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TMJ Stem Cell Therapy: Valerie’s Story

POSTED ON IN Back and Neck Procedure Outcomes Neck/Cervical Regenexx Spine Procedures Regenexx-DDD Regenexx-PL Disc Regenexx-SD TMJ TMJ Stem Cell Therapy BY Chris Centeno

TMJ stem cell therapy

Every doctor sees patients who, right off the bat, he or she knows are a huge challenge. Valerie was one of those patients with one of the most severe cases of TMJ I have ever seen. She was unable to eat solid or soft foods at any level, and I was pretty sure she also had severe neck injuries that had gone undiagnosed. Ultimately she got her life back through highly precise TMJ stem cell therapy as well as a novel first of it’s kind therapy in her neck.

What Is the TMJ, and What Can Go Wrong?

The temporomandibular joint (TMJ) is the hinge joint at the jaw that you use to eat and chew. In mild TMJ syndrome, patients notice intermittent pain in the joint in front of the ear or in the muscles around the joint when talking or chewing. The joint has four key components with two that are often missed even by expert TMJ physicians, surgeons, and dentists.

First, like any joint, the TMJ has cartilage inside that serves as a protective cushion where the bones that make up the joint meet. In addition, like the knee, there is a natural spacer in the joint known as the “disc” (articular disc of the TMJ joint). This is a meniscus-like structure that moves in tmj syndromepredictable ways as you open and close you jaw and that provides further protection for the joint due to the immense loads that can be generated with chewing. Like any other joint in the body, the cartilage or spacer can be injured or become damaged due to wear and tear leading to painful arthritis.

The next key component of the joint is the muscles that help to move it. There are many different ones including the masseter, the large temporalis that comes from the side of the head, the pterygoids, and strap muscles. The muscles work together in afunction of tmj muscles symphony of millisecond-timed precision to open and close the jaw. These are powerful muscles that can develop trigger points like any other muscle—areas that are shut down and painful. These muscles also have tendons that attach to bone, so these areas can develop tendinopathy—or small tears and degeneration which can cause them to become painful.

The final two key components are often overlooked by TMJ experts, and they’re key to why we were able to help Valerie with precise TMJ stem cell therapy. These are the ligaments that stabilize the joint and how the TMJ fits into its regional ecosystem in the body—the head and neck.

Ligaments stabilize joint by acting like pieces of duct tape that TMJ ligamentsguide it and prevent motions for which it wasn’t designed. The TMJ has many ligaments that often get ignored by medical providers. These are the sphenomandibular, stylomandibular, and capsular ligaments. In addition, the tough covering of the joint (capsule) is further divided into collateral (lateral) ligaments, similar to the knee.

Finally, most TMJ providers focus on the bright shiny object of the TMJ itself, forgetting that it’s a joint that lives in the ecosystem of the head and neck and that it can’t work efficiently without it’s neighboring structures working well. So neck problems will place more pressure on the TMJ joint. In addition, if the neck is unstable because its ligaments have been injured or the small muscles that stabilize it are off-line, then the body attempts to use the TMJorthopedics 2.0 muscles as accessory stabilizers of the neck. Given that the joint and its muscles aren’t designed to handle these extra loads, it eventually breaks down, and the muscles get overwhelmed. To learn more about how ligaments and muscles stabilize the neck and back, read our book Orthopedics 2.0.

Valerie’s Nightmare and Eventual TMJ Stem Cell Therapy

When I first evaluated Valerie, in December of 2014, she had a history of issues with her TMJ since age 18, and she was 60 at the time. It all began with having her wisdom teeth removed as a teenager, and then five years ago, her teeth got stuck on something and she felt intense and then progressive TMJ pain. In her past she had also suffered from whiplash and head injuries. More recent was a fall that fractured a low-back vertebra and injured her SI joint. In addition, a yawn earlier that year had dislocated the TMJ, further exacerbating her issues. She was on a liquid-only diet, forced to blend her meals and drink them. She had tried every TMJ treatment under the sun without much relief.

