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What Causes Clicking Sound In Temporo-mandibular Joint?

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Posted on Mon, 20 Apr 2015
Question: Hello.My name is XXXXXXX and here`s my story shortly
I had an accident about a year ago,broke my zygoma bones and orbital floor on the left side of my face.
Got a reconstructive surgery 20 days after the accident.
Thing is that now,a year after the accident,i developed Tmj,my jaw joint on the left side of my face(where the accident happened) is popping in and out and can clearly hear and feel a clicking sound.My bite has changed,like my teeth are not coming in touch anymore on this side.My speech has changed.I get no pain,but the my face feels fatigued and my muscles streesed out.I got problems with my neck,my fingers got numb (on the right hand-weird),same as my legs.I feel that my right leg is shorter than the left one and definately my way of walking has changed.I feel so imbalanced when i walk or run and my moves became clumsy.
I am sure these are not just in my mind.
I did some researches and found out more people having the same issues after accidents affecting their jaws.I found out that jaw problems can change your whole skeleton`s structure,since everything is connected.
I`ve been asking questions on this site since my accident,but now i got a couple of CT scan pictures.
Please let me know if you see something wrong,and what should i do,i can`t handle it anymore,i feel like a zombie,i feel like i am trapped into a disfuntional body
Thank you in advance
doctor
Answered by Dr. Neel Kudchadkar (2 hours later)
Brief Answer:
This is "normal". Your body is healing itself.

Detailed Answer:
Dear XXXXX,

I am Dr. Neel Kudchadkar and I will help you.

Tip #1. I have reviewed your CTScans and I do not find anything untoward, abnormal or subtly problematic in them. Something that could be as yet a "hidden problem", and resurface to cause problems in the future.

Tip #2. The TMJ (Temporo-Mandibular Joint) creates a "clicking" sound normally in many people. So much so more, when an accident has occurred. It will heal slowly but if the clicking is getting worse, please get an xray called OPG (ortho-pan-tomogram) of the jaw. It will show the TMJ in a very detailed way. You might also want to visit an Oro-maxillo-facial surgeon for that.

Tip #3. You are convalescing. This means your body is in a recovery stage. You are in a transit between "Injury" and "recovery". Let your body adjust. Things will settle on their own. This is a fact. Regardless of the system of the body involved.

Tip #4. I politely request you to rest yourself, and take it easy for a minimum of a week. Kindly contact me after this period, we will review things, and take care of issues as required.

Tip #5. The numbness in right upper and lower limb needs more elucidation. Do you have neck pain? Does it radiate to your fingers? Can you perform fine activities like writing, eating with fork and spoon and buttoning easily or do you do it with difficulty? Do you find any decrease in strength in the right upper and lower limb?


Regards,
Dr. Neel Kudchadkar
Medical Consultant
healthcaremagic.com
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Neel Kudchadkar (1 hour later)
Thanks a lot dr.Kneel
I got few questions though..

How am i still in a healing process since the accident happened 13 months ago?

How is my body got so unbalanced that even my left shoulder got more elevated and my right foot feels shorter than the left one ?
The accident was that i fell with my face on the floor.My body did`t receive any damage at all

Plus i rest 1 year now, i stay at home,and all the symptomps began 3-4 months after the surgery.The first months after the the accident,everything was pretty normal,i never noticed anything different on me..

Plus i got an exoplthalmos on the left eye after the opeation..I think that my eye socket is smaller after the surgery.Take a look,comparing with the right one..

Plus i noticed a portion of bone missing,below the metal mesh that i got on my zygoma..Or just the zygoma is more elevated there,propably causing my tmj,since my teeth are not coming in touch on that side.Take a closer look.

Are these things normal ?after 13 months of this kind of accident.I didnt get crushed by another car,i just fractured my facial bones.

Plus i think every couple of months,symptomps are getting slightly worse.
Especially my numbness on my fingers and my walking.
And yes i got weakness to my right arm,comparing with left one,and my right one supposed to be my good one back in the days.
Thanks in advance

doctor
Answered by Dr. Neel Kudchadkar (19 hours later)
Brief Answer:
The chronology wasn't elucidated earlier. Here is my opinion.

