Case Study: Skeletal Deformities Involving the Maxillofacial Skeletal Complex

Case Study: Skeletal Deformities Involving the Maxillofacial Skeletal Complex

Skeletal Deformities Involving the Maxillofacial Skeletal Complex

This month’s case report demonstrates the team approach we use to treat more complicated skeletal deformities involving the maxillofacial skeletal complex.    These types of skeletal problems commonly include deformities of the nose and the bones surrounding the orbits.  They are still growth deformities however and should not be confused with congenital deformities of the maxillofacial complex such as Pierre-Robin Syndrome and Treacher Collins Syndrome. 

Acquired skeletal deformities that are hypoplastic/hyperplastic in nature are commonly treated in private practice but the treatment of these acquired skeletal problems with orbital reconstruction and nasal reconstruction is not.  Very few orthognathic surgeons outside of academic settings can offer this valuable service to their patients.  A team approach is a must.  Having the right combination of a facial plastic surgeon and an oral and maxillofacial surgeon is not enough, however.  The magic ingredient?  A well trained operating room and anesthesia staff.

Performing nasal surgery and jaw surgery is a great benefit for the patient.  It saves the patient a separate surgery, anesthetic and hospital bill, not to mention the second period of recovery.  But doing them together requires a hospital-based anesthesiology department and operating room staff skilled at converting nasally intubated patients to orally intubated patients in the middle of a long, complex reconstructive surgical procedure involving the entire airway. 

The case presented this month is commonly performed at Mercy Hospital- Anderson and is not possible without the skill and expertise of the operating room staff and anesthesiologists.  

The patient in figure 1 is typical of individuals who present with skeletal deformities of the nose, midface and mandible.  From a frontal and lateral view, the sunken in look to the orbital bones and upper jaw are easily recognizable.  The nose appears large because it is long and narrow but also because it is projecting from a hypoplastic midface. The mandible appears narrow and prognathic, but in reality is not significantly enlarged, at least not horizontally. It is more so vertically.   The most common mistake made in cases such as these is for the surgical team to focus on the strong looking mandible and treatment plan the patient for an extensive mandibular setback procedure.  This is a disaster on many fronts – both aesthetically and more importantly from an airway standpoint.  Sleep-disordered breathing is certainly to follow!

There is always overwhelming dental compensation in these cases and the orthodontist must pay special attention to positioning the upper and lower incisors to obtain perfect incisor inclination before surgery.  Without proper placement of the incisors, overbite and overjet will be compromised and uncoupling of incisors can occur post-operatively.  Figure 2 shows the presurgical setup of a similar case where improper incisor set up limited overjet and overbite.  

Compare this to the presurgical setup in our case, figure 3 and side by side models of the two cases, figure 4.

Fig. 3

Fig. 4

From figure 1, the hypoplastic look to the upper jaw, orbital bones and zygomatic arches is easily recognizable.  These areas will look even more sunken in if the maxilla alone is advanced.  Infraorbital rim/zygomatic bone augmentation is needed to obtain good aesthetics.  This graft is very simple to do once the infraorbital rim and the lateral aspect of the arch is dissected out of the overlying soft tissue and a pocket is developed next to the bone to accept the graft.  The graft is a combination of nonresorbable hydroxyapatite, collagen and water. They can be molded into soft wafers the size of miniature Hershey chocolate bars and placed under a heat lamp. (Figure 5) 

 After several hours of drying they can be slipped into place and positioned to obtain symmetry and projection of the infraorbital rim region.  (Figure 6)  

Maxillary hypoplasia accentuates the complexity of any nasal deformity.  In our case, the nose appears elongated with a slightly downturned nasal tip.  It overwhelms the face.  Softening the dorsum of the nose and advancing the maxilla greatly improved the patient’s aesthetics. (Figure 7)

The patient’s mandibular prognathism, is accentuated by his midfacial hypoplasia. A common mistake made by the inexperienced surgeon is to focus on the prognathic mandible and aggressively set it back when, in reality, an extensive maxillary advancement is in order.  This can be facilitated by advancing the maxilla to its optimum aesthetic position using glabella vertical as a reference. (Figure 8)

Figure 9 compares the preoperative and postoperative facial result.  His preoperative and postoperative occlusion is seen in Figure 10.

