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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 06-07-2004, 08:30 AM   #1
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Katie G HB UserKatie G HB User
Surgery to realign the maxilla

Hi all. I know that someone here will have an answer to my question or advice about how to proceed. My story is posted on this board several times so I won't go into long detail (I hope!) in reviewing it.

I was diagnosed with moderate/severe TMD about 15 years ago, but didn't actively seek treatment due to neither medical or dental insurance covering treatment. Just had a nighttime splint made to get through the really bad times. In Sept. 03, I started TMD treatment (now considered severe +++ TMD) with the same orthodontis who consulted with me 15 years ago. I have no complaints about this ortho - he has been through Phase I & II TMD treatment himself - Phase II was crowning/capping and braces as needed. He also continues to "keep up" with techniques and research related to TMD and has gained a reputation as being somewhat of an "expert" in the TMD arena. Since no one can claim to be a TMJ specialist, he comes about as close as can be - at least for treating Phase I & II (if braces are recommended).

I've been wearing a splint 24/7 since Oct. '03 (actually I'm on to my 4th splint since portions in the back of it keep breaking off), and will be until he feels I'm symptom-free or the jaw is stable. I expressed concern during my appointment today, because I've noticed my bite is becoming even more "open" since splint therapy. He said that was actually good because my joints were severely displaced in an anterior position, and as the joint was re-aligning in the fossa, it would make it feel like my lower jaw was actually moving back, and thus giving the impression of an increasing open bite.

As soon as my ortho determines my jaw is in the right position, he says I'll most likely have to have surgery to pull the maxilla back to realign it and stablize the jaw more. Splint therapy will only do so much, but he believes surgery will be the only answer for permanent jaw stablization. Probably braces too - to realign the teeth once the jaw is stable. He does not do surgery, but will refer me to a trusted colleague (his words).

My question is this - what's the name of the surgery he's talking about? I've tried researching jaw stablization, but I don't think that's what it's called. By pulling the maxilla back to realign the condoyle/fossa and stablize the realignment - is that called orthognathic (sp?) surgery, or does the procedure I'm describing have a different name? I'm REALLY worried about jaw surgery after reading so much negative stuff here. I know he's not talking joint replacement or joint reduction because we've already talked about that, and he does not recommend joint replacement for anyone. Even if I have arthritis and bone loss, he wants to save what I have and surgically stablize it. I just want to do some research on the type of surgery he's recommending before I agree to it. I would have asked him today, but he was already on to another patient. I will see him again next week, and will be sure to ask him.

Am I making any sense? Thanks to all you veterens out there who respond. Sorry this is so long,

Katie G

 
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Old 06-07-2004, 08:43 AM   #2
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MSUGuy02 HB User
Re: Surgery to realign the maxilla

Hi!

The surgery sounds like what I had - orthognathic surgery. I had upper/lower in which I used to have an open bite after doing splint therapy. I went through the surgery and it was not the most successful for me and has caused more joint problems than anything. I'm not trying to scare you out of this, but definitely weigh the pros and cons of it. If you want to email me, feel free because I know I was freaked out before it and I can tell you what to expect, etc. [ removed ]

Hope this helps!
Andy

Last edited by moderator2; 06-07-2004 at 06:30 PM. Reason: Do not post any kind of off-board contact information. Please carefully review the Healthboards.com Policies and Guidelines. Click on Posting Rules at the top left of this page. Thank you!

 
Old 06-07-2004, 08:48 AM   #3
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Katie G HB UserKatie G HB User
Smile Re: Surgery to realign the maxilla

[ quote removed ]

I know I'm nowhere near surgery at this point - but I like to do a lot of research ahead of time before I make a decision about something this life-altering. My joints are such a mess now that I don't want to be any worse off pain-wise or mobility-wise than I am now.

Katie G

Last edited by moderator2; 06-07-2004 at 06:33 PM. Reason: Do not quote or respond to messages that violate the posting rules. Please review the posting rules and know them as you agreed to do. Click on Posting Rules at the top left of this page. Thank you!!

 
Old 06-07-2004, 09:38 AM   #4
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Mosmom HB User
Re: Surgery to realign the maxilla

Oh Katie...I'm so glad you asked this question because I think I have some great information to share - especially since you said your doctor keeps up on all the newest things.

Some quick background - my daughter has been in a splint for around 18 months and is now symptom free, but like you she has been left with an open bite. In the past this would involve surgery (my understanding is that it is like a surgical impaction of the back teeth), shaving down teeth (but you usually can't shave off enough), crowns...implants...etc.

