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Temporomandibular Joint Surgery: Methods & Treatment

Temporomandibular joint surgery treats disorders and dysfunctions of the jaw joint. It is used when conservative therapies have not provided sufficient relief.

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Temporomandibular joint surgery treats disorders and dysfunctions of the jaw joint. It is used when conservative therapies have not provided sufficient relief.

What is Temporomandibular Joint Surgery?

Temporomandibular joint (TMJ) surgery is a subspecialty of oral and maxillofacial surgery focused on the operative treatment of diseases, injuries, and functional disorders of the temporomandibular joint. This joint connects the lower jaw (mandible) to the skull and enables movements such as chewing, speaking, and yawning. When the joint is damaged or dysfunctional and conservative treatments have failed, surgical intervention may be required.

Indications – When is TMJ Surgery Needed?

Surgery is generally considered only after non-surgical treatments such as physiotherapy, occlusal splints, and medication have proven insufficient. Common indications include:

Temporomandibular disorders (TMD): Dysfunction of the joint and chewing muscles causing pain and restricted movement
TMJ osteoarthritis: Degenerative wear of the joint cartilage
TMJ dislocation: Recurrent dislocation of the jaw
Ankylosis: Bony or fibrous fusion of the joint severely limiting jaw movement
Tumors and cysts in the region of the joint
Trauma: Fractures or injuries to the condyle following accidents
Rheumatoid arthritis with severe joint involvement

Diagnosis Before Surgery

A thorough diagnostic workup is performed before any surgical procedure to identify the exact cause of symptoms. This typically includes:

Clinical examination of jaw mobility and masticatory muscles
Magnetic resonance imaging (MRI): To assess the articular disc and soft tissues
Computed tomography (CT): To evaluate bony structures
Radiographic imaging of the joint
Functional analysis and occlusal diagnostics

Surgical Procedures

TMJ Arthroscopy

TMJ arthroscopy is a minimally invasive procedure in which a small camera (arthroscope) is introduced through a small incision in front of the ear into the joint space. It allows surgeons to release adhesions, remove inflamed tissue, and perform joint lavage. This approach is well-tolerated and associated with rapid recovery.

Arthrocentesis

Arthrocentesis involves puncturing the joint with two needles and flushing it with saline or other fluid. It is used to remove inflammatory mediators and reduce intra-articular pressure, particularly in cases of acute disc displacement.

Open TMJ Surgery (Arthrotomy)

For more complex conditions, the joint is opened directly through an incision in front of the ear. This approach allows for:

Removal or reconstruction of the articular disc (discectomy / discopexy)
Reshaping of the condyle (condyloplasty)
Removal of tumors or cysts
Treatment of severe ankylosis

Alloplastic Joint Replacement

In cases of severe joint degeneration or following multiple prior surgeries, a total alloplastic TMJ replacement may be necessary. The entire joint is replaced with a custom-made or stock prosthesis made of titanium and polyethylene.

Autologous Joint Reconstruction

Alternatively, the patient's own tissue may be used, such as cartilage and bone harvested from a rib (costochondral graft), to reconstruct the joint. This technique is preferred in children and adolescents, as the graft has the potential to grow with the patient.

Surgical Procedure Overview

TMJ surgeries are most commonly performed under general anesthesia. Depending on the type of procedure, the operation may last from 30 minutes to several hours. Minimally invasive procedures such as arthroscopy are often performed on an outpatient basis, while open surgeries typically require a hospital stay.

Aftercare and Rehabilitation

Careful postoperative follow-up is essential for a successful outcome. Standard elements of rehabilitation include:

Physiotherapy: Exercises to restore jaw mobility and function
Dietary modification: Soft food diet during the healing period
Pain management and anti-inflammatory medication
Regular follow-up appointments with the treating surgeon
Possible fitting or adjustment of an occlusal splint

Full recovery time varies depending on the procedure and can range from several weeks to a few months.

Risks and Complications

As with any surgical procedure, TMJ surgery carries potential risks. These may include:

Infection at the surgical site
Injury to the facial nerve causing temporary or permanent sensory disturbances
Bleeding or hematoma formation
Scarring
Restricted jaw movement (trismus)
Prosthesis loosening or failure in joint replacement cases

Individual risk depends on the type of procedure, the overall health of the patient, and the experience of the surgical team.

References

American Association of Oral and Maxillofacial Surgeons (AAOMS): Parameters of Care for Oral and Maxillofacial Surgery. www.aaoms.org
Mercuri LG: Temporomandibular Joint Total Joint Replacement – TMJ TJR. Springer International Publishing, 2nd edition, 2016.
Nitzan DW, Dolwick MF, Martinez GA: Temporomandibular joint arthrocentesis: A simplified treatment for severe, limited mouth opening. Journal of Oral and Maxillofacial Surgery, 1991; 49(11): 1163–1167.

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