TMJ pain 4 months after BSSO, caused by asymmetric posterior open bite?

[baldguy83]

Hi all,

As I've detailed in several other threads I've had a BSSO (+ chin wing and malar osteotomy) done a while back. Immediately after the operation I noticed that the back teeth on the left side didn't meet at the same time as the ones on the right side did (unless I actively tried to compensate with my jaw muscles). Naturally, I asked the surgeon about this, and he mentioned that this was not no problem, and that the jaw muscles needed to adapt or something like that.

Now, four months later, I noticed the TMJ on the left side started clicking when chewing/swallowing, and it also started radiating pain down my left cheek (more like a constant minor ache though). I suspect this has to do with the posterior open bite on the left side which is still present, and my jaw muscles on the left side being strained trying to compensate for it. Could this be true? And can such an asymmetric posterior open bite be fixed using orthodontics? Hopefully I don't need to have the BSSO redone or something like that...

[molestrip]

Yes, your orthodontist can extrude the molars. In fact, this is done on purpose sometimes even, as molars are expected to extrude somewhat as part of settling. The view is that it's relatively easy to extrude molars but much more difficult to intrude them. You'd need skeletal anchorage probably.

TMJ problems are common post-op, especially with larger movements (>7mm occlusal). Stats I've read are 40% up to 70% >10mm. Muscles do need time to adapt, as they stretch or shrink to their new locations and you relearn how to use the jaw. Your joint bears the load in the mean time. Usually it settles on its own in time, doing physical therapy can help I think. Shouldn't  need to redo BSSO.