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Oral Surgery/herbst appliance


My 21 yr old daughter has TMJ compression and head compression and cervical dystonia,we think from the Herbst appliance when she was younger.  Both of her physical therapists  believe this is related to the Herbst appliance. She has not been able to chew solid food, talk or smile much for over two and a half years.  We are looking for an expert who can guide treatment to restore her back to function from a Herbst appliance gone wrong. She has even been to the Mayo Clinic and they have ruled out any disease processes and my husband is a dentist but no one seems to have any knowledge regarding complications from the Herbst appliance. It started with waking up one morning with facial swelling that hardened and she has not been able to open her mouth much since and looking down with her head causes her face to turn red and even swell (angioedema)  Please help!!!

Debbie- I am so sorry to hear about what your daughter is going through.  I have expressed a number of times, on this site, that I am not a supporter of the Herbst appliance and the associated procedures.  I have repeatedly seen and many on this site have contacted me of their similar experiences.  My main disagreement with this procedure is the excess stress and subsequent anatomical changes within the TMJ.  I have mainly found that these anatomical changes have altered jaw muscular functiong due to the changes within the TMJ.  The changes have changed the able of of attachments of the jaw muscles creating muscle spasms and subsequent pressure within the TMJ that can lead to additional anatomic changes that just reinforce and accentuate the pressure in the TMJ, increase pain and continued altered muscular functioning and spasms causing more pain.  Then cycle continues.  Your husband, as a dentist, knows of the excess forces on the TMJ from dental restorations (crowns, bridges, fillings and bite changes from the kids of teeth)altering the bite balance.  Well the forces of Herbst do it similarly, but from the changes in the TMJ.

Of course, without examining her I cannot be sure, but the facial swellings that harden sound like the jaw muscles have gotten inflamed and then harden from internal scarring of those muscles.  This change causes more spasms of other jaw muscles and continued pain.

The main problem now is an attempt too reverse or compensate for the changes.   My suggestion is to have her examined by an board certified oral and maxillofacial surgeon to examine her.  A proper exam will need MRI and or ct scan of her TMJ.   That doctor might help in a number of ways.  

If you have additional questions, please feel free to contact me again.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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