Oral Surgery/orthognathic surgery
QUESTION: Due to birth complications our son's left mandible and TMJ was fractured. He was seen by Children Hospital specialist who gave OT/PT for the first 9 years. At age 9 he could still only open his mouth 8mm. At this time we found a TMJ specialist for another opinion. After the CT scan and MRI's showing that his left side was fused together and was not growing due to the growth plate not being intact, his left TMJ was fx in multiple pieces and fused. This specialist set us up with several Drs. in Colorado (we live in Maryland) and from that point he has had 2 major surgeries and 2 minor surgeries for to fix the problems. The first surgery was in 2005 when he was 9 years old. At that time they had to place in a partial TMJ (lt) joint and molded the bone that was there to work as the other portion (which it has)they also did distration osteogeneisis of his left mandible. We distracted his left mandible out 17mm and he could open his mouth to 45mm. The surgery was a success but with his growth the surgery was repeated at the age of 12. At this time we distracted his Lt. mandible out 23mm (the maximum the device allowed).These have been the 2 major surgeries and the minor surgeries were 6 months post each procedure to remove the distraction device. Since this time...over the past 5 years our son has grown 11 inches and is now 6 foot. His jaw is shifted a considerable amount due to the right mandible growth plates continuing to grow and the left not growing. This off sets his chin to the left and it is very visually apparent. He has constant discomfort in both TMJ's and in the muscles. He also had frequent "popping"of both TMJ which is painful. This is something that is new and is occurring more frequently. He also has occasional numbness starting at the left side of his nose extending down the left cheek.Last year when we met with his surgeons in Colorado they wanted to put off the surgery until this year. He was fitted for a splint to wear. Even though this has helped with the pain he still deals with considerable discomfort on a daily basis. We are flying out next week to meet with the surgeon in Colorado for possible orthognathic surgery this summer. I came across this site as I was trying to learn more about orthognathic surgery and to make sure that this was the next best step for our son. We very much would like your opinion and recommendations. Thank you very much.
ANSWER: Maureen - Of course, without seeing xrays of your son or examining him, it is a little difficult for me to advise you if the planned procedure is correct. But it sounds like the doctors who have been helping him have a plan that will correct the appearance and function. The main thing that needs to be considered and explained by the doctors is that, although they can correct his facial contours and jaw position, he has a chance to continue with TMJ problems. MInor changes in many people produce the muscle spasms and the joint pain that he has suffered with.
So most likely down the line, the TMJ will need some type of treatment. What type, I don't know, but your son needs to be aware and prepared and have doctors to help in the future. If in the future you further questions, feel free to contact me again.
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QUESTION: Thank you for your prompt response. I realize that without visually assessing our son and reviewing his film it is difficult to make a definitive plan of action. We have so much trust and appreciation in his surgeons in Colorado that the idea of not continuing his future care with them is hard to consider. However, soon our son's life will change as he enters college and the possibility of him being able to continue all F/U care in CO is less likely not to mention that his surgeons have plans to retire sometime over the next 5 years (2 of them have already done so). I want to make sure that he continues to remain in great hands and would like to know if there is a specialist on the East coast that you would recommend. I have sifted through many hours on the Internet trying to find someone and this is how I found your site. If you have any recommendations we would greatly appreciate your input. Thank you for taking the time to correspond with us. V/R,Maureen
Maureen - Fortunately, there are extremely skilled and well trained board certified oral and maxillofacial surgeons on the east coast. Whether he is in the Boston, New York City, Philadelphia, Miami or North Carolina, there are extremely skilled surgeons in those locals who are known nationally for their skills and knowledge. When you know where he will attend school, get back to me, tell me where he will be and I will send you a list of highly skilled and good board certified oral and maxillofacial surgeons.
So, when you are ready don't hesitate to get back to me.