My daughter is scheduled to go into the oral surgeon in a couple of weeks and have two tiny little implants/brackets put in her upper jaw. This is done under a local anesthetic. These implants are then used as anchors for the orthodontist to slowly pull the back teeth up (impact) to close the bite. After those teeth have been pulled up the 2 or 3 mm needed (a year or so) she will get braces.

Let me stress that although this is a newer technique, it is NOT experimental and is now being taught in dental schools. Implants like these have been used for a long time for things such as jaw reconstruction, but this application is fairly new. Believe me...I am not going to make my daughter a guinea pig. I've gotten several opinions and all agree that this is a good idea.

Our TMJ orthodontist is the former chairman of the orthodontics department at Loyola University and one of his students has been a leader in this area. The oral surgeon we are using has done several of these in conjunction with the orthodontist and says the results have been amazing.

I suggest you go to Google and type in "The Use of Skeletal Anchorage in Open Bite Treatment" and share this information with your doctor.

Mo's Mom

 
Old 06-07-2004, 09:54 AM   #5
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Katie G HB UserKatie G HB User
Smile Re: Surgery to realign the maxilla

Quote:
Originally Posted by Mosmom
Oh Katie...I'm so glad you asked this question because I think I have some great information to share - especially since you said your doctor keeps up on all the newest things.

Some quick background - my daughter has been in a splint for around 18 months and is now symptom free, but like you she has been left with an open bite. In the past this would involve surgery (my understanding is that it is like a surgical impaction of the back teeth), shaving down teeth (but you usually can't shave off enough), crowns...implants...etc.

My daughter is scheduled to go into the oral surgeon in a couple of weeks and have two tiny little implants/brackets put in her upper jaw. This is done under a local anesthetic. These implants are then used as anchors for the orthodontist to slowly pull the back teeth up (impact) to close the bite. After those teeth have been pulled up the 2 or 3 mm needed (a year or so) she will get braces.

Let me stress that although this is a newer technique, it is NOT experimental and is now being taught in dental schools. Implants like these have been used for a long time for things such as jaw reconstruction, but this application is fairly new. Believe me...I am not going to make my daughter a guinea pig. I've gotten several opinions and all agree that this is a good idea.

Our TMJ orthodontist is the former chairman of the orthodontics department at Loyola University and one of his students has been a leader in this area. The oral surgeon we are using has done several of these in conjunction with the orthodontist and says the results have been amazing.

I suggest you go to Google and type in "The Use of Skeletal Anchorage in Open Bite Treatment" and share this information with your doctor.

Mo's Mom

Thank you so much! I will certainly be looking into the info you posted and taking it to my ortho with questions. The procedure you described certainly sounds a lot like what my ortho was talking about.

Thanks again,
Katie G

 
Old 06-07-2004, 09:59 AM   #6
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Mosmom HB User
Re: Surgery to realign the maxilla

You're welcome. And please let me know what your doctor has to say about the procedure.

 
Old 06-07-2004, 12:22 PM   #7
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Cymy Sue HB User
Re: Surgery to realign the maxilla

Katie G,

Andy is right about the name. Most of the realigning or restructuring procedures fall under the category of "Orthognathic Procedures."
(Maxilla or mandible)

He's also right about possible trauma to the joints.
Healthy joints can be traumatized and damaged.
Already fragile or unhealthy joint structure can be worsened greatly.

The Orthognathic procedures are really invasive and it takes time to get well. Find out all you can about the particular surgery your Doctor is suggesting. Always be aware of the risks involved.

Cymy Sue

 
Old 06-07-2004, 12:34 PM   #8
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Katie G HB UserKatie G HB User
Smile Re: Surgery to realign the maxilla

Quote:
Originally Posted by Cymy Sue
Katie G,

Andy is right about the name. Most of the realigning or restructuring procedures fall under the category of "Orthognathic Procedures."
(Maxilla or mandible)

He's also right about possible trauma to the joints.
Healthy joints can be traumatized and damaged.
Already fragile or unhealthy joint structure can be worsened greatly.

The Orthognathic procedures are really invasive and it takes time to get well. Find out all you can about the particular surgery your Doctor is suggesting. Always be aware of the risks involved.

Cymy Sue

Thanks Cymy Sue. I will certainly enter into consideration of surgery very cautiously. I was hoping you'd reply having read your posts before and discussing everything you went through. I do not plan on entering surgery until I know exactly what it's all about or finding out if there are alternatives to surgery.

Katie G

 
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