Long term right tmj problems

Consult for Orthognathic surgery

Consult for Orthognathic surgery this week. Long term right tmj problems. Post disc arthroplasty in this picture. Most surgeons and some orthodontists want to try upper and lower orthognathic surgery. A few tmj dentists say they can solve this with orthodontics such as ALF appliances, elastics to close the bite etc. Consultant orthodontist and maxillo facial surgeons say orthodontics CANNOT solve this but surgery can. With tmj problems this is a risk. Which way to go is tricky!


Discussion


Shahrad Mavandadi Where are you living. I might know some one to help you. Surgery is the last resource. You most Probebly can be help with ALF and day orthotic fabricated to the balanced skull at either correct CR or proper phonetic bite .Some times the swallow technique can be the solution. Don’t do surgery with out going through diagnostic treatment phase and perhaps later on go through the orthodontics correction techniques and get the empty space between upper and lower jaw filled with teeth to hold the corrected position achieved and prevent the surgery. Again where are you living.

Vivek Shivdani Rob….Don’t make surgery your first option. Try the other solutions. Mr. Shahrad is right.

Rachid Abid I have the same issue Mr shahrad and I live in Brooklyn, NY

Shahrad Mavandadi I will get back to you . I have to see whom I can refer you to.

Rachid Abid Thank you so much for your generosity!

Darick Nordstrom Great advice from Shahrad and the group. Are the surgeons and orthodontists above the law such that they are protected from the consequences of their cavalier prescription? Brendan Stack and i will be speaking in Washington DC area in October. European ALF course in Hungary in November. Some cases treat quickly, some slower, but you have many years to go in life, and one surgery is followed by another. WW1 wasn’t the war to end all wars.

Dan Hanson surgery has poor success rate. Properly positioned orthotics combined with changes in nutrition , lifestyle, breathing habits and posture may help but without records impossible to tell. Avoid surgery at all costs is my view.

Shahrad Mavandadi Keep in mind the air way. Without proper airway all including surgical intervention will fail. Skull can be corrected to some extend by ALF with out seeing you I won’t be positive to what extend. Choose your conservatives option first before choosing the last resource. Good luck.

Sören Linge how many follow up visits did u have using gnm?

Darick Nordstrom I can understand why many orthodontists say only surgery, based on this patient, where the harder they tried with braces the deeper in trouble they got … then surgery must be the answer. The patient flew in for treatment, braces removed, Maxillary ALF-Stealth (because of poor alveolus from years of misdiagnosis, etc.), Mandibular OmNi+. Visits 3-4 months apart.
On the 5th visit, you can see progress with the ‘cant’, but, even more, you can see progress with her overall being … confidence and vitality. Due to travel challenges, expenses, this is where they stopped. I am not overly concerned, because her body knows what to do now. There is a big contrast between being told all that is bad about you, how you need drastic measures (surgery), and being told you have the power to heal (with help and support), and see it begin to unfold.

Amparo David In Washington , Dr Bronson has been doing Alf for years.

Darick Nordstrom The combination of not enough tongue space, improper swallow / posture (including during sleep), unilateral TMJoint / cervical rotation create this. Does your splint create more space for the tongue and correct the cervical rotation? If it is/was very thick, it will worsen the postural biomechanics. We do Prolo so that we don’t need problematic thick splints. Light elastics on occasion, but not for extruding, but for stabilizing the laxity.

Darick Nordstrom Will the surgery correct all the above underlying problems at once? If you have had chronic pain and altered sleep then your testosterone and anabolics will be off, leading to poorer recovery from surgery (which could create a nasty long term cycle). Have the surgeon show you all 7-10 of her/his latest cases, and how each complication was handled, before / after sleep studies (not just o2 sat, but sleep staging patterns), then show the long term patients … do they continue to improve because their underlying problems were resolved (like this patient)?

Darick Nordstrom Some miracles take time, but the results stay with you. It should be required pre-surgery (also pre-ortho … but more for the parents) to have Somato-emotional and primitive reflex/oral myofunction evaluation and some initial therapy to help define short-term and long term goals for life. A pivotal event for me was in ’80-’82 (pre-MRI) when a few of us were serious about TMJ, and dye and fluoroscopy was very new. An orthognathic surgeon and I sent patients we thought had perforations to be seen by the pioneering interventional radiologist. His patient was a very attractive young woman who had had a significant cross-bite that was ‘corrected’. She said that everyday she wished she could go back. Her expression was so pathetic that it has stuck with me. It is a major driving influence for me to find solutions.

Darick Nordstrom I believe that everyone has a beauty that is stunning when it is unleashed or fully revealed because it is our individual heritage as children of God. He doesn’t make mistakes, we just fail to see the whole picture.

Elsherbini Elshal This patient has limited mouth opening due to TMJ dysfunction. The best approach for this case is condylotomy either by vertical osteotomy or bilateral sagital osteotomy of the mandible.

Tatiana Gelfand “There is a big contrast between being told all that is bad about you, how you need drastic measures (surgery), and being told you have the power to heal (with help and support), and see it begin to unfold.” — I love this!!!
Her spasm on the left side got released, the jaw is no longer pulled to the left ear and she can have enough space for it and for the tongue. She looks relaxed and great! Thanks for posting these pics!
BTW, I had the same experience so I know how both states feel.

Tatiana Gelfand Ha-ha-ha! Which part of it? LOL I have enough stories in 15 years for a dozen of patients! LOL. That particular one?

Tatiana Gelfand BTW, I looked again at this pretty girl and she might actually need a tiny bit more relaxation of that left side, maybe a tiny bit higher VDO towards the fronts. Look at her ears, the left one is still slightly lower and actually the eye is a bit too. She looks like she might be even slightly biting her lip to hold the jaw. And her left shoulder is still lifted a bit. It’s hard to tell because her head is slightly turned as well. But this is for a perfection of her body alignment, she might not even ever become aware of it to such a degree. A great example, great pics!

Rob Stubbs How can the lower jaw be tilted level, the upper cant can be levelled but the lower jaw is based on the condyle lengths right? If one is shorter than the other

K.m. Andrews I am in the same boat for phase two, although I’m inclined to note that the more advanced or experimented practitioners are the ones who say it’s not possible in my case w/o surgery. Otoh, there is a long-term appliance use modification technique which is a bit particular which could work. Only, how would I eat for so long? Best of luck!!!!

Add a Comment

Your email address will not be published. Required fields are marked *