Fig. 9

Fig. 10

This case demonstrates the nuances of combined orthognathic surgery and nasal reconstruction.  We thank Dr. David Quast for his referral of this most complicated case and for his orthodontic expertise in preparing him for surgery. Additionally, we thank Kevin Shumrick MD for his expertise in nasal reconstruction.

 Case Study: “C” Shaped Facial Asymmetries

Case Study: “C” Shaped Facial Asymmetries

Facial asymmetry is a relatively common maxillofacial skeletal deformity.  All patients have some degree of asymmetry, but minor discrepancies from one side to the other are not perceived by the average layperson and have no functional clinical significance.  Marked facial imbalances, however, can cause functional issues with mastication and overloading problems with the masticatory system.  While some skeletal asymmetries can be masked orthodontically, many cannot and, as interest in facial aesthetics increases, more patients are seeking orthognathic surgeons for treatment.  More orthodontists are referring patients for treatment of facial asymmetries as complaints of crooked smiles and deviated chins are voiced by their patients.  This is especially true among dental patients undergoing “smile aesthetics”.

Midface and mandibular skeletal asymmetries are complicated deformities involving all three planes of space and encompass yaw, pitch, and roll of the jaw bones.  Understanding the movement of the jaws in three planes of space is very important because success is dependent upon removing all bony interferences at the time of surgery to ensure a stable outcome. 

Cone beam CT scanning along with three-dimensional virtual surgical planning has been a game-changer in this regard.  Through these advanced technologies, orthognathic surgeons have the ability to see the midfacial and mandibular skeletal deformity clearly and from all angles.  Figure 1 shows a patient preoperatively and the extent of the skeletal facial asymmetry. 

Facial asymmetries can be categorized into four distinct groups with the simplest asymmetry being confined to the body of one side of the mandible and the most complicated asymmetries being what is termed a “C” shaped asymmetrical skeletal pattern because it involves both the upper and lower jaw.  With this type of deformity, as demonstrated in Figure 2, the condyle, mandibular body and symphysis of the mandible is affected in combination with maxillary canting and yaw. 

The patient in Figure 1 is a 22-year-old male with a facial asymmetry involving both the maxilla and mandible in a classic “C” shaped pattern.  There is a definite cant to both the midface and mandible with a severe deviation of the lower jaw to the left and a corresponding shift of the mandibular midline to the left side.  Canting of the maxilla follows the cant of the mandible with a midline shift to the left as well.

Virtual surgical treatment planning allows for a three-dimensional view of both the maxilla and mandible to better evaluate yaw of both jaws.  Evaluating and correcting this yaw has plagued orthognathic surgeons until virtual surgical treatment planning became available five years ago.  Figure 3 demonstrates the pre-surgical and post-surgical rotation of the jaws and correction of the yaw. 

In Figure 4, it is easy to see the extent of the maxillary cant after the mandible has been corrected for cant and deviation. 

Note the sagittal advancement on the left side of the mandible (Figure 5), compared to the right side that actually went backward as the asymmetry to the left was corrected and the midline of the mandible was placed on the midline of the upper jaw. 

Leveling the maxilla requires raising it on the right side almost 2mm and lowering it on the left by just as much (Figure 6).  

Advancement of the maxilla by 6mm corrected the anterior posterior position of the midface and corrected the Class III pseudoprognathism (Figure 7). 

Figures 8 and 9 compare the pre-operative and post-operative result.  Good aesthetics is accomplished along with re-establishment of normal function.  The chin is still asymmetrical as was noted in the virtual surgical planning.  A genioplasty procedure was declined by the patient.

