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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index

[QUOTE=interested27;5217453]Canuck, I'm sorry to hear your problems have worsened over the years and you need surgery. what exactly do they want to do with you, if you don't mind me asking.

It's funny. I actually just purchased a therabite too, but it aggravated my face and left jaw joint to no end, so i stopped using it too. i read up on the dynasplint and considered that but was torn. online, i read that TMJ patients aren't supposed to have their mouths opened for long periods of time, and the dynasplint requires like 30 minutes of sustained opening numerous times a day. Even though the dynasplint logic makes more sense to me than anything else, when it comes to encouraging and maintaining an opening, i'm still torn about it. How often did your docs want you doing the therabite? mine wanted me to do the 5-5-30, i think it was, but the second i stretched even a little beyond my comfort zone, my face went haywire.

the first doc i saw here is affiliated with a university and he's convinced my problem is all muscular, but my joints hurt like crazy so i have my doubts. he wants to do botox and then have me aggressively stretch, but wooza, that idea scares me. passive, easy stretching makes my face crazy. and I am schedule for a second MRI, i just can't open very wide, and they're worried we wont get a good look at the discs, so i don't know what to do about that.

i'm sorry you're having swallowing pains and problems too. i have to say that out of everything- a limited opening, joint and muscle pain- the swallowing problems are what freak me out the worse, so my heart really goes out to you. i hope your issues are resolved soon and your surgery goes well. when is it scheduled for? and did they try you on splint therapy in the past?[/QUOTE]

Here's my story. In Feb 2010 my jaw locked up and my muscles spasmed. I had an mri and i was diagnosed with a anteriorally displaced disc in the right tmj joint. I tried conservative therapy - had night splint to wear at night - covers all of my upper teeth and is a flat plane doesn't do any repositioning. I clench at night its supposed to help take some of the wear tear of clenching off the joint and I think it has helped; I also tried muscle relaxants which I had adverse reactions so ended up on Clonazapam (klonopin) and anti-inflammatories - arthotek/celebrex (tried both) and physio. Wasn't getting anywhere so I had arthoscopic surgery on the my right tmj joint in December 2011. (Unfortunately I had to have surgery on my leg in Sept 2010 and there were complications and has delayed treatment of my TMJ). Arthoscopic surgery - the surgeon washed out the joint; shot some steroid into the joint and released scar tissue (adhesions) around the disc that can build up when the jaw doesn't move and these adhesions cause the disc to stick and not move well. He alsos stretch my jaw under anesthetic and got it opening to 30 cm (I was at about 20). But I couldn't maintain the opening post surgery. So he said something is else is going on - because the surgery should have made an improvement if all it was was a disc issue. Anyways had a CT scan and found a osteochondroma on the condyle of the right TMJ joint - this is a bony benign growth and the surgeon thinks that's part of the problem because it taking up room in the joint passage so its blocking the disc and the disc can't get around it. He was also concerned that my temporalis tendons are scarred and if they have become scarred he said the jaw won't open.

So he proposed open jaw surgery to make an incision in front of my ear to shave off the osteochondroma; to take out the disc and replace it with fat extracted from my thigh (he said disc is likely in bad shape); he would sew me up and mobilize my jaw but if wasn't opening to 40 cm under a general anesthesia he would then go inside my mouth and make further incisions to cut out a peice of the jaw bone where the temporalis tendons attach. This is over night surgery. He then wanted me to use the therabit device to mobilize jaw - I think 4 x day 15 reps to 30 reps starting the next day.

I was planning to do this in September 2012, (he has a long surgical wait list), however, in March of 2012 I tore the meniscus in the knee on the leg I surgery on and I wasn't in any kind of physical or emotional shape to do surgery in September so I rescheduled surgery for Janury 2013.. HOwever, I have had ongoing problems rehabbing my leg so I delayed surgery again and now looking at January and I feel I can't delay any longer (my leg still hasn't fully recovered but I figure I have to live with it and deal with it later). The sides of my forehead is caved in, which is where the temporalis muscle is and its a sign of muscle atrophy. I now have problems with my left TMJ joint (which may mean more surgery now for my left TMJ joint - I have to talk to my oral surgeon) and since March 2012 I have had first right sided neck and shoulder pain but in the last few months my left side is getting affected too. And the neck pain is just getting worse.