When I first met Valerie and looked at everything from her low back to her neck to her jaw, I have to admit, I was a bit overwhelmed. So I cautioned her that while I could treat the whole picture using ultra precise TMJ stem cell therapy injections under ultrasound and fluoroscopic guidance as well as platelet procedures in many areas, given that she couldn’t even chew soft foods, I didn’t know how far we would get. Over the ensuring year and a half, we treated the TMJ joint and discs; all of the TMJ ligaments above, including some on the inside of the joint; damaged facet joints in the neck; neck ligaments; her SI joint; bulging and painful spinal discs; and then finally her alar/transverse ligaments. The final treatment was really what I feel helped her recover the most, and this procedure to treat the ligaments that hold her head on (alar/transverse) was developed by me only a few months before she tried it.

The head is held on by strong ligaments. These connect the upper two neck bones to the head and are called alar and transverse ligaments. We know from a few studies that they can be stretched in whiplash injuries or when there’s a blow to the head. These patients often have headaches, a heavy- or tilted-head feeling or appearance, problems thinking and concentrating, and other symptoms. The surgery to fix this issue is an upper cervical fusion which is a huge and high-risk affair, with many patients avoiding the procedure due to fear of major complications.

In Valerie’s case, while she was making progress with each successive procedure, I felt that laxity in these important head-stabilizing ligaments was causing her body to use the TMJ and its powerful muscles as secondary stabilizers, causing the joint to break down. In other words, we would never be able to fully get her better without also treating these upper neck ligaments. I ordered a moving stress X-ray of the cervical spine called a DMX, which did confirm that the alar/transverse ligament complex was lax and not protecting her upper neck.

Injecting into these ligaments with stem cells to help them heal and strengthen has been impossible until recently. They can’t be accessed from traditional ligament injections that come from the back of the neck as the spinal cord is in the way. I had been thinking for years that there had to be a way as we had many patients who had sought us out for our rare expertise in injecting upper neck joints (C0–C2) and posterior ligaments with fluoroscopy. Then one day, while staring at a model of the upper cervical vertebra and its ligaments that we have in the office, it hit me. There was a small hiatus (medical speak for hole) in the front of the spine between C1 and C2 that could allow a needle to be passed using fluoroscopic guidance through the front and into these ligaments. After about a year of planning and consulting with colleagues, in September of last year, Valerie was one of the first patients in the world to have her own stem cells injected into her damaged alar/transverse ligaments (or anything else for that matter given no physician had ever injected these structures).

So how did Valerie do? I recently pinged her via e-mail because I am giving a talk on this novel, ultraprecise injection of the alar/transverse ligaments in Florida next week. This is what she wrote back:

Hi!

I apologize for not writing sooner, I’ve written to you in my mind at least 100 times. I wanted to thank you for the incredible care that you have given me over the past year.
The last procedure in September was extremely successful. By October I was back to solid foods (carefully) and in November I could eat just about anything. Additionally, I can now feel that my head is literally on straight. I have an entirely different orientation and feel much more comfortable, the benefit has been tremendous.
I have though about coming back for a “tune-up” as I think I have lost some of the benefit through my sacral area as I have been sitting for hours on end at work and unable to get out early enough to even just walk. But I don’t see that occurring at this time.
I also wanted to tell you that you have a wonderful caring, efficient staff who helped to make my overall experience truly enriching. Please tell Bridgette that I really appreciated her.
So, thank you again  for your dedication and expertise…
Warm regards,
Val

Wow! Given Val was one of those patients who I really had my doubts I could help, what a great way to wake up on a Saturday morning! We all take for granted the little things that when they’re lost can be devastating—the ability to walk, talk, run, or chew.

