generally extremely successful. Many people have these each year and go on to have no problems. The sticky part here is the actual TMJ surgery. As you know, there are no guarantees with TMJ surgery. Sometimes it works, and sometimes it doesn't. It also depends on what type of arthroplasties you will be having.
Do you know what your doctor means by "reconstructive arthroplasty"?

I hope this helped. I did some research on surgery for condylar resorption, and will be replying with a specific study next. Feel free to ask any questions.

Please know that we're all here to support you through your journey. Please keep us updated!
Sincerely,
Stacy

Here is the study I mentioned regarding condylar resorption. If you would like to research yourself, please visit http://www.pubmed.com

Please also note that this study was published in 2002. I couldn't find a specific study that included all of your issues that was newer, but I think this will give you an idea of the success rates of your surgeries.

Concomitant temporomandibular joint and orthognathic surgery: a preliminary report.
Wolford LM, Karras S, Mehra P.

Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A & M University System, Dallas, TX, USA. lwolford@swbell.net

PURPOSE: In the present study, we evaluated the outcome of concomitant temporomandibular joint (TMJ) and orthognathic surgery in patients with TMJ articular disc dislocation and coexisting dentofacial deformities. PATIENTS AND METHODS: The records of 70 patients treated with TMJ articular disc-repositioning surgery and concomitant orthognathic surgery (double jaw or only mandibular surgery) were retrospectively evaluated. Patients were divided into the following 3 groups: group 1 patients had mandibular advancement, group 2 patients had mandibular setback, and group 3 patients had a mandible that remained in the original position. Lateral cephalometric radiographs and lateral cephalometric tomograms were assessed at the following intervals: before surgery (T1), immediately after surgery (T2), 6 to 12 months after surgery (T3), and at the longest follow-up (T4). Lateral cephalometric tracings were superimposed to calculate surgical change (T2 - T1), short-term stability (T3 - T2), and long-term stability (T4 - T3) of the orthognathic surgery procedures. Maximum interincisal opening (MIO) and subjective TMJ pain (visual analog scales) were comparatively evaluated at T1 and T4. RESULTS: Subjective TMJ pain levels and MIO improved in all 3 groups after surgery. Before surgery, 56 of 70 patients (80%) had pain and 14 of 70 patients (20%) had no pain. At the longest follow-up, 42 of 70 patients (60%) reported complete relief of TMJ pain. Only 5 of 70 patients (7%) had severe pain after surgery compared with 37 of 70 patients (53%) before surgery. At the longest follow-up, 6 of 70 patients (9%) showed less than 35 mm MIO, residual severe pain, or both. One patient had significant condylar resorption after surgery. The orthognathic procedures were found to be stable in the long term. Concomitant TMJ and orthognathic surgery had an overall success rate of 91.4% based on a greater than 35 mm MIO and a decrease in pain. CONCLUSIONS: When indicated, TMJ and orthognathic surgery can be concomitantly performed with predictable results and a good success rate. Strong consideration should be given to early surgical intervention because the success rate decreases significantly with pre-existing TMJ dysfunction of greater than 48 months' duration. Copyright 2002 American Association of Oral and Maxillofacial Surgeons


Hope this helps!
Stacy

Hi Vasque,
I just wanted to check in with you and see if you had any news regarding your treatment or surgery?
I hope you are doing better!
Sincerely,
stacy