Temporomandibular joint (TMJ) Surgery

Temporomandibular joint (TMJ) surgery ranges from minimally invasive procedures, like arthrocentesis and arthroscopy, to joint replacement surgery.

The temporomandibular joint acts like a sliding hinge, connecting your jawbone to your skull. TMJ dysfunction can lead to painful jaw problems and reduced range of motion that can be difficult to treat.

TMJ surgery is considered a last resort when conservative treatments (like bite guards, physical therapy, and pain medications) fail to provide relief.

This article discusses different types of TMJ surgery. It explains how TMJ surgeries are performed, their success rates, potential complications, and what to expect during recovery.

Benefits of TMJ Surgery

The goals of TMJ surgery are to reduce pain and improve jaw function. That said, surgery may be considered to correct problems that give rise to TMJ syndrome, such as:

• Arthritis of the temporomandibular joint
• Dislocated jaw
• Injury to the condyles (the rounded ends of the lower jaw bone)
• Displaced discs (cartilage discs that help cushion the temporomandibular joint)

This type of surgery can be especially beneficial for those who:

• Have unremitting jaw pain
• Are unable to open or close their mouth completely
• Have difficulty speaking, eating, or drinking
  

Types of TMJ Surgery

TMJ surgeries include closed procedures like arthrocentesis and arthroscopy and open procedures like arthrotomy and joint replacement surgery.

Open surgeries involve larger incisions and longer recovery times than closed procedures. However, for people with severe TMJ syndrome, open surgeries have more favorable results.

Arthrocentesis

Arthrocentesis, also known as joint aspiration, is the least invasive TMJ surgery. Arthrocentesis involves the injection of fluids (typically hyaluronic acid) into the joint space for lubrication. It does not require an incision.

Arthrocentesis is typically performed with local anesthesia as follows:

• Two hypodermic needles are placed into the joint, and the joint is flushed with sterile saline or lactated Ringer’s solution to remove anything causing inflammation and pain.
• If needed, your surgeon may adjust your jaw to help remove scar tissue adhesions.
• At the end of the surgery, a corticosteroid may also be injected to reduce inflammation in the joint.

The procedure usually takes less than 30 minutes, but multiple treatments may be required. Arthrocentesis for TMJ has an 80% success rate.

Arthroscopy

Arthroscopy is a minimally invasive procedure used to remove scar tissues, smooth bones, or reshape cartilage discs in the joint. It involves tiny "keyhole" incisions that accommodate specialized surgical tools and a fiber-optic scope.

TMJ arthroscopy is done under general anesthesia as follows:

• Your surgeon will make small incisions around your jaw joint and insert cannulas. These thin metal tubes contain cameras that let your surgeon visualize your jaw joint and the surrounding structures.
• With this visualization, the surgeon can wash out the joint or perform a disc repair or bone spur removal with small, specifically designed surgical instruments.

An arthroscopy is an outpatient procedure, so you’ll go home the same day. The procedure may take between 30 minutes and two hours. Arthroscopic disc repair has a 94% success rate.

Arthrotomy

Arthrotomy, also known as arthroplasty, is an open-joint procedure used to treat structural problems of the TMJ joint. The procedure can repair, reposition, or remove parts of the joint to relieve pain and make it more functional.

The procedure involves larger incisions and longer recovery times than arthroscopy. It is performed under general anesthesia and often requires a hospital stay.

Arthrotomy is performed as follows:

• An incision is made along the ear, avoiding damage to the facial nerve.
• Disc repair, disc repositioning, or discectomy (removal of the entire disc) is then performed, as needed.
• The surgeon may also reshape the condyle (end of the lower jaw bone) and the fossa (socket) if you have arthritic changes.

The surgery may last one to two hours. You may be able to go home the same day or you may require a short hospital stay.

TMJ arthrotomy/arthroplasty has success rates between 79% and 89%.

Joint replacement

Joint replacement is an open surgery used to treat people with severe TMJ syndrome. During the surgery, part or all of the temporomandibular joint is replaced. It is performed under general anesthesia.

An open surgery involving larger incisions and longer recovery times. Although this is a major surgery, the results may be more favorable for people with severe TMJ syndrome.

