How It Works

First off -- if any of you are having trouble posting under "anonymous," (*ahem* Mom) click "preview" first and then post.

OK, on to the rest of my post. I wanted to describe the type of surgery that I am going to be having. It is called arthroscopic TMJ surgery, and as far as jaw surgeries go, this is about the least invasive as they get. Until the early 90's, this procedure was done as an open surgery, with a much longer healing and recovery time. With the advent of arthroscopic surgery, the procedure has increased in safety and outcome (my doctor helped pioneer this method -- which is reassuring). The above diagram gives a very loose idea of what is wrong, if I were to explain it with crayons and fingerpaints.

Now, I'm knocked out for all of this, but because I am curious, I looked up the procedure and everything. It is done under a general. As a side note, general anesthesia is a particular challenge for singers, for obvious reasons -- I am a tiny person, and therefore, my throat and vocal cords are 

tiny. If they are not gentle, the cords can be damaged ... but it is unlikely in a non-emergency scenario.

My doctor will insert a laproscope into the TMJ via a pencil sized incision. 

He will literally have a look around and see what kind of 

gunk is in there (bone debris, inflamed tissue, other damage).

 The joint gets "cleaned out" and all the rough surfaces are smoothed down, making it easier to open, eventually, hopefully, please God. We know already that my left TMJ is arthritic, but no one really knows the full extent until they go in.

It supposedly looks something like the diagrams below ... and since I clearly will be be taking pictures in the OR, these will suffice. 

That's basically it. He will "scope" both sides. Then I go to recovery, and then I go HOME! No overnight stay, which is wonderful. In addition to attempting the recapture the meniscus, though, as the diagram shows, he will be doing the procedures listed above. Nothing will be replaced (ie meniscus, etc.).

And yes, I am happy I will have no pictures of myself with all these things sticking out of my face!!

SURGERY UPDATE!!

My surgery got moved up by three weeks and is scheduled for August 17th. I am REALLY excited. I definitely paid (in pain) for opening that wide over the weekend ... it was so awful that it woke me in the night, which never happens. 

So, I'm going to go with it. I sat awake this morning practically in tears because of the pain and just silently prayed for God to just take the pain away .... and not even 3 hours later and I get a phone call from my surgeon's office. Too many things are happening at once. I can't explain it, but I finally have this little voice in me that is saying, "It's OK, Yona".

Not a good day pain-wise, so I need some rest ... need to keep these muscles loose.

ps - passed my pre-op physical with flying colors :)

Pain "Management"

I find this to be one of the worst phrases ever, because really, how do you manage pain? Even with treatment, you cannot determine when and where it will reappear.

Perhaps I am particularly gru

mpy because I am in a particularly annoying amount of pain today. I had stabbing pains in my jaw yesterday during a voice lesson (it was the opening and closing thing -- if I could just stay open ...), which threw everything off and landed me with a headache today ... which wouldn't go away and is still nagging.

Sorry. Complaining.

So, let's return to TMJ pain management (for lack of a better phrase). I take Clinoril 

NSAID (non-steroidal anti-inflammatory)) for the inflammation in the joint and other tissues in the jaw. NSAIDs are pretty much standard for TMJ problems because they involved inflammation, especially when the joint is arthritic (which mine is). 

I also take Amrix, a muscle relaxant. They're supposedly addictive, but I couldn't tell you because I take them at night and then hit the pillow.

I also use a TENS unit, which uses electro-stimulation of the muscles to relieve tension and knotting. It is a very odd sensation, and I find that it actually does not go deep enough on me! Most people feel the current at around five ... I'm closer to 9. At least I was today, anyway. I can carry it around with me in this dorky little plastic box that resembles a walkman. Perhaps I should paint a walkman on the front of mine. Would I look like less of a dork? 

One of the loneliest aspects of this is that people do not understand pain., certainly not people my age. The pain may not always be directly on/in my jaw ... but may manifest in my neck or shoulders. It is very very draining. I am so thankful for the good days. It's not cool to have too much in common with old people!!! I've always been told I have an old soul, but come on.

But, I can't dwell here ... that's a fine balance: giving in to pain and resting or pushing through. I tend to go or the former, lol ....

The Pin Cushion

The muscles surrounding the jaw are directly impacted by the trapezius and other muscles in the neck. These literally run up the neck or over the skull; tightness in this muscles can further problems with the TMJ. 

Of course, with any injury, there is pain, and pain leads to muscle spasm (of course the disc damage to my neck did not help either. I receive trigger point injections every week from my MD, and cervical spine epidural injections every other week, all in an attempt to relax the muscles as much as possible before surgery.

 A trigger point injection involves the doctor palpitating the sore/tight regions of the neck and feeling for the extremely painful knots (trigger points). He circles the area with a pen and then injects a mixture of a small amount of medication with lidocaine directly into the muscle. The patient feels strong pressure and pain as the medicine is injected. The goal of the injections is this: when muscle is in spasm, no blood supply is going to the region. By poking them with a needle, blood rushes to the area, thus relieving (or partially relieving) the spasm.

My MD was very into my blog project, and allowed me to take pictures of the procedure.

And yes, it hurts! But it provides immediate relief (and helps release the muscles in the face). It is important that people with TMJ problems explore ALL their options for relief of muscle spasm. Surgery is less successful with muscle tension. Pre-op, patients should get themselves in as good of shape as possible ... again, so that the muscles can relax.