After a Decade, TMJ/Orthognathic Surgery Still Changing Lives

People suffering from chronic facial and joint pain will find relief in a procedure instituted at Boston Medical Center (BMC) by Drs. David Cottrell and Pushkar Mehra of BUGSDM’s Department of Oral and Maxillofacial Surgery. They are two of just a handful of surgeons in the country (and the only in Boston) trained to perform simultaneous temporomandibular joint (TMJ) and orthognathic surgery.

The surgery, which Drs. Cottrell and Mehra began performing ten years ago, replaces the TMJ with a carefully-designed prosthesis and reshapes the face to correct jaw problems such as underbites, overbites, and uneven bites causing medical problems.

The demand for the surgery remains constant, with about five to eight performed at BMC annually. "If and when that need arises," Dr. Mehra says, "this has become the center to go to for this kind of surgery."

Candidates for the surgery include people with rheumatoid arthritis, advanced degenerative joint disease, ankylosis, or post-traumatic deformities who have not found help through traditional surgical and non-surgical methods. Patients may be in constant pain and unable to eat or receive proper dental care from these conditions.

"Before this surgery, there was no good treatment for them," says Dr. Mehra. "They used to undergo a surgical procedure once, then another one six months later then another one six months after that."

It takes 10 to 12 hours for Drs. Cottrell and Mehra to complete the surgery. Due to the complex nature of the surgery, Drs. Cottrell and Mehra simulate the procedure in the laboratory before the operation date.

After as little as two to four days of hospital recovery, patients go home with a special diet, scheduled physical therapy, and regular follow-up appointments.

Department chair Dr. David Cottrell adds, "Many of our patients are so debilitated with severe pain and uffering that this surgery gives them an opportunity to improve their quality of life.”