 “C” shaped facial asymmetries are the most difficult to diagnose and treat.  Postoperatively they require close follow-up by both the orthodontist and the oral surgeon because shifting can occur from muscle function and the complexity of the skeletal move.  Three-dimensional virtual surgical planning has lessened relapse dramatically by exposing bony interferences that prevent passive movements of the mandibular segments.  This can be seen in a close-up of the left sagittal split osteotomy site.  Virtual surgical treatment planning identifies these interferences so they can be removed at the time of surgery.  (Figure 10)

I thank orthodontist, Jay Parekh, DDS, for referring this most-complicated case and having confidence in our ability to diagnose and treat complex deformities of the midface and mandible. 

Case Study: Orthognathic Surgery for Maxillary Hypoplasia + Compromised Orthodontic Treatment

Case Study No. 2: Orthognathic Surgery for Maxillary Hypoplasia + Compromised Orthodontic Treatment

A complication of orthodontic treatment sometimes arises when anterior maxillary tooth position is compromised in an attempt to camouflage the need for Orthognathic Surgery. This scenario has become more and more common in the last few decades as orthodontists try to forgo the incorporation of Orthognathic Surgery in patients with combined dental and skeletal malocclusions.

Patients sometimes struggle to accept treatment plans that include jaw surgery. They reject treatment altogether when they can’t find simple answers to their questions about medical insurance coverage and cost of Orthognathic Surgery. Many times the orthodontist becomes frustrated when they become mired in a case they can’t finish because a skeletal deformity stands in their way. Camouflaging the misaligned jaw, compromising the final position of the teeth or compromising the final bite sometimes seems the only way out. Sometimes this strategy is “successful”. Mild mandibular asymmetries can be hidden, a minimally hypoplastic maxilla can be covered up by proclination of maxillary incisors, and mandibular retrognathia can be concealed by flaring mandibular incisors. While these compromises may not lead to immediate functional or stability problems, over the course of years or decades serious issues may arise. Such is this case.

The patient is a 48-year-old female who, as a young adult, underwent orthodontic treatment to resolve maxillary crowding and a palatally impacted canine. (Fig. 1)

No treatment was suggested for her skeletal mid-facial hypoplasia. After several years and several attempts at moving the right canine into position, it was lost and a particulate graft was done to prepare the site for an implant. The first fixture that was placed failed. The second implant successfully integrated but was positioned so apically to the adjacent teeth that it could not be restored. (Fig. 2) 

Complicating the situation, the patient began experiencing mobility in her anterior teeth. Her workup confirmed maxillary hypoplasia and her compromised orthodontic treatment, consisting of proclination of the maxillary incisors, canines and bicuspidsto obtain overjet, resulted in tooth mobility, and root resorption of # 7. (Fig. 3) 

Another orthodontic consult was obtained and, through a team approach, a treatment plan was formulated to correct the position of the anterior maxillary teeth and replace the missing right canine.

Our first step was to agree that the malocclusion would require Orthognathic Surgery. The workup by the orthodontist using a Sassouni analysis was confirmed with a G. William Arnett analysis and a work up using Andrew’s “Six Elements of Orofacial Harmony”. A multi-segmental LeFort I advancement was determined to be the best surgical procedure to return the anterior maxillary dentition to its proper position to the skeletal base.

Two hurdles had to be overcome:
1. Removing the implant and reconstructing the area with an autogenous bone graft so that an implant could be placed after the orthognathic surgery.
2. Obtaining space to allow for clockwise rotation of the premaxilla and repositioning of the anterior segment for the advancement of the entire maxilla to a Class I canine relationship.

Prior to orthodontics, the implant in the area of # 6 was removed and the area bone grafted using an enbloc bone grafting technique overlaying a particulate graft to fill the defect from the removal of the implant. A CBCT confirmed the success of the bone graft. (Fig. 4)

 

Progress model surgery confirmed the premaxilla could be rotated clockwise by extracting the maxillary 1st bicuspids and using the extraction spaces to pivot the premaxilla clockwise and rotate it down. The posterior segment was split and widened to correct the Curve and Wilson. (Fig. 5)

The posterior maxillary segments were then advanced to a Class I canine relationship and the extraction spaces closed. (Fig. 6)

A postoperativecephalometric x-ray confirmed the clockwise rotation of the anterior maxillary segment by 15 degrees. (Fig. 7) The patient is awaiting the placement of the titanium fixture in the area of # 6.