The upshot? There’s more to TMJ stem cell therapy than injecting magic stem cells into the TMJ joint or starting an IV. Not only does it often take precise injections into the joint, but also into obscure ligaments and oftentimes the neck. For Valerie, it also took a new procedure that was developed based on the need to have a treatment for ligaments that had never before been injected!

————————————–

After I posted Val’s story, she sent this e-mail to elaborate on the results from all of the different body areas we treated:

“You might want to add that I have been completely rebuilt by your Regenexx treatments. I am straighter, sturdier and have much improved mechanics than I ever thought would be possible, even before I broke my back and dislocated my jaw. I barely even have a click in my jaw that I have had since age 16. And, I am taller 🙂

Thank you~Val”
So here’s to a better Val in all areas!

    comments

    Shannon Lewis says

    Wow, this is great.

    The regenexx website does not typically note treatment for the TMJ.

    I am a 46 yo female with advanced TMJ dysfunction and prominent crepitus on my right joint. I have managed my TMJ since my 20's.

    What regenexx Doctor works on the TMJ? I live in Menlo Park, CA

    Kindly,

    Shannon

    replies

    Regenexx Team says

    Shannon,
    Dr. Centeno at Regenexx Headquarters, the Centeno Schultz Clinic in Colorado, is the only Dr. currently doing this treatment. htpp://www.centenoschultz.com

    replies

    Sam says

    Long live Dr. Centeno! Brilliant!

    replies

    Yoli says

    Amazing!! Dr. Centeno you are God sent!! With your talent, expertise and the healing power of stem cell that was a game changer.

    I wish I could afford a stem cell treatment for my carpal tunnel, chronic lower back pain that goes all the way to my ankle, and knee pains. I hope sooner rather than later insurance will pay at least half of the cost.

    Best,
    Yoli

    replies

    Regenexx Team says

    Yoli,

    Thanks! Figuring how to help people and broadening the knowledge base to help more people is the point of all we do... So do we re insurance!

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    ColoradoYaz says

    What really struck me with this story is how Dr. Centeno was looking at Valerie's ENTIRE body, not just her jaw. And his investigative thinking, about all the different reasons contributing to her pain. I'm working with Dr. Shultz and have begun this journey with him - he is not rushing in to 'treat'. He is asking 'why does she hurt there?' 'what else may be going on that is contributing to the pain?' I am very grateful for this. Getting more hopeful by the week.

    replies

    Regenexx Team says

    ColoradoYaz,
    That IS the Regenexx way. Dr. Schultz is amazing! Please keep us in the loop...

    replies

    JOSE TORRES says

    If I have compressed nerves I'm serveral locations of my arm and I have a bad knee, could I get that all done on the same day by the doctors at Colorado?

    replies

    Chris Centeno says

    Jose,
    It depends on what's causing the issues. That's something that would be covered in the Candidacy Evaluation once the Doctor has had the opportunity to read your MRI's and take a medical history.

    replies

    Jill Cauwels says

    Hi, my name is Jill and I am a intense teeth grinder. I suffer everyday with jaw/muscle facial pain from the previous night of grinding. I've tried everything to get out of pain. I feel pain everyday of my life. I have taken so many different kind of medications and nothing really helps. I know the teeth grinding is stress related and unfornately, I cant stop this from happening at night. I do need some relief. Any suggestions about the stem cell therapy is much appreciated.

    replies

    Chris Centeno says

    Jill,
    Avoiding caffeine and alcohol may help, as both interfere with getting into the deep sleep part of the sleep cycle, and therefore increase the possibility of teeth grinding. Our TMJ treatment would be to address the damage to the area, however continual nightly teeth grinding would continue to damage the area.

    replies

    Cc says

    Are any other practitioners now treating Tmj in other states in the northeast?

    replies

    Chris Centeno says

    Cc,
    There are a few of our providers that treat TMJ. The Doctor in the Northeast would be Dr. lieber at RAPS in Pittsburgh. Here's the website: https://www.rapsmd.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations Please call 855 622 7838 for assistance.

    replies

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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