TMJ surgical failure

[uga2000]

I had a bone anchor put into my tmj to try to solve what I thought was a disc issue.  It failed and now I'm in chronic pain and the muscles in my face are atrophying.  Not sure what to do.  Just wanted to see if anyone knew anything about this.

[GJ]

What did the surgeons say in terms of prognosis and options?

Sorry, I know nothing about this.

[terry947]

Are you also having condyle resorption and what Is/was your bite like when you started to have tmj symptoms?

[Alue]

You had an arthroplasty?  What was the name of the procedure that was done and how was it stabilized?   How long ago was the surgery? 

[uga2000]

The surgery was 3 months ago.  It was performed by a doctor in Georgia.  I had perfect function, but chronic neck pain and a feeling that my jaw was shoved into my ear.  The surgeon saw a slipped disc on the MRI and thought arthroplasty would fix it.  He put a suture anchor called the Juggerknot into the bone and tied the disc down.  The disc displaced sometime after the procedure.  Now I have chronic neck pain that is so bad I can barely work.  I can only relieve it by posturing my jaw extremely forward like a bulldog, but it only gives me some relief.  My facial muscles on the right side where the surgery was have started to atrophy.  The doctor at the largest hospital in Georgia told me he would not accept me as a patient to correct it because "I've seen too many people."  Another surgeon who is well-respected wants to do a temporalis sling procedure to fix the failed anchor surgery.  He would leave the anchor in the bone.  I don't know what to do and I'm in so much pain. 

[Alue]

I'm sorry to hear that happened, keep searching till you can find a surgeon that is willing to help you.  Sounds like you may have to start looking outside of Georgia. 

Is there anything you can do, any exercises to prevent further atrophy of the facial muscles until you can get this fixed? 

I'm sorry I can't really provide any technical help, I was considering having an arthroplasty done in addition to jaw surgery, but I have mostly decided to not do the arthroplasty part. 

[LoveofScotch]

I'm so sorry, uga2000.

Even though you're in a lot of pain I would proceed carefully. If it's an option I would consult with as many people as possible (you will probably get different treatment plans from everyone). Before proceeding I would figure out exactly what's going on. Is it a problem with your condyle or the position of the disc? Maybe both are alright, but your bite is actually causing the problem? (A lot of people have a disc that's in a less than ideal position; it doesn't always cause pain.)

I can't even believe I'm suggesting this, but can you get to Texas to see Wolford?

[uga2000]

I've heard so many horror stories about Wolford and the mitek anchors that I don't think I'd trust him enough to be able to see him.  I am looking at a guy on the West Coast that has experience deactivating the anchors arthroscopically, but he doesn't use a splint afterwards.  There's a guy near me that wants to do a temporalis flap surgery.  That seems really invasive to me.  There's also Brendan Stack's surgeon in Virginia.  The main surgeon in my town won't take me as a patient because "I've seen too many people."  I'm so scared and in so much pain.  I'm trying to make the best choice but my health is deteriorating.

[Alue]

Not seeing you because you've "seen too many people" is a ridiculous excuse.  Whatever his real reason is, maybe it's a good think you don't see him. 
I hope you find one that is willing to help.  Did you have TMJ pain before the surgery? 

[molestrip]

I've gotten that from practitioners before. It's really selfish of them. Basically, if you've seen too many people he figures you'll be picky and that he's unlikely to have a happy patient. That's not good for his reputation so he won't help you because he doesn't want to risk his reputation. Big name surgeons turn this negative into a position, that they get redos. Their reputations are so strong, too, that they can afford unhappy patients sometimes. Smaller name surgeons can't. Try to move past it, my advice.

[Rico]

The doctor at the largest hospital in Georgia told me he would not accept me as a patient to correct it because "I've seen too many people.

that means his not so good and selfish

i'm picky patient and found 2 surgeons who answered to all my questions... even on 2 consultations and now i'm gonna choose on of them  very soon. and my problem is very tricky - chronic nerve compression + zygomatic deformatione after overlooked fracture.

