Temporomandibular Joint Disorder, can be a chronic and even debilitating painful condition. In this condition, joints, muscles, and tendons relating to the temporomandibular joint, which connects the jawbone to the skull, can become swollen and inflamed. Most cases will not require surgery, but in some cases it is the only way to cure TMJ.
Surgery is a treatment option which is only considered as a last resort. There are 3 types of surgeries which can be performed to treat TMJ.
- Open Joint Surgery: This type of surgery is performed to re-sculpt or remove the areas that are affected. Open joint surgery is performed to access tumors or bone structures that have deteriorated, chipped, or scarred.
- Arthroscopy: This is a surgical procedure that is done to suture discs, treat inflammations, and remove scar tissue that is loose. It is an outpatient procedure in which a scope is used to look at the affected temporomandibular joint. However, a scope is not always used. In order to get to the endoscope the procedure itself involves an incision which is made at the temple, found at the front of the ear.
- Arthrocentesis: This procedure is done by an oral surgeon. The surgery is performed to adjust the position of the joint hinge disc and also to remove tissue that is sticking together. The procedure involves inserting needles into the TMJ to remove sterile fluid.
In cases of TMJ where there is a physical deformity present, a severe injury to the jaw area, or a fracture, surgery may be a necessary treatment. Patients with crepitus are one example of such a case. A fracture may have caused the crepitus, which can be heard when the bone fragments move against one another. Moving the jaw would produce a significant amount of pain, and the sound of the bone fragments would be audible. Inflammation and swelling in the temporomandibular joint can also spread to the muscles and tendons that connect to and stabilize the eardrum, resulting in severe pain.
Some cases may be so severe that surgery is required for TMJ and ear pain treatment. In other cases, a congenital deformity may be present – this is a deformity that someone is born with. Certain developmental deformities can cause the underdevelopment of joints, including the temporomandibular joint. Therefore, surgery to replace the entire joint or parts of the joint such as the disk may be necessary.
There Are Several Types of TMJ Surgery
- Disk Repositioning
- Articular Eminance Recontouring and TMJ Replacement
Arthrocentesis is the simplest type of surgery. A syringe is used to add synovial fluid into the temporomandibular joint. This fluid has a consistency similar to that of an egg yolk, and its job is to provide lubrication and reduce friction during movement of the joint. This is an outpatient procedure.
Disk repositioning is more complex, and requires a hospital stay. During this surgery, the disk of the temporomandibular joint is put back into its proper place, and held with a stitch so that the muscles and ligaments are able to repair themselves.
Discectomy involves removing the cushioning disk of the joint and also requires a stay in the hospital. Recovery from this procedure is a long one requiring you to wait for the body to produce enough natural tissue to replace the cushioning of the joint again. The jaw is usually wired shut for this procedure.
Articular eminence recontouring and TMJ replacement is an extensive and invasive surgery, performed to reshape the ball of the joint, remove diseased temporomandibular bone, or replace parts of the jaw with prosthetics. The recovery time is a month or more, and the jaw is also wired shut after this procedure to allow more complete healing. Once this type of surgery has taken place, there will be restrictions placed on the types of food that can be eaten for the remainder of the patient’s life.
As with any surgery, there are risks to be considered. Risks associated with the use of general anesthesia, risks of the surgery failing or needing multiple attempts to be successful, and damage of the ear or facial nerves are all to be taken into consideration before undergoing surgery. Any concerns about TMJ surgery should be fully addressed with your TMJ specialist.