Re: New to the group - to Greda

[Guest guest]

Hi Greda,

I have had 4 jaw surgeries so far - two to correct my bite and two

on my TMJ's. My TMJ problems stemmed from being born with an

underdeveloped mandible which caused my joints to dislocate

repeatedly when I was about 9 or 10. Fortunately (after hearing

about others' bad experiences with TMJ surgery in the early 80's)

the TMJ specialists I was seeing at the time always advised me to

avoid surgery at all costs. However my joints continued to

deteriorate and I had a lot of bone loss. I had had mainly an open

bite as a teenager (large enough to easily stick my finger through

when I was biting down) but that developed into an overbite as well

that kept getting worse. By the time I had my first surgery, I had

an almost 20 mm overbite.

I was finally persuaded to do something about my bite after I saw

numerous dentists, oral surgeons and TMJ specialists (including my

pediatric dentist who had years earlier warned me away from

surgery). They felt that the stress of trying to force my teeth

together was making the joints worse and we could hopefully halt the

progression of the arthritis through orthognathic surgery.

After 6 years of braces, I finally had my first surgery in Sept

2002. The surgeon did everything possible to minimize further stress

on the joints. He did the surgery in two stages. First, he advanced

my mandible gradually by using distraction osteogenesis for total of

17 mm. Then in November 2002, he moved the upper jaw 5 mm (Lefort

I). I finally had a perfect bite for the first time in my life.

Unfortunately, it didn't last very long. Instead of getting better,

my joints got worse. The condyles (what there was of them) rapidly

deteriorated. Within 6 months, I had an 8 mm overbite and my lower

jaw was deviated to the left. That was when I had my first TMJ

surgery. My TMJ surgeon wanted to be as conservative as possible. He

did a temporalis muscle (one of the scalp muscles) graft into the

left joint to replace the cartilage. On the right, he salvaged part

of the disc and sewed it back in place. It held for a few months and

then my bite was off again and my opening was very limited. A CT

scan showed that while the muscle graft had healed well and was

holding, the left condyle was now completely gone. The right joint

was fused and had avascular necrosis (dead bone). We had been hoping

to put it off for years but now we didn't have a choice. I either

needed a joint reconstruction or artificial joints.

We opted for the joint reconstruction. It (theoretically) has better

long-term results than artifical joints which last, at best, 10-15

years. Since I'm only 37, that would mean multiple surgeries in my

future. In January, the condyles were reconstructed using

distraction again. We achieved 15 mm of new bone growth on each

side. I also had the temporalis muscle graft on the right. Right

now, everything is holding up well and my bite is perfect again.

Next week, the distractors come out and my surgeon will apply bone

plates to hold everything in place. Then I will start aggressive

physical therapy to get the range of motion back. Right now my

opening is only 12 mm because the muscles have atrophied and there

is a lot of scar tissue. I'm being cautiously optimistic that

everything will work this time. My surgeon is so happy about the

results so far that he presented my case at a recent TMJ conference.

I hope he's right.

I really hope the orthognathic surgery helps you and gets you relief

from the pain. I can really empathize with the constant pain and

getting tired of having surgery after surgery. Even if this doesn't

work, I quit. No more surgery for me. I'll live with whatever the

results are. If it's any consolation to you, the Lefort I was the

easiest jaw surgery I went through, much easier to recover from than

the TMJ surgeries. I wish you all the best.