Surgical treatment for temporomandibular joint (TMJ) disorders is rare and only performed when all other non-surgical treatments and chronic pain management options have been tried without success. In some cases, surgery may be beneficial or the only option to treat certain TMJ disorders.

Considerations for TMJ Surgery

Surgery may be considered for TMJ disorders that require one or more of the following treatment methods:

  • Repair of tissues
  • Removal of unrepairable tissues
  • Replacement of missing tissues with grafts

Surgery may also be considered in TMJ disorders with joint issues that are confirmed by diagnostic imaging tests or other invasive diagnostic tests.

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Surgically Treatable TMJ Disorders

TMJ disorders that may benefit from surgical treatment include conditions with:

  • Chronic limited mouth opening, such as ankylosis (fusion of bones) or recurrent dislocation of the lower jaw.
  • Birth defects, such as condylar hyperplasia—an abnormal growth and enlargement of the mandibular condyle.
  • Tumors, such as osteochondroma of the mandibular condyle.
  • Internal derangement of the articular disc—although this condition is not a definitive case for surgery, sometimes surgery may be indicated depending on the severity and symptoms.
  • Advanced degenerative disease of the TMJ, such as arthritis with severe pain and dysfunction of the TMJ.
  • Mechanical interference, such as painful clicking and grating sounds in the TMJ.
  • Severe pain and dysfunction of the TMJ that may prevent mandibular functions like chewing, talking and/or breathing among others.

Usually, TMJ disorders with localized or specific symptoms have better outcomes when surgically treated than those with diffuse or widespread symptoms. It is important to note that TMJ disorder cases with muscular problems or chronic pain syndrome may not benefit from surgical treatment.1

Types of Surgeries for TMJ Disorders

TMJ surgeries may be broadly grouped under the following two categories:

  • Minimally invasive or closed TMJ surgical procedures. These procedures use injections to treat TMJ disorders. Early stages of TMJ internal derangement with closed lock, non-reducing disc displacement, and/or recurrent TMJ dislocation may be treated using these procedures. There are two types of closed TMJ surgical procedures:
    • TMJ arthrocentesis, a technique where the TMJ is lubricated and medications, such as steroids or hyaluronic acid are injected directly into the joint space of the TMJ. The technique uses two needles, one to inject medicines into the joint space, and the other to provide an outlet for fluid, avoiding fluid build-up in the joint.
    • TMJ arthroscopy, a procedure that involves insertion of a small tube with a lens (arthroscope) into the TMJ space to obtain visual images of the internal structures. TMJ lysis (removal of adhesions) and lavage (rinsing) are commonly performed using this technique. An advanced form of this procedure uses the insertion of an additional working cannula along with the arthroscope (operative arthroscopy) to correct mechanical disorders, such as internal derangement.
  • Open TMJ surgical procedures or arthrotomy. These procedures involve the surgical exposure of the TMJ via an incision in front of the ear. Disc repair and repositioning, removal of complete or partial disc that is beyond repair, removal and replacement of the condoyle, and/or total joint replacement may be performed using open surgical procedures.

TMJ surgeries usually have a recovery period of 2 to 4 weeks depending on the procedure, and may be followed up with physical therapy.

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Risks of TMJ Surgery

TMJ surgery is a relatively safe and effective procedure. However, as with any surgery, it has the potential for serious complications, such as infection, allergic reaction, and/or excessive bleeding. Other risks may include:

  • Nerve damage. Temporary or permanent nerve damage of the facial nerve, trigeminal nerve, or other nearby nerves.
  • Infections. Contamination during surgery from adjacent structures, such as ear or scalp and/or a weak immune system may contribute to the development of infection after a TMJ surgery.
  • Pain. Post-operative pain after a year following TMJ surgery may occur due to scarring and growth of tissue in the TMJ’s joint space.
  • Poor range of motion. Reduced range of motion of the TMJ may be temporary or permanent and may occur due to loss of muscular function.

Some people may need additional surgical procedures once a TMJ surgery has been performed. This may be due to disease progression or unwanted bone formation. For the most part, TMJ surgeries may be successfully performed and post-operative functionality may be achieved by strictly following post-operative therapies, medications, and care.

References

  • 1.Dimitroulis G. Management of temporomandibular joint disorders: A surgeon's perspective. Aust Dent J. 2018;63 Suppl 1:S79-S90.
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