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Question: One MRI Scan - Two Interpretations?


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Old 09-16-2008, 07:15 PM   #1
pipdog
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Question: One MRI Scan - Two Interpretations?

6 months ago I had an MRI scan done of both TMJs in open and closed position, Radiologists report said the right side was fine but that on the left the disc was permanently displaced to the inside. I have pain on the left side.

I then began treatment with a repositioning appliance based on this diagnosis but was told to more than likely expect surgery as this type of displacement is harder to correct non-surgically.

The first specialist referred me to another one nearer to where I live to manage the adjustments but the second one said that the MRI report was insufficient and we had the scans re-reported by one of the 'leading TMJ radiologists in Europe'.

The second report is longer. more detailed and totally at variance with the first one and based on the findings no surgeon would go near me.

My left TMJ is in pretty good shape with 'the disc covering the condyle uniformly' but says my right TMJ has early signs of an anteriorly reducing disc. Right side I have no or never had any symptoms ever so this all leaves me very confused.

Could it be that I don't have a TMJ disorder at all?
Could it still be a TMJ problem but muscular?
Which radiologist can I believe?
What would you do?

Last edited by pipdog; 09-18-2008 at 09:01 AM.

 
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Old 09-17-2008, 12:41 AM   #2
temera2
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Re: Question: One MRI Scan - Two Interpretations?

If i were you , i would seek two other opinions of people , and i mean BIG doctors at hospitals... go and confront both doctors nicely that is and ask why they provided you with inconsistent findings.. explain to them you are scared and make sure you tell both , make them call one another and then call you back and explain.. if they are ignorant and cant do that then just go see two other people who could help you ..

What symptoms do you currently have? Any clicking jaws..

Lots of Love

 
Old 09-17-2008, 05:15 AM   #3
abond0073
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Re: Question: One MRI Scan - Two Interpretations?

Quote:
Originally Posted by pipdog View Post
6 months ago I had an MRI scan done of both TMJs in open and closed position, Radiologists report said the right side was fine but that on the left the disc was permanently displaced to the inside. I have pain on the left side.

I then began treatment with a repositioning appliance based on this diagnosis but was told to more than likely expect surgery as this type of displacement is harder to correct non-surgically.

The first specialist referred me to another one nearer to where I live to manage the adjustments but the second one said that the MRI report was insufficient and we had the scans re-reported by one of the 'leading TMJ radiologists in Europe'.

The second report is longer. more detailed and totally at variance with the first one and based on the findings no surgeon would go near me.

My left TMJ is in pretty good shape with 'the disc covering the condyle uniformly' but says my right TMJ has an anteriorly reducing disc. Right side I have no or never had any symptoms ever so this all leaves me very confused.

Could it be that I don't have a TMJ disorder at all?
Could it still be a TMJ problem but muscular?
Which radiologist can I believe?
What would you do?

Hi pipdog

I have had controversey regarding my MRI readings

Basically, some people have abnmormal scans and have no symptoms. MRIs can vary from day to day too apparently.

What would I do? I have withdrawn from the TMJ treatment circle (yes my life
has been seriosuly affected by TMJ) as Ive had mixed results form TMJ tretament and there is too much controversy in this field to make a rational decision.

My advice to you: scan or no scan, only go for the treatment which improves you (hopefully cures you) and lets you lead a full normal functional life!
Best of luck

 
Old 09-17-2008, 05:17 PM   #4
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Re: Question: One MRI Scan - Two Interpretations?

Pipdog - I would ask the 2nd dr to re-review the MRIs to ensure he did not switch or mis-interpret which sides - right or left - he was reviewing. Although so far everyone I have showed my MRI films to have consistently found nothing significantly abnormal - I did have one dr who said my problem side was the right side due to abnormal angularity of the jaw bone - yet when I mentioned to him that several drs found that on my left side only - he looked at the films again and said he was mistaken - it was my left side - and then went on to explain that the films were taken "out of order" by the radiologist and that's why he made the mistake. But mistakes can happen.

If however he feels his initial assessment is correct I would take them to other drs for their input as well. Sometimes when confronted with such a problem its better to try and get a "consensus" of several drs.

 
Old 09-18-2008, 01:30 AM   #5
abond0073
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Re: Question: One MRI Scan - Two Interpretations?

i hoep you find the right answers from somone about teh problem
just get well soon

Last edited by abond0073; 09-18-2008 at 01:35 AM.

 
Old 09-18-2008, 03:17 AM   #6
pipdog
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Re: Question: One MRI Scan - Two Interpretations?

..........

Last edited by pipdog; 09-18-2008 at 03:58 AM. Reason: Posted twice

 
Old 09-18-2008, 03:32 AM   #7
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Re: Question: One MRI Scan - Two Interpretations?

Thanks for the feedback

TL - you got me worried. How could these specialists mix up right and left? It would be like the surgeon removing the wrong leg.

