Hand Surgery Questions and Answers Archive

Sep
2000

Q&A: What should I do if I had jaw surgery for TMJ and now my other jaw is popping?

Question:

I have been diagnosed with DJD left TMJ. I have had surgery to correct but now the right side is popping and clicking. I don't seem to be able to find a way to chew that I can control or eliminate the popping. The closest I come is placing the food in my mouth then placing my hands on both sides of my jaw and chewing then repeating until my meal is finished. Any suggestions?

- Victoria

Answer:

 David A. King, DDS - LocateADoc.com

My first recommendation would be to follow-up with the surgeon that treated the other joint to re-eval both sides. These symptoms may be early changes that could be managed conservatively ie: soft non-chewing diet, physical therapy, bite splints etc.

-- David A. King, DDS
Wilmington, Delaware



Jul
2000

Q&A: What can I do outside of surgery to reduce my huge male breasts?

Question:

i have huge size breats for a guy and i was wondering what excersises i should try before i consider plastic surgery, and if there is anything else i can try

- Dan

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Gynecomastia is enlargement of the male breast. There are a number of causes for this although it is usually idiopathic (unknown cause). You should visit with a medical doctor or endocrinologist to make certain that your hormonal status is normal. If it is, which is usually the case, the best available treatment is ultrasonic liposuction. Although there are no excercies or ways to spot reduce, overall weight loss (if you are overweight) will help. The ultrasonic liposuction is best able to handle the fobrous tissue in the male breast and works much better than regular liposuction in the treatment of this condition.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Mar
2000

Q&A: What is the cause of and timing for the loss of a large lump in my cheek following 4 wisdom teeth extractions?

Question:

I am a 23 yr old otherwise healthy female, and I just had all 4 wisdom teeth extracted 5 days ago. The two on my left side were both vertically impacted. They gave me IV sedation, and my teeth came out easily, so the surgery itself was painless and the rest of that day wasn't too bad except for the bleeding. The next day, however, my left cheek had become massively swollen. It is now still very swollen and moderately painful, with little sign of subsiding, making it very hard to smile or to open my mouth wide enough to fit small bites of food. My left cheek continues to be very tight and painful, but my main problem is that there is a half-walnut-sized lump in my cheek, a bit above the level of my mandible. It is extremely hard, seems like its located in the muscle, and doesn't appear to be getting smaller. I called the resident who performed my surgery, and he said that it just happens in some cases, and it might take 3 weeks to go away. Is that true? What causes it? Will exercising my jaw help, or should I try to keep it still? I'm a vet school student, and would like to know some of the medical details also. Thank you very much for your help!

- Kristen

Answer:

Dear Kristen, As you will no doubt learn in your orthopedic rotation what your are experiencing in a bony callus formation over the area where the bone was removed during the wisdom tooth extraction. As the natural underlying bone heals it will lay down a protective layer. As the socket fills the callus will disappear. It may last three weeks, but usually by the second week, baring any inflammation or infection, it should be quite small, and only perceptable with palpation. The pain in the more swollen side is most likely muscle inflammation which is best treated by ASA or NSAID and moist heat. Use the heat as you did the first day or two with the ice packs. You will have beter pain relief if you take the OTC meds on a regular schedule, just don't exceed the daily recommended dose ( prevent GI upset). You trismus, tight jaw will resolve faster as well with consistent use of the moist heat when you can do so. Do not attempt to over do jaw motion, as it will just further inflame the tissue. Stick to a softer diet and be protective of yawning and sneezing( I know sounds odd, but think about it) Also, as your resident will learn as time goes by...young women will swell more at your age for a number of reasons (big teeth, small mouth, his inexperience, length of time it takes to complete treatment etc...)but one he won't realize for a while is if he is right handed, all his patients will swell slightly more on the left because access and visibility are more difficult on that side for a right handed operator, especially if he was sitting down for the surgery! Us old guys still stand up for everything! Good luck with school and don't worry about your cheek, it will be very self limiting.

--Charles R. McNamara, DMD
Winter Park, Florida



Sep
1999

Q&A: Is one laser eye surgery type better than another for avoiding night vision issues as result of the surgery?

Question:

I have read about potential night vision problems after laser surgery. I drive a lot at night. Is one laser procedure better than others in this regard? Thank you.

- Andrew

Answer:

John D. Zdral, M.D. - LocateADoc.com

Glare problems after LASIK are fortunately quite rare, because there is no haze development or scarring, typically (unlike RK or PRK). Occasionally, people may notice some night glare, but it tends to be mild, and temporary only. One issue that can predispose to night time glare is very large pupils which we check and will discuss with you beforehand. To schedule a complimentary consultation please call Pam, our laser vision coordinator, at 1-800-824-1073. Sincerely, John Zdral, M.D.

--John D. Zdral, M.D.
Fullerton, California



Aug
1999

Q&A: Will I find LASIK eye surgery hard for me to handle if I am a fairly nervous person?

Question:

I am considering lasik surgery. I tend to be fairly nervous. Will this be hard for me ?

- Michele

Answer:

John D. Zdral, M.D. - LocateADoc.com

It is normal to be a little nervous before eye surgery. We provide a mild sedative right before the procedure which makes you completely comfortable. In the hands of an experienced surgeon, you should have no problems. If you would like to schedule a complimentary consultation, call Pam, our laser vision coordinator at 1-800-824-1073. Sincerely, John Zdral, M.D.

--John D. Zdral, M.D.
Fullerton, California



Aug
1999

Q&A: What can be done about the scar below my cheek from a dog attack?

Question:

Hi, On Dec. 29, 1997 I was attacked by a Lab/Chow mixed dog. The animal bit a large whole on the left side of my face, under my cheek. I recieved plastic surgery which involved 30 stitches on the surface and 10 dissolving stitches on the inside of my face. I was left with a scar. It could of been a lot worse than what it is, but I am very insecure about it. I try to do everything in my power so people do not see the scar. I always wear my hair down, I try to cover it with my hand, etc... My question is I would like to know if there is anything (laser or plastic surgery)that can be done to improve the appearance of the scar? My doctor told me that he could cut open the scar again and I would have to go through the same healing process as I did before, but I don't think I could go through it again. Please HELP ME. Thankyou

- Michele

Answer:

Carmen Ann Paradis, M.D. - LocateADoc.com

Sorry to hear about your accident. Without seeing you, I can't give you specific advice about how your scar can be improved. Scar revision usually involves rearranging the skin to make the scar lines fall in less noticeable planes, or recutting portions of the scar so that the texture of the scar is better. Laser is not usually useful for this. Nothing will make a scar disappear; we can only try to make it less obvious. While it is true that if the scar is revised, you will go through a wound healing process again, that process should be less of an ordeal with revision. In dog bites these is a lot of crushing and tearing of tissue which is much more traumatic than scalpel incisions. You migh consider consulting a couple of plastic surgeons about what might be done for you specifically. Another thing to remember is that people are not as concerned about your appearance as you are, especially if you do not call attention to it. Good luck Carmen Paradis M.D.

--Carmen Ann Paradis, M.D.
Cleveland, Ohio