This is an open-joint procedure that requires general anesthesia as follows:

• The surgeon makes two incisions for both components to be implanted–one that’s attached to the skull and one to the lower jaw.
• After a section of the jawbone has been removed, a custom-made prosthetic joint is implanted between the lower jaw and the base of the skull.
• The surgeon will place an artificial replacement called a prosthesis.

Surgery length varies from person to person, but it will likely take several hours. Following the procedure, you will be admitted to the hospital for observation for three to five days.

Total TMJ replacement surgery has a 90% success rate.

Recovery from TMJ Surgery

After outpatient TMJ surgery, you will go home the same day and return to the office in a few days for a post-surgical follow-up appointment.

Surgeries requiring general anesthesia may require an overnight hospital stay for observation. After joint replacement surgery, you may need to stay in the hospital for up to five days.

When you are discharged, you may be prescribed pain medicine to take at home. Your jaw joint and the area around it will be numb or temporarily paralyzed. This is caused by the anesthetic and should last for a few hours.

How Soon Will I Recover From TMJ Surgery?

The amount of time it takes to recover after TMJ surgery depends on the procedure. Your jaw will probably be sore for a few days after closed procedures. Discomfort and swelling can last a week or more after surgery.

Time to full healing varies by procedures, as follows:

Your surgeon will inform you when you can expect to return to work after your procedure. For minor procedures, this might be the next day. On the other hand, open-joint procedures may require several weeks off, depending on your job and the type of surgery.

At-Home Healing After TMJ Surgery

Depending on the procedure you had, you may have to wear bandages for several days. Your stitches may dissolve on their own or need to be removed at a follow-up appointment.

With most TMJ surgeries, you’ll experience swelling, bruising, jaw pain, and tenderness. To aid with healing:

• Apply ice packs to the face for no more than 20 minutes at a time for the first day after surgery.
• Change the dressing regularly as directed by your surgeon, applying antibiotic ointment.
• Keep your head elevated using two or three pillows when resting to help with swelling.
• It is usually OK to shower and shampoo starting the second day.
  
• After 48 hours, you can apply warm heat from a heating pad to help ease discomfort.
• An over-the-counter painkiller like Tylenol (acetaminophen) may be used if pain is significant.
• Avoid bending over, heavy lifting, or activities that cause increased blood pressure in the head.
• On the third day, you may advised to do jaw exercises to prevent stiffening of the jaw.

For anywhere from one to six weeks following surgery, you should eat a mechanical soft diet to reduce jaw movement and aid with healing. It may also be easier to eat smaller amounts of food every few hours rather than three large meals.

Possible Complications of TMJ Surgery

All TMJ surgeries have risks, though complications can be more extensive with open joint procedures. Possible complications include:

• Bleeding problems
  
• Damage to adjacent structures, such as blood vessels, muscles, nerves, and other nearby tissue
• Facial paralysis or weakness
• Frey's syndrome, which causes excessive sweating of the face and neck
• Infection
• Loss of hearing on the treated side of the head
  
• Misalignment of teeth
• Nerve injury, causing weakness or facial paralysis
• Persistent pain
• Reduced jaw mobility

Joint replacement can also lead to significant complications due in part to the limited lifespan of the implant. Over time, artificial implants can break or malfunction. This is why joint replacements are generally reserved for older adults to ensure that the prosthetic lasts for the rest of their lives.

Alternatives to TMJ Surgery

For people who are not good candidates for surgery, TMJ syndrome may be treated with:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Tricyclic antidepressants
• Muscle relaxants
• Mouthguards (occlusal appliances)
• Physical therapy
• Stress management and counseling
  

Summary

TMJ surgeries include minimally invasive procedures like arthrocentesis and arthroscopy or more invasive open surgeries, like arthrotomy or total TMJ replacement. These procedures aim to treat jaw pain or immobility, and they have relatively high success rates when performed on appropriate candidates.

Recovery time after TMJ surgery depends on the procedure and ranges from a few days to several weeks. During this time, you may need to follow a mechanical soft diet as chewing may be difficult. Follow your surgeon's instructions, call if you have any questions, and be sure to keep your follow-up appointments.