TMJ surgery has received some bad press lately. You may have read horror stories on the Internet about TMJ surgery gone bad. But countless patients would still be living with acute jaw pain and limited jaw motion if surgery had not been an option for them.
I have spent the past 30 years focused almost exclusively on treating patients with TMJ and facial pain problems. I’m often asked how do I determine when TMJ surgery is needed. Here is my answer:
First, it’s important to understand that TM joint problems are orthopedic problems just like tennis elbow, for example. And, like all orthopedic problems, there are times when non-surgical treatments can fail. In my practice, we always try non-surgical treatments before surgery is ever considered.
Sometimes, however, tissue injury in the TM joints can be very severe and involve compromised ligaments, stubborn inflammation, displaced cartilage, and/or arthritic and erosive problems affecting the bones. We use MRI and/or CT scans to evaluate what is going on.
After all, non-evasive therapies have been tried, and when TM joint pain is due to inflammation, our one last non-surgical effort is often injecting steroids into the “hot” joint. This option is considered even when MRI or CT scans reveal structural damage in the joint.
This procedure is no different than injecting a steroid into a painful tennis elbow or rotator cuff. And its success is dependent upon how long you’ve experienced pain, the origin of your problem, the condition of the underlying bone, ligaments and cartilage, and your ability to avoid new injury to the joint. If progress is made after the first injection a second is usually administered in about three months.
However, when no relief is experienced after the first injection, the steroid method is put aside.
What If Steroid Injections Don’t Work?
If steroid injections are unsuccessful, the next option is usually arthrocentesis. Arthrocentesis is a procedure whereby the injured TM joint is in essence, washed-out. The goal here is to remove irritating chemicals that accumulate when you have tissue injury.
In addition, injured TM joints sometimes don’t move easily to sticky adhesions. So, the second goal of arthrocentesis is to break down these adhesions, which allow the joint to move more easily. When movement is easier so are the prospects of healing. Arthrocentesis is usually performed under local anesthetic and light sedation.
When Arthrocentesis Is Not Chosen Or Fails Is TMJ Surgery Next?
Arthroscopic surgery is usually the procedure of choice in this instance. Arthroscopic surgery allows the practitioner to visualize the damage in your TM joint and effectively remove adhesions, smooth irregular bone, and inject steroids right into areas that are inflamed. We can also take tissue biopsies at the same time.
When performed by experienced hands, arthroscopic surgery is extremely effective in starting the process of natural healing which results in profound pain reduction and increased ease of jaw motion. Although usually performed under general anesthesia arthroscopic surgery is an outpatient procedure.
Home exercises and/or physical therapy are always required after arthroscopic surgery.
When All Else Fails
In cases where the MRI and CT scans reveal extreme tissue damage, extensive bone erosions, and/or degenerative arthritis, we may need to surgically open the joint. Opening the joint enables extensive repairs to be made, but it requires special surgical skills and experience. And, like all of the procedures in this article, long-term rehabilitation is put in place and is required.
The Takeaway About TMJ Surgery
A full regimen of non-surgical care must always be attempted before TMJ surgery is ever considered. TMJ surgery can repair injured tissues, relieve (or even eliminate) pain, and improve your jaw function. But it should be always considered the last resort.
If you do need surgery, ongoing collaboration between your dentist, your surgeon, and your physical therapist must exist in order for you to heal and experience long-lasting results.
To find a dentist in your area that is experienced with TMJ problems, visit The American Academy of Orofacial Pain at http://www.aaop.org/.