Something like TMJ is quite popular esecially in stressed persons. - a lot of surgeries in this area.

if a surgeon is really good and he has good personality and if  you let him know you are fully aware, that every surgery is little risky and there is no guarantee, then he will help you

the best example for me is Zarrinbal. I asked him why he does not perform LF3 osteotomies and other things like this on zygomatic bones and he answered me that he does not do it, because he wants to have good reputation    but he used to do it when he started to be a surgeon...so he never had opportunty to become professional in this area. I mean he is good for many things, but he knows that he is not good in more complicated surgeris so he just avoid such procedures what makes him a surgeon with good reputation

[Rico]

hmmm now I realised ...that as a not local I mean foreign (another country) patient i'm a "safe" patient. You know I can't speak German nor Italian...so the power of my complaining after botched surgery may be not strong to reduce their reputation. However I'm the one who knows the risks and I'm not gonna do this if that happen...if it will not be a total botched surgery
But we still have Internet - so that would be stupid thinking. I can always ask somone to write me something in other language

now I scared myself

[molestrip]

TMJ symptoms are aggravated by stress so many practitioners naturally assume that it is also caused by it. Pretty much the same can be said for all disease however for many, alternate causes are already well known so people are willing to overlook the link. There's quite a lot of published literature on the topic but most of it is unknown to the wider dental community for some reason. Much of the more reputable research seems to point to skeletal deformities as causative but stops short of prescribing skeletal fixes as preventative or curative.

What the surgeon meant in your response to LF3 is precisely what I said in another post, it's a lot easier to maintain a good reputation when 99/100 patients walk about happy but a lot harder when only 85/100 do. I've spoken to a few surgeons, all the LeFort procedures are routinely performed. You don't need to go to a special surgeon in Germany for it, chances are there's a guy who's doing it and doing it often in your city. He's just not doing it for you. He's doing it in syndrome and trauma cases, cases, that is, where the patients have little to lose for the relatively high risks. You're not ordering dinner here. When it fails, lives are destroyed and you only get one life. No one wants to be responsible for ruining hundreds of otherwise relatively normal lives in their career.

[Rico]

TMJ symptoms are aggravated by stress so many practitioners naturally assume that it is also caused by it.

stress causes bruxism ...
bruxism causes TMJ in long term

TMJ is highly related to stress , especially to  GAD - it's not just simple stress
+ some problem with occlusion, etc + predispositions

You don't need to go to a special surgeon in Germany for it, chances are there's a guy who's doing it and doing it often in your cit

SURPISE.... but not I wrote about this in PM. Believe me in Poland no surgeon performs LF3 / zygoma osteotomy, etc for mild cases. I think they have not enough skills due to bad health system. In Poland you need  big deformation (not fresh fracture) to get surgery and high risk your nerves will be damaged too much after surgery... this is why they do not want to do it for mild cases. and that makes viocious circle. No patients to treat, no experience... - problem with health system. I have had consultation with 7 surgeons in Poland. 6 refused. 7th has not enough good opinions.

or surgeons from another countries do not give a f.... about foreign patients

No one wants to be responsible for ruining hundreds of otherwise relatively normal lives in their career.

you are right. but explain me this difference , that I can easily find a surgeon abroad, but not in my country

[molestrip]

I'll repeat a quote I found in one of the TMJ papers, I don't recall who wrote it. TMJ is exclusively found in patients with skeletal abnormalities. That's different statement than occlusion and it is highly suggestive that in cases where jaw surgery can fix the skeletal abnormality and TMJ problems don't appear as a result of the surgery that there's a very good chance that TMJ symptoms will also likely never appear in that person going forward, regardless of other risk factors. Fingers crossed, I could be one of those

All I meant about the LF3 statement was that it's not something that only special people can do, it's just hard to find someone willing to do it on you (and for good reason). The reason you can find someone abroad to do it is simply that the number of choices is far greater so the odds of finding someone when only a small percentage will consider it increases.