Detailed Answer:
Dear XXXXX,

Thanks for your persistence in pursuing these issues. Tenacity pays. You'll get better.

1. I have carefully reviewed your case. A comparison helps, and with the detail that you have provided, we had quite some data to go with.

2. I think both of us understand that you need a lot of help now. As you have mentioned about the unequal length of limbs and the exophthalmos and numbness weakness in your right hand, I want to address each of the issues.

3. The unequal length of your lower limbs needs to be examined physically as we need to see if it is a neurological issue or an orthopedic issue. Due to nerve injury there might be hypertonia in one of lower limbs thus shortening or it could be issue with the hip joint. In case of the former, you would feel that limb is much tighter and stiffer than usual; and than the other unaffected limb. If it is the later, you would mostly get pain in the hip joint. So you need to see a neurosurgeon and or an orthopedist initially and depending on the causative factor, one would refer you to the other. Personally I would seek both opinions and weigh them.

Coming to the exophthalmos, I think a visit to the re-constructive surgeon is warranted. Also the mesh is there in place of the bone, as the bone most probably would have been fractured in multiple pieces and a proper reconstruction of orbital floor wasn't possible without using a mesh graft. That is expected and the mesh takes on the purpose and action of the orbital floor. As to the occurrence of exophthalmos it is all left to a re-constructive surgeon. You should also discuss the issue of the TMJ with him as he would deal with it too.

Coming to the numbness which has been getting worse and the left shoulder being a bit elevated than right, you should see a spine/ neurosurgeon get an examination done to see exactly where the nerve is getting pinched, how the sensations on your hand are, and which muscles are weakened and get an MRI of cervical spine and a whole spine screening so as to assess the complete spine in the same sitting.

All in all I think from now on you should be proactive and start seeking appointments and commit yourself to do everything advised. After talking to your spinal surgeon/ orthopoedist, please seek their opinion as to the need for intensive physical therapy. It will help you immensely but also might be a bit painful in the starting. But you should persist and go through it.

4. You should visit your doctors now, kindly listen to the advice, be vocal in expressing all your problems, take medication if any, and you'll get better.

5. I am confident of my diagnosis. Kindly try visiting the above doctors. You have everything to gain and nothing to lose.

Regards,
Dr. Neel Kudchadkar
Medical Consultant
helathcaremagic.com
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
Answered by
Dr.
Dr. Neel Kudchadkar

General & Family Physician

Practicing since :2004

Answered : 532 Questions

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What Causes Clicking Sound In Temporo-mandibular Joint?

Brief Answer: This is "normal". Your body is healing itself. Detailed Answer: Dear XXXXX, I am Dr. Neel Kudchadkar and I will help you. Tip #1. I have reviewed your CTScans and I do not find anything untoward, abnormal or subtly problematic in them. Something that could be as yet a "hidden problem", and resurface to cause problems in the future. Tip #2. The TMJ (Temporo-Mandibular Joint) creates a "clicking" sound normally in many people. So much so more, when an accident has occurred. It will heal slowly but if the clicking is getting worse, please get an xray called OPG (ortho-pan-tomogram) of the jaw. It will show the TMJ in a very detailed way. You might also want to visit an Oro-maxillo-facial surgeon for that. Tip #3. You are convalescing. This means your body is in a recovery stage. You are in a transit between "Injury" and "recovery". Let your body adjust. Things will settle on their own. This is a fact. Regardless of the system of the body involved. Tip #4. I politely request you to rest yourself, and take it easy for a minimum of a week. Kindly contact me after this period, we will review things, and take care of issues as required. Tip #5. The numbness in right upper and lower limb needs more elucidation. Do you have neck pain? Does it radiate to your fingers? Can you perform fine activities like writing, eating with fork and spoon and buttoning easily or do you do it with difficulty? Do you find any decrease in strength in the right upper and lower limb? Regards, Dr. Neel Kudchadkar Medical Consultant healthcaremagic.com