Metal implant to fix a worn-out jaw joint: The breakthrough to give you your bite back
02:23 GMT, 25 September 2012
It’s not only knee and hip joints that surgeons can replace — music teacher Lauren Reed, 33, from Walthamstow, East London, had a pioneering procedure to give her a replacement jaw
'My jaw would pop out of its socket several times a day,' said Lauren Reed
From my earliest memories, my jaw has been a real problem.
I was born with temporomandibular joint disorder, which meant my jaw joint did not sit in the socket properly.
It was constantly painful and I often woke up with blinding headaches that had been caused by it.
I’ve taken painkillers every day of my life.
They worked a bit, but I still couldn’t sleep or eat properly so I was constantly exhausted.
It was like seeing the world through a grey fog.
My jaw would pop out of its socket several times a day.
It made such a loud crack people nearby would ask what on earth had made the noise.
Doctors said there was nothing they could do, so I tried to get on with my life.
But it got worse and worse so when I was 21 I found an orthodontist, who offered me an operation that involved breaking and realigning my lower jawbone.
After recovering from the surgery, I knew something wasn’t right.
On opening my mouth, my jaw swung to the right by two centimetres.
The operation had basically gone wrong and left my jaw even more badly dislocated, and more painful than ever.
I started taking painkillers like they were sweets, but the pain got worse.
I’m a violin teacher and sometimes it was even painful to talk, which obviously affected my ability to do my job.
So two years ago I was referred to Shaun Matthews, a surgeon at King’s College Hospital in London.
He told me about a new operation that could give me a completely new jaw joint made of metal.
The metal joint would be held in place with screws, but he said no one would be able to tell or see the scars.
'For the first time ever I didn't have any pain. It felt like a miracle,' said Lauren
I did feel pretty terrified, but he said if I didn’t have it the pain would probably get worse and at some point in the next few years I might not even be able to open my mouth.
So I went ahead, in November 2010.
The operation took nine hours and I was under general anaesthetic.
Afterwards I was on morphine for the first 12 hours, but then just regular painkillers.
My jaw was very swollen, which took three days to start going down. But for the first time ever I didn’t have any pain. It felt like a miracle.
I was allowed home after four days’ observation and given jaw exercises that would stop the muscles seizing up.
I could eat only soft foods such as scrambled eggs for two months, but four weeks after the op I could fully open my mouth.
A few weeks later I went back to teaching — now, I’ve got so much energy that I’m bouncing around like a 20-year-old.
The only restriction is that my new jaw cannot move from side to side, but it doesn’t stop me from doing anything such as chewing, talking, yawning and so on.
It will need to be replaced in 15 to 20 years due to wear and tear, but that’s fine.
This operation has transformed my life and I’m ridiculously happy.
Shaun Matthews is an oral and maxillofacial surgeon at King’s College Hospital in London. He says:
We have two jaw joints, one on each side of the face, sitting just in front of the ears and connecting the jawbone to the skull.
The jaw is a ball and socket joint — the head of the jawbone fits into a hollow, close to the ear.
The jaw joint is a complex joint and probably the most used in the human body, in activities such as eating and talking, so problems are common, with around one in four people affected at some point.
Temporomandibular joint disorder, which Lauren has, is an umbrella term for jaw dysfunction — some people are born with it, but it can be triggered by an injury or dental work.
It can also be caused by overworking the jaw muscles through frequent chewing or clenching or grinding the teeth.
Jaw problems can also be caused by rheumatoid arthritis, osteoarthritis and tumours.
Jaw replacement can help with all of these conditions.
This type of surgery has been available since the Eighties, but previous metal jaw joint implants were poorly engineered.
So though short-term results were encouraging, longer-term results were less impressive and many of the joints failed and had to be removed.
However, recent developments have hugely improved outcomes.
The new jaw implants have been designed and modelled on technology used in the manufacture of artificial hip and knee joints — so they are a lot stronger and better made.
Web-based technology and virtual surgery also means we can plan more complex surgical procedures and construct bespoke implants that precisely fit the patient’s anatomy.
Lauren’s implants were created specially in the U.S. using three-dimensional scans of her head and jaw.
Her scans were performed three months before the operation.
These allow for the mapping of important nerves and blood vessels, so these can be avoided during surgery, making it safer.
The new joint implants work like a hinge.
There are two parts — a plastic socket, which we attach to the cheekbone, and a metal implant, which is secured into the jaw below.
This metal section has a ball at one end, which sits inside the plastic socket so the joint can open and close.
The replacement is small, about the size of a matchbox, but flat.
The operation involves making incisions in front of the ear and behind the lower jaw line, to allow access to the jaw joint and lower jaw.
First, we remove the damaged part of the jaw joint.
We secure the hinge on to the patient’s cheekbone using titanium screws, then wire the jaw together so the new joint fits precisely in the correct bite.
We then secure the metal implant to the lower jaw, stitch the incisions and remove the wire.
Lauren’s operation took nine hours because of its complexity.
Similar but more straightforward procedures usually take five to six hours.
Patients have jaw exercises to do from the day after surgery and full recovery takes six to eight weeks.
Not everyone having this type of operation needs to have custom-made implants — some can have a generic version, which comes in various sizes and shapes.
Because it is such new technology, few dentists and GPs are aware that people with these problems can be helped.
It’s an excellent operation that will allow many patients to get their quality of life back — or as in Lauren’s case, actually know some quality of life for the first time.
The implants cost 5,000 to 16,000. This procedure is available on the NHS, with a referral from a GP, and privately, though there are only a limited number of surgeons in the UK, Europe and worldwide who perform it.