Ask the Doctor: TMJ Joint Replacement

CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves ([email protected]) 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.

New Must-Read Book for Teens

Ride High Pineapple Beats the Bully and Faces Up

CCA is excited to announce a new book in our collection of recommended reading. 

Children’s author, Jenny Woolsey, announces the release of her debut middle grade novel, Ride High Pineapple.

This gutsy contemporary realism novel, is a must read for any child or teenager. Ride High Pineapple is written through the honest eyes of a teenager born with a rare craniofacial syndrome, Crouzon Syndrome. She also suffers from severe anxiety. Written as a journal, the story deals with critical childhood issues: bullying, difference, mental illness, friendship ups and downs, and young love. It also shows how one can find self-empowerment through sports. 

CCA loves this book because it goes along with our educational initiatives in that it is yet another text that is relatable, enjoyable, and features a young person with a facial difference. Offering an additional perspective to Wonder, Ride High Pineapple captures the raw emotions that teen girl, Issy Burgess, experiences. The book presents another lovable character who struggles with bullying at school. Plus, since it's from an Australian author, you'll pick up lots of cool new Aussie jargon! 

From the author:

Adolescence is a tough gig, but Issy Burgess has a few added challenges—facial difference, anxiety, and a relentless bully. Issy’s story of confronting her fears and working through her difficulties will inspire middle grade readers. Kudos to Jenny Woolsey for writing Ride High Pineapple. It ticks all the boxes: skateboarding, besties, and boys. And it’s chock-a-block full of hope, insight, and solid strategies for handling bullying and managing anxiety. A must for school libraries and school counsellors! -Alison Stegert, School Counsellor & Kidlit Author

About the Author

Jenny Woolsey is a Christian, teacher and blogger. She is an advocate for inclusion of disabled children, and for people living with facial differences and mental illnesses. She has a Diploma of Teaching (Primary), Bachelor of Education, Master of Education (Honours) and a Certificate of Creative Writing. Jenny lives in Queensland, Australia.  She writes from personal experience and aims to help children with their social and emotional wellbeing.

Ride High Pineapple is available on Amazon.com as a paperback and ebook.

Hospodka Family Spotlight

Bridget, our CCA Kid, is the second oldest of 4. She is 12 years old and keeps busy at Holy Name School, which she attends with her little brother and sister.  Moving up to 6th grade and middle school has presented its own sets of challenges and opportunities.  She has three main teachers and has to keep track of her FM amplifier when moving from class to class.  Her classwork has gotten more challenging, but she is more than capable of doing the work and excelling. After school, the fun doesn’t stop!  Bridget keeps busy with mass choir, chess, maker’s club, and played soccer this spring.  She loves texting and talking with friends, but hanging out is the best. In other exciting news, Bridget got braces!  She’s sporting pink and green bands and getting used to the new feeling and what she can and can’t eat.

Big brother Daniel can be seen at meals and for brief moments when he is not in his room reading everything he can get his hands on!  He is adored by his littlest sister for his ability to carry her everywhere and swing her around like a carnival ride.  After a tough freshman year, Daniel  transferred schools midyear, and the change has been beneficial for him academically!  He is looking  forward to taking more culinary arts and design classes.  This summer holds big changes on the horizon, as Dan got his driver's license and is looking forward to his first job.

Little brother Conor is busy riding bikes and racing BMX, when he isn’t bugging his sister.  I keep telling them they’ll probably end up being best friends. Since starting out at the track less than 2 years ago, he has earned a shelf full of trophies and medals, while making friends and inviting friends to join.  Conor just finished third grade, and loves math.  He is a Wolf Cub in Cub Scouts, and worked hard on his pinewood derby car—it was a submarine with room for a Lego captain to ride along!

Adeline is our tiny terrific not-quite-a-toddler anymore, but not quite a preschooler.  Daycare (aka “school at Miss Shannon’s house”), potty training, and getting into whatever looks interesting are at the top of her to do list.  She sings about anything that comes to mind, she babies any doll or stuffed animal that crosses her path, and she loves the heck out of all of us.

Although we won’t be able to make it to the Retreat in 2016, we hope to make it next year! Can’t wait to see pictures!

See you all soon!