Nicole23
01-15-2002, 11:28 PM
I am really at a loss. I don't know what to do. I have been told by a surgeon to get the Arthroscopy despite the fact that it won't help with the ear problems. I have been told not to get the Arthroscopy because it won't help with the ear problems, but to get a Disectomy because it will clear up the noises. I have also been told by another surgeon that the Arthroscopy and Arthrocentesis may make my problems worse, if I eventually need an open surgery. I have been told (by my Orthodontist) that Disectomies generally havent been done over the last 20 - 30 years because it could cause more scar tissue and create more problems, such as my jaw not being able to open. Who do I listen to? Please advise.
Sponsor
Elaine
01-16-2002, 12:53 AM
Nicole,
My first post disappeared so will try again.
My third surgery was to take out the disc. The first surgery was to put the disc back in place which was stupid as I wasn't in a lock, only popping and pain. The second surgery was to remove scar tissue, I had lost my opening. The third surgery the oral surgeon said I had such a build up of arthritis and scar tissue that he didn't know how I had functioned. That is when he took out the disc and put in the Christensen implant to replace the disc. Now my condyle is deteriorating due to metal against bone and of course more arthritis, not to mention that the screws in the implant are loose and needs to be removed. My opening after each surgery was always right around 23mm. I did physical therapy for months after each, trying to keep my opening. I am now down to 13mm again and can't eat solid food. The jaw pain and noise in my ear(gravel pit from arthritis) is nothing compared to the 6 to 8 hour puking headaches I get once a month.
You ask who to listen to??? I suggest your orthodontist for one. He is right about the scar tissue. Also if you decide surgery is your answer make sure you have insurance coverage for further surgeries as there won't be just one. TMJ surgery is a vicious
"Merry GO Round", unlike most merry go rounds this one is tough to get off, once you get on.
Elaine
My first post disappeared so will try again.
My third surgery was to take out the disc. The first surgery was to put the disc back in place which was stupid as I wasn't in a lock, only popping and pain. The second surgery was to remove scar tissue, I had lost my opening. The third surgery the oral surgeon said I had such a build up of arthritis and scar tissue that he didn't know how I had functioned. That is when he took out the disc and put in the Christensen implant to replace the disc. Now my condyle is deteriorating due to metal against bone and of course more arthritis, not to mention that the screws in the implant are loose and needs to be removed. My opening after each surgery was always right around 23mm. I did physical therapy for months after each, trying to keep my opening. I am now down to 13mm again and can't eat solid food. The jaw pain and noise in my ear(gravel pit from arthritis) is nothing compared to the 6 to 8 hour puking headaches I get once a month.
You ask who to listen to??? I suggest your orthodontist for one. He is right about the scar tissue. Also if you decide surgery is your answer make sure you have insurance coverage for further surgeries as there won't be just one. TMJ surgery is a vicious
"Merry GO Round", unlike most merry go rounds this one is tough to get off, once you get on.
Elaine
Nicole23
01-16-2002, 12:59 AM
Elaine, thanks for the advice. I haven't made any decision, but my Orthodontist is pushing me into the arthroscopic surgery and I was told that and/or the Arthrocentesis can make things worse, especially if I eventually need open joint surgery.
Elaine
01-16-2002, 04:06 PM
Surgery should only be considered after all other treatment options are exhausted. Your dentist must also have determined that the cause of your TMD is connected to a structural problem within the jaw joint. For instance, you may have limited jaw movement or lockjaw due to disc displacement.
Before undergoing any surgery, be sure to get a second and third opinion from other dentists. Remember, surgery is irreversible. While it has been successful in a "few" cases, it sometimes results in more pain and jaw damage. Be sure your dentist clearly explains why you should have surgery, the risks and benefits of the proposed surgery and other possible treatment options. Surgery and other invasive treatment, like injections, can create more problems and are best left as a last resort.
There are two main types of surgery for TMD: arthroscopy and open-joint surgery.
Arthroscopy: Like most types of surgery, arthroscopy requires that the patient be given general anesthesia. While the patient is unconscious, the surgeon makes a small incision in front of the ear. A small, thin instrument equipped with a lens and light is inserted through the cut. This instrument is connected to a video screen and monitor, which allows the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove tissue or realign the disc or the condyle. This type of surgery is less invasive than open-joint surgery and leaves less scaring. However, depending on the cause of your TMD, it may not be possible to use this technique. Again, sometimes this does nothing to help the problem.
