Arthrocentesis verus Arthroscopy versus Disectomy

[Nicole23]

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.

[Elaine]

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

[Nicole23]

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]

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).]

[MelanieB]

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.

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).]