TMJ Surgery

A TMJ surgery helps to correct Temporomandibular joint disorders. If you have a TMJ disorder, you will have pain in the lower jaw area. As it progresses, you will find it difficult to open your mouth. Medicines may help you to control pain and improve jaw movements.

TMJ exercises and correcting the way you chew will also help. But if the symptoms get too severe, your doctor may recommend a TMJ surgery.

The TMJ or temporomandibular joint connects your lower jaw to the skull. Articular disc placed in between the bones acts as a cushion to help in smooth movements of your jaw. Muscles and ligaments help to stabilize the joint and aid in jaw movements. 

There are two TMJs in either side of your face. It is a hinge joint that allows you to move the lower jaw up and down. Also, both the joints work together to move your lower jaw.

You can have a TMJ disorder due to several reasons. Some are due to degeneration of the joint, while others may be due to your habits. If you have habits like clenching of the jaws and grinding of teeth, you are at risk of TMJ issues.

Similarly, wear and tear of the articular disc due to overuse and conditions like arthritis will also damage the joint.

Continuous pain in the joint is the most prominent symptom of a TMJ disorder. Stiffness of the jaw is another. If medications, exercises, and occlusal splits do not help, the only option before you is to have a TMJ surgery.

Causes of TMJ disorders 

You can have a TMJ problem due to the following reasons 

• Problems with the muscles and ligaments in the joint
• Degeneration of the joint
• Injuries to the joint

Certain factors increase your risk of a TMJ disorder. Some of them are

• Your gender- Women are more likely to have TMJ problems than men. The exact reason is not very clear, but female hormones are the suspects.
• Your age- TMJ problems peak between the age of twenty to forty
• Your habits- Clenching of jaws, night grinding, nail or lip biting, long term use of chewing gums, etc. may increase the risk
• Injuries to the joint- A history of traumatic injury to the joint ups your risk
• The alignment of your jaws and teeth- If this is not proper, it puts a lot of strain in the muscles and ligaments of the joint.
• Stress- Whether stress causes TMJ disorders or TMJ issues cause stress is highly debatable. But stress can aggravate your problem without a doubt.

Certain diseases can also lead to TMJ problems the common ones are

• Osteoarthritis
• Rheumatoid arthritis
• Fibromyalgia

But you can have a TMJ disorder even if you are not at risk.

Symptoms of TMJ disorders

The symptoms affect either one or both sides of your face. The common symptoms include

• Pain- You may have severe pain that radiates to the ear, jaws, neck, and shoulders. The pain will be more when you open your mouth to eat, speak, or even yawn.
• Tenderness over the joint- Even a light touch can give you severe pain
• Difficulty in opening the mouth- Due to stiffness of the jaw muscles
• Inability to open your mouth wide
• Locking of the jaw- You won’t be able to open your mouth or to close it after opening.
• Hearing sounds while opening or closing your mouth-You may hear a clicking, grating, or popping sound.
• Inability to chew properly
• Swelling near the joints or side of the face

Some other symptoms are

• Tinnitus
• Headaches
• Dizziness
• Irritability or anxiety
• A tired look to your face

Treatments for TMJ disorders 

There are different treatments for TMJ disorders. They are

• Medications- Pain relievers and muscle relaxants can give you relief. 
• Bite correction- Correcting the way you bite will reduce the stress on your jaw muscles.
• Occlusal splints- It helps to stabilize the joint by correcting the alignment of your upper and lower jaws. It also prevents you from grinding your teeth. 
• Relaxation techniques- Stress is a contributing factor to TMJ disorders. Practicing mind relaxation techniques like yoga will help you to calm down.
• Physical therapy- Two standard methods of physical therapy for TMJ disorders are
  • Ultrasonic treatment- Surgeon uses ultrasonic waves to increase the temperature of tissues close to the TMJ. Heating increases the blood flow to the region, which helps to eliminate the mediators of pain and inflammation.
  • Transcutaneous electronic nerve stimulation(TENS)- The treatment uses small electric currents to stimulate the superficial nerve fibers responsible for the transmission of pain signals. It helps to reduce pain. 

Temporomandibular joint surgery(TMJ Surgery) 

You will have a TMJ surgery if other treatment methods fail to give the desired results. Medications and physical therapy are the two standard methods. 

But, if you do not get any relief with these or the symptoms become more severe, you will need a surgery

There are three different types of surgical techniques for correcting TMJ disorders.

1. Arthrocentesis – It is a minimally invasive surgery. In this, the surgeon uses normal saline to wash the joint area and remove the mediators of pain and inflammation.

Arthrocentesis is an ideal treatment for TMJ disorders that occur due to the derangement of the articular disc responsible for smooth movements of the joint. 

You will have general anesthesia during the procedure, which makes it painless. The surgeon will then insert two needles into the joint space. One will have saline to wash the area, and the other is for removing metabolic waste products responsible for pain and inflammation.

The treatment is not possible in those with infections in the joint area.

The common complications include

• Injury to the facial nerve
• Bleeding 
• Swelling of the joint 

The procedure gives long-term pain relief in some, while in others the effects will be temporary

2. Arthroscopic TMJ surgery

It is a minimally invasive surgery to correct TMJ disorders due to 

• Articular disc derangement
• Traumatic injuries
• Osteoarthritis

You will have general anesthesia during the surgery. Once you are asleep, the surgeon will make two small incisions in front of your ear. 

Through one of the incisions, the surgeon will pass a cannula, which is a hollow tube. He or she will then insert a small camera through it to view the joint from inside. 

The camera will start transmitting images to a monitor. The surgeon will then insert surgical instruments through the other to carry out the surgery by viewing the joint in a monitor.

Since the surgery has only two small incisions, your recovery will be faster than open surgery. Post-operative complications will also be fewer.

3. Open TMJ surgery

If the surgeon feels that arthroscopic surgery will not help you, the only option left is open surgery.

You will have general anesthesia during the surgery. The surgeon will then make an incision close to the ear to expose the joint.

If there is a dislocation of the disc, the surgeon will put it back to its position. In some situations, the disc will be worn out and beyond repair.

Then the surgeon will remove the disc and place an artificial disc in its position. It will help to improve the movements in the jaw. Once this is complete, the surgeon will place sutures to close the incision.

For a day or two after the surgery, you will have some pain in the joint. Painkillers will help to control it. You will need to keep icepacks over the joint to reduce the swelling.

For the first two weeks after surgery, you will find it very difficult to open your mouth. The doctor will prescribe some exercises to ease the movements of the jaw.

After three or four weeks, the pain in joints will go off. You will also find it easier to open your mouth than before.

Some of the complications are

• Bleeding
• Swelling
• Injury to nerves including the facial nerve
• Scar tissue formation in the joint that limits movement

Most of those who have TMJ surgery get good relief from the symptoms. Long-term pain relief and improvement in jaw movements are the main benefits. In some, the operation may give little relief, or the benefits will be temporary