Tuesday, June 28, 2016

Ask the Doctor: TMJ Joint Replacement

CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves (areeves@ccakids.com) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!

Ask the Doctor

Earl Gage, MD, Kids Plastic Surgery, MercyChildren’s Hospital
Ask The Doctor
Earl Gage, MD
Kids Plastic Surgery, Mercy Children’s Hospital – St Louis, MO

Question: We are considering a new procedure for Peter's upcoming jaw surgery.  It involves a TMJ joint replacements (vs a rib graft & jaw distraction).  The company making the joint is TMJ Concepts (www.TMJConcepts.com) in California.  I'd love to hear if Dr. Gage has any thoughts about this new procedure.

Answer: Thanks for your question. I do not have any personal experience with artificial TMJ replacement in children. At the most recent meeting of the American Cleft Palate Association in Atlanta, I asked a number of my colleagues and mentors if they had any experience or thoughts, as well. Nobody I spoke with had ever used an artificial joint in a child. None of my colleagues were aware of any surgeon who is doing a large volume of artificial joint replacements in children either.

I would be concerned about placing an artificial TMJ replacement in a child because no artificial joint is likely to last a lifetime, particularly when you consider the high load and stress placed on the TMJ. This makes future replacement surgery likely, in contrast to using bone and cartilage which is perhaps more likely to last. In addition, I worry about how the changing, growing facial skeleton will affect an artificial joint since the artificial material will not grow and change with your child. Finally, any time you place something artificial in the body, whether it is an artificial knee, an artificial heart valve or a synthetic facial implant, there is a risk of that artificial material becoming infected and needing to be removed. When biologic tissue (like bone or cartilage graft) is used, this risk is much, much lower.

I recognize that innovation and technologic advancements in joint replacement may produce an artificial joint that outperforms bone grafts. At this time, however, I am not sure there is enough data and experience to recommend it if bone grafting is also an option.


3 comments:

  1. This story reminded me of how I finally healed my TMJ after years of agony.

    My life used to be miserable. I had jaw, neck and facial pain, clenching, teeth grinding, unexplained headaches and many other symptoms that drained the joy from my days.

    My doctor suggested I use an acrylic night guard during the night. This worked for a while but the pain returned just as bad as before.

    I subsequently visited several specialists, had CT scans done, and underwent numerous therapies, all to no avail. In the end, doctors would basically conclude one of two things: 1) That I either had nothing wrong with me or, 2) that there was nothing they could do.

    I knew that there had to be another way. I searched long and hard and finally came across some simple natural remedies that finally made my debilitating TMJ disappear for good...to the amazement of my doctors.

    In fact, you might want to check out this article, it really helped me a lot:

    http://www.journalofnaturalhealth.com/tmj

    Hope it helps anyone reading this!

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  3. My son has had the jaw distraction, which brought out his jaw but as a side effect his jaw then stopped growing and his temporomandibular bones grew and fused to his skull.
    He has had four jaw surgeries to try and free his joints up and detach the bone from the skull... all have failed. The bone temporomandibular bone grew back and re-fused.
    We are now in the process of talking about braces (as much as they can do due to the jaw being fused and his mouth won't open) to help straighten his teeth and provide better self esteem and quality of life. We are also discussing artificial joint replacement. FDA recommendations are not to do joint replacement in children who are still growing. My son will be at the age (15-16 yrs old) where the maxilla bone has stopped growing and since his lower jaw stopped growing a long time ago, we are going to try and either do a leg bone-fibula or artificial joint replacement. (We have already done the rib graft...but instead of the jaw bone growing up to the skull to fuse the skull grew down to the rib bone and fused again). We understand the joint may need replaced at a later time within his life. It would be nice to hear some feedback. Thanks
    Shannon
    crittersmp@yahoo.com

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