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April 15, 2006

BehindTheMedspeak: Do not undergo elective jaw surgery for a TMJ problem — unless you are prepared for a lifetime of misery and regret


No, I am not speaking as a customer but, rather, as one who has over the years aided and abetted the performance of countless such surgeries.

Just as Lord Bismarck remarked, "A person should never see how his laws or his sausages are made," so with the performance of elective temporomandibular joint (TMJ) surgery.

This is one of the more closely–held secrets of modern medicine, one you will not read anywhere else, and I expect a firestorm of protest and invective from plastic, head & neck, and oral surgeons.

No matter.

I have been there and seen that, as it were, with my very own eyes, and winced and felt the pain–to–be of their hapless patient–victims.

Long story short: it's an inexact art governed more by time constraints and the surgeon's mood than dysfunctional anatomy.

The TMJ is amazingly complex, capable of motion along all three axes as well as rotation.


Much happens in a very confined space.

When something goes wrong in the joint, symptoms are myriad.

The problem is that these symptoms can result from any number of things completely unrelated to the TMJ.

TMJ surgery to correct malocclusion (bad bite) is fraught with peril, namely that no one knows how the post–surgical joint will function — or even if it will function.

Elective jaw surgery to shorten the mandible (lower jawbone) for cosmetic rather than functional purposes is, in my opinion, tip–toeing right along the edge of malpractice.

I have attended many such surgeries as the anesthesiologist.

Apart from the cost and postoperative misery — for starters, tremendous pain, and your jaw will be wired shut for weeks while the bone heals so you'll be dining through a straw — which are part–and–parcel of such work, the thing you will never know unless you are right there in the O.R. as part of the surgical team — or read bookofjoe — is that the surgeons proceed in a very off–the–cuff and ad hoc manner.

For example, the O.R. cut–off time for elective dental surgery at UCLA was 4 p.m.

Translated, that meant the patient had to be out of the room and in the recovery room by that time.

That was so everyone could go home by 5 p.m.

Overtime is expensive.

The penalty for the surgeon who didn't comply was to have his O.R. time reduced.

Not a welcome outcome.

Now, it's not as if the surgeons didn't have plenty of time to do what they needed to do.


It's just that, having begun at 8 a.m. with all the time in the world, once they got going with their various bone saws and drills and other stainless–steel, high–priced carpenter's tools and toys and whatnot, time just flew.

At least, for them.

So part of my job was to inform them at 3 p.m. that they needed to finish up so I could wake the patient up and get her/him to recovery by 4 p.m.

Frequently this would result in abandonment of some crucial part of the procedure or a shortcut to get done in time.

The patient would never know.

I remember when I moved to Virginia from LA and my new dentist looked at my severe crossbite and told me it was one of the worst he'd ever seen.


I mean, I'd heard that before and had never had any problems eating or whatever so it didn't seem to me that I had a problem worth thinking about.

Then he said I should have it corrected, which meant undergoing the kind of surgery I've just described above.

It was all I could do to keep a straight face while I listened patiently and then replied that I would give it serious thought.

For the next couple years he'd mention it each time I came in for my semi–annual cleaning but after a while I guess he came to realize that I probably wasn't gonna go for it.

I haven't heard a word — or had a problem — since.

Bottom line: if you're considering TMJ or jaw surgery, get not only a second but a third, fourth and even fifth opinion.

Money very well spent.


And that's all I have to say about that.

April 15, 2006 at 12:01 PM | Permalink


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I cannot speak with any knowledge about TMJ surgery but I did have double jaw surgery to correct a 9 mm overbite. It had never bothered me, I experienced no pain, looks-wise you could not really notice it, but my dentist, orthodontist and maxillofacial surgeon recommended I had surgery and the latter suggested a genioplasty too. Biggest mistake of my life. A year and half later I have constant muscle pains and numbness in my lower jaw. Surgeon tells me to "give it time" and suggested I had botox to relax muscles, temporary fix and not really effective. Please think extremely carefully about this horribly invasive surgery.

