Jaw Surgery

I recently found two articles on MTD - one on the voice aspect and the other on the breathing aspect. I had both components. The articles describe my case very well. The only thing that is not mentioned is that bite problems and jaw misalignment can be factors in the muscle tension. I hope to see something written about this in the future. I feel I must not be the only one this has happened to.

Greetings to all my friends on the board! I will be glad to answer questions for anyone. The urls I mentioned on MTD are:

http://www.voice-center.com/MTDvoice.html
http://www.voice-center.com/MTDbreathing.html

I responded to your BB post months ago, when you first described what you had discovered about your own case and what you planned to do about it, so I'll respond again.

Congratulations on your progress and, based on knowing you face-on, I commend you for all the research you went through and being so committed to finding an answer that worked for you. After meeting so many people in person at SD and dystonia conferences, I am awed by the "differences" in our cases and am convinced that many people who are dx'd with SD actually have something else. (And, of course, people with SD still go years without a diagnosis when they are dx'd with something else...what an irony!!!). As we all know, many docs are still mystified by SD so that's the reason. I'm sure they are equally mystified by MTD so we're all still in the same boat and have to take responsibility for our own cases. Continually, the Internet is a huge blessing for all of us.

You've met so many of the same patients in person that I have and I sure hope we can all continue to be supportive of each other....no matter what we have (exactly) and no matter how light-or-severe it is. Thanks for sharing your story and information that might help others. Hugs for a full recovery, my friend. Happy 2001.

Thanks for posting. I wondered what happened to you. Congratulations on the success of your surgery. I am really happy for you. It is good that you were persistent and found out the real cause of your problem.

Like Lynne says, I too think that there are a mixed group of us on this BB who have different voice disorders and some of us have been misdiagnosed. I think the doctors try to give us their best guess but they don't really know for sure.

I have been thinking that I don't have true SD......it is not just wishful thinking, but my symptoms more match MTD. But I have not found a doctor that knows the difference. I am planning to go see James Thomas in Portland, if he ever gets back to me!!

I checked out the urls you posted and found it useful. please stay in touch and when you have some time describe exactly what they did to your jaw.

I am benefinting from my hypnosis therapy, relaxation exercises, supplements, and am keeping the faith that my voice will improve. It is pretty depressing for me to think there is no cure!!

I hope that I will get an accrate diagnosis so I can move on to the right treatment. So far my best help has come from this BB. Supportive, knowledgable, and understanding people who are willing to share their findings. Please let me know some of your sources of help you found for MTD.

I wish you well in finding answers to your voice problems. Mine has paid off, I think, but it did take a while. It was early in 1995 when I developed what was later dxed as SD and I now believe was MTD. I also had problems breathing, just like the breathing component that is mentioned in one of the articles I posted urls for in my previous post.

Things I found that helped my MTD were relaxation techniques (as in Feldenkrais method - you can do a word search and find lots of information), voice and speech therapy, treatment for gastric reflux (with Prilosec), and aerobic exercise (on an exercise bike) to build the strength of my diaphragm muscles. The last one really helped with the breathing part of my problem.

But as I have said, none of these things really addressed the root of my problems. Only time will tell how much relief I will feel in my throat from this surgery. Even recently I have kept an irritation in my throat - the same kind I had for a few years before developing the MTD. I am hoping that will disappear.

My jaw was in poor alignment and my bite was very bad. The orthognathic surgery surgery has corrected this. There will be further adjustments with the orthodontics in the next few months, but then my bite should be as good as it can get. My doctors tell me I will still need to wear a bite guard at night. When it comes time for retainers after the braces come off one of my retainers (upper or lower) will be a bite guard.

A bite guard is what first helped me the most with my MTD. It is specially built by the dentist to appoximate a good bite. When I began that treatment in 1996 my vocal symptoms began to improve. I couldn't tell right away because I took my final BOTOX around the time I began treatment for TMJ dysfunction.

But as the BOTOX wore off that time, the voice and breathing never got bad enough to send me back for another BOTOX. As my vocal cords began to strengthen again the spasms did not return with the same severity. I would say it took several months, but my voice returned to being pretty good. It was also at this time that I learned that my aerobic exercise for the diaphragm had paid off. When the vocal cord would spasm when I breathed, the diaphragm was strong enough to compensate - at least it seemed that way. And the breathing spasms began to get better, too.

The final thing that helped the breathing spasms was treatment for gastric reflux. That summer (1996) I bagan to have episodes at night where I would seem to wake up suddenly from a sound sleep aware that I was not breathing. I went to my ENT and after looking at the larynx with a scope, he dxed gastric reflux as the reason for the laryngeal spasms at night. I began taking Prilosec. The episodes stopped.

