Back when I was the guy who stood at Gold’s Gym at 05:00 hours.  That’s 5 am for anyone who is not familiar with the 24-hour time clock. Then one day I was driving home, and it was a dark and rainy night (sounds like a good beginning to a horror story, and as it turns out, it was). There was a jaywalker in the middle of the road, so I hit the brakes hard and stopped, but so did the bus to my right. Unfortunately, the guy behind me did not stop and slammed hard into the back of my car, doing around 40 mph. My neck snapped pretty hard, and my beautiful car was crunched up quite badly. (Sure, it was already 15 years old, but it was my baby :)). I took down the name of the guy who nailed me, went home and went to bed. The next morning my neck hurt so bad I could not move, could not get out of bed and could only call for help.

This was the beginning of a 20-year nightmare of neck pain and back pain that would never cease. I felt like I was living on Advil. My neck, traps, back, shoulders, everything had been in pain for so long that it felt like there was no solution. And then, I slowly began to notice that I was having difficulty swallowing my vitamins and eventually even food was tough to get down my throat. It was like I had to really ‘work it’ to force down my food and people were noticing that I had lots of issues, they actually asked if I was choking. Well, it turns out that I was indeed having swallowing problems sounding like choking!

As the years progressed, I sought countless physical therapy appointments, osteopath visits and any other doctor to help with the pain.  Some of them were really good, others not so much. The problem with all this treatment was that nothing would really alleviate the pain or swallowing problems for any length of time. It was all ‘palliative’ treatment, as they call it.

So, I already knew that I had a severely deviated nasal septum that would greatly affect breathing and healing, obviously. As a member of the ALF Academy, I learned more about my own problems. I learned that when the body incurs trauma, like I did, the ligaments that exist from the mastoid bone behind the ear and go to the hyoid in the throat will often calcify into bone. This calcification is our body’s way to help open up the airway and reduce spinal compression, both of which I had going for me. If you can imagine having long pieces of bone stuck in your throat on both sides and these darned things are blocking both your airway and your ability to swallow, then you can understand what I have been through, and many of my patients have experienced. Was this diagnosed as Eagle’s Syndrome? No, not really, but some of my doctors did suggest it. And what do you do about Eagle’s? You generally watch it and keep an eye on it. So that’s what I did until recently.

In my practice, we have always watched for this, and appliance therapy slows down the calcification process tremendously. To be clear it does not get rid of the problem.  The concern is the compromised airway and continued pressure placed on the carotid artery. Obviously, this is a concern that can lead to a stroke. This is why we have a CBCT X-ray completed from the neck up.

Now, back to my story. There came a time in middle to late 2022 when I was choking on most foods and literally gave up on all the vitamins and supplements that my doctor wanted me to take. I knew my hyoid ligaments were very calcified at this time. I took a good long look at my own X-rays and said, ‘That’s enough XXXX’, I need to deal with this problem. I made the call to the most wonderful ENT doctor that I have known for years. He and I discussed treatment and he explained he has dealt with these issues for many years now and knew exactly what to do. Needless to say, I knew I had to deal with this, so I scheduled a surgical intervention. His surgery involved correcting the deviated septum and removing the calcification from either side of my throat.

The next three days of my life were really rough. All I could do was to choke down the oxycontin and cry for the next five minutes or so. The oxy would kick in for a while and it was three days later before I could even think of consuming chicken broth or anything similar. So, for the next week, I would choke down my broth, and sometimes there was a bit of noodle in there as well.

At 12 days post-surgery, I am at the computer typing away with a very sore throat and just taking Tylenol as needed for the pain. Last night, I was able to choke down some noodles and sauce and it was a bit less difficult than the night before. No more oxycontin is needed. My nasal passages are also popping out lots of scabs these days and if I blow my nose, lots of junk comes out. Overall, it is getting better, but ever so slowly. I have been sleeping up to 12 hours each day; not sure if this is recuperative sleep from losing so much sleep over the years or just from the lack of sleep post-surgery. I am still having problems with swallowing, but the throat is still quite swollen, so I guess that’s par for the course.

So, how would I rate doing this surgery? The jury is still out. I do admit that I believe I can breathe a little better through the nose and hope this continues to improve. Also, when I take Tylenol, it does not get stuck in my throat nearly as much. The neck pain is still there – I had no expectations about curing that. Sleep is much better and definitely more restful. My main reason for writing this very long blog was to set expectations if one ends up doing such a surgery. Expect a lot of pain. Expect difficult days and rough nights. But in the end, as long as it helps, it was worth it!

The post The Case of the Calcification and the Correction or How I Handled Eagle’s Syndrome first appeared on Sleep & TMJ Therapy.

Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

Over the many years of treating TMJ disorders, my office has realized a couple of things: Do not use appliance therapy that is fixed or cemented in the mouth and using the AGGA or similar devices like FAGGA, MARA, ARA, FORA and RPE may not be wise when it comes to achieving the goal of palatal expansion and/or moving the upper jaw forward. The first reason, and the biggest, was the decrease of effective oral care. The reason for the other appliances is a big one.  The bones of an adult skull will simply not move 10+mm forward as some AGGA practitioners claim. The only way to achieve such a distance is to surgically reposition the upper jaw and our office does not recommend that. The reason is the nerves and blood vessels may be damaged in the process. The only time MMA (Maxillary and Mandibular Advancement) is recommended is with hopeless apnea cases where all other modalities have failed.

I have personally seen a number of AGGA type cases over the years and have observed that most of them tip the upper teeth forward so quickly that the teeth will come out of the bone, leaving them mobile in many cases. The jawbone itself does not remodel and come forward as the advertisers indicate. This has been the problem all along: too much force too fast in adult cases. In my office we have never used and never will use the AGGA or similar device. This is why my office has also banned the use of RPEs (Rapid Palatal Expanders). When expanding the palate rapidly, the same effect can occur, whether in children or adults. If a palatal expander is ever used, it must be done slowly and carefully, regardless of the patient being a child or an adult.

A better device is called the ALF (Alternative Lightwire Functional) developed by Dr. Darick Nordstrom many years ago. With children the ALF provides expansion for crowded cases, but perhaps more importantly, it gently opens up the bones to provide relief from head pressure and pain. With adults, the ALF is not a palatal expander, but more of a support appliance. The analogy I use is that it is like an arch support in your shoe; providing support that has been lacking. It is quite the opposite of a forceful AGGA. To achieve relief from your TMD symptoms such force is neither logical nor necessary.

The ALF was developed to help avoid extraction of permanent teeth like bicuspids. When teeth are extracted, this can collapse the airway and change the position of the cervical spine (the neck). Using the gentle approach of the ALF can open up narrow arches in children and avoid the extractions which used to be the ‘norm’ for orthodontists. So in lieu of even the palatal expander, the ALF offers a better approach.

When it comes to patient care and the decisions you make for your family it is important to keep in mind that the FDA recommendations regarding AGGA are quite clear, and I wholeheartedly agree that the AGGA and similar devices have the potential to damage the jaws and the teeth. Ask your dental provider about the FDA concerns and be aware what it means to wear such devices. If you have any questions about these devices or your dental health, we welcome you to call our team in Falls Church, Virginia at 703-821-1103. Dr. Jeffrey Brown is ready to help you with all aspects of your smile!

The post Response to the FDA Concerns Regarding AGGA and other Similar Devices first appeared on Sleep & TMJ Therapy.

The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

The post The Case of the Misunderstood Surgery first appeared on Sleep & TMJ Therapy.