I find it interesting that you had the same problem with the Therabite aggravating your neck muscles. I tried it in June after seeing my oral surgeon because he really wanted me try it to now - to get into the habit and to see if I could get any mobility in my jaw and to hopefully stop some of the muscle atrophy. He told me to do at my own pace. So I kept the therabite at the lowest setting; no resistance and first did 10 - 15 reps just once a day; then gradually increased to 3 x a day and just to the point of feeling pain - I didn't try to force it - it was at about 3 x a day and I was beginning to get my opening so I could fully open the therabite device at the lowest setting that my neck pain started to really set in. And so I stopped because I couldn't tolerate the pain.

The dynasplint was recommended by another oral surgeon that I saw for a second opinion on jaw surgery. The one thing that put me off is that it is very expensive - $399 to rent a month in Canada! - I think its not that much cheaper in the US. The other thing is that it seemed to put an awful lot of weight on your jaw - I thought the Dynasplint rep said it started out at 1/4 of pound but I need to confirm this. My understanding is with the Dynasplint is that you gradually work your way up to 30 minutes 3 x a day. And you gradually increase your opening as you work your way up. I think you start out at 5 minutes a day, 3 x a day. And I'm not sure I could even do that, so I would try it for 1 minute a day and then gradually increase it. I am waiting to see if my insurance will cover the rental cost of the dynasplint.

With respect to the second MRI, when was the first one taken? If it was taken a short time ago then maybe its not worth the aggravation. But the doc should tell you whether or not you have a displaced disc - that's the main reason for doing an MRI. I know the radiologists want you to be able to open because they want to see if the disc is translating or moving as it should when you open and close your jaw. That being said I had a recent MRI and I'm opening only about 15 cm, and its true on the right side they didn't get a very good look at the disc but on the left side they were able to pick it up and determine that its not moving. I would also discuss with your doctor getting a cone CT scane that can pick up any bony abnormalities like what I had - at least it would rule it out so you know your are dealing with a muscular issue and possibly a displaced disc. Your joints can hurt even if its just muscular.

I have tried trigger point injection therapy with anesthetic in my neck and it help my neck pain; didn't do much for my face/jaw pain. And I am now trying to find someone who can do botox because I was having to go once a week for the trigger point injections. I think you should hold back on these two altnernatives. There are always risks with these injections and you should always try the least invasive course of action first. There are lots of muscle relaxants which if you haven't tried you should try. There also various types of non-narcotic pain medication which you should also consider - gabepentin; baclofan; lyrica etc. Again before injecting a steroid into the joint I would try anti-inflammatories like celebrex or arthotek for a few months to see if that helps get the inflammation down. You can also try alternating hot and cold packs and see if that helps.

You need to confirm that this is just a muscular disc/displacement issues which is why some more tests like CT scan or panaromic xray may be worth it. If you clench or grind a flat plane custom night guard would be worth it - with your limited opening it may be difficult to make but I was at about your range when I had mine done - it did aggravate things for a few days but in the long run its helped.

Try to find a good physio that has experience with TMJ issues. It is important to get your jaw moving again -the longer you wait the more difficult it will be - key to getting inflammation down is also getting your joint moving - it takes all the bad inflammatorie chemicals the build up and brings in fresh blood supply; you also you risk muscle atrophy like what I have developed. So the challenge is to stretch your jaw without aggravating the pain. I wouldn't force it and go crazy. I would take it slow and stop at the point where you start to feel pain - but the pain shouldn't be too bad and it should calm down quickly - like within 30 minutes. My experience is like yours - if I try to force my jaw open it just makes thing worse. My real problem now is managing the neck pain. As I said I'm looking for someone who can do botox.

I hope my comments help. My only other comment is be careful if anyone recommends orthodentics or splints that change your jaw or bite and neuromuscular denstistry. From my reading, I think these are all questionable practices in terms of helping TMJ but others on this forum may have different experiences and some of them may have be positive. Rule of the thumb - always start conservatively - with treatments that aren't irreversible. And if you have questions -ask. Your doctors should be upfront about the risks and benefits. Good luck to you. Let me know how things go.

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