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Old 09-11-2003, 02:46 PM   #1
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Michelle W HB User
Question My TMJ story and Can anyone explain nerve irritation to me?

Hello,

I have been watching the board for a few months but then my computer died. I am now back online.

I had bilateral TMJ arthroplasty in March of 2003. I found this board after surgery. I could not chew at all on my right side the pain was just too great. Most of last year I ate only on my left side while I had splint adjustments most of last year. Prior to surgury I wore a splint for a few years, and it really helped. Despite the splint I ended up having surgery. Maybe if I had gotten into a splint earlier I wouldn't of had to have surgery. I don't know for sure.

I have been in a splint 24 hours/7days a week since surgery. I should of had my lower braces put on a couple of months ago, but my orthodontist does not want to start moving my teeth around until everything calms down. I did PT at home for eight weeks. I was doing pretty good for the first few months. I then started back on a medication called Paxil due to anxiety/depression. I had taken it for several years prior to surgery, but I discontinued it before surgery due to concerns about it exacerbating my grinding problems, which I think it does. I have been reading a lot on the internet about antidepressants and grinding. Anyone else have this problem or heard anything similar?

About three months after my surgery out of no where my left ear starting hurting me more than before surgery. My right ear was my major concern prior to surgery. My surgeon tells me I am having muscle spasms, and he gave me some Flexaril. He also gave me alot of suggestions on reducing my weight, stress and exericise, which I am considering at this point. I am overweight but I am not currently obese. I was a few years ago. Although, I am skeptical that exercise can rid me of my pain. My surgeon took a lot of tomagrams and everything looks fine to him. The Flexaril he prescribed helps about 50% of the time, and I take a lot of Ibuprofen.

I am reading a book by a Dr. Wesley Shankland on TMJ. He mentions taking Elavil at bedtime to reduce grinding. I told my psychiatrist's nurse practitioner that I would like to try it for my depression/anxiety. She was open to the idea.

I saw my medical doctor yesterday and asked her for suggestions regarding my ear pain. She suggested taking Zanaflex at bedtime, which I have tried for a couple of days. It does seem to help my neck and shoulder pain are better, but I still have symptoms at times of ear pain. I told my medical doctor that my ear hurts when I lie on it or touch it. She thinks I might have nerve irritation, but she didn't explain to me how I got it. We may try another medication with or without it after a trial run on the Zanaflex. My left ear started ringing a couple weeks after surgery and has not stopped. It is an off and on problem like the ear pain. I read something online about that being a sign of nerve irritation. I can't find anything online that really defines nerve irritation. All I can find is advertisements for different doctors. Does anyone know what medical definition of nerve irritation is and how it differs from nerve damage? Possibly you know a web site? I would think it might be a side effect from my surgery.

Thanks for your help and feel free to email me.


 
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Old 09-11-2003, 03:07 PM   #2
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I don't really have any clear answers, but I've been trying to figure out ear related issues too, my ears ringing and rumbling were one of my first unignorable TMJ symtoms (coming before any jaw pain) and looking at websites explaining TMJ causes or even symptoms I don't see that ear inflammation is ever really given the prominance it can seemingly have. I know I have inner ear inflammation, an endoscopy showed it, I can't change altitude without the eardrum expanding, and very loud noise makes my face go into spasms. Yesterday a person (who I don't know but wholeheartedly loathe for doing this!) found it necessary to run his car engine in the road for hours and my ears got so bad in the end I couldn't tell if I was hearing a real engine or it was just a noise in my ears (well it was just my ears in the evening, loud constant maddening rumbling). I am guessing that inflammation (and of course the inner ear is intimately connected to the TMJ joint though saying this is fairly meainingless too, a kind of blanket statement) causes nerve irritation? I don't know how to reduce it. Does anyone?

I hope you recover fast and feel better daily.
hugs,
Isobel

[This message has been edited by Isobelj (edited 09-11-2003).]

 
Old 09-11-2003, 03:58 PM   #3
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Hi Michelle & Welcome,

I'm terribly sorry to hear about the complications after surgery and your pain.

