TMJ Surgeon.com: A Patient’s perspective

Note: I operated this patient two years ago. Below is her own account of her personal experiences. It is published in this blog with her permission. I know that all of my colleages in the American, British, European, Asian, and Austrailian Societies of Temporomandular Joint Surgeons see such patients on a daily basis. .

“At about age 12, I began to have joint pain in my TMJ on the right side. At first, it mimicked a chronic ear ache. My parents took me to ENT doctors but no ear problems were seen. This was the first experience with the diagnosis “TMJ”. My dentist noted that my bite was off and drifting to my right side. To correct this, an appliance was placed in the roof of my mouth. My “bite” was never on target and dentist after dentist filed my teeth down to try to ge a proper occlusion. I had many bite splints and other dental treatments, including dental caps to correct my worsening occlusion but with no improvement in my pain.

Starting in my 20s, headaches and incredible muscle pain in the head, neck and shoulders began. Debilitating pain returned in my right joint in my 30s and never went away. At age 35, an orthodontist finally took an xray which showed that the condyle in my right TMJ was much smaller than my left. My jaw was shifting to my right. Orthognathic surgery or jaw repositioning surgery was recommended. My insurance company denied this surgery. Now I am thankful this was the case because my TMJ problem was due to severe arthritic disease in the joint and this operation would not have dealt with that problem.

When suffering with TMJ, a patient feels lost. My dentist tried to have all of the answers, but after much experimentation, you realize that he doesn’t. Your try an orthodontist and after everything they have to offer, you are still in pain and lost. Folks would say “Find a TMJ Specialist”. I had no idea who that might be or where to find one- much less a reputable one! A friend finally called a surgeon in Pittsburgh and asked for a recommendation.

At the age of 45 and after 33 years of difficulties, pain of many and confusing types…..I finally had a diagnosis made. This was the first time any provider suggested definitive diagnosis with an MRI.

I cried in Dr. Kirk’s office the day he showed me pictures of what my right TM joint currently looked like. Compared to normal images that he showed me, I could see for myself with clarity that this was a terrible case of degeneration, arthritic degeneration from years of wear and tear. It is likely that my problem began due to a growth malformation of the right jaw joint. The right side was smaller than the left causing the jaw to pull off to the right side and wear the joint out. An MRI is what finally led to solid answers for the first time in my life !!

My surgery was a success. I did not experience as much pain from the procedure that I expected. The worst of my chronic pain of 33 years is now gone and I can now function as a happy mother of 2 little ones. Due to the longstanding problem, I still have headaches at times but they are managed very well with physical therapy and exercises I have been taught to control chronic muscle issues. Before, nothing would help headache.

In my case, headaches, neck pain, shoulder pain, ear ache, ringing in the ear, dizziness, pain in all facial muscles,and chronic sore throat can all be related….I had all of these symptoms at one time or another during 33 years!

For 33 years, what was missing was an accurate diagnosis and imaging provided that. One can not put a price on your health..and one must be educated about their own health issues. A specialist who will actually suggest imaging a patient before treatment is my most important recommendation to you.

D. Agnone
Charlotte, NC
February 4, 2011

COMMENTS:

I think most surgeons who encounter patients like Deborah become frustrated when they encounter patients like this who report such histories. It is frustrating. MRI of the TM joints were reported in the medical and dental literature back in the 1980s. It became very clear that this would become the gold standard for imaging any joint in the body, but its employment in TM joint work was very important. Despite publications in the dental literature, most “TMJ Specialists” rarely employ it unless they are teamed with a surgical specialist who can direct the patient to hospital or other imaging centers. There are pockets of providers scattered in the US who will image patients and even base their non surgical treatment on simulated therapeutic intervention based on what MRI predicts…but these are few and far between.
Also note that this patient’s known history of problems began at a young age. The assumption that her TMJ issue was related to occlusion issues was unfortunately misguided…..the occlusion issues were a consequence of an early degenerative process alive and well during the period of skeletal growth and development. It can not be emphasized enough that the cause and effect in growing patients with significant malocclusion and a crooked growing jaw may just indeed be an abnormality impacting joint development, the growth center of the lower jaw.

WSK
Charlotte, NC