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FAQ:  Jaw Surgery




Question:
I had jaw surgery 20 years ago and had the joints shaved down so there would be smoother movement. I had such excruciating pain the only thing that would help was morphine.

When I had the surgery I was vomiting for 18 hours straight and my jaw healed improperly. I could only open my mouth approximately 1 inch. After considerable therapy I could open it again.

But now after all these years, the pain is back with a vengeance. Could you help me with what I could do? Do I need more surgery? My doctor wants to put me on clonazepam for the rest of my life ... Visitor from British Columbia Canada

Answer:
The condition that you describe can be very challenging to treat. Often what happens is that the articular eminence is shaved down to allow the condlye (head) of the mandible (lower Jaw) to move more freely.

The resultant decrease in movement immediately after surgery is often due to a tightness in the muscle and ligaments of the joint as a response to the trauma of the surgery. If the ability to open continues to be decreased then you need to look at possible adhesions forming.

These adhesions may be fibrous or boney. If boney then there will be severe limitations in opening; often without much pain. Fibrous adhesion may limit opening to a lesser degree, however you may have significant pain.

Future treatment may consist of arthroscopy of the joint (a procedure where two or more small holes are placed in the joint so that a camera and small instruments can do microsurgery), which will flush the joint of any inflammation. It may cut or loosen the adhesion and may allow for steroid injection to the damaged inflamed tissues.

Systemic medication may be necessary to relax the muscles, control the pain and decrease the inflammation. Physical therapy will help to naturally lubricate the joint and help with keeping the mobility of the jaw.

You have been in pain for a long time and this will start to have affects on your overall well-being and emotional response to pain and treatment. There may be some benefits achieved by treating with small amounts of antidepressant medication for a while to break the cycle of pain-depression-lowering pain threshold-depression-pain, etc.

Editorial Staff



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