Open-Joint Surgery:
There are many types of open-joint surgeries. In all of them, the surgeon operates on the TMJ without the use of special equipment like video monitors. Instead, he or she opens up the area around the TMJ to get a full view. This provides better access and allows the surgeon to move around more easily. Your dentist may suggest this type of surgery if:
You are in a closed or open lock
There are tumors in or around your TMJ
There is severe scarring or chips of bone in the joint
It takes longer to heal from this type of surgery than it does from arthroscopy. There is also a greater chance of scarring, nerve injury and scar tissue . If you are considering open-joint surgery be sure to use
caution, surgery does not always cure pain.
[This message has been edited by Elaine (edited 01-16-2002).]
Before undergoing any surgery, be sure to get a second and third opinion from other dentists. Remember, surgery is irreversible. While it has been successful in a "few" cases, it sometimes results in more pain and jaw damage. Be sure your dentist clearly explains why you should have surgery, the risks and benefits of the proposed surgery and other possible treatment options. Surgery and other invasive treatment, like injections, can create more problems and are best left as a last resort.
There are two main types of surgery for TMD: arthroscopy and open-joint surgery.
Arthroscopy: Like most types of surgery, arthroscopy requires that the patient be given general anesthesia. While the patient is unconscious, the surgeon makes a small incision in front of the ear. A small, thin instrument equipped with a lens and light is inserted through the cut. This instrument is connected to a video screen and monitor, which allows the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove tissue or realign the disc or the condyle. This type of surgery is less invasive than open-joint surgery and leaves less scaring. However, depending on the cause of your TMD, it may not be possible to use this technique. Again, sometimes this does nothing to help the problem.
Open-Joint Surgery:
There are many types of open-joint surgeries. In all of them, the surgeon operates on the TMJ without the use of special equipment like video monitors. Instead, he or she opens up the area around the TMJ to get a full view. This provides better access and allows the surgeon to move around more easily. Your dentist may suggest this type of surgery if:
You are in a closed or open lock
There are tumors in or around your TMJ
There is severe scarring or chips of bone in the joint
It takes longer to heal from this type of surgery than it does from arthroscopy. There is also a greater chance of scarring, nerve injury and scar tissue . If you are considering open-joint surgery be sure to use
caution, surgery does not always cure pain.
[This message has been edited by Elaine (edited 01-16-2002).]
MelanieB
01-16-2002, 05:53 PM
Originally posted by Nicole23:
[B]my Orthodontist is pushing me into the arthroscopic surgery[B]
Don't walk, RUN AWAY from your orthodontist. I am in shock that he is pushing you into surgery after having you wear a splint for only four months without weekly adjustments and close follow-up. That is a huge sign that he doesn't know what he's doing. :nono:
1. TMJ Splints need to be adjusted as often as necessary until they work. If it isn't working, this means weekly visits for adjustments. From what you told me in another post, he only tried to adjust it once then gave up because it wouldn't fit back in your mouth. That is totally unacceptable - he should adjust it until he gets it right, period. I also know that your splint is out of adjustment because you said it slips out if you wear it while eating. That should NOT happen. It should feel a little weird while eating but you get used to it after a week or so and it feels totally natural, like it is a part of your mouth.
2. As someone who is treating TMJ patients non-surgically, he should be making every effort to make your splint work, and he should be encouraging you to exhaust all conventional methods, NOT pushing you into surgery. To me that says that he's giving up and is getting rid of your case. He's not trying hard enough or doesn't know what to do.
3. 4 months is not long enough to rule out that the splint doesn't work. 6 months is the generally accepted minimum, and during those 6 months it should be adjusted weekly if it's not working. That's when it can be ruled out - after 6 months of regular adjustments.
The fact that he has given up on splint therapy with you after only four months and with very little adjustment makes me think this guy doesn't know what he's doing. Doctors are very good at convincing you that they are competent. Don't trust him blindly. Go see another specialist or two, and ask their opinions on adjustment periods for splint therapy and minimum length of time to try a splint and they'll likely tell you what I just said. DO NOT tell the new specialists anything about your previous splint therapy. If you say "my old ortho said four months is enough" then the new doctor will not disagree for fear of being sued by your orthodontist (one dentist/doctor cannot say that another dentist/doctors treatment was in error, it's against their professional code of ethics and they can sue for it). Tell the new specialist that you don't want to tell him about your existing treatment because you don't want to put him in a situation where he'd be at risk of a law suit from the orthodontist. ASk him specifically what should be done in your case. Ask specifically how often a splint should be adjusted if it is not working (because if it IS working it doesn't need adjustment as often, don't want to mess with it) and how long you should wear it before ruling it out.
I really hope you see someone else and ditch this orthodontist of yours!
Melanie
PS: Really good advice from Elaine. Good work girlie. Have you had your implants removed yet? How are you doing?
[This message has been edited by MelanieB (edited 01-16-2002).]