What was done during your Arthroplasty?
I've had 2, I might could help you out in understanding what is going on.

I can tell you that anytime your joint is surgically invaded, there is always the possibilty of nerve damage or nerves being irritated. The Trigeminal Nerves are sometimes aggravated or irritated with these procedures. This is not uncommon with this procedure. "The SURGICAL PROCEDURE most likely irritated the nerves." Every surgery I've had caused some nerve damage or irritation. The TM joint is a very sensitive and fragile area.

The closest medical term for this would be neuralgia.

The ear problems could be muscular. These surgeries also traumatize the muscles and cause additonal muscle spasms and problems.

These problems will usually settle down after a while.
I didn't get a lot of relief from medications.
A splint designed to support my joints and let the muscles relax and passively reposition has helped all of my TMJD symtoms and the damage I had from surgeries. I had several prior to the arthroplasties.

There are several anti-depressants that will cause grinding and clenching.

Board Guidelines do not allow the exchange of e-mail addresses, but feel free to ask any questions and I, or other members will be glad to help you if we can.

Take Care,
Cymy Sue

[This message has been edited by Cymy Sue (edited 09-11-2003).]

 
Old 09-11-2003, 05:03 PM   #4
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Cumy Sue,

I noticed you mentioned that some anti-depressants cause clenching, Ive been in this fight w. a doc, I tell him those pills make me worse he keeps saying they will help me w. the anxiety caused by TMJ. I am wondering if you know which ones I refuse to take any of them but Id like to tell him.
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Old 09-11-2003, 05:07 PM   #5
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Michelle W

I have terrible ear problems too. They started about 6 months in to my TMJ, a roaring sometimes, a heartbeat always a constant ring in my left ear and it feels full, I get dizzy and it drives me insane to have to be trapped or to walk around in a store and feel so out of touch with the world, like the people are spinning around me. I wish there was something they could do but Ive been to 4 ENTS, they all say its TMJ related.
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Old 09-11-2003, 05:12 PM   #6
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For nerve irritation look up neuralgia or cranial neuralgias and in particular atypical facial pain.

 
Old 09-11-2003, 11:57 PM   #7
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mdla,

I'm not sure which anti-depressants cause grinding and clenching to be worse. I've never taken them.

Several members have mentioned this on the board about different ones and I've seen it listed as a side effect for many of them in the Presciption Drug Guides.

There are several places you can find extended side-effect lists for medicines. (More than are listed on the paper you get with the prescription.)

You could do a "Search" on the board, I know it's been discussed several times.

Take Care,
Cymy Sue


 
Old 09-13-2003, 11:02 PM   #8
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I replied this morning, but I am unable to find my reply on this thread. This is so strange, but I have had an off day all the way today.

Cymy Sue I had my disc on both sides put back in place, and they put a pin in there to hold them in place. The pin is suppose to look like the end of an arrown. I had an MRI prior to surgery. Also my TMJ Dentist adjusted my splint most of last year without bringing me any relief. I had stretched out the igaments by grinding. On the left side my doctor told me that I had some ridges in my bone. He smoothed it out. I don't understand how you get ridges in the bone and how smoothing the bone out helps you in any way. Any clues?

I got a splint a few years ago, and it helped for awhile, but I still became more dislocated over the years. Maybe if I had gotten into a splint earlier I would not of had these problems.

I could not eat anything on my right side prior to surgery. My lower jaw was sitting way back and my mouth would go to the right side when I opened it. It looked really weird to me. I just ate everything on the left side. It still hurt, but I could get by I guess you could say.

I am guessing the nerves are so close to the surgical site that they disturb them during the surgery? My incision is basically on the inside of my ear. I do not really see anything like a scar, but I can tell my ears look different at the top and bottom of my ear. Does nerve irritation go away? How does a doctor diagnosis nerve irritation? Do you know if there is any treatment for it? How do you know if you have nerve damage other than your face symetry? You mentioned that the muscle spasms will lessen as time goes by. What was your experience with the spasms? I just figured by six months post op they would be gone by now. I feel like I have so many unanswered questions right now.

