To Surgery or Not to Surgery

[walkthroughwalls]

[sic]

Summer 2014 I had surgery on my teeth. I also have braces. But while this has brought my teeth in position, it unexpectedly has not corrected my misaligned lower jaw. I now have two options:

1. do nothing, and seriously risk jaw-related problems later on,
2. undergo another operation, in which part of my jaw will be broken and extended.

The operation will lead to me finally being able to chew properly, have a symmetric face (although it isn't too bad now) and avoid jaw issues later on. My orthodontist definitely recommends the second option.

But, you guessed it, my main consideration is: will it have an effect on my tinnitus? This could be positive as well as negative. The cause of my t is unknown.


Any thoughts? Experiences? Stories? Considerations?
Thanks.

 

[svintegrity]

@walkthroughwalls I understand your dilemma. I went through TMD treatments for six months. It made it so that my teeth do not come together, so I have not been able to chew for the past five months. My jaw was also quite painful. My main concern has been my T. The cause of my T is known to be from a vascular loop in my inner meatus, but I can easily manipulate the sound by pressing on my jaw. I have been trying to let my jaw just go back to pre-TMD treatments levels and then consulting an orthodontist about teeth and jaw alignment. I will be interested to hear more about your condition.

 

[walkthroughwalls]

@svintegrity Thank you for your response.
Are you saying that the TMD treatments made your dental situation worse? What did these treatments consist of? What kind of specialist identified the specific cause of your t?

I can make my t increase by pushing my jaw towards the back of my head. And when I wake up in the morning, I often can manipulate the frequency in my left ear. Neither is easy or is like having 'complete control'. I'm also unable to chew properly for at least ten years.

Please let me know if you have any specific questions.

 

[svintegrity]

@walkthroughwalls Yes the TMD treatments made my dental situation worse, but not irreversible. The TMD treatments just consisted of wearing three different types of oral appliances to pull my jaw forward. The specific cause of my T was identified by a neuro-radiologist. Then I followed up with a team of neuro-otologists and neurosurgeons. The neuro-otologist says that pressing on my jaw just changes the impedance of the sound, and that I am not really changing the sound directly.

How long have you had braces? And do you know why they didn't help with your jaw alignment?

 

[walkthroughwalls]

@svintegrity Thanks. That's very helpful. I hope someone can someday determine the cause of my tinnitus. So far, no one has even been trying...

I've had braces for about 20 months.


It all started when I was around 10 years old and it was discovered that I was missing two permanent teeth in my lower jaw. An orthodontist proposed a treatment to my parents, who rejected it and chose to have it not treated.
A new dentist I went to deemed it 'nothing serious', until brushing my teeth in that area became increasingly difficult. I had two sort-of-holes in my lower jaw where the permanent teeth would be, and I had two primary teeth below that hole (at age 27!). The teeth next to the 'holes' were starting to fall over... And that's when he sent me to an orthodontist.

The orthodontist was surprised to see me. My problem was common, but because it was left untreated for so long my dental situation was a complicated as it could get. He was the first one to explain to me that pretty much all my teeth are now misaligned as they were trying to compensate for the 'holes'. As a result of that, my upper and lower teeth didn't connect properly which caused my lower jaw to be misaligned.

I've had braces and rubber bands to reposition my teeth, and surgery to remove the two primary teeth and weaken the bone structure (I think that's what they did) to make faster teeth movement using braces possible.

Thanks to all of that, most of my teeth are now positioned correctly, so my jaw should reposition itself as it doesn't have to compensate for my previously misaligned teeth. Unfortunately, it doesn't and is now fixed in this position. This time, a new and more intense surgery is the only way out of this.


Sorry, if the above was bit more elaborate than necessary... I hope I managed to explain how I got where I am now, and why the braces didn't help my jaw.

 

[svintegrity]

@walkthroughwalls Yes, you explained your situation very well. Not too elaborate at all. I appreciate your thoroughness. My parents too decided not to take the path of orthodontia, so I am left with a dental problem too. Does anyone think that your T is from the misaligned jaw? Does your orthodontist have any ideas why your jaw is not repositioning itself?