Posted by: Jane Carmichael | Apr 26, 2009 8:07:05 PM

my name is nicole, i am 16. when i was born i had an underbite. It seemed to have ran in my family, my father as well had it. He is ok to this day but i got a retainer in when i was 10 and it fell out. A few years later, my dentist told me i needed braces and i got them on. They were on for 5years and moved my lower jaw back and made my teeth straight. What the dentist did NOT say is there might be complications involved. If i could go back, i would have not gotten the braces. Although my teeth are now beautiful, my jaw started to experiance clicking noises on the right side. I left it go until it started to have pain. I was told from my dentist it sounds like TMJ and that i should go see a ears, nose, and throat doctor. He diagnosed me with TMJ and told me to try a mouthgaurd and heated pad for 15mins. a night. which did not work. Now my jaw is hurting me that tylonal does NOT take away. I read up on the surgery for this matter and talked to people who said they had the surgery. Most people had complications and regret getting this and that leads me to live with the pain. My moms friend said she had this and she got a shot in her jaw and its been fine since. My pain is so bad that it went into the left side of my jaw, and my right ear. ouch..
if you have any advice please e-mail me [email protected]

Posted by: nicole | Jan 10, 2009 11:33:24 PM

I have had this problem for twenty years of locking jaw and nobody could help or explain, rather they would send me to doctors that would teach me to relax my muscles and wear a mouth gaurd. What a load of nonsense. Recentlyl I went through the braces and the operation of the jaw and it was painful for two weeks yes pain but after that the improvement of my jaw, neck, back, head and shoulders was amazing. I am pain free and I can sleep in a any position I like. So I don't regret it as it has improved the quality of life for me.

Posted by: | Dec 7, 2008 1:42:37 AM

hey everyone

i would all just like to let you know that 2003 i had elective jaw surgery in adelaide (australia) and it was the best decision i ever made yes i was in pain and it hurt like crazy but i i had no infections and nor did i have anything else wrong.

My case also travels around the world as i am the first major success story for a major jaw operation... i had so many x-rays and and things like that right before i had the operation as well to make sure that they didn't have to do anythink else coz one false more or snip could screw you up for life.

If you are in australia and go through a dental hospital before your child is 18 then you have to pay so much and the government pays the rest. it cost my mum $600 for braces, my wisdom teeth out and my jaw operation.

Posted by: Carmen | Oct 20, 2008 5:33:05 AM

Anyone have any info on Dr. Piper? My daughter (17) has been referred to him but we've not taken that step yet. We're told surgery is 40k and he is fee for service - meaning you pay him up front and then hope your insurance company will reimburse. He is out of network...isn't there anyone else qualified to do this type of surgery?

Posted by: brenda | Sep 27, 2008 6:07:58 PM

i read your posting emma and i was wanted to see if you might know if doctor pipers surgery to fix tmj is covered under insurance or how much it is out of pocket? i am very interested in coming to see him from texas. i have been suffering from tmj for 12 years now and it just keeps getting worse and worse. i am currently seeing a tmj doctor but he can't do the surgery if need be. any information would help. thanks

Posted by: sarah | Sep 25, 2008 3:27:47 PM

If you want your life to change, though, and go from suffering an eight to ten on the pain scale every moment of every day to almost no pain, go to the RIGHT surgeon. Joint surgery is as delicate as brain surgery, and on top of that, almost no one is trained in it. Fly to St. Pete Florida and see Dr. Piper. http://www.piperclinic.com/ He changed my life. Surgery always poses risks, true. However, there is hope.

Posted by: Emma Caywood | Sep 23, 2008 1:24:12 AM


I'm 24 years old and I had jaw surgery two years ago. I had both my upper and lower jaws realigned. Prior to the surgery I had been experiencing pain so intense that every time I ate, I ended up in tears. The pain happened for years, improving at times and worsening at others. I saw many specialists and doctors, had bone scans and MRIs, and finally it was determined that for no obvious reason, my joints had begun to deteriorate. Thankfully this process seemed to have stopped before I needed to actually replace the joints.

I was rubber-banded shut after my surgery, not wired, and my pain was relatively minimal. It was crummy to be on a liquid diet for 8-10 weeks, but I got through it and at first I was very pleased with the results. I do have more of a chin (prior to surgery my lower jaw was angled very far back). My teeth are straighter - they aren't perfect but before the surgery I could stick my entire tongue through the gap between my upper and lower front teeth when my back teeth were closed.

I had quite a bit of facial numbness. Most of the feeling returned, except for my chin and a portion of my lower lip. I'm left with a kind of uncomfortable tingly sensation in those areas now, and since it has been over 2 years, this is likely permanent. They tell you that permanent nerve damage is unlikely, but clearly it does happen.

The following two years I had a whole host of problems: hyper-baric chamber treatments for osteomyelitis (bone infection) on my right side, my right jaw gave up a screw and they had to go back in and get it surgically, etc.