Most of my pain is right in front of my left ear. If feels like an earache, and I have ear fullness and ringing. I do have some neck pain in the back of the neck, shoulder and front of neck. I just don't know what to make of it. I am also finding medication does not seem to make much of a difference right now. I haven't taken anything at night that I felt made a significant difference the next day. I have only taken a couple of different muscle relaxers and the Elavil just the past couple of days.

I wish they made some type of device that would wake you up when you started grinding your teeth. I hate to sleep anymore, because I know I will grind my teeth. It makes it hard to sleep when you are stressed out grinding.


mdla, I found the SSRI medications for depression, and the mood stabilizers/seizure medications made my grinding worse. I have not had any trouble with anti-anxiety medications such as Ativan causing me trouble.



[This message has been edited by Michelle W (edited 09-14-2003).]

 
Old 09-14-2003, 02:49 AM   #9
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Michelle,

I had bilateral disc replacements with ear cartilage with my first arthroplasty. The cartilage was sutured into place. I've never heard of a pin to hold your original disc in place. I have heard of your originals being relocated and sutured. Sometimes this requires being done again, so putting a pin in may be a relatively new technique. It probably works better in the long term, but having something foreign (the pins) in the joint/disc could be causing a longer healing process and more pain. They once used stainless steel with many TMJ surgeries. I've read another type of material is used now that is better. These pins would most likely be very small, but your body has to get used to them. I've have 6 steel loops in my mandible and chin for 16 years. They caused some pain for a while, but did stop hurting. In the joint/disc area, there are very sensitive nerves.
My best guess is, this is causing a lot of your pain and nerve irritation.

Anytime they go into your joint, if you have any bone abnormalities or damage, they normally take the opportunity to smooth the bone, sometimes to reshape, if the condyle is jagged or worn. I've never been told I had ridges, but I've had smoothing and reshaping twice. The bones (Condyles) need to be very smooth and shaped as normally as possible. Any type of wear, damage or abnormalties can cause pain. It could also cause your joint not to function correctly.

With the first Arthro I had with replacements, I did very well and the pain did not last but a month or so. The worst pain was where they took the cartilage from my ears. I had very little problems with muscle spasms.(I had some problems from prior surgeries, but this one didn't add any)
I did pretty well. The Surgeon was one of the best. My incisions were right in front of my ears.

Having the incisons more into your ears would most likely cause more pain. Your right about the nerves, they (Surgeons) are working in an area that has a lot of complex nerves and they do react to being disturbed or moved a little during the surgery. The muscles also will react to these surgeries.

If you are still grinding and clenching, this will add to the problem. Did you get a different splint after the surgery? Usually a different splint would be needed, due to the alterations made in surgery, even if there is a very slight difference in your joints.

Ear pain is usually muscular, so your muscle spasms may be getting worse for the ear ringing to start up weeks after the surgery. The fullness is usually muscular, too.

My first Surgeon did not give me any of this information. I had very few problems from this surgery and the muscles seem to settle down a good bit.

My second Arthro was 5 years later when the replacements failed and I had a discectomy. I was sent to a "Pain Specialist". When they do not replace the disc, there is incredible pain and nerve irritation.

(I had some nerve damage from surgeries 10 years prior to the Arthro's, mostly around the joints and mid to lower face. The Trigeminal Nerves had been damaged. This caused burning "flares" and numbness from my nose down. I had pretty much learned to live with this)

With this last surgery, the healing time is longer, the nerves got more irritated and the muscles went haywire and spasmed terribly.

The "Pain Specialist" explained the old nerve damage and what was going on with the new nerve pain.

They prescribed Neurotin for the nerve pain. I couldn't take it, so they wanted me to take Tegretol.
Tegretol can cause liver damage and blood problems so I didn't want to take it. I was given Baclofen, which helped a lot. I still had terrible muscle spasms and medication did not seem to help that. The muscle spasms also aggravated the nerves.
I was not given a splint, this Surgeon did not believe they help. I found out years later a splint would have helped in healing and helped the muscle spasms.

