Closed Lock/Lavage?? Need advice - TMJ Disorder -TemporoMandibular Joint Message Board

laskalady · 08-26-2006, 09:59 AM

Well I've been in this tmjd situation for almost a year now...coming up on my anniversary in September :-0) and I'm still with a closed lock. The tmj doc I have is very nice...and hes had me use a 24/7 horseshoe splint for about 4 mos. now. He was hoping I'd start clicking and could go to phase 2 braces. He said my case is difficult, and hes consulted with many professionals about me..even from other parts of the world. HE says they recommended something called Lavage?? Im going to try to look it up.. This is a process where they remove the scar tissue..and usually it will go back in place. They say its given them lots of success. However, I have noticed my opening is much wider than before. I can actually put 3 fingers in..but its a very tight squeeze. What are the odds of me clicking again?? I realy dont want this surgery. My tmj doc is hoping it will start opening up..I'm even seeing a physical therapist about 2 times a week.

raylp · 08-26-2006, 11:01 AM

Lysis and lavage is arthocentesis. It's done as an in-clinic procedure in which they fill up the joints with a solution and free things up. It is a blind procedure, in which they can't see inside the joint. Some arthocentesis procedures add the removal of scar tissue or using other tools to move the disc around.

I had it done for closed lock and it didn't help. I went to arthroscopy.

What concerns me about your TMJ doc is that it sounds like it took alot of investigation to come up with something that is a standard treatment for closed lock, once the conservative treatments have been exhausted. With my bias that I would only get treated by highly skilled folks, that may be a red flag.

Having a closed lock that does not respond to conservative treatments is not unusual. I don't know why he had to go all over the world for direction as to the next steps.

The success rates from studies have been high, but I know of many who didn't have success from this, and know of highly skilled surgeons who question it's effectiveness. They advocate arthroscopy, because of the ability to have visualization of the joint.

The doc I went to, Dr. Tarro, who I consider one of the top surgeons, does it as a next step after conservative treatments. If that doesn't work, he has them in for an arthroscopy. From what I gathered, it's commonplace for their clinic to move on from conservative treatments within 6-8 weeks. The doctor had an attitude that it just makes sense to take care of the patient and get the joint operational again without dragging things out.

This attitude was good for me.

I am pro-surgery by the way, that's my bias, but only with highly skilled surgeons with great references, success rates, and high levels of experience.
I wouldn't take any risks with anything less.

So I would research the avenue your doctor is recommending by having an intial consult with the surgeon, and asking alot of questions. You can postpone your decision until you are certain of what you want to do.

If your insurance would cover out of area procedures, I highly recommend Dr. Tarro in the Boston area. He made me feel completely comfortable, and I am not easily satisfied. He quotes a 90+% success rate, so given that, I'd think there is an excellent chance of having things in better shape.

laskalady · 08-26-2006, 01:15 PM

Well, the things make sense. I think the doc was hoping ohter professionals would perhaps give him more ideas for conservative therapy in a severe case. I think its b/c he is anti-surgery. He got hurt from a surgery and since then has tried only to use conservative measures. I'm really not looking forward to this surgery if I do have to get it. So you think my odds are really low of recovering the disc back to normal position w/o surgery?

raylp · 08-26-2006, 02:07 PM

I'm not sure about your odds with non-surgical measures. I didn't go the route of splint therapies, so I know very little about them. I do think though, that if you don't have some degenerative issues in the joint, the odds are pretty high that a highly skilled surgeon could help alot.

After being exposed to so much anti-surgery sentiment here, I was nervous about surgery, even though the surgeon had such a great track record. I think what helped me alot was his no-nonsense style, and attitude that this was pretty common. It really helped me to be treated as if it was nothing unusual. Anyway, I was extremely surprised at how easily I recovered. Sure everyone there told me this, but having such deep concerns about surgery I still wasn't convinced.

GoodThings · 08-26-2006, 04:57 PM

Quote:

Originally Posted by laskalady

Well, the things make sense. I think the doc was hoping ohter professionals would perhaps give him more ideas for conservative therapy in a severe case. I think its b/c he is anti-surgery. He got hurt from a surgery and since then has tried only to use conservative measures. I'm really not looking forward to this surgery if I do have to get it. So you think my odds are really low of recovering the disc back to normal position w/o surgery?

My question for you is: do you where your joints are relative to the fossa as of now with the splint in? If you still have a closed lock, your disc is still anteriorly displaced. Meaning that, your joint is still sitting back there.

GT