A Melbourne surgeon is being sued for negligence by a woman who alleges he did not fully advise her of the risks before an operation on her jaw which she claims left her with life-changing injuries.
In a statement of claim filed to the supreme court of Victoria, the patient, Bianca (who asked for her real name to be withheld), alleged her condition was not serious enough to warrant the procedure to replace both of her temporomandibular joints with prostheses, carried out by the maxillofacial surgeon Dr George Dimitroulis. The temporomandibular joints, or TMJ, connect the jaw to the skull, with one on each side of the head.
Bianca also alleged Dimitroulis had not disclosed his commercial interest in the company that manufactures the devices he inserted into her jaw, or that he was a director of that company, Maxoniq.
In her statement of claim she said her injuries since the operation included vertigo, severe pain in her jaw, speech difficulties, tinnitus, hypersensitivity to noise, and disfigurement. As a result, she told Guardian Australia, she had been forced to give up her job and move states to a quieter location closer to family support.
In his defence filed to the court, Dimitroulis denied wrongdoing and said Bianca had been adequately advised of the risks and likely results of the procedure.
“At all relevant times he acted in a manner that was widely accepted in Australia by a significant number of respected practitioners as competent professional practice,” his defence statement said.
Dimitroulis said he had advised Bianca of his involvement in the design and creation of the OMX TMJ prosthesis at their first meeting, and otherwise denied her allegation that he did not advise that he had a commercial interest in the company or that he was a director of Maxoniq.
“My understanding … was he was one of the specialists that worked collaboratively with researchers and gave specialist input,” Bianca told Guardian Australia.
Dimitroulis established Maxoniq in 2016 to commercialise the TMJ device he designed, according to Maxoniq’s website and his own website.
The surgeon denied any of Bianca’s injuries were caused by his negligence.
He did not respond to requests for comment for this article.
In her statement of claim, Bianca, who is being represented by senior legal counsel Shari Liby of Slater and Gordon, said Dimitroulis had diagnosed her with “category five” degenerative disease of her TMJ, which he acknowledged in his defence.
The Australian peak body, the Australian and New Zealand Association of Oral and Maxillofacial Surgeons, told Guardian Australia there was no standard classification system used to diagnose TMJ patients and recommend surgery.
“Temporomandibular joint disorders is a large group of conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement,” a spokesperson said.
“As such, there are many causes and each cause may have a variety of different ways to treat it.”
In her statement of claim Bianca alleged Dimitroulis had told her neither of her TMJs was salvageable and that he had not discussed any non-surgical options with her.
She was 38 at the time, and she alleged in her statement that Dimitroulis had told her the longer she waited to have surgery, the worse her degeneration would be.
In his defence, Dimitroulis denied he had told her there was no option other than surgery. He said that at one meeting he discussed the option of a non-surgical splint but had said this would not have corrected one of her issues and was not recommended as she had previously had a splint that had not resolved her symptoms.
Dimitroulis had told her the prostheses would be custom-fit to each side of her jaw – important to Bianca because she has a small face with delicate features.
But although the prostheses were a custom fit, Bianca told Guardian Australia, it “feels too big for my jaw”.
Dispute over tinnitus
Bianca told Guardian Australia she had asked questions about the procedure in several subsequent appointments before deciding to go ahead. She said she had been particularly concerned that “ear problems” were listed as a potential complication.
In her statement of claim she alleged Dimitroulis had told her only one patient of his had temporary deafness following the procedure. In her statement she said she also raised concerns about tinnitus – a ringing, roaring or buzzing sound in the ear – and Dimitroulis had advised that rather than causing tinnitus, the surgery could actually improve it.
Dimitroulis denied in his defence statement that he had said the device could treat tinnitus, stating that he advised Bianca there was a less than 1% risk of tinnitus associated with the surgery, and that it was usually temporary and resolved with time.
He said he had told her the risks of TMJ surgery could include ear problems, including ringing in the ear, transient or permanent hearing loss or ear drum damage, such as a burst ear drum. He denied that he had failed to obtain her medical history, or to consult other specialists.
In her statement Bianca also claimed he did not tell her about other TMJ devices available and their risks and benefits. He admitted that was the case, but said that was because they were either not appropriate for her as they could not be customised, or were unapproved by the Therapeutic Goods Administration and therefore would cost her more to import.
In her statement Bianca said she would not have consented to the surgery had she been made fully aware of the potential complications.
“The plaintiff was adequately advised of the risks and likely results of the procedure,” the defence document stated.
When Bianca woke up in intensive care after the surgery, she told Guardian Australia, she was unprepared for the immediate pain she felt from every sound.
“The pain was excruciating,” she said. “I was sensitive to both volume and frequency. I was in a panic. They eventually agreed to move me to a room on the opposite side of the hospital. But it was right next to the main road, and I couldn’t close the door completely to my room to block out sound from the corridor.
“I also had extremely loud tinnitus in both of my ears and it was really distressing,” she alleged.
After her surgery, Bianca said, she had seen a different maxillofacial surgeon in New South Wales who advised her that to remove her implants and replace them with different prostheses would take two separate 12-hour operations.
“It’s complex surgery, and he said there is no guarantee the surgery will fix my problems,” she said. “If I went through another surgery only to be the same or worse, that would genuinely be the end of me.”
Bianca said she was now working with an audiologist, a psychologist and other specialists to treat her symptoms.
As a result of her health issues, Bianca said, she had to quit her job in the entertainment industry and leave Melbourne.
“I studied music, I’m a former dancer, and the whole arts world is so important to me, it brings me meaning and joy. And I can’t do it any more.”
She has moved to a quiet location in Western Australia into a property owned by her parents, where she can be closer to their support.
“My life now is very isolated,” Bianca said.
“Just day-to-day things like going to the grocery store or driving to an appointment or to visit one of my parents are difficult, because there are days when the pain is too much and I need absolute silence. When I lay on my pillow on my side, sometimes the pressure hurts.
“There’s no peace.”
• Do you know more? Contact melissa.davey@theguardian.com