This case demonstrates the problem of tooth mobility and bone loss when anterior teeth are proclined and placed into functional occlusion. Flaring the teeth outside the limits of their skeletal base to camouflage a Class III or Pseudo-Class III skeletal relationship is sometimes a recipe for severe dental consequences. Treatment through a combined orthodontic and Orthognathic Surgical approach can be the solution. A pre-operative and post-operative smiling image demonstrates the aesthetic difference when anterior maxillary teeth are placed in their proper axial inclination. (Fig. 8)

 

Dental Implants 101


What is a Dental Implant?
A Dental implant is a titanium post surgically threaded into the jawbone beneath the gums. It has four parts: threaded post, crown substructure, ceramic crown and a screw to attach it to the substructure and threaded post in the bone. Dental implants may replace a single tooth or multiple teeth. Dental implants are the ideal tooth replacement solution because they actually mimic the roots, appearance and feel of a natural tooth.

What are the advantages of a Dental Implant?

• Improved aesthetics: Dental implants look more natural than other prosthetics (bridge or denture). It mimics the natural appearance of a tooth.
• Improved speech: Many people wearing dentures have difficulty when speaking because dentures can slip and get dislodged.
• Better chewing power: Slipping dentures make it hard to chew food properly as they are very unstable.
• Convenience: Dental implants don’t need to be removed to clean, unlike dentures.
• Durability: Dental implants, when taken care properly, last much longer than a bridge. Bridges fail over 40% of the time within 10 years of placement. And when they fail, the patients lose another tooth. Implants can last 20 – 25 years.

Who can have Dental Implants?
The simple answer is almost everyone is a candidate for some type of dental implant to help restore chewing function. Start by discussing your options with your dentist or by calling Dr. Lee’s office for a consultation.

After your consult, Dr. Lee and your dentist will develop the best dental implant treatment plan for you. You will need to visit the dentist two to three times a year for dental implant cleaning. Good dental home care routine should also be practiced. Dental implants are like your own teeth and require the same care. Keep your implants plaque-free by brushing and flossing.

Read more about dental implants and the Cincinnati Center for Corrective Jaw Surgery here.

Dr. Lee Further Establishes Himself as One of the Region’s Experts in Dental Implants

Dr. Lee attended a unique course on the latest innovation in dental implant surgery.

Advances in dental implant surgery continue to make the replacement of teeth easier, less time consuming and more affordable.  The latest innovation comes from Straumann Implant Systems and allows the immediate placement of dental implants in almost every situation. 

Called the Ring Graft, the technique consists of the placement of a bone graft in the shape of a donut that is prepared to accept an implant in the hole.  Placed together on the site of an extracted tooth, it affords needed stability so that the implant will be incorporated into the healing bone of the extraction site. 

Dr Lee (pictured in the middle of the second row) attended the second cadaver course in the country designed by Straumann Dental to certify dental surgeons in the new bone grafting/implant placement technique. This technique is now being performed by Dr. Lee.  Additional information will be available on Dr. Lee’s website, soon but Dr. Lee is scheduling patients for evaluation for the new procedure now at his office.  Please call 513-232-8989or visit us on our website, cincinnatijawsurgery.com

The Staff of the Cincinnati Center for Corrective Jaw Surgery Received Advanced Education and Training

The Staff of the Cincinnati Center for Corrective Jaw Surgery Received Advanced Education and Training 

 Our Office is Unique

Our staff and faculty comply with all rules and regulations pertaining to office IV sedation and anesthesia.  Accredited by the Ohio State Dental Board and required by the American Dental Association and the American Association of Oral and Maxillofacial Surgery.

Why is this important? It’s important because the American Association of Oral and Maxillofacial Surgery sets the highest standards of all the dental specialities or education and performance of office IV sedation and anesthesia. 