The first scan report was done by the second choice facility (the good one was booked up) and the radiologists there are looking at twisted ankles one minute TMJs the next. The second report was done by a guy who only looks at TMJs and lectures and writes on the subject so I am inclined to believe him more.

I got the second report on Monday and its taken a few days to sink in. I realised I am probably being 'over-treated' - the Gelb and the vertical dimension are designed for a problem I now don't have so I stopped wearing it and went back to the Aligner I had earlier in the year. The Aligner is an upper and lower splint you bite into and its holding my jaw in the down and forward position like the Gelb but with much reduced vertical. I think I had WAY to much before and it was actually making the pain worse - go figure on this one.

I can't believe how there is just so much trial and error in TMJ treatment. I mean we are supposed to trust our docs and respect all their years of experience and knowledge but then you find out they were working to the wrong diagnosis. All part of the journey I suppose.

 
Old 09-18-2008, 03:51 AM   #8
abond0073
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Re: Question: One MRI Scan - Two Interpretations?

Quote:
Originally Posted by pipdog View Post
Thanks for the feedback

TL: you got me worried. How could these specialists confuse right and left? It would like a surgeon removing the wrong leg.

It took about 24 hours for the information to sink in. Going on a gut feeling #2 is more credible. The MRI scan was done not in the first choice company because they couldn't schedule me but in another one which I was told afterwards does not have such a good reputation.

I stopped wearing the Gelb yesterday I think it was causing more problems. I am back in my aligner which is doing much the same as the Gelb in keeping my lower jaw down and forward but with much less vertical dimension. I was built up so high before for what in hindsight was a condition I don't have.

I really feel sorry for us all on here - there just seems to be so much trial and error in treatment that it could drive you crazy. I mean on the one hand we are supposed to trust our docs and respect their years of experience and knowledge but on the other we have to trust our own instincts as well.
TRIAL AND ERROR - I know what you mean - i think this whole illness had driven me crazy and changed me.

if your splint is causing you harm, id leave it. i been in a splint for years - but thats out of addiction - at first i believed it was causing me harm, but i trusted the treatment and kept it in - now im ina position - i cant live with it and cant live without it.

i rang the tmj association in america - they were quite helpful
research is moving in the tmj direction

in a few years we may finally know why some of us are predisposed to tmj/facial pain (ginetics, structual, innervation) and be treated accordingly. that might put some end to trail and error.

thats what gives me hope!

Last edited by abond0073; 09-18-2008 at 03:58 AM.

 
Old 09-18-2008, 12:21 PM   #9
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Re: Question: One MRI Scan - Two Interpretations?

Ya know a couple years ago I had an MRi and joints fine but my dentures were made to high (verticle and held my jaw too far back so I had ear pain and tight neck. Fast forward now - new tmj dentist that did the mri put me in a splint and sent me to a osteopath, pulled the jaw forward too much, now still in a splint and still seeing ostepathic doctor and worst off too boot. I should of been happy with just the ear pain.

Read my post on the mi dental school, apparently they don't do much for tmj there either. Personally I think all this tmj treatments have just made me worst.

 
Old 09-18-2008, 07:31 PM   #10
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Re: Question: One MRI Scan - Two Interpretations?

Pipdog - it was just a suggestion based on my experience - it doesn't mean the 2nd dr made a mistake but you just never know - it wouldn't hurt to explain to him that another dr said it was the other side with the problem and see what he says to that - it may just make him reconfirm his initial diagnosis.

I went to Dr Gelb (his son Michael actually) in NYC and really was not that impressed - I too tried a splint he made for me that was a upper and lower one peice unit that felt like it pushed my lower jaw backward - I literally could not breath when it was in - I thought perhaps since my tmj dentist referred me to him - he did not feel it was necessary to really look at my problem since I was another drs actual patient. He also did trigger point injections on me once when I got locked closed on one side - but they didn't help much - I don't think I was really locked close either but just so lopsided from the bite adjustments my tmj dentist had done. Its one of the reasons I stopped looking for "well known specialists" and just tried to find one locally who took a more simpler and holistic approach to resolving my problem that made sense to ME - and was not just textbook and theory.

I agree - too much vertical can cause other problems - I think that's what started me on my tmj journey - a new upper front bridge that was longer in length - the dentist said my bite was anteriorly open so he closed it by lengthening the teeth of the front bridge - but this added to my vertical dimension and that's when I started to grind my back teeth and have chronic jaw pain or neuralgia.

Last edited by Thelma-Louise; 09-18-2008 at 07:36 PM.

 
Old 09-19-2008, 01:32 AM   #11
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Re: Question: One MRI Scan - Two Interpretations?

Going to get 3 more readings wouldn't be such a bad idea. With just 2 the odds of picking the correct diagnosis would be like a coin toss.

 
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