Author Topic: To do TMJ or not to? - Mitek Anchors (HELP)  (Read 2995 times)

Ghul

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To do TMJ or not to? - Mitek Anchors (HELP)
« on: June 14, 2015, 08:16:13 PM »
Hello guys (and gals)

This is my first post on here (but I've been enjoying reading the forum for a while... Many insightful posts by very kind posters!)

My surgeon is a fellow of doctor Larry Wolf ord from Dal las-TX. Ive got a mild case of TMJ disorder. However, he keeps pushing me on having Mitek anchors done on my TMJ besides BSSO and Lefort 1. I told him I dont think its a good idea, however he warned me that I have greater chance of surgical relapse if I dont get those Mitek anchors done.

It's a no-brainer for me, I want durable aesthetical results with no relapse however, on current literature, thereĀ“s almost no evidence of benefit of Mitek anchors in preventing post-BSSO relapse. The little evidence we have, however, is the research done by dr Larry himself... :-X ::) ::)

When I see those pictures, fear skyrockets...

Open the link to view the picture *coudnt add the image to my post without deforming it
Relapse 23yo woman

A 23-year-old woman who had maxillary posterior impaction, mandibular autorotation and genioplasty for advancement. Relapse of Class II maloclusion was evident at long-term postsurgery due to condylar resorption. Facial photos before orthognathic surgery (A); 6 months (B) and 3 years (C) after orthognathic surgery are shown. Patient signed informed consent authorizing the publication of these pictures
Source

Another example: A 19-year-old man had his mandibular prognathism corrected with bilateral mandibular ramus sagittal split osteotomies with a stable immediate postsurgical result. However, at 6 months postsurgery, he began to shift into a Class III end-on occlusal relationship. By 1-year, he was 5 mm Class III and getting progressively worse. This patient has active bilateral CH Type 1 that could continue to grow into the mid-20's. Serial lateral cephalograms and tomograms taken at 6-12 months intervals, presurgery, could have identified CH so that the appropriate TMJ procedure could have been performed at the first surgery. Bilateral mandibular high condylectomies, articular disc repositioning, and the required orthognathic surgery would eliminate the TMJ pathology and provide predictably stable results.
Source

I really dont know what to do: Should I get only BSSO + Lefort1 or should I add a couple of Mitek anchors to the package?  >:( :(

Thanks in advance!

GJ

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Re: To do TMJ or not to? - Mitek Anchors (HELP)
« Reply #1 on: July 20, 2015, 11:42:56 AM »
You should contact Ryan from the forum -- he consulted with Wolford and was recommended the same thing and declined it. He can probably give you the most info. If he does, then come back and share what you find.
Millimeters are miles on the face.

molestrip

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Re: To do TMJ or not to? - Mitek Anchors (HELP)
« Reply #2 on: July 21, 2015, 02:43:02 PM »
I consulted with Dr Wolford, nice man. He didn't see my MRI but others have and there's no indication for myself. Of the people I've met who had anchors done they failed miserably. I've met maybe a half dozen. However, they were all seriously screwed up people to begin with. I can point you to one such patient if you want to discuss or check out the FB TMJ group. They've told me they know people who did well with them. I haven't checked myself but I'd think a resorbable anchor might be ok but I don't think they do those yet in practice.

This is one of those f**ked if you do f**ked if you don't situations I think sadly. It's true that Dr Wolford stands alone in his research here but there's a lot of unpublished anecdotal research from other surgeons that reproduces his findings. He's very well respected in the oral surgery community, I don't think the data is fabricated or anything like that and he certainly has larger volume of patients at his disposal than most other studies would have. Long term, surgical intervention is the right approach for many people I think. In your shoes, I wouldn't do it however. Some amount of canon fodder is necessary for this technique to become perfected and I wouldn't want to be in that position, it's not there yet. Dr Wolford has been doing it for over 15 years now and from my meeting with him, I don't think he'd still be doing it if he weren't seeing a lot of success. The alternative is homeostasis approach. The thought is that a pseudodisc forms from scar tissue in the joint stabilizing it. Other researchers have noted high success rates in jaw surgery on these patients. This is one area that I think Arnett/Gunson really excel, the pharmaceutical intervention for degenerative joints. I'd look into that for yourself. Prepare yourself for a long hard road, you may continue to have joint pain for a year or more afterwards and your bite may relapse, just remember that it's likely better than the alternative. In my case, I'd still be better off after surgery a small malocclussion.

Hold out as long as you can, stabilization splint, TMJ Nextgen, etc whatever it takes. You might have to wait a decade or two but a good solution will appear. One of the risks of surgery is the preclusion of future surgery. Scar tissue, new/unknown problems, etc. can make it hard to redo previous surgeries.

terry947

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Re: To do TMJ or not to? - Mitek Anchors (HELP)
« Reply #3 on: July 21, 2015, 10:46:13 PM »
Google "starecta"- it's a mouth guard to help with tmj pain and posture. Though it's different than any regular dentist splint.