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Exostosis surgey l and TMD
satingirl posted:
Thank you for this web site.

I am a 52 year okd female who loves serving elderly ministry through church. I grind my teeth and have several exostosis. One in particular is in on my upper left gum above my last molar and has broken open a few times. It feels and looks like a pencil point in the upper middle part of the red grape size lump and is very tight between the gum and cheek and hard to see, being high and back. It was ulcerated for some time and my dentist missed it four times due to heightened location. When found, I was sure i had an abcess as was dentist, but xray was negative and given a flucanade gel. The monthly undiagnosed pain may have caused me to clench and then I had TMD pain.

I plead with first Orthodontist for a MRI which showed moderate TMJ and a very small bite(lock on opening) of two tiny fingers. He visually saw an unusually protruding exostosis, but said people leave them alone as they dont bother them, but bothered me. I wanted him to decide, but he only offered high priced TMJ massage, so I sought another opinion. Next OS, I was again feeling like an oddball with a few things going on, given a custom splint 3 weeks ago and had physical therapy, but had to push for all of these. My dentist was puzzled by it all as well and did say it could be partly occlusional, but OS stated not. He said I thrust my teeth forward, thus causing them not to meet right.

I feel the pain when touching the tendon deep inside my cheek and ironically, right above the exostosis on the gum. It all runs together. In addition to muscular pain, am unsure if it's the exostosis size or TMJ/TMD causing a quarter-size extreme tenderness in upper cheek, inside and out when touching or not. I guess this is a third issue, but all I know is the left side of my face hurts so bad I cant function. A few days here and there, the little cheek area settles down, but is overwhelming in terms of pain. It seems to be infraorbital in location and to me, adjacent to exostosis. The TMJ joint itself gets sore if smiling, smirking to left or with chewing and talking much. The masseter muscle is tender to touch.  I also have very tender areas in temple, behind upper ear on scalp, and in front of ear. I'm taking baclofen and tylenol and will restart PT tomorow after two weeks off. At PT, I receive masseter massage, ionphotoresis, ultrasound, and TENS, with exercises for my posture. I believe PT helped some, but stopped after seeing OS for a follow up and having a random "ok" day.

I have questions as my Oral Surgeon is really leaving things up to me and although kind, he is quiet and i believe my issues are not clear cut, thus he is tenative. He is not sure one way or the other what will help or hurt and generally doesnt say much and brings up the differing symptoms as if they are all seperate maladies. He is puzzled by the exostosis bothering me so much, yet says it feels odd and pointy. I am scheduled to have the exostosis removed under twilight medications by him in ten days and am very frightened the symptoms of TMJ will worsen.

I am quite curious if they could do a TMJ or TEMPORAL block at the same time of exostosis surgery as long as I'm under?? I'm thinking this would help from having my mouth worked over and opened more than usual for surgery and want to ask him. Is the TMJ block the same as the Temporal Tendiniits block?? From reading, I think the pain is from cheek, to temple, and behind upper ear, sometimes in ear, but most say Temporal Tendinitis is connected to TMJ.

I am wondering if I should postpone surgery and try a block before surgery? My OS eluded that TMJ blocks can make you feel worse when discussing this prior to surgery talk.. Any thoughts on how long the surgery takes and will the blocks be administered before I am anesthetized?? Can the usual upper blocks cause additional issues or having the cheek pulled back worsen pain?  

Thank you kindly for any guidance offered as I'm quite concerned. Grateful, Kathleen

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