[B]my Orthodontist is pushing me into the arthroscopic surgery[B]
Don't walk, RUN AWAY from your orthodontist. I am in shock that he is pushing you into surgery after having you wear a splint for only four months without weekly adjustments and close follow-up. That is a huge sign that he doesn't know what he's doing. :nono:
1. TMJ Splints need to be adjusted as often as necessary until they work. If it isn't working, this means weekly visits for adjustments. From what you told me in another post, he only tried to adjust it once then gave up because it wouldn't fit back in your mouth. That is totally unacceptable - he should adjust it until he gets it right, period. I also know that your splint is out of adjustment because you said it slips out if you wear it while eating. That should NOT happen. It should feel a little weird while eating but you get used to it after a week or so and it feels totally natural, like it is a part of your mouth.
2. As someone who is treating TMJ patients non-surgically, he should be making every effort to make your splint work, and he should be encouraging you to exhaust all conventional methods, NOT pushing you into surgery. To me that says that he's giving up and is getting rid of your case. He's not trying hard enough or doesn't know what to do.
3. 4 months is not long enough to rule out that the splint doesn't work. 6 months is the generally accepted minimum, and during those 6 months it should be adjusted weekly if it's not working. That's when it can be ruled out - after 6 months of regular adjustments.
The fact that he has given up on splint therapy with you after only four months and with very little adjustment makes me think this guy doesn't know what he's doing. Doctors are very good at convincing you that they are competent. Don't trust him blindly. Go see another specialist or two, and ask their opinions on adjustment periods for splint therapy and minimum length of time to try a splint and they'll likely tell you what I just said. DO NOT tell the new specialists anything about your previous splint therapy. If you say "my old ortho said four months is enough" then the new doctor will not disagree for fear of being sued by your orthodontist (one dentist/doctor cannot say that another dentist/doctors treatment was in error, it's against their professional code of ethics and they can sue for it). Tell the new specialist that you don't want to tell him about your existing treatment because you don't want to put him in a situation where he'd be at risk of a law suit from the orthodontist. ASk him specifically what should be done in your case. Ask specifically how often a splint should be adjusted if it is not working (because if it IS working it doesn't need adjustment as often, don't want to mess with it) and how long you should wear it before ruling it out.
I really hope you see someone else and ditch this orthodontist of yours!
Melanie
PS: Really good advice from Elaine. Good work girlie. Have you had your implants removed yet? How are you doing?
[This message has been edited by MelanieB (edited 01-16-2002).]
Nicole23
01-16-2002, 09:36 PM
Melanie and Elaine, thank you so much for the advice. Yes, I have had some suspicion that my Orthodontist wants to get rid of my case. (i.e. I think when he was doing the adjustments, well his technician anyway, left my mouth open too long and I don't think she was too experienced). I then started having the TMJ symptoms, not too long after. I have had the TMJ for four months, but I don't think I have been in splint therapy for that long. The situation of my TMJ is that my disc is completely stuck on one side and limited on the other. I am definitely going to see another Orthodontist. I have an appointment on Monday I did go for weekly appointments to have my splint "checked." Do either one of you know how splints have worked for discs that are stuck? As far as arthroscopy is concerned, I was told that this procedure would not correct the ear problems, and if I were to ever need open (as I said) that it may make things worse. Please advise. I want to try everything conservative before going into surgery. Also, Elaine did Melanie say that you had jaw implants?
[This message has been edited by Nicole23 (edited 01-16-2002).]
[This message has been edited by Nicole23 (edited 01-16-2002).]
Elaine
01-17-2002, 12:06 AM
Nicole,
You have so many threads started on this board, it is tough to answer you. Yes, I have one implant. If you read the second post on this thread all the way through you would have read that. Also read the TMJ reality thread as it pretty much tells all about my medical mess.
I have a friend from the LA area who may know of a good doctor for you to see. I suggest you stay away from the doctors who are talking surgery this early in the game....
I don't think surgery is the answer.
Elaine
You have so many threads started on this board, it is tough to answer you. Yes, I have one implant. If you read the second post on this thread all the way through you would have read that. Also read the TMJ reality thread as it pretty much tells all about my medical mess.
I have a friend from the LA area who may know of a good doctor for you to see. I suggest you stay away from the doctors who are talking surgery this early in the game....
I don't think surgery is the answer.
Elaine
Elaine
01-17-2002, 09:21 AM
Nicole,
My friend went to a Dr. Stringer - Riverside. He totally rebuilt her condyles with pieces of her ribs. Destruction was caused by one of "our" famous oral surgeons that left silastic implants in for over 10 years. They were suppose to be short term period, six months. She said this doctor really knows his profession so give him a try.