I saw a Neuro-otologist several times during this period and he explained the ear problems and their relation to TMJ damage and problems. I developed Tinnitus 3 years after the surgery. It was due to the continuing severe muscular problems.

The nerve pain did get a little better, I healed from the surgery but I still had all kinds of symtoms, old and new, 5 years later. I joined this board and read about splint therapy helping many people. (I had been convinced it wouldn't help me, by surgeons. I had not worn a splint for 10 years)

I started a Splint Therapy in Dec 02, and immediately started to have improvements in pain and symtoms that I had for years. The splint was designed for someone with no disc and long-term muscular problems.
The muscles are now relaxed and in a more normal position.
Muscle spasms and nerve pain are almost none existant.
My Tinnitus and other ear problems are almost gone and my opening which had been 10-19 mm for 16 years has increased to over 32 mm.

I'm sorry to write a book, but finding out what was wrong and what would help was a very long process.
Our surgeries were a little different, but it seems we ended up with many of the same problems. I believe yours can be helped with the right medications and therapy. (I had TMJD for many years, several damaging surgeries and very long-term muscle problems. I am now better than I have been in 26 years)

I don't know exactly how for you to get help, but from experience, this is what I would do.

First, if your surgery was successful, the nerve pain needs to be addressed. If your surgeon will not prescribe a nerve pain medication (many people use Neurotin) ask to be referred to "Pain Specialist". If he won't do that, a Neurologist will treat nerve pain. It does sound like your GP might be considering this, many GP's or Internists will prescibe it. If she does not or is not able to help, a Neurologist or Pain Specialist will.
(As far as I know, there are no tests for nerve irritation. Your recent surgery and description of the pain should be all they need, to know you are having nerve pain. There are tests for nerve damage, but I would not want them on my face. I've had them on my back and legs and one is quite painful)

With your neck and shoulder pain, a Theraputic Massage Therapist can help or a Physical Therapist. I've done both and the Massage Therapy worked a little better.
There are many trained to work with TMJD surgical patients.
This did not stop my long-term facial muscle problems, it did help. It completely stopped the neck, shoulder and upper back pain and spasms.

You have to find some way to stop grinding and get the muscles in your face relaxed. Nothing worked for me until I got the appropriate Splint for my condition.
My own Dentist has training in TMJD treatment and Splint design. The splint designed for me, has almost miraculously stopped all of the problems. I didn't grind, but I had been in a clenched state for years. I had incredible relief from all symtoms in a few weeks.

We are all different and what worked for me, may not work exactly the same for you.

If your surgeon won't help you after 6 months, someone else will. Everyone who has nerve pain, needs medication to stop it. The pain itself will cause anxiety and slower healing.

Doing something to help the muscle problems in your neck and shoulder will also help with getting better. Pain in the shoulder and front of the neck is usually caused by one large muscle (the sternocliedomastoid, if you see a picture of it, you can see how it causes such pain when it spasms) and a hands on therapy will work to stop it and usually pretty quick. Muscle relaxants never seemed to help me.

My personal belief is, the correct Splint Therapy after surgery will stop the majority of the other problems, ears included. The hardest part is finding someone who knows how to design one for surgicals. It can be done. Your current Dentist may know you need something different.

I hope this helps you and makes you feel a little better, knowing that someone else has gone through a similiar ordeal and (finally) found the answers.

I relied on Surgeons for many years to tell me what to do and their only answer was Pain Management. This was OK for a while, but it did not solve the problems. I tried to find help and answers for many years and found out about my ear symtoms and how well Massage Therapy works.

I was still in a lot of pain and had almost given up on ever being better, and I found this group, talking about new splint treatments and therapies.

I decided if there was a "Splint Therapy" for someone in my condition, that might be the answer. It was.

Try not to worry, it sounds like your Surgeon did a got job. Make a plan on finding help for everything that is still not right and take a step at a time to get each one treated.