Basic Life Support

Our entire office staff, including the administrative staff, is training in BLS.  Our nursing staff is training in Advanced Cardiac Life Support.  And, unlike general dental offices and periodontist offices that perform IV Sedation and anesthesia, Dr. Lee’s office is staffed by two ALLS-trained nurses.  Some general dentists and pediatric dentist offices have no nursing staff.   Unlike Dr. Lee and the Cincinnati Center for Corrective Jaw Surgery, some dental offices that perform IV sedation and anesthesia do not have dedicated recovery rooms staffed by nurses who are trained to manage post- operative complications and give instructions you and your family on your post-operative care.  

How Will You React to Anesthesia? Sedation Facts for Patients

How Will You React to Anesthesia?  Sedation Facts for Patients
Dr. Michael B. Lee, Cincinnati Oral and Maxillofacial Surgeon

 

Our Patient’s Experience is Unique

Delivering office intravenous sedative and anesthesia is the cornerstone of Dr. Lee’s Oral and Maxillofacial surgery profession.  No other dental or medical specialist is better trained to deliver this safe and cost effective service.  Dr. Lee and his nursing staff carefully evaluate each patient’s medical history before performing office IV anesthesia.

No two patients react the same way to IV anesthesia.  The Cincinnati Center for Corrective Jaw Surgery is prepared for any response because so many things affect how one may react to sedating medications. They include:

  1. Age
  2. Weight / Size
  3. Genetics
  4. Physical characteristics
  5. Medications you take
  6. “Medications” you don’t want to admit you take

Age
A patient’s age is very important to take into consideration when planning an office IV anesthesia procedure.  Children are not “little adults”.  They react differently to medications both physically and psychologically.  They have very different physical characteristics in the size of their mouths and airways. Not only are they smaller, but they usually have large tonsils blocking their throats.  Older patients are quite different too.  They are universally more sensitive to medications, more compromised by their other ailments, and more prone to medication altercations – because they take so many other medications.

Weight / Size
No other factor has changed the delivery of IV sedation in the office setting more than the increased size and weight of the patient population.  30% of Americans are now obese, and another 10% are overweight.  Add to this the general increase in the size of young women and men (from increased muscle mass), and you have a population that generally can take much more medication to achieve sedation and anesthesia.

The increasing amounts of medication given is directly proportional to the increasing numbers of complications.  Overdosing a patient on both ends of the weight spectrum is problematic but especially on the patients who are overweight.  Their increased weight effects their neck size and breathing, and ultimately, their airways are harder to control.

Genetics
From a genetic standpoint, there are some patients who are resistant to the medications we give to accomplish IV sedation and anesthesia.  Also, there are some patients who seem to just naturally fight the effects of the drugs that we administer.  These are usually the patients who hate to be out of control of their emotions or environment, or patients who are naturally aggressive.  If these genetic traits describe you, you may want to reconsider the location of where you have your surgery and what technique is used (i.e. IV anesthesia verses inhalation anesthesia with gas).  No one successfully fights a gas anesthetic and wins – the anesthetist or anesthesiologist always does.  While Dr. Lee is good at picking up these traits, he isn’t 100% successful.  That is why he and the nursing staff are trained to handle all types of situations.  If it seems likely that you will have a problematic response to the medication we use, Dr. Lee will recommend an outpatient setting for your surgery with a qualified anesthesiologist.

Blood tests are being developed and will be available soon to help detect problematic genetic markers. Anecdotally, we see special problems with patients genetically featuring red hair.  We know from experience that they will take more local anesthesia to get numb during the procedure and that they are more likely to bleed during the surgery.

Physical characteristics of the mouth and airway
When considering a patient for office IV sedation or anesthesia, we carefully evaluate their airway size and the access we will have in their mouth to efficiently and successfully perform surgery.  Not all mouths open as wide as the next.  Some tongues are larger than others.  Some cheeks are fuller.  Some gag reflexes are stronger.  All of these factors can add to surgical difficulties and increased surgical time.