 

[carlover]

If you can put your little fingers in your ear and really feel the jaw when you wiggle it around ,then if they can bring the jaw forward for you ,then I reckon you have a good chance of getting relief from the noise

 

[Quentino]

Your jaw problem seems sort of important, so is it worth it to avoid a surgery, even because of T?
It depends, i don't understand if the next surgery is very important or not.

 

[walkthroughwalls]

@walkthroughwalls Yes, you explained your situation very well. Not too elaborate at all. I appreciate your thoroughness. My parents too decided not to take the path of orthodontia, so I am left with a dental problem too. Does anyone think that your T is from the misaligned jaw? Does your orthodontist have any ideas why your jaw is not repositioning itself?

I've asked that question -where does my t come from?- to many specialists, but all of them say it can't be determined. Some have said that 'there can be a connection'.
I've asked a GP, two ENT's, dentist, orthodontist, audiologist and the surgeon who performed the first operation.

My audiogram shows very slight hearing loss in my left ear (-18dB or so at 4kHz and 16kHz), but all hearing specialists still describe my hearing as 'excellent', 'normal' or 'fine'. I used to be a full-time musician, so the risk was there, but systematic use of earplugs has saved me from any real damage. However, in my perception, all specialists seem to look mainly at my ears for the cause.

Another peculiar fact: one week after I had surgery, I had loud paralysing tinnitus for about one week. Then it went away. This, also, couldn't be explained by anyone.


To answer your second question: my orthodontist said that there were two variants of a misaligned lower jaw. The first is that my jaw can move to different positions, but stays in a misaligned place because this is the only way I can close my mouth properly, with my teeth being misaligned. The second variant is, as my orthodontist said it, that the jaw itself 'just is misaligned'.
Repositioning my teeth has not resolved the jaw issue, so he concluded that I have the second variant.


If you don't mind me asking, how is your relationship with your parents now?

[rant warning]
Mine has never been good, but as of yesterday there's been... uhm... social turbulence. I came back from the orthodontist, my father asked how it went and I told him what the orthodontist said to me - as neutral as possible. But that was enough... He picks an extremist position and I'm forced to defend my "let's gather all the information we can and choose what seems to be the best option"-approach.

My father and I cannot 'talk about a situation/idea/approach'. He will often picks the opposite opinion (not held back by any lack of information in the slightest) and starts arguing. And we're immediately in a 'versus-mode' instead of a 'collaborative-mode'. He mostly considers these treatments unnecessary, unreasonable perfectionism, academic nonsense, and finds most specialists to have déformation professionnelle, which is in direct contrast to his down-to-earth common sense.

Having to negotiate these social minefields is, at the moment, harder than gathering information and choosing the best treatment for my jaw. I'm not sure if anyone can help me with this... so I guess the only reason I'm writing about it, is to get it off my chest. Sorry if you read all of this and felt that it wasted your time...
[end of rant]

If you can put your little fingers in your ear and really feel the jaw when you wiggle it around ,then if they can bring the jaw forward for you ,then I reckon you have a good chance of getting relief from the noise

Yes, quite clearly. And I probably looked really silly while doing so. But isn't this something everyone can feel? Is this a prank?

My lower jaw doesn't need to be moved forwards. It needs to be moved to the left, or possibly rotated anticlockwise.

In all seriousness, thank you for your contribution

Your jaw problem seems sort of important, so is it worth it to avoid a surgery, even because of T?
It depends, i don't understand if the next surgery is very important or not.

Yes, this surgery is important and is 'without doubt' recommended by my orthodontist. Choosing to ignore it will very likely (but not certainly) lead to problems years down the line. Facial pain, not being able to chew, excessive wear on my teeth, further misalignment etc.

However, if there a big chance that this treatment will increase my tinnitus, then it may not be worth it.

 

[svintegrity]

@walkthroughwalls I certainly appreciate what you have shared and didn't consider it a waste of time. It is always good to get things off our chests. This forum is great for support of such issues. Keep us posted as to how things work out for you, and what you decide.