I would suggest to start some type of Therapy to de-stress. Medications sometimes just won't do it and I think you're really worried because your questions are not answered. Relaxation tapes work. Massage Therapy works. Believe that you will get better. I know these problems seem enormous, but they can all be addressed, it just takes a little time and I believe you (like me) need a little additional help that your Surgeon or GP may not be able to provide.

Take care,
Cymy Sue




[This message has been edited by Cymy Sue (edited 09-14-2003).]

 
Old 09-14-2003, 09:38 PM   #10
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Cymy Sue,

You are an angel to write me such a long email to help me out. I am so happy that splint therapy has helped you so much. Do you wear it all the time or just at night time? Two weeks after my surgery I starting wearing my splint 24 hrs/7 days a week. I am working with an excellent orthodontist. My surgeon told me that he had worked with such and such at a prestigious university. I had no idea who he was talking about. My ortho told me when I saw him last week that I was hitting to hard on the left side. He thinks it was causing me problems with that left side pain and muscle spasm. I guess even after six months my muscles are still relaxing which is causing my bite to change. I told him I was not very optimistic about getting my pain under control. He told me it was just a matter of finding that one right certain spot for everything to become comfortable. He said, "I am very optimistic that we will find that spot for you. It just takes longer for some people." My ortho explains everything to me in great detail. Did you have to have any orthodontic work done? My surgeon told me I would most definitely have to have it done for my surgery to be successful. My teeth are pretty straight, but my jaw slides to the side when it hits in the back causing me problems. I am anxious to get started, but the ortho tells me I must be comfortable before he starts moving teeth around. In my TMJ book written by the expert Wesley Shankland he says never move the teeth around until you are comfortable with your current splint.

I think I will continue to work with my GP for a month or so regarding medications. I will definitely look up the neurological drugs you mentioned such as Neurontin, Tegretol and the other one. I will keep them on file if I do not continue to improve on the Zanaflex and Elavil. I also think I will see about a few PT visits. I am hoping the therapist can help me strengthen my upper body for better posture. I have a very large natural bust line that pulls me forward. I think it aggravates my TMJ. I think they could also show me how to self massage myself for the neck and shoulder discomfort. I also have been curious about the Tens Unit. I don't know how much they cost but it might be an option.

Also, I think the material they used to pin the ligament or disc is called titanium. I think that is what the Physical Therapist called it. I had to go in and learn how to do my own PT after surgery. I did it for two months. I can open 38 mm now. I would say I was at 20 prior to surgery. I have pretty small mouth. I always have been this way.

Thanks for everything. http://www.healthboards.com/ubb/heart.gif

 
Old 09-15-2003, 12:56 AM   #11
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Hi Michelle,

Not having any othdontics done until your jaw is relaxed is the way it should be done. All of the TMJ symtoms should be "comfortable" and also you need to be completely over the surgery. It sounds like you're getting good advice and good treatment.

I was in orthodontics prior to my first surgeries, and a couple of times after. I didn't have very much that was off in regard to my bite, but they treated TMJ problems with ortho 25 years ago.

I had 2 orthognathic surgeries over 16 years ago to realign, extend my jaw and change my bite. I was in braces during this surgeries. (These surgeries didn't work because my problem was bad disc and these deal with bone.)

I didn't have any real problems, and most likely would have not worn braces had it not been treatment for TMJD.

My bite was changed and "set" and has not changed enough to notice at all since then. I have a very slight overbite and they have tried to correct it a couple of times, but my teeth always go back. They finally decided this was normal for me and have left it alone.

So, I had the orthodontic work first. That's how it was done then.

Thanks for reminding me of "Titanium". I knew that, it just wouldn't come to me. Being able to open 38mm this soon is great.

I wear my splint at night now. I wore it 24/7 for a few weeks. My muscles responded so quickly, I was able to cut down to night very quickly. I can wear it in the day if I get tense of stressed.

I know you will do well, it does take a little longer than we expect sometimes.

I hope you feel better soon,
Cymy Sue

[This message has been edited by Cymy Sue (edited 09-15-2003).]

 
Old 10-01-2003, 08:16 AM   #12
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