Increased surgical time increases medication given.  An increase in medications given is proportionality related to increases in complications.  Remember, airway sizes also affect office IV sedation and anesthesia.  A large neck sometimes means a smaller airway.  Larger tongues certainly mean a smaller airway.  Smaller lower jaws and recessed chins definitely equate to more difficult airway management. Add to any of these physical characteristics an increase in body weight and the job of keeping your airway open and you breathing gets more problematic.  However, Dr. Lee’s top priority is to avoid problems.

Medications you take
Many of medications that Dr. Lee’s patients take can influence and alter the medication we use in IV Sedation and anesthesia.  These interactions are beyond the scope of this review, but during Dr. Lee’s evaluation of your medication list and your medical history, potential interactions will be carefully considered.  If potential interactions are problematic and increase your risks, Dr. Lee and the nursing staff will contact your medical doctors and consult.  Sometimes medications are changed, sometimes Dr. Lee’s IV sedition and anesthesia techniques are changed and sometimes the setting for your surgery is switched to an outpatient facility.  Safety first!  This problem frequently arises with patients on medications for depression and for hyper activity disorder.  All of these medications can affect the medications used for office IV sedation and anesthesia and can cause physical and psychological issues.

Medications you don’t want to admit you are talking
Even more problematic than the medications you are taking are the medications you don’t want to admit you are taking – alcohol, pain killers, stimulants, psychedelic medications and marijuana.  Nothing ads more variability to a patient’s response to IV sedation/ anesthesia medications than “recreational” medications.  That includes routine use of alcohol and marijuana.  All recreational drugs increase resistance to the medications Dr. Lee and his nursing staff give you. Additionally, they can all increase their effect causing prolonged sedation and even breathing difficulties and depressed heart function. Therefore, always be honest about the recreational drug and other “medications” you use. Dr. Lee and his staff don’t care what you use.  All they care about is your safety and putting you to sleep in the safest environment possible.  Remember the old saying, “You don’t pay the doctor to put you to sleep, you pay the doctor to wake you up”.

Click here for more information on the surgical procedures performed at the Cincinnati Center for Corrective Jaw Surgery. Or contact us at 513.232.8989/office@cincinnatijawsurgery.com

Dr. Lee Completed Advanced Training with New Technology for TMJ Arthroscopic Surgery

Dr. Lee Completed Advanced Training with New Technology for TMJ Arthroscopic Surgery 

Encouraged by the technological advances made in arthroscopic surgery by noted TMJ surgeon Dr. Joseph McCain, Dr. Lee returned to Miami in early February to undergo advanced training.

Dr. McCain has recently introduced a remarkably repeatable and simplistic technique for arthroscopic surgery of the temporal mandibular joint (TMJ or jaw joint). In concert with Nexus-CMF arthroscopes have been redesigned and instrumentation simplified.

While the fall course was intense and included the use of fresh cadaveric specimens to practice on, the early February course offered advance training.

“You can never practice enough when new technology intersects new ways to use it. The learning curve gets steeper the more advanced surgeries are introduced using this less invasive technique to treat TMJ problems,” Dr. Lee said.

While arthroscopic surgery of larger joints such as knees and shoulders is widespread and common, arthroscopic surgery of smaller joints like the jaw joint is not as common.  It is divided into an upper compartment and a lower one.  It holds less than a teaspoon of fluid making it difficult to find and even more difficult to operate in. The McCain system increases visibility and his techniques for entering the joint and operating is more predictable and safer.

“Getting into this small joint which is situated close to the ear and surrounded by facial nerves that control the muscles of the face has always been the challenge.  Access is much improved with the McCain/ Nexus – CMS System.”  Dr. Lee added.  Advances in arthroscopic surgery of the TMJ offers a more conservative approach to treating many conditions that plaque patients like painful popping, clenching and locking of the jaw joint.

“With these newer techniques we will be able to offer some patients a procedure to clean and re-lubricate the joint, not to mention the possibility of structurally altering the internal joint anatomy to save patients from undergoing more invasive joint surgery,” Dr. Lee predicted.

