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Case History

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Pam

My name is Pam Walsh and I live in St. Louis, MO. In 1992 I was hit in the jaw with a volleyball. At the time I did not realize the cartilage in my jaw on both my right and my left side was torn. By July of 1997 I had already had three reconstructive surgeries to my temporomandibular joint. One surgery involved bilateral meniscectomy and placement of a dermal skin graft. After the surgeries, I had limited movement of my jaw, and some pain and discomfort while eating certain foods. I was told that I would never regain full movement of my jaw and there would always be pain or discomfort of the joint.

In the summer of 2003 I noticed that my right jaw was tender which became much worse when I would chew. My dentist discovered a cavity which was taken care of, but the pain persisted and eventually became intolerable. 4 physicians and many months later I finally had a CT scan done that showed the pain was from my temporomandibular joints hitting bone against bone. I consulted with two of the top oral maxillofacial surgeons within St. Louis only to be told there wasn't much they could do.

By July of 2004 the pain in my jaw was so bad that I could not bite into a banana without excruciation pain to my entire face, especially my right side. For most of 2004 I barely worked, and spent much of my time at home on the couch or in bed. I was taking various over the counter pain medications with little relief. Other problems that I had at this time were muscle spasms and a pressure feeling above my right eye, severe fatigue, headaches, neck stiffness, right ear pain, and inability to sleep due to so much pain.

I felt helpless and didn't know where to turn to. I am a nurse and work in an academic setting at a large university medical school in St. Louis. I asked numerous physicians, nurses, friends, and family members if they knew where I could go to for help. No one seemed to know.

I finally was referred to Dr. Prabu Raman by a friend of a friend, Dr. David Boeg in Atlanta. In August of 2004 I visited with Dr. Raman. After examining me he told me he might be able to help me. I put my trust in him and by the end of my first visit, I had been fitted with a mandibular orthopedic appliance. Immediately I noticed less pain. The appliance allowed me to eat without severe pain. Another thing I noticed right away was that my jaw did hot hurt whenever I yawned. I was beginning to feel better already.

Because of the severe pain that I had been dealing with for so many years, I had many other problems most of which involved muscle tightness, orthopedic problems, and pain in other parts of my body due to my trying to compensate for the jaw pain. Gradually I started feeling better after receiving physical therapy along with the help of Dr. Raman.

After 5 months, many questions, much improvement, a sense of hopefulness, and discussions as to what type of treatment I wanted to pursue, I was fitted with permanent caps on my teeth. It has not been an easy road to recovery, but it has been extremely rewarding. Every hurdle that I crossed was reason to celebrate and still continues to be rewarding.

I now am almost completely pain free, and am in better shape both physically and mentally than I have been in years. I now have much of my energy back, I have more mobility of my mouth, the pressure and muscle spasms above my right eye are almost gone, headaches completely gone, I'm sleeping better and neck stiffness much better. More than anything I am enjoying life again. My friends, family and co-workers now see me smiling and laughing, something I haven't done in a while. I can eat anything and am back to cooking and baking which I love so much. Soon, I hope to be back enjoying many of the activities that I love so much.

It has now been 6 months since my first visit with Dr. Raman, 1 month since I have had my permanent caps, and I notice more improvement every week. This has been the first winter in years that my mouth did not "freeze shut" when I went outside in the cold. I now notice that I can turn my head to either side instead of having to turn my whole body. I can now "chew", my jaw moves for the first time in years. To say that I am grateful to Dr. Raman, his expertise, and his wonderful staff is touching only the tip of the iceberg of how I feel. I don't think I can ever repay him. He has given me a second chance at life, a life that I am so thankful for, aa life that I never thought I would get back. I am indebted to him.

Pam Walsh, R.N.


Dr Raman:


TMJ Implants
After four surgeries in each TM Joint, the tops of the condyles had been shaved down. The glenoid fossa (socket) was also shaved down. Scar tissue had built up between the two bones of the joint. Pam no longer had a normal functioning joint left. The only surgical option left was to replace them with artificial Titanium joints.

The images here illustrated the implants.

Artificial TM Joints

Artificial TM Joints

Our initial plan was to get her bite stabilized and send her to Michigan for this implant surgery. But once the bite correction made it pain-free for Pam, she wished to avoid another surgery and another painful recuperation. Pam just wanted to keep being pain-free. So bonded porcelain restorations were made for all of her teeth to stabilize the bite relation that we had achieved by then.