Since you asked, my jaw surgery did several things. The upper jaw was moved up and made level (it had been tilted giving me an open bite.) It was moved up 4.5 mm in front and 5.5 mm in back - the result being my teeth don't show under my upper lip quite as much. The lower jaw was made longer by about 3 mm and my chin was moved forward by 5 mm. With the added rotation of the lower jaw caused by the movement of the upper jaw my chin should end up 12 mm farther forward than it was.

I am still swollen but the pictures I have had taken recently show the difference in my chin. Now it looks like too much chin to me! I don't really think it is too much, it is just more than I am used to. If you are interested I can send you some of the pictures I have scanned. They are in jpeg format.

If anyone has any questions you think I can answer please email me. I am very grateful for the support I have received from this online group and I am more than happy to help someone else if I can. If you use my aol address (MarilTX@aol.com) I may be more likely to see your email. My husband is now getting a flood of emails from a support mailing that he is on and I am more likely to overlook an email from someone here if I don't know who you are yet.

I have been kinda lazy with the aerobic and your note motivates me to stick with it.exercise has always helped me physically and mentally. I am sure the strengthening the diaphram will be helpfl, especially with my asthma.

Goly

I couldn't help but respond to this interchange as I am in the very unique position of having met both of you in person. I tried to restrain myself but couldn't.

If there is any "bottom-line" to alot of this online communication, it is (for me) that the value of meeting each other in person (and comparing notes about our disorders, while we can also observe each other and hear each other...which we can't online) goes beyond the online. Online communication has saved alot of our lives and provided us with a community; but, reading these notes from both of you, I can see you and hear you at the same time so it's a step beyond.

Goly...when we met in person, you asked me after over 4 hours if I thought you had SD and I really couldn't answer that. I only know what I hear and observe so I can only describe that...since I wouldn't even begin to dx someone. Your voice sounded very smoothe and relaxed while we were talking normally and softly; but, remember you told me that your neck tension and the straining starts when you talk about your voice? (besides the other straining and neck tension you experience). It did. I could hear that when you started describing your voice issues. But, also, when you started talking louder (in that demo at the restaurant), I could finally hear some catches. SD-type catches.

Anyway, both of your voices are way different from mine as I had all the classic straining, severe catches on vowels and tremors too...of SD prior to surgery. I just hope that this interchange you are having online will help Goly with her own case and maybe it will help others too. Truly, it is difficult to describe (and compare) all this stuff in print. And, we all acknowledge that many doctors are unfamiliar with SD so they often have nothing to compare us to (as we would, as patients meeting each other face-to-face). Fortunately (one of my "SD-plusses") I was diagnosed by a long-term acknowledged SD-expert so once I got beyond the four years of "specialists" who were not able to recognize my SD, at least the dx was firm. Not everyone has that benefit.

Good luck to both of you and thanks for sharing all this information. By the time I see you both again, I probably won't recognize Marilyn (you look different in the post-surgical pictures!!) and I hope Goly gets to see Dr. Thomas, or some other voice professional who knows alot about SD and MTD. I'll be following this thread. It's fascinating.

I didn't have a lot of pain, but opening wide for very long was something that made me uncomfortable. Another sign that I had a bite problem was that I sometimes bit the inside of my cheeks. I also was clenching and grinding. Also the fact that I didn't like to bite into an apple but preferred to cut it up first was also a clue. I learned all this from my TMJ dentist. Does any of this sound familiar to you, Goly?

You really should find a dentist who is trained in the treatment of TMJ. My dentist has taken training at the Pankey Institute in Florida. They have a website. I forget what it is but you could find it with a search engine. I think they can help you find a list of dentists in your area with the specialized training. There are different levels of training, too, depending on how much time the dentist has spent at the institute.

I say that you should find a dentist with this training because in my opinion it is hard to find any other health care professional who understands how serious bite and jaw misalignment can be. Other health problems are also caused by this - headaches and even backaches have been known to improve or even disappear after the alignment is corrected. I'm afraid if you ask anyone else they are going to tell you that jaw misalignment and TMJ problems couldn't possibly cause your voice problems.

I can't say for sure that this is what is causing your problem, but I really don't want you to take the chance of missing it if it is. Even insurance companies seem to be downplaying the significance of TMJ dysfunction and not wanting to pay for the treatment. Please check it out. If this is your problem you don't have to have surgery to find relief. I got a normal voice back before the surgery. If you need help let me know. I wish you well with your search.