Finally I underwent an additional surgery because the bone infection had made the right side of my jaw too weak to stand on its own after one of my teeth had to be pulled because of damage from the infection. This time I really got sick from a hospital acquired infection - drainage tubes, hospital stays, a line put in through my arm to my heart to deliver several IV antibiotics for months at home. It was a nightmare.

Now I'm finally well, so to speak. I have scars along my jaw that I was never supposed to have, numbness that wasn't supposed to be permanant, and some transient facial/head pain. But I can eat and go about my daily activity.

So I would say to anyone who is considering this type of surgery: don't do it because you want to look better, or because your symptoms are an annoyance. Only do this kind of surgery if you have no other alternatives - if you just can't live with your current symptoms. I know the surgery often turns out fine (and my doctor was the head of oral/maxillofacial surgery at a very good hospital), but you need to be prepared for the unexpected bad things that can happen. It is a major surgery and nothing is certain.

Posted by: Sara | Aug 25, 2008 5:38:04 PM

As a teenager, I developed a very painful case of TMJ, tried braces which didn't help, and finally underwent an intense 8 hour jaw surgery which resulted in steel screws being inserted into my jaw to keep it in place. The recovery was difficult and lasted about two months, but everything turned out fine at the end, there were no complications and having the jaw wired shut was not something I had to go through with this type of surgery. The procedure used to fix my TMJ problem was fairly experimental in 1991 when I went through it, and my oral surgeon used my surgery as a case study for a paper he was writing on the subject. It's 2008 now and I've been mostly TMJ-symptom free except for the last few months, where I've been experiencing a return of jaw popping and clicking, but not nearly as severe as it was before the surgery. I can't say the surgery made the TMJ problem completely disappear, but it did an excellent job of making things a lot better. If you have severe TMJ and need jaw surgery, look into this type of procedure.

Posted by: Deb | Aug 16, 2008 1:11:37 PM

I have had TMJ for years. I just lived with it because it wasn't that bad. My jaw would dislocate if I painted my ceiling, things like that. A definate popping and clicking. I had root canal/crown few months ago with three long sessions of mouth open wide. Very painful. Since then, I can't chew on my left side, I get earaches, headaches, tooth aches, my jaw no longer pops, now there is just a grinding sound, and if I eat something chewey, even though it hurts, hey, I like a bagel now and then, I pay dearly the new few days. Oral surgeon suggested mouth guard for $800. I don't grind or clench, so he's full of it. Wonder family practice physician said they can do a lot with arthroscopic surgery these days and got my MRI today. If they wan't me to have surgery, I will do it. If they can fix knee, hip, and shoulder joints, I guess they should be able to fix a jaw. And what hospital stops mid surgery so everybody can go home? I've worked in insurance field for 28 years and have heard more whining and complaining than you can imainge, but that's a new one.

Posted by: amy | Aug 14, 2008 2:03:22 AM

I am 27 and have had severe TMJ for 3 years now. I have been to 3 doctors, who just give me splints and eventually refer me to pain management (which does NOTHING). I have had a MRI, X-rays, acupuncture (what a load of crock), physical therapy, and even some kind of shock therapy (ouch). I have been in the medical field since graduating from High School. If Dr.'s can fix a BROKEN BACK as an outpatient procedure, why can't they fix my jaws? IT IS MISERABLE!!!!! I can seriously understand how people in chronic pain want to kill themselves!! Of course I'm not there yet :) According to my MRI, I have absolutely NO cartledge in my Left or Right jaw and haven't for some time now. So long that my jaw bones have become deformed from rubbing together for years. Any input would be appreciated from fellow sufferers.

Posted by: Brandi | Mar 19, 2008 7:17:11 PM

After 20 years of TMJ symptoms...my last symptom was this hissing in my right ear. It also affected my hearing in one ear..after the "best" ENT I could find did exploratory ear surgery "otosclerosis" with no finding...hello and a splint and nightguard 6 months later...my ear/jaw/TMJ joint has seemingly gotten worse...To anyone out there who has these syptoms or instinctivly knows it's TMJ related get an MRI of your joints before starting a conservative or advanced program to treat TMJ. I will get my MRI results in a week to really see what is going on.

