Jaw Joint (Temporomandibular Joint) Surgery

TMJ (Temporomandibular Joint) surgery is an option for management of temporomandibular dysfunction, a group of conditions that cause pain and loss of normal function to the TMJ, and TMJ pathology.

TMJ (Temporomandibular Joint) surgery includes procedures of varying complexity:

• simple washing of the joint (arthrocentesis)
  
• inserting a scope (arthroscopy) through the incision to examine and treat the joint
  
• open joint surgery
  

Symptoms of Temporomandibular Disorder (TMD) may vary from pain and/or clicking of the TMJ to chronic pain with limited TMJ movement. Jaw movement disorders include restricted mouth opening and recurrent jaw dislocations.

TMD is only partly preventable with avoiding habitual hard diet, parafunctional habits (e.g. grinding one’s teeth) and excessively wide mouth opening.

The exact cause of TMD is often difficult to determine. TMD may be the result of various factors, such as the habitual grinding or clenching of teeth, the presence of significant stress, and previous TMJ injury. Certain systemic conditions may also contribute to TMJ dysfunction or pathology, e.g. rheumatoid or psoriatic arthritis.

You may be a candidate for joint surgery if

• there is disease or degenerative changes in your TMJ
• joint function and mobility are significantly abnormal
• there is significant TMJ pain that does not respond to non-surgical management

There are several types of TMJ Surgery Procedures

• Arthrocentesis
  This is usually done under local anaesthesia where two needles are inserted into the TMJ space to allow the space to be flushed and where appropriate, medication to be instilled.
  
• Arthroscopy
  This procedure is done under general anaesthesia. A small incision is made in front of the ear to access the joint with special instruments to visualise the joint surfaces and where appropriate, dissect any adhesions.
  
• Open joint surgery
  The TMJ surface or disc that is significantly diseased may require open joint surgery to trim irregular joint surfaces or remove the disc. An incision is made in front of the ear and scalp. Depending on the TMJ condition, the disc may be repaired or removed, and any joint surface irregularities or pathology may be removed.
  

In some cases, the TMJ condyle may be removed and reconstructed with rib bone or a prosthesis.

The oral and maxillofacial surgeon will carry out a clinical examination and imaging tests which may include

• x-rays
• dental panoramic tomography
• conventional computed tomography (CT)
• arthrography
• cone-beamed computed tomography (CBCT)
• magnetic resonance imaging (MRI) or
• ultrasonography

The surgeon will study your joint condition and discuss if you are likely to benefit from joint surgery. You will gain a better understanding on the type(s) of surgery most appropriate to you and the risks and benefits involved.

Post-operative recovery for joint surgery may take 5-10 days. You will be prescribed medications to reduce pain and swelling and aid in your recovery.

You will experience soreness but usually, no severe pain should be experienced. Post-operative swelling is expected and usually minor, but occasionally more pronounced swelling can occur and should resolve within 24 - 36 hours. Cold compress may be applied to the area for the first 24hours after the joint surgery.

It is uncommon, but possible, that you may experience numbness or muscle weakness in the region of the joint surgery. This is usually temporary and should resolve without treatment.

You are advised to go on a liquid-diet following your procedure. The surgeon will discuss the progress of your diet during your post-operative visits. There are jaw exercises that you may be required to perform after the surgery which are critical for the success of the treatment.