Dr. Lee practices Oral and Maxillofacial Surgery and with the Staff of the Cincinnati Center for Corrective Jaw Surgery, focuses on the correction of Jaw deformities and bite problems through the use of orthognathic surgery and Dental Implants reconstruction.  A high percentage of patients with Jaw misalignment and bite problems have jaw joint issues as well.  Dr. Lee’s office is adjacent to Mersey Hospital – Anderson.  Mersey will be the first community hospital to offer arthroscopic surgery of the TMJ using the McCain./nexus – CMF System.

 

Dr. Lee Further Establishes Himself as One of the Region’s TMJ Arthroscopy Experts

Dr. Lee Further Establishes Himself as One of the Region’s TMJ Arthroscopy Experts

TMJ

Like most industries, technology in the dental industry is ever-changing. This pushes the industry forward, allowing us to refine techniques and provide the most efficient and advanced treatments possible.  As an Oral Surgeon, it is imperative that Dr. Lee stays up-to-date with the latest advancements in technology, diagnostics acumen and treatment. This is why he is constantly seeking the very best in his field of Oral and Maxillofacial to expand his knowledge specialty.

This October, Dr. Lee completed the Miami Anatomy Research Center TMJ Arthroscopy Mini-Residency Program further establishing himself as one of the region’s leading Oral and Maxillofacial Surgeons.  This week, he will be completing part two of the training.

What is TMJ and TMJ Disorder?

The temporomandibular joint (TMJ) is the joint that connects the jaw to the temporal bones of the skull in front of each ear. The temporomandibular joint is a ball and socket joint. In between the ball and socket is a disk. Temporomandibular disorder (TMJ disorder) occurs when there are problems in the relationship of the ball and socket.

The temporomandibular joint is one of the most complex joints in the body, responsible for the opening and side to side movement of the jaw.  Any incoordination of the ball and socket that inhibits the intricate system of muscles, ligaments, discs and bones from working is sometimes referred to as “TMJ”.  Often, TMJ feels like your jaw is popping, clicking or “getting stuck”.

TMJ_1

What are the symptoms of TMJ disorders?

There are many symptoms of TMJ disorders, including:

  • a sudden change in the way the upper and lower teeth fit together
  • a clicking or popping sound during normal jaw function
  • pain while chewing or yawning
  • headaches or migraines
  • earaches

Unfortunately, these TMJ symptoms can also be present for many other reasons. Your dentist can help correctly diagnosis TMJ disorder by examining your dental and medical history and performing a clinical examination, but appropriate X-rays for this condition are usually obtained only at the oral surgeon’s office. When the jaw joints are affected and basic treatments have been unsuccessful, jaw joint surgery may be recommended.

Dr. Lee is one of the Region’s TMJ Arthroscopy Expert

Dr. Lee recently completed a TMJ Arthroscopy Mini-Residency program, further establishing himself as one of the region’s leading Oral and Maxillofacial Surgeons for temporomandibular joint disorders and corrective jaw surgery. This didactic and cadaver mini-residency course was established by a faculty of internationally recognized TMJ surgeons who have dedicated their careers to the practice of TMJ arthroscopic surgery.  It provided a unique opportunity to further develop the skills and knowledge needed to incorporate arthroscopic surgery into a full scope oral and maxillofacial surgery practice. 

Unique for this course was the extensive cadaveric surgery portion.  Fresh cadaver heads were used to simulate clinical conditions and, thanks to Dr. Joseph McCain and Nexus Corporation, all surgical procedures were performed with new, state-of-the-art arthroscopic instrumentation.

Areas that were specifically addressed included: diagnostic and treatment approaches to TMJ internal derangements, surgical techniques for disc repositioning and arthroscopic approaches to TMJ lavage and visco-therapeutics.  

In January,  Dr. Lee attended part two of the conference, where he receive advanced training in TMJ arthroscopy. 

Reach out to Dr. Lee and the staff at the Cincinnati Center for Corrective Jaw Surgery at any time with questions relating to TMJ disorder, its symptoms and treatment options:

513.232.8989 / office@cincinnatijawsurgery.com / drlee@cincinnatijawsurgery.com