Excuse me for large post (written, in addition, not in native English), but I am now in a very complicated situation and just don’t know what to do… I would be grateful for any advice.
I had the disc repositioning surgery approx. 3 month ago.
Before surgery, I had clicking, TMJ pain, and some kind of hypermobility (all in the right TMJ). All this was caused by a trauma which I had 2 years ago. MRI showed anterior disc displacement (mostly in the lateral part of the joint) with reposition by mouth opening. I have tried 2 splints and special gymnastics and then agreed to the surgery.
The aim of the surgery was to shorten the elongated tissues in the posterior part of the joint to reposition the disc. After surgery, the surgeon told me that everything was found to be as expected and that the disc was successfully repositioned.
Although I had a post-operative pain (I felt like I had a very hot lamp in my joint) and there was too strong counteraction in my joint during mouth opening, I was doing better and better and I felt that very soon I would not even notice the difference between my joints.
But then, 5 weeks after surgery, I’ve got a problem.
The doctor told me that it was very necessary to do exercises, mouth opening, more function for joint. Once, when doing exercises (mouth opening), I did it too quickly (and this was a great mistake) – I opened and closed mouth 5-10 times quickly without any problems in the joint, but then I accidentally opened somehow incorrect - something became blocked in the joint and I opened my mouth against this by inertia, with some crepitating sound, pressure and large amount of incorrect motion in the joint, before I could stop this mouth opening.
Something was certainly changed in the joint. The jaw motion became clearly more free, although remained within the same limits as before. (The counteraction in the joint became weaker, but the limitation of motion within the joint seemed to be the same). Also, there appeared some crepitation. In the next day, some pain (like a small spasm) appeared in the joint, additionally to the post-operative pain. And, the most important, I felt physically that something was changed inside the joint.
I decided to do MRI and then visit my surgeon. In MRI, the disc position was found to be OK. The radiologist noticed some (not clearly pronounced) disc deformity and some dark spots in the lateral part of the joint, which she could not interpret.
Unhappily, my surgeon was in the business trip and I could visit him only 3 weeks after doing MRI so that my visit coincided with the planned visit for control after surgery. First of all, he measured mouth opening (it was 30 mm) and said that I seemed not to have done the exercises actively as he prescribed, because the mouth opening should be 35 mm, two months after surgery. I started to talk that I could have damaged something during exercises, but he interrupted me with the reply that I could not have damaged anything and cannot damage anything and I should do as actively as possible. I told him that once I did very inaccurately so that some sounds and pain appeared and I worry that something was changed. He replied that nothing could have been changed. He added that the joint is a living joint and it adapts after surgery, everything forms and transforms in order to function. So, the appearance of some sounds and even appearance of some pain 5 weeks after surgery is quite normal, there is no reason to worry and I should not consider anything in such small time scale like two months after surgery. He didn’t even try to understand me! And he didn’t realize that I was talking about some kind of accident! Then he asked about pain relief (yes or no), wrote something and told me that he would like to see me in a year! Concerning new MRI scans, he told me that, two months after surgery, MRI scans are not informative and are always misinterpreted. He hardly agreed to have a look at MRI and told me that he found nothing to worry about. I asked him whether he sees any change with respect to what he leaved after surgery and he replied “yes, but there should be a change due to adaptation after surgery”!
Now, it is one week after this visit. I clearly feel that something is damaged in the joint, as a result of the “accident”. When I try to do exercises and open my mouth, there is practically no counteraction in the joint (in contrast to what I had before the “accident”), till the head of the joint finds some obstacle and could not open any wider. Thus, the exercises seem to be meaningless - I can only press this obstacle.
I don’t know what to do now. What can I do? Visit my surgeon again? Tell him something like I had a new accident not related to the exercises? Or do another diagnostics? It seems that I have no chance…
I would be grateful for any advices and opinions!
P.S. I would be also very grateful if anybody could comment my MRT scans that I can upload..
Re: I’ve got a problem after surgery! Need advice…
I'm very sorry to hear that you had to have surgery, and now are going through this stressful situation. I have not had surgery, so I will leave advice about that to others who are more knowledgable.
I just want to say, that this is not your fault. Don't blame yourself for this "accident". You were clearly just following doctor's orders to exercise - you were doing the right thing. There's nothing you could have done to prevent whatever happened.
Clearly, you cannot wait another year to see if something has gone wrong. Vogell, you are very articulate - if necessary, can you document all of this and send it to him by fax, so he can have a chance to reconsider it? Hopefully he is right, and things will settle down, but your gut feeling has got to mean something.
If he refuses to see you, then, in my opinion, you are forced to seek a second opinion. Can you go to your family doctor for help and advice on the next step?
Re: I’ve got a problem after surgery! Need advice…
thank you for your reply! That is a good idea – to send him the description in the written form. As for family doctor, I still have no family doctor here, in Germany (I am in Germany only 2 years now).