TMJ Disease

Treatment

Arthrocentesis

Arthrocentesis is the irrigation of the joint. This is the most minimally invasive procedure used to treat TMJ diseases. Because of the low risk and a high success rate, surgeons will typically use this method before exploring more aggressive treatment options, such as open-joint surgery (arthroplasty).

This procedure is typically completed in approximately 15 minutes. Usually performed under either IV sedation or general anesthesia, the surgeon injects the joint with local anesthetic and fluid to flush out inflamed fluids. Steroids may also be injected to help combat any inflammation. Patients are often able to tell whether pain has decreased shortly following the procedure.

This procedure involves minimal risk and is both therapeutic (it can reduce pain and fix the patient's problem) and diagnostic (if the pain does not subside, physicians can use this information to plan continuing treatment).

Surgery (arthroplasty)

Arthroplasty refers to all types of open surgery for TMJ, including disk repositioning, discectomy, and joint replacement. Arthroplasty can range from minimally invasive to complex surgery. Due to the general risks associated with surgery, this treatment is used only after other treatment options have been considered.

Although TMJ surgery is highly successful in reducing pain and increasing the functionality of the TMJ, it does have risks. Swelling, pain, bleeding and infection — risks associated with all surgery — may occur. And, although rare, injury to the nearby ear and some facial motor nerves is possible.

Although all treatments can improve the functionality of the TMJ and reduce pain, patients may still experience some pain (especially with partial and total joint replacements).

Disk repositioning

Disk repositioning is used when the protective cartilage disk has slipped out of place inside the TMJ. This condition often creates the "popping" noise inside the joint. Although popping in the joint is not always caused by TMJ problems, in some patients the joint can become damaged and the supporting ligaments can become stretched and inflamed. Nerves surrounding the TMJ may also be pinched by a slipped disk, causing considerable pain and even inflammation.

Disk repositioning requires an overnight visit and approximately two hours in surgery. Under general anesthesia, the surgeon makes an incision, moves the displaced disk back to its original position and stitches it in place. The surrounding ligaments are also repaired, if needed.

Although this can be a very effective treatment, and preserves more of the patient's original anatomy, sometimes the disks do not stay in their new position. If this happens, a discectomy (surgical removal of the disk) may be required to remedy the problem.

Discectomy

A discectomy is performed when the disk providing padding and protection to the TMJ has deteriorated or become damaged. Disks that are constantly out of position or pop back and forth inside the joint are also good candidates for a discectomy.

A discectomy requires an overnight visit and approximately two hours in surgery. Under general anesthesia, the surgeon makes an incision and removes the disc. Although typical recovery time is two to three weeks, it may take several months for scar tissue to completely fill the joint and prevent the bones from rubbing and grinding together.

Discectomies can also help reduce pain associated with TMJ disease. When the disk is removed, so are parts of the surrounding tissue. This tissue often contains nerves that cause significant TMJ pain. Research has also shown that many patients have improved function of the jaw (able to open and close), which continues to improve over the next few months and even years following surgery.

Articular eminance recontouring

In some cases, the articular eminance (part of the "socket" portion of the TMJ) can be too deep or too steep. This can result in excessive forces being placed on the condyle (the ball portion of the joint). The surgeon shortens and smooths the articular eminance in to prevent these excessive forces, and improve range of motion and lessen pain. This procedure is sometimes done as part of a larger TMJ surgery, such as joint replacement.

TMJ replacement

If a joint is badly damaged and cannot be repaired, it must be removed and replaced. See joint replacement for treatment information.