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Arthroscopy: New Tool in Jaw Disorders : Technique Used on Knees Adapted by Oral Surgeons

August 26, 1986|PATRICK MOTT

When her condition was at its worst, Vicki Gimenez could make cooked pasta sound crunchy.

"I'd go to eat spaghetti," she said, "and people would look and say, 'What's that noise?' "

It was her jaw. For nearly two years, Gimenez, 35, had suffered from intermittent pain in the left side of the jaw, cracking and popping noises in the joint there and, as the condition worsened, increasing inability to open her mouth wide enough to eat even a sandwich. The jaw would lock occasionally, forcing Gimenez to "work my jaw sideways until it cracked and opened again."

Gimenez was one of an estimated 20 million Americans who suffer, to varying degrees, from disorders caused by malfunction of the temporomandibular joint (TMJ), which connects the lower jaw to the rest of the skull.

Those afflicted experience a range of symptoms, from clicking and popping of the joint when they chew, to headaches and dizziness, to great pain when they try to open the jaw even slightly.

The disorders are treatable but, until almost a year ago, anyone suffering from a TMJ disorder who required surgery faced an operation that involved opening large areas of the face containing significant nerves and blood vessels.

In recent months, however, the same technique that has enabled athletes with knee injuries to leap off the disabled list in a matter of days has found its way into the repertoire of the oral surgeon.

Minuscule Incisions

Arthroscopy, the technique of using tiny optical instruments inserted into the surgical site through minuscule incisions to diagnose and treat joint disorders, was presented to more than 300 oral surgeons and other physicians from throughout the world late last month at Memorial Hospital in Long Beach.

The organizers of the three-day Symposium on TMJ Arthroscopy and Arthroscopic Surgery, as it was called, were a pair of Orange County oral surgeons, Christopher Davis and Ronald Kaminishi, who say they are among only 15 to 25 practitioners in the United States who are performing such surgery.

Arthroscopy for the jaw, although new to the United States, has been performed in Japan by, among others, an oral surgeon named Masatoshi Ohnishi, said Kaminishi, who lives in Orange. However, the knowledge stayed in Japan because a paper Ohnishi published on the subject in 1974 was written in Japanese and was never translated, he added.

Also, said Davis, a Seal Beach resident, the sophisticated optical instruments needed for the procedure had not been universally available until recent months.

But, Kaminishi said, "after this symposium, I think you'll see a lot of things happening, a lot of people starting to use it. We've got the instruments now." He added that even more delicate surgical instruments are needed for the jaw than for the knee. "When you're working on the TMJ, it's like working on a peanut compared to the knee, which is like working on a softball. Before we just didn't have the equipment to do it."

Nonprofit Organization

The symposium was sponsored by the Southern California Oral and Maxillofacial Surgery Foundation, a nonprofit research and education organization. Davis and Kaminishi are members of the foundation's board of directors.

Although treatment is complex, the cause of most TMJ disorders, Davis and Kaminishi said, is relatively simply to explain: Part of the joint acts like a doorstop.

The jaw, said Kaminishi, moves up and down as a hinge, which accounts for about a third of its total function, and rotates forward and side to side, which accounts for the rest. A normal jaw should be able to open about two inches and rotate freely, he said.

However, a cartilege-like buffer in the joint, called the articular disc, can become displaced, moving forward of the joint and jamming against it when the jaw attempts to open. This is the most common TMJ disorder, Kaminishi said, and can account for everything from clicking of the jaw to an inability to chew.

"We've seen people whose faces just turn white from not wanting to move their jaw," Kaminishi said. "And because their jaw muscles tighten so much automatically in order to try to ease the pain of movement, those muscles can spasm and cause pain of their own."

Davis, who said he and Kaminishi have been performing arthroscopic TMJ surgery for about a year, said the surgery should be used "only after attempts at conservative therapy" such as physical therapy, medication or dental splints to realign the jaw.

This is what happened in Giminez's case. She said she visited two dentists and an oral surgeon, all of whom prescribed splints, before Davis prescribed arthroscopic surgery.

After spending a night in the hospital, Gimenez, who lives in Lakewood, said she now has "no problem with pain, no cracking, no symptoms that I know of. I'm going to need to wear braces at night for a couple of years to hold the jaw in place, but after 2 1/2 years of what I went through, I can't say enough (about the surgery)."

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