3 surgeries, 7 years of treatment and now joint is getting worse – Wilkes stage 4 - TMJ Disorder -TemporoMandibular Joint Message Board

Staffjam · 05-22-2009, 10:27 AM

Well I’ve had TMJ disorder for 12 years now. The first few were the hardest when no one believed there was anything was wrong with me.
I started actual treatment over 7 years ago and have had three surgeries on the joints since then. For the last 2 years I have been a patient of Patrick Grossmans in London – who is a very knowledgeable practitioner. Sadly he hasn’t been able to reduce the awful headaches I am having.
The joint seems to have significantly degenerated and after the last MRI scan they were said to be at Wilkes stage 4 (Doctors write up is below.)
Both joints become exhausted when I eat or laugh, and the left side is uncomfortable all the time now.
I’m beginning to think that splint therapy may not be the answer to my problems, but it is galling as I did have a period of about a year when everything was very good.
So the purpose of this post is to see if anyone has any ideas as to what I can do next – Can I just take the splint out?
I am leaving London shortly and Dr Grossman has advised I see Brendan Stack – does anyone know this chap and can they offer a review.
I’d also be grateful if someone could shed a little more light on Wilkes stage 4 and just how bad or good that is.

Thanks for any responses – The MRI report is below (starting with the conclusion)

MRI: Bilateral Temporomandibular Joint

CONCLUSION
These appearances would be consistent with bilateral anteriorly displaced non reducing articular discs. Surgical changes are noted on the left. There is evidence of bilateral synovitis and condyle and eminence degenerative change. The appearances would be consistent with Wilkes stage 4 joints bilaterally.

RIGHT SIDE CLOSED
The articular disc is poorly demonstrated but anteriorly displaced lying with it’s posterior aspect in the 9 o’clock position in relation to the condyle. The condyle is centrally but superiorly positioned within the gleniod fossa with narrowing of the joint space. The condyle demonstrates flattening with some surface irregularity and anterior osteophyte formation. The eminence demonstrates flattening with inferior beaking. High signal is noted to surround the head of the condyle. There is no joint effusion noted.

RIGHT SIDE IS CLOSED WITH SPLINT IN SITU
The condyle is more anteriorly positioned within the glenoid fossa with slight widening of the joint space but the disc still remains anteriorly displaced

RIGHT SIDE OPEN
The condyle translates to a point in line with the most inferior point of the articular eminence. The disc is not recaptured and lies bunched up anterior to the condyle with an abnormal configuration.

RIGHT SIDE CORONAL CLOSED
On these images no disc material is seen to cover the condyle.

LEFT SIDE CLOSED
The articular disc is poorly demonstrated but appears to lie anterior to the condyle with its posterior aspect in the 9 o’clock position. The disc has lost it’s normal configuration. The condyle is superiorly positioned within the glenoid fossa with narrowing of the joint space. Note is made of flattening with osteophyte formation. Metal artefact from the previous surgery makes it difficult to evaluate the lateral aspect of the condyle.

LEFT SIDE CLOSED WITH SPLINT IN SITU
On these images the condyle is more anteriorly positioned within the glenoid fossa but the disc is still not recaptured. There is minimal widening of the joint space compared to the images without the splint in situ. High signal is noted to surround the head of the condyle. There is no evidence of any joint effusion. The eminence demonstrates inferior beaking with some articular surface irregularity.

LEFT SIDE OPEN
The condyle translates to a point in line with the most inferior point of the articular eminence. The disc is not recaptured and lies bunched up anterior to the condyle.

LEFT SIDE CORONAL CLOSED
On these images no disc material is seen to cover the condyle. Note is made of surgical artefact lateral to the condyle. Soft tissue covering the condyle almost certainly represents thickened retrodiscal material.

LEFT SIDE CORONAL OPEN
Once again no disc material is seen to cover the condyle. No further abnormalities of note.

Thanks for getting this far. If you guys have any comments on this I’d very much like to hear them.

Thelma-Louise · 05-22-2009, 08:59 PM

I'm not good with the technical aspects of test results - so I will leave that to those members here who are - but just wanted to suggest to you to do an Advanced Search on Dr Stack on this forum as there have been some previous posts regarding him. I know my dentist has often referred to or mentioned him and his website is pretty impressive and that he does have a lot of experience in treating tmj.

StillHope · 05-22-2009, 10:05 PM

Hi,
from the book "From TMJ to Smile Design" by Dr. Dawson I understand that the Stage IV is with very little or no chance that the disk will go back in place. What it says is that the occlusal corrections might be needed, on the other hand he warns of any irreversible permanent occlusal changes.

The main focus, as it is throughout the whole book, is to make sure that the jaw can go easily to the CR or ACR (centric relation or adapted centric relation).
He says that a splint might be helpful, but again it should allow the jaw to go to CR or ACR.
According to Dawson there are V stages of TMJ intracapsular disorders.
The "good" thing is that when the disk is totally gone there is no pain (according to the book) and the jaw bones are just sliding against each other.

What are your symptoms currently? Can you load the jaw, I mean can you bite hard on smth or they hurt when you press against food?

Staffjam · 05-23-2009, 02:08 AM

Thanks for replying guys - i'll do some more research on Dr Stack.

StillHope - My symptoms have now mushroomed - so i'm stuck with headaches every day. The morning is usually okay - but when it gets to the afternoon it's very unpleasant. It's a little like a pressure headache, but also something worse. It's very difficult to explain as it's just a feeling of wrongness in the head that is actually worse than the headache.
Also the left hand side of the face spasms under the eye (this was fine 3 weeks ago), but since my last adjustment it has been very bad - it also has an impact in social settings as the face is moving all over the place.

The left joint is constantly hurting now, so the encouraging thing is that the problem is localised and i know where all this bother is coming from.
Eating isn't really a problem and my mouth opening is about 48mm. I do therabyte three times a day and have done so for the last 2 years (god i hate that device.)

So it's not great, but i'm going to go back to Patrick Grossman next week (4th time in 3 weeks) and have another adjustment.
The thing that worries me is that i'm leaving England soon to go to Mexico City - so i'm not aware of any practitioners there. I'm also getting a little wary of TMJ specialists now, as i've been to a few and as nice as they've been they really have achieved very little.
But if anyone knows of anyone in Mexico City please do let me know.

I've had all the relevant brain, head, and neck scans so i don't think the problems there - just this damn TM joint.

Thanks for any more info or advice.

luvtocamp · 05-23-2009, 08:37 AM

May I ask what you feel was the cause of your tmj at the beginning? dental work, injury, or just came on by itself, ginding of teeth etc?

It is good you can eat and have a wide opening. I would love to be able to give you advice but I have yet to find an answer, but everyones case is different.