January 12, 2012

Millions of Americans suffer from painful popping and clicking in the jaw commonly associated with a temporomandibular joint (TMJ) disorder. Frances Frazer of Elkins, W.Va., had lived with the discomfort of TMJ for more than two decades, but when her condition got so bad that she needed surgery to relieve her debilitating pain, she was discouraged to learn that there were no physicians in her area that could help.

So in October 2010 Frazer did what millions of Americans do every day – she turned to the Internet for help. There she found Michael Jaskolka, MD, DDS, an oral and maxillofacial surgeon who had joined the CAMC Facial Surgery Center a few months earlier and just happened to be the only doctor in West Virginia performing the surgery that she needed – total custom jaw joint replacement.

“Over time Frances had developed a rare fusion of the jaw joint to the base of the skull, which reduced her ability to open and close her mouth and eat normal foods,” Jaskolka said. “Her physician in Morgantown had performed several procedures on her temporomandibular joint over the last several years, but she continued to have degeneration and pain that was impacting her every day. So the next step was to replace the entire jaw joint.”

Frazer said finding Jaskolka was “meant to be” because she was out of treatment options and living in extreme pain.

“It affected every part of my life – eating, talking, it even hurt to smile,” Frazer said. “And it got to the point to where I couldn’t open my mouth.”

The temporomandibular joint is one of the most frequently used joints in the body. It is located in front of the ear where the skull and lower jaw meet and allows the jaw to move and function, enabling you to talk, chew and yawn. It is uncertain what causes TMJ disorder, but symptoms often result from problems with the muscles of the jaw or with the parts of the joint itself.

“I liken it to having degenerative changes of the knee or hip. The same thing can happen to the temporomandibular joint,” Jaskolka said.

Jaskolka reconstructed Frazer’s jaw using a custom-made prosthetic device, which is a newer method of treating jaw disorders that is proving to have better results than older procedures. Frazer underwent release of the jaw from the base of the skull and reconstruction in a single surgery in May 2011.

“I removed the bony fusion from her jaw joint to the base of the skull, and I was able to get her jaw moving and open. Then I replaced the joint with a custom-made prosthesis made from a high resolution CT scan,” Jaskolka said.

For Frazer, the results have been life-changing.

“I can smile again!” Frazer said. “Everybody also notices the way I talk. They say I sound a lot different. I can brush my teeth the right way. I’m eating a lot of things that I haven’t been able to eat in a long time. The pain is gone. Everything’s just better!”

As for the future, Frazer’s new jaw joint should last many years.

“There may come a time when she may need another surgery – an ‘oil change’ per se, but at this point we’re expecting between 15 to 25 years of life expectancy from this prosthesis,” Jaskolka said.

Jaskolka said although Frazer required surgery to repair the degeneration of her jaw, most TMJ disorders are less severe and can be successfully treated without surgery.

“If you were to take a poll of 10 people, at least half to two thirds would say they’ve had some periods of time where they’ve had popping, clicking, grinding or pain in their jaw,” Jaskolka said. “The first line of treatment for anybody is non-surgical management, which can include physical therapy, soft diet, anti-inflammatory [medications] and night guards or splints to help relieve symptoms. Most of the time that resolves things. Only once a patient has been evaluated or treated in that kind of fashion by their primary care physician or dentist should surgery be considered.”

Frazer is happy to be doing the things she enjoys again, like working with preschool kids and walking.

“Feeling better makes everything a lot better,” she said.

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