Posted by: John | Mar 15, 2008 7:08:21 AM

I just found out that I have TMJ. I went to see the doctor thinking that there was fluid build up in my ears because I couldn't hear as well as normal. It turned out that all the clicking I have been hearing is from the TMJ. I was told that a mouth guard is one of the best things to try at first. Is this true? Has it worked for anyone else? I am about to go get my mouth moulded for one soon and I want to make sure that my first investment for TMJ is a good one. Any advise would be greatly appreciated.

Posted by: Tori | Feb 20, 2008 10:10:21 AM

fifteen years ago i was eating steamed rice and my jaw just went CRACK and was stuck open for three days. because i was on 'welfare' at the time, nobody wanted to pay for it to be fixed. dental said it was a medical problem, and medical said it was a dental problem. meanwhile i couldnt even shut my mouth. sheesh. now, fifteen years later, my husband has dental and medical coverage, so it doesnt really matter (so long as you dont use the word TMJ on any paper work, or else they wont touch your file and then you're shit out of luck. go figure.) my point is, after a decade and a half of debilitating pain, i have tried everything under the sun to ease my pain. yes, morphine does work quite nicely, but it doesnt fix the problem, does it? it only creates another one. A big addictive one, and that's a road i am not willing to take. so, i'm schedualed for a vertical ramus osteotomy. it's going to HURT. it might work, it might not, there are no guarentees. but at least i can say that i've tried everything. How many doctors and specialists have i seen? about twenty.

Posted by: tammy | Sep 4, 2007 5:53:09 PM

Hmm, "the anesthesiologist is an idiot"....
I get a Gilbert & Sullivan feel from that.
Let's see...hmm...think, think,
Ah ha! I have it!

Oh, the anesthesiologist is an idiot,
Well, a how-de-do
And a big bone screw!

He's an idiot, idiot, idiot,
(If the patient knew
He would never chew!)

Then a how-de-do
To the idiot who
Did spin his yarn of risk
To you

Yes a how-de-do
(With a jaw askew)
To the anesthesiologist idiot!

Posted by: Flautist | Aug 12, 2007 1:47:06 AM

Personally I think the anesthesiologist is an idiot. Don't believe him. I had bilateral TMJ joint replacements 21 years ago---due to a severe exacerbation of rheumatoid arthritis. I recovered well without being wired and haven't had a single problem since. It was no different than having any other joint surgery. I would do it again in a heartbeat. I have endured several root canals and crowns over the years, with no problems with hours of stress on the jaw during these treatments. But that being said you need to find the right surgeon--one who does NOTHING else but this specialty. Good luck to all.

Posted by: Lorrie Koppein | Aug 11, 2007 10:09:13 PM

My ENT said I possibly have TMJ. He referred me to a specific dentist that he claimed was "good". Holy crap, were they about to guinea pig me?

Posted by: Amber | Aug 9, 2007 12:18:31 AM


I've just had my upper jaw widened and my bottom jaw lowered, and it took 2 and a half weeks of constant liquid morphine for me to exist. I was sent home with tylenol, and was told pain would be minimal. It wasn't. Also, after having my jaws closed with elastics for almost 4 weeks, I just had the elastics removed 4 days ago, I am now having muscle pain in my left jaw. The surgeon gave me elastics to wear when I am sleeping and not eating, and I have been trying that, but when i take them off, the pain is horrific. I just can't see me wearing them that much anymore. I am tired of the morphine, and almost wish I had never had the surgery at all, never having been told of the major consequences afterwards.

Posted by: Robert | Jul 10, 2007 11:36:02 PM

I've had two dentists and one ortho encourage me to get this surgery. I'm going for another opinion and personally I'd rather suffer a little jaw pain now and again than deal with major surgery. To me its too risky of a surgery to warrant a "perfect bite" or a "perfect jaw"
Thanks for posting this.

Posted by: Sierra | Jun 16, 2007 4:27:52 PM

hey all,
i had reconstructive jaw surgery on may 18, 2004. i had braces on two separate occasions totalling over 7 years! i was wired shut after the surgery for over 6 weeks and was completely miserable! i have to admit i'm happy w/ the surgery and its asthetic results, as my lower jaw was pushed far back and also had a genioplasty at the same time as the jaw surgery. the only thing is that i still have jaw pain and clicking 2 years later, and it really sucks. :-) Oh well. Maybe I'll go see my surgeon again sometime this year... Cheers to all...

