So about 15 years ago, I had a car accident in which the side of my head hit the driver’s side window. It left a pretty good knot and some damage to the left side of my jaw. It would hurt, I’d take some ibuprofen, and life would go on. When I opened the left side of my jaw, it opened like a snake’s. My dentist loved that and would give me “awards” for the most clicks of any of his patients. (Typically, there are three such “clicks” which happen when the surfaces of the joint don’t mesh properly.)
Fast forward to 2013. I’m now working in a call center where I talk most of the day. About three or four months ago, my jaw started to hurt like hell, worse than it’s ever been, and bad enough that ibuprofen wouldn’t touch it unless I took a lot of it. And the swelling was bad enough that it closed off the Eustachian tube to my left ear and I ended up with fluid trapped in there, which made it hurt worse and which gave me the whirlies. I went to see my doctor who sent me for an x-ray and put me on prednisone to get the swelling down. It worked; the pain is now back to being manageable (sorta kinda) and I don’t have the whirlies anymore.
I just got the x-ray report and it shows that the left mandibular condyle is flattened and broadened. My question is this. Is this something that can be fixed, and if so, how? Am I looking at surgery, or am I looking at being on some anti-inflammatory drug for the rest of my life? Keep in mind that I am under a doctor’s care for this and that you are not my doctor/dentist and that the information is worth what I’m paying for it. All I know is this fucking hurts and I want the pain to go away.
Speaking not as a medical type but as the husband of someone who had TMJ problems with several procedures for it years back …
The TMJ is a pretty impressive joint. The thing to understand about how it functions is that the condyle of the mandible, the ball, does not actually articulate with the temporalis portion, the socket, directly. It sits in a cartilagenous cup that is suspended between the two bones. That anatomy is what allows the jaw joint to do all its amazing things, from hinging to sliding forward and back. The clicks and clunks you experience are often the result of the condyle sliding up and over the edges of that cup and landing on the band that suspends it and sometimes popping back in.
My wife’s surgeries were intially arthroscopic to free up the scar tissues that kept the cup from sliding correctly and then a surgery that repositioned the upper jaw. Later she had orthodonture to reposition as well. It’s worked well ever since.
Milder cases of course are can be handled with bite guards, NSAIDs, and PT.
Some cases that needed surgery before are now handled with innovative orthodonture.
No idea what that implies for your flattened condyle though. They will not try to reshape it. They may try to help it function differently.
I have TMJD, although of a different type than yours.
First, I recommend finding the nearest dental college with a TMJ clinic. I have excellent health insurance and bounced around to a lot of different practitioners, all of whom were willing to take my money, but were not competent to actually fix the problem. It took 9 months on a waiting list to get into the TMJ clinic at our dental college, but the doc had me fixed up in 2 weeks–and with simple, non-invasive remedies.
Your problems sound more serious than mine, but I would strongly recommend following the same route for treatment. The problem is, most medical and dental insurance doesn’t cover TMJ treatment. This has created a situation in which various doctors and dentists claim to have the magic cure…but often, they’re just trying to fleece you. (For example, I had one private practice dentist tell me the “solution” was to grind down all my perfectly healthy teeth and cap them.) The treatment I got at the dental college was by far the cheapest AND the most expert.
Good luck, and keep up with the Advil (or try to get your regular doc to prescribe Etodolac, which is gentler on your stomach and safer for long-term use). You can go up to 3200mg/day with Advil; the equivalent is 800mg with Etodolac. Etodolac is by far what gave me the most relief.
My physical therapist also noted I had serious musculoskeletal problems in my neck and back. His treatments didn’t make a dent in them. But I found an acupuncturist who specializes in TMJ to work on my neck, back, and face. My TMJ is triggered by too much “screen time” at work, too much talking on the phone, sitting still for hours in a lecture hall, etc. Within 3 treatments, my neck has greater range of motion, my shoulders are more relaxed, and most importantly, my jaw joint is less swollen, my ear drains properly, and my teeth fit together properly for the first time in over 2 years. I don’t know why it works, and I don’t care. I’m not sure it would be helpful for you, but I throw it in because I know acupuncture has been found to be useful in pain reduction in general.