Mount Sinai’s jaw joint replacement


Imagine losing the ability to chew, bite or even keep your mouth closed.

Liane Hoffman lived that nightmare until surgeons at Mount Sinai Hospital transplanted a new jaw joint so she could enjoy the every day things most people take for granted – speaking, eating, swallowing properly, or even talking.

For eight years, the 41-year-old Ottawa mature student has suffered from rheumatoid arthritis, a disease in which immune cells invade the joint and stimulate enzymes that can deteriorate cartilage and joint edges.

In Liane’s case, it began with pains in her wrists and shoulders, but progressed to her jaw. After trying different treatment options, including surgery, she was referred to Dr. David Psutka at Toronto’s Mount Sinai Hospital.

“When Liane came to me, she was in serious pain – her jaw had almost completely deteriorated because of her arthritis,” said Dr. David Psutka, senior surgeon in the Division of Maxillofacial Surgery at Mount Sinai Hospital. It’s the only service in Ontario providing both assessment and advanced management for complex temporomandibular joint (TMJ or jaw joint) reconstruction. The Hospital has been a provider of prosthetic TMJ replacement surgery since 1995.

More than 500 jaw joint replacements have been performed at Mount Sinai since the program began. Partly as a result of the surgery’s complexity, only about 25 patients can undergo this surgery per year, receiving a combination of one-sided or two-sided prosthetic replacements.

TMJ degeneration occurs when the cartilage and the jaw bone itself decay as in Liane’s situation, resulting in extreme pain and discomfort and an inability to open and close the jaw correctly. In addition, she suffered from severe jaw and facial deformities as a result of the deterioration.

Liane was unable to eat properly, swallowing food whole or having it fall out of her mouth. Add the inability to close her mouth and she became extremely self-conscious.

“The joy of eating and going out was completely gone,” recalled Liane. “The embarrassment of not being able to bite and chew properly kept me from enjoying my life.”

Following the jaw replacement surgery, Liane was thrilled to be able to use her jaw properly again.

“It was a real confidence booster,” she said. “Finally, I had the ability to chew and speak normally again. I know that in the future, no matter how far my arthritis progresses, I will always have the ability to speak. That is important to me.”Up to 15 per cent of Canadians report TMJ problems with the overwhelming majority successfully managed with relatively simple, non-surgical procedures.

“We see people who have the most severe cases from across the country,” said Dr. Gerald Baker, head of the Division of Oral and Maxillofacial Surgery and Director of the TMJ Surgical Reconstruction Program. “As more awareness on this issue is raised, and therefore additional funding made available, we hope to be able to treat more patients in the future.”

It’s been two years since Hoffman’s surgery and she is enjoying life again. She is no longer on medication and has full use of her jaw.

“If you’re lucky enough to get the surgery, do not give it a second thought,” she advises others suffering from TMJ degeneration. “Feel blessed to be given the opportunity to change your life for the better.”

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