Posted by: christine | Aug 3, 2006 8:55:59 PM

I have suffered from TMJ for over twenty years. I have had an open bite, and braces to correct this problem twice. The surgery has helped the bite, but the pain and discomfort I still feel after almost three weeks is disturbing. A week after my TMJ surgery I was hospitalized with a severe ear infection that required IV antibiotics. My surgeon informed me this was in no relation to my TMJ surgery. Funny, never had ear infections before, is this something anyone else has experienced or heard of?

Posted by: Sherry | Jun 25, 2006 1:33:25 PM

My daughter had TMJ surgery June 13, 06 mouth wired shut for 6 weeks & is miserable. Her teeth are so tight together eating this so called liquid meal is almost impossible. She said there was no other choice with the pain & all she has had for years. Isn't there anything else? Too late now. A Mom

Posted by: Gloria Osborne | Jun 19, 2006 10:45:58 PM

I can't seem to post this.

It seems to be rare to find people talk about the negative side of TMJ or jaw surgery so I was interested in what you had to say in regards to the long-term effects from this type of surgery, seeing as how I just had this surgery myself almost 3 weeks ago, and judging by the title of your post, that was what you were going to write about. However, other than your observation on a few surgeons you've come across who you say took shortcuts, I didn't see any examples of how one might actually go thru a life of misery and regret. While I agree that this type of surgery is too easily recommended, there are many many many people who go thru the surgery and couldn't be more pleased with the result. In any case, I'll be interested to know when you have some examples of how this surgery causes more grief than happiness.

Posted by: Rach | May 31, 2006 2:11:17 AM

I'm a 45 year old woman. Just about all I have left, that I can really say I own, is a couple of faulty jaw implants, and a whole host of associated sypmtoms that come along with them. Nobody wants to/will take responsibility for putting these time bombs in my head, let alone cover the cost of taking them out. Can't really blame them-- I don't really want to be responsible for the damned things either, but, I have no choice. They, or rather, what's left of them are mine-- and mine alone. TMJ implant patients have been abused and then left all alone to deal (or not be able to deal) with the aftermath. I'd take my TMJ symptoms (before implant surgery) back in a heartbeat!!!

Posted by: Cindy L. Grantham | May 20, 2006 12:54:42 PM

I am so glad I read about the fact that you are seeing this surgery with your own 2 eyes. I see this is a $$$$making job as well as other plastic surgeries.
Here is my story. I am a 50 year old woman with no jaw. I want to have lower jaw surgery to get a jaw like everyone else. My kids are fine because my hubby is very cute.
Am I terrible to want to have a jaw and be able to close my lips mormally? You tell me . Will I be sorry if I have lower jaw surgery?

Posted by: Sue | May 9, 2006 3:25:41 PM

another procedure one should avoid at all costs is a bunionectomy
9 mos. and counting, still swollen, unable to wear any thing but sneakers, pain in places that were fine before procedure, limping after a walk of any distance,still have bump albeit smaller, horrendous scar

Posted by: mbpmbp2 | Apr 18, 2006 12:12:55 PM

Thanks Joe.

I have had a lifetime of noise while moving my jaw this way and that. On occasion, I have pinched some nerve in there and felt the unique and excruciating pain resulting. It goes away, and I eat very soft things for a day or two thereafter. On other occasions, I've had the joint lock up, and taken some time to unlock (my first rememberance is during one of my first adolescant kisses - how embarassing).

I've given up chewing gum, as I suspect, perhaps incorrectly, that overuse wears down the joints involved. I chew mostly on my left side, as this seems to cause less problems.

As a result of yours above, and many other attestations, I shall continue my practice of avoiding surgery for this and most other potential surgical opportunities which come my way.


Posted by: mattp9 | Apr 15, 2006 3:05:59 PM

After suffering from TMJ for a decade, I went to see an osteopath. It had gotten to the point where every yawn was painful enough to bring me to my knees. As soon as I told him I had TMJ, he said that I'd had braces, and that it started as soon as I got braces. Damned if he wasn't right. He explained that a common side effect of forceably rearranging the teeth is that the jaw becomes slightly misaligned. He spent about thirty minutes palpitating my jaw, determining that it was just slightly out of groove, and working it back into place. He said it wasn't a cure -- that the muscles around my jaw had built up around the improper alignment, and that it'd probably slip back in a few years.

I walked out of there symptom-free. I remained symptom-free for about five years. A few months ago I had my first painful yawn-pop, and I can hear my jaw a bit when I open and close my mouth. I'll go back to him soon and he'll fix me up again.

Posted by: Waldo Jaquith | Apr 15, 2006 2:57:38 PM

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