As some of you may recall, I underwent surgery in late March to remove the titanium strap in my jaw. After five years, it had started to loosen, causing irritation and repeated infections, so it was decided it needed to come out.
During the diagnostic phase, they discovered that the TMJ on my left side was almost completely destroyed by arthritis. I'd also been having some trouble with my left ear, and had a bony spiculum growing into the ear canal which had ruptured my eardrum and caused hearing loss.
The doctors here in our new city were all for a total joint replacement of the TMJ. After much research on my part, I was somewhat skeptical; failures of these artifical joints struck me as being rather high.
I recently returned to Calgary for my five year cancer clinic check up. All clear on the cancer front ( YAY) but the jaw and ear problems are serious issues.
The ENT who did my original surgery examined all the imagining, and gave me a careful exam. His opinion ( which I value a great deal) is that total joint replacement in my case bears an unacceptable level of risk, with minimal potential for gain.
I have greatly reduced range of motion in my jaw...it has not changed substantially in five years, and he doesn't believe this surgery will change that. He also is VERY reluctant to undertake it due to the failure rate, and the potential for catastrophic failure is high, which would leave me in a very bad place with very little that could be done to fix it.
His recommendation is that if I decide to do something with the joint, to simply remove it entirely and have only a fibrous connection. This of course would mean a permanent feeding tube, since a fibrous jioont would not support chewing. Of course the other option would be to do nothing and live with the pain that I currently have.
The ear issue must be addressed through a modified mastoidectomy. He is proposing that they effectively remove most of the mastoid process on the left side to eliminate the bony growth source ( likely radiation induced; non malignant but uncontrolled nonetheless), and a rotational flap from under my scalp to close over the fault in my middle ear and repair the ear drum.
Fairly major reconstructive surgery in it's own right, and not without some risks, however after a lot of thought, I've decided on what I'm going to do.
The mastoidectomy is being booked. Sometime in early fall but the looks of things. The jaw/TMJ issue...I am going to leave that be. I have some functionality now, and will continue to for hopefully some time to come. that could not be guaranteed with the surgical options I was given. I know at some point the joint will fail, and I will have to have a feeding tube placed permanently, but that time isn't right now.
Until then, I will continue to "adapt", and make the most of what I have to work with, and cross that next bridge in due course.
I can't say I'm excited by the prospects, but...it is what it is.
The whole thing is now officially on "ignore", until surgery is booked. In the meantime, We're on 24 hour "phone watch"...our daughter is due to give birth to our first Grandbaby any day, and we have a nine hour drive to get to her when she goes into labor. Thank goodness I haven't had a speeding ticket in years...I suspect that's going to change on the trip back to Calgary :^)

Congratulations on reaching five years cancer free! What a wonderful milestone.

I'm glad you have a surgeon whose opinion you trust. I hope your TMJ holds out for a long time yet. I'm sorry that it is causing you pain but it sounds like the artificial joint surgery was a very bad idea. Good luck with the modified mastoidectomy. I hope that it brings you some relief.

You must be so excited about becoming a grandfather. Babies are such a joy.

I think it is a great call to skip the TMJ replacement. I used to be in the medical device / implantable device market before cancer. These things, even in perfect situations can have issues. The articular disc between the nomal condyle and the fossa over many years can wear a hole in it, and that's what keeps the two bones from rubbing against each other. It usually starts with a popping, but eventually when the hole is big enough the bones chaffing against each other becomes painful. It can (and will) eventually change people's bite, or how the cusps and fossas of their teeth mesh (interdigitate) with each other. The longer you can deal with this the better in my mind.

Good luck with your surgery - you have the heart and spirit of a lion - you will do fine!!! Great secision, pain is hard to live with but trying to maintain the ability to eat is lo important - congrats on the grand baby and 5 years-hugs!!

Brian,

thanks for posting this. it really reaffirms my decision as being the right one. I kew you had been involved in that industry, so hearing the same thing from the PROVIDER of these appliances makes us all, my wife most importantly, much more comfortable with the decision to leave things alone.

I think we get so caught up in "doing Something, anything" during our battles with the Beast, we sometimes lose sight of the fact that on occassion the best course of action is no action at all.

I know things will undoubtedly worsen over time, but then...I'm getting older too and other things are doing the same thing. the bonus here is having to chance to actually wear out body parts instead of having to remove them prematurely to continue to live.
[quote=Brian Hill]I think it is a great call to skip the TMJ replacement. I used to be in the medical device / implantable device market before cancer. These things, even in perfect situations can have issues. The articular disc between the nomal condyle and the fossa over many years can wear a hole in it, and that's what keeps the two bones from rubbing against each other. It usually starts with a popping, but eventually when the hole is big enough the bones chaffing against each other becomes painful. It can (and will) eventually change people's bite, or how the cusps and fossas of their teeth mesh (interdigitate) with each other. The longer you can deal with this the better in my mind. [/quote]

Wayne, your options and choices sound to me like it would be exactly what I would do if in the same situation. I wish you all the best with your upcoming surgery and congrats on the new grandbaby!!!!