Few others she recommended:
Doctor Larry Moore - Chino Hillls
Doctor Moses - San Diego
Dr. Nicholls - - Misson Viejo and also Newport Beach
Good luck and don't rush into anything...
Elaine
[This message has been edited by moderator3 (edited 01-18-2002).]
My friend went to a Dr. Stringer - Riverside. He totally rebuilt her condyles with pieces of her ribs. Destruction was caused by one of "our" famous oral surgeons that left silastic implants in for over 10 years. They were suppose to be short term period, six months. She said this doctor really knows his profession so give him a try.
Few others she recommended:
Doctor Larry Moore - Chino Hillls
Doctor Moses - San Diego
Dr. Nicholls - - Misson Viejo and also Newport Beach
Good luck and don't rush into anything...
Elaine
[This message has been edited by moderator3 (edited 01-18-2002).]
Nicole23
01-17-2002, 03:27 PM
Elaine, thanks for the Doctors names. Is Doctor Stringer the good Doctor? Who was the bad Doctor that your friend went to? I don't want to go to him. Would you or your friend mind if I talked to her? How is she now? Please let me know and I will give you my phone number, or you can give me her phone number if that's OK. If I read one of your posts correctly, I think that we are the same age. I just turned 24 on Januray 13. Your advice is really helping.
Elaine
01-17-2002, 09:06 PM
Nicole,
I don't know who the bad doctor was, you can find that out. I gave my friend your email so she will be in touch with you.
No, you didn't read my post correctly. Please read again and tell me how old I am then I will know you have done your homework. LOL!!! Lots of information on this board, slow down and read it!!!!!! The life you save may be your own. I am not trying to be sarcastic, just don't want to see you make the same mistakes I did.
Elaine
I don't know who the bad doctor was, you can find that out. I gave my friend your email so she will be in touch with you.
No, you didn't read my post correctly. Please read again and tell me how old I am then I will know you have done your homework. LOL!!! Lots of information on this board, slow down and read it!!!!!! The life you save may be your own. I am not trying to be sarcastic, just don't want to see you make the same mistakes I did.
Elaine
Sharbear
01-18-2002, 04:00 AM
Nicole,
I am the friend that Elaine speaks of. The numbers that Elaine already post are numbers of Doctors that I sought out. I did a lot of research on Doctors in this area. All the ones that are listed are wonderful and have excellent reputations. One that is in LA and is not listed is Dr. Felenfeld, he works out of UCLA I believe, he is in charge of the TMJ clinic. I see Dr. Stringer in Riverside, he is WONDERFUL and really knows his stuff! THe Doctor that really, really messed me up is in Redlands, so don't worry, you have probably never heard of him.
NICOLE, STAY AWAY from surgery. No surgery will take away the problems with your ears, I am not a Doctor but only speak of my own TMJ nightmare.
Surgery does not take away pain, the only thing surgery does is sometimes improve function and that is usually only for a short while until the next surgery. Once you have ANY type of jaw surgery, one only leads to another. It is never ending. I have had all the surgeries that you spoke of, none of them were helpful, only made matters worse. My first surgery was the "harmless arthroscopy" that lead to another surgery and another and assisted in making my life worse and even more miserable.
I woish tha I had someone around back then to give me the advice that you are getting right now. I have your e mail addy and I will e mail you right now. Take care and don't be talked into something not necessary. They make surgery sound like the cure all, fact is there is no "cure all" for tmj.
Sharri
I am the friend that Elaine speaks of. The numbers that Elaine already post are numbers of Doctors that I sought out. I did a lot of research on Doctors in this area. All the ones that are listed are wonderful and have excellent reputations. One that is in LA and is not listed is Dr. Felenfeld, he works out of UCLA I believe, he is in charge of the TMJ clinic. I see Dr. Stringer in Riverside, he is WONDERFUL and really knows his stuff! THe Doctor that really, really messed me up is in Redlands, so don't worry, you have probably never heard of him.
NICOLE, STAY AWAY from surgery. No surgery will take away the problems with your ears, I am not a Doctor but only speak of my own TMJ nightmare.
Surgery does not take away pain, the only thing surgery does is sometimes improve function and that is usually only for a short while until the next surgery. Once you have ANY type of jaw surgery, one only leads to another. It is never ending. I have had all the surgeries that you spoke of, none of them were helpful, only made matters worse. My first surgery was the "harmless arthroscopy" that lead to another surgery and another and assisted in making my life worse and even more miserable.
I woish tha I had someone around back then to give me the advice that you are getting right now. I have your e mail addy and I will e mail you right now. Take care and don't be talked into something not necessary. They make surgery sound like the cure all, fact is there is no "cure all" for tmj.
Sharri
Cymy Sue
04-08-2003, 07:25 AM
bump.