What to Know About Surgery for TMJ Disorders

Temporomandibular joint (TMJ) disorders are surprisingly common, affecting nearly a third of adults and more than 11% of children and adolescents. Facial trauma, unusual jaw anatomy, and chronic grinding and clenching habits are all potential causes of TMJ disorders, and arthritis and genetics can contribute, too.

While many people with TMJ disorders find relief with conservative treatment, like rest, physical therapy, and medication, surgery is a better option for a small subset of patients with severe problems. Understanding when surgery is recommended and what types of surgery are available can help you feel more confident about every stage of your care.

At Oral & Facial Surgery of Mississippi, Michael R. Nichols, DMD, MD, offers various treatment options for TMJ disorders, including noninvasive therapies and state-of-the-art surgery. Here, learn when surgery is the best choice for treating TMJ, what options are available, and what happens during and after the procedure.

TMJ disorders: When surgery is the best option

Even though TMJ surgery can offer relief for people suffering from pain and other TMJ symptoms, it’s almost never a first-line treatment. 

Before recommending surgery, Dr. Nichols evaluates your jaw and typically recommends conservative therapies to see if symptoms improve. He only recommends surgery when these noninvasive therapies fail to provide meaningful, long-lasting relief. 

He also recommends surgery for patients with severe TMJ disorders and underlying problems, like:

• Severe jaw joint dislocation
• Inability to fully open or close the mouth
• Severe joint degeneration or other joint damage

Once it’s apparent that surgery is the best treatment choice, the next step is deciding which type of surgery is appropriate.

Types of surgery: What to expect

There are three primary surgical options for treating TMJ disorders: arthrocentesis, arthroscopy, and arthrotomy.

Arthrocentesis

Also called joint aspiration, arthrocentesis is a minimally invasive procedure that literally washes out your jaw joints. The procedure focuses on removing debris, scar tissue, and other irritants that cause inflammation and pain inside the joints.

Instead of incisions, arthrocentesis uses needles inserted just in front of each ear. The needles administer sterile fluids to gently clean the joints of debris. After the joints have been thoroughly washed, Dr. Nichols administers medications to relieve inflammation and lubricate the joint space.

Arthrocentesis takes about a half hour or so, and it’s performed using sedation and local anesthesia to keep you relaxed and comfortable. 

Arthroscopy

Arthroscopy is a second type of minimally invasive TMJ surgery. During this procedure, Dr. Nichols makes a tiny incision near your ear and inserts a thin instrument called an arthroscope. The instrument is equipped with a light and a camera and projects images to a monitor, enabling Dr. Nichols to examine your joint without making a large incision.

In addition to taking video images of your joint, the arthroscope can also be used to wash out the joint and make repairs to the joint structure or surface. Depending on the type of repair, Dr. Nichols may make additional small incisions to admit surgical instruments. 

Arthroscopy takes about 20-30 minutes per joint (more for some types of surgery), and the procedure is performed using general anesthesia, making it a good solution for people with moderate TMJ dysfunction. 

Open-joint surgery (arthrotomy)

Also called arthroplasty, arthrotomy is called “open-joint” surgery because it uses a larger incision to provide more direct access to the jaw joint. This procedure is designed to correct structural problems or abnormalities responsible for TMJ symptoms and jaw joint dysfunction.

Arthrotomy is performed using general anesthesia. During the surgery, Dr. Nichols makes an incision along the border of the ear to access the temporomandibular joint. Through that incision, he can repair or reposition a disc, remove a damaged disc, or reshape the joint or its surface, particularly in cases of arthritis.

Surgery typically takes 1-2 hours or more and sometimes requires an overnight hospital stay. Open-joint surgery can also be used to replace one or both joints when damage to the joints is severe.

Healing and recovery

Recovery time depends on the type of surgery you’re having, along with other variables. Not surprisingly, recovery is faster with minimally invasive procedures compared to open surgery. 

In all cases, you’ll need to follow your aftercare instructions carefully, adhering to a soft-food diet, taking medications, and avoiding strenuous activity as recommended during the initial stages of healing. For open surgery, you’ll probably need physical therapy to restore normal jaw function in the later stages of healing.

The right treatment for your needs

TMJ surgery helps people with significant TMJ disorders finally find relief for their symptoms. Call the office today to request an appointment with Dr. Nichols and his team at Oral & Facial Surgery of Mississippi in Flowood, Mississippi, to learn more about surgery and other TMJ treatments.