Winnipeg man ‘in constant pain’ after nearly 3-year wait for jaw surgery

Daniel McClelland never thought he would have to wait for almost three years to be able to eat solid foods again.

“I can do pancakes, but I kind of have to shove them in — slurp it in, if you will,” said the 38-year-old Winnipegger, who is on a waitlist for a jaw joint replacement surgery that can’t be done in Manitoba.

“I can’t open my mouth at all or chew,” he said, leaving him limited to soft foods like soups, yogurt, scrambled eggs, mashed potatoes and protein shakes.

In June 2021, McClelland was referred to an Ontario oral and maxillofacial surgeon — a surgeon who specializes in oral surgery, including the mouth and jaw — after a previously removed bone growth returned, causing his jaw to lock.

“I asked when my surgery was coming and where I was on the waiting list. No one can give me an answer,” he said.

He’s living on disability benefits right now. His lack of a proper diet means he’s constantly tired and cannot work, he said.

“I am in constant pain,” said McClelland. “I have to crush my pain pills to get them into my mouth. I am not supposed to, but I have no other way.”

He said his jaw issue dates back to when he had a tonsillectomy in 2010.

Surgical aggravation led to a bone growth, which caused his right jaw joint to stop functioning. He tried to ignore the problem for years, but finally saw an oral surgeon in Winnipeg.

“The surgery I had in August 2020 was to make a joint out of a piece of my rib — not so much a rib surgery as a piece of rib was needed,” he described.

He spent the weeks following that surgery doing jaw exercises, and his mouth was slowly opening back to a normal range of motion, he said. But then his jaw began to lock again.

“The doctor couldn’t figure out why … so they finally did an X-ray around late October 2020 and noticed a rare bone growth called osteochondroma.”

‘Low demand’ for procedure: Shared Health

McClelland says his Winnipeg surgeon referred him to a specialist in Mississauga, Ont., for a jaw joint replacement in June 2021.

He spoke via Zoom with a doctor who “didn’t really give me a specified date … and I’m still waiting,” McClelland said.

“They told me they knew I was on a list but they couldn’t tell me where I was on this list. I was getting conflicting information.”

Jaw joint replacement is “a highly specialized surgery,” said a spokesperson for Shared Health, Manitoba’s provincial health agency.

Since it isn’t done in Manitoba, patients who need it are “referred to one of the half-dozen out-of-province Canadian specialists who could do this procedure, but they would manage their own waitlists,” the spokesperson said. Shared Health would not say if it advocates for Manitoba patients once they’re referred.

The surgery is only done in locations where a surgeon is “able to maintain their clinical competencies by performing a certain volume of cases each year,” the spokesperson said.

“Manitoba’s population means there is relatively low demand for this procedure, with fewer than 10 referrals annually.”

McClelland says last July, a doctor suggested he could have his surgery done in the U.K. at a cost of $100,000. That was not an option for him because it wouldn’t be covered by Manitoba Health, he said.

The province says it will pay for procedures outside of Canada only if adequate care is not available in the country. However, it will cover costs for an out-of-province surgery elsewhere in Canada.

McClelland has been left frustrated with the medical system.

“I think that the whole bouncing between Manitoba medical bureaucracy and the Ontario bureaucracy trying to talk to each other — I think that needs work.”

He’d also like to see some sort of appeal board for cases like his — “something that supersedes provincial lists. Perhaps communicating the approximate wait times with patients so they aren’t left guessing.”

Timely treatment critical

Adnan Shah, a professor of oral and maxillofacial surgery at the University of Manitoba, says it’s critical for patients like McClelland to be treated in a timely manner.

“It’s a major surgery when you talk about reconstructing the joint,” said Shah. If a case progresses to a joint disease, “that’s where we would need total reconstruction.”

Shah adds jaw replacement surgeries have seen success over the last 20 years.

There are few places in Canada that are licensed to do the surgery — including centres in Toronto, Vancouver, Halifax and in Alberta. None are licensed in Manitoba, but Shah hopes that will change.

“Currently Manitoba has three surgeons who are trained to do total joint replacements,” he said. “We are in the process of getting these facilities approved by the government.”

Shah says if that’s approved, Manitoba Health would avoid the costs of having to pay for the treatment in different provinces.

“I think we are very poised at this point to take on these surgeries in Manitoba, provided the funding is [made] available by the government,” said Shah.