Associates for Oral and Maxillofacial Surgery

TMJ DISORDERS

TMJ stands for temporomandibular joint. This is the joint that allows you to open and close your mouth. This joint is formed where your jaw bone meets with the base of your skull. It is similar to a ball and socket joint, like your hip, but it can also slide. There is a disc, made out of cartilage, between the two bones which allows the joint to slide smoothly while opening and closing your mouth. Muscles and ligaments help keep the jaw joint together and stabilize the joint while opening and closing your mouth.

TMJ disorders can occur when the jaw joints, muscles of mastication (chewing muscles), and the fit of the teeth are not working together properly. This can happen if you clench or grind your teeth, have sustained trauma to the jaws, have a pathologic condition within or around your jaw joints, or have severe degenerative changes in the joint, like arthritis. These conditions may cause boney changes within the joint or may cause the disc to be worn down or moved out of proper alignment. This can result in pain, popping or clicking of the joints, headaches, and locking of the jaws in a closed or open position. The doctors at Associates for Oral & Maxillofacial Surgery are well trained in treating these disorders and will perform a full clinical and radiographic evaluation (which could include CT Scans and MRI) to determine the treatment that is right for you. Most patients can be treated with conservative measures which include:

Soft Diet
Anti-inflammatory Medications
Muscle Relaxants
Hot & Cold Compresses
Physical Therapy
Occlusal Splint/Night Guard
Analgesic Medication (Pain Medication)
Dental Treatment such as:
Bite (Occlusal) Adjustments
Dental Restorations
Orthodontic Treatment

Surgical treatment is usually used if conservative therapy has failed to improve the patient’s condition or if the patient has severe TMJ disease that will not be benefited from conservative treatment. Surgical treatments include:

1) Arthrocentesis – This involves the insertion of needles into the joint space to allow flushing of the joint with fluids and to allow steroids and special medicinal lubricants to be injected into the TMJ. This procedure can be done in our office under general anesthesia or I.V. sedation.

2) Arthroscopy – This procedure is generally done under general anesthesia in a hospital setting on an out-patient basis (you go home the same day). This involves the insertion of a tiny camera (endoscope) and tiny instruments into the joint which allows the surgeon to visualize the joint for diagnostic purposes, as well as to treat inflammation, remove scar tissue, and mobilize a disc that may be stuck or out of position.

3) Arthroplasty – This is an open joint procedure. This procedure is usually performed in the most severe cases of degenerative joint disease. The incision for an arthroplasty is placed along the crease in front of the ear or part of the incision can be placed partially within the ear, similar to the way facelifts are performed. This makes the incision site more esthetically pleasing once it has healed. Your oral & maxillofacial surgeon can then surgically repair the joint by recontouring or removing bone, as well as reposition or remove the disc (cartilage between the jaw bone and base of the skull) if necessary. This is usually done on an out-patient basis, but may occasionally require an overnight hospital stay.

4) Total/Partial Joint Replacement – This procedure involves replacing either the entire TMJ or part of the TMJ. Patients that may be candidates for this procedure are those whom have TMJ’s that have undergone severe degenerative changes i.e. osteoarthritis, rheumatoid arthritis, sustained trauma resulting in ankylosis (boney fusion of the jawbone to the base of the skull), TMJ’s that have had multiple surgeries, joints that have had pathological changes, and those patients whom have severe developmental defects. The surgeons at Associates for Oral & Maxillofacial use custom joints that are designed and built specifically for your temporomandibular joint. They do this by having a 3-D acrylic model of your skull and jaw bone made from a CT scan of your joints. Your surgeon will develop a treatment plan for you by taking measurements and performing the surgical cuts on the model and sending it back to the lab to have a custom prosthesis made specifically for you. This surgery involves two incisions being made. One incision is in front of you ear and the other is below the jaw line. The incisions once healed are very esthetic. The components of the prosthesis are made with the same materials that have been used for decades in orthopedic surgery for hip and shoulder replacement and reconstruction. This surgery generally does require a 1-2 day hospital stay. For more information temporomandibular joint replacements please click on the following link: www.tmjconcepts.com/patbro.html

Photos courtesy of TMJ Concepts

Rehabilitation from any surgical TMJ procedure may vary from 6 weeks to 6 months or longer depending on the severity of the disease within the joint, as well as the amount of opening you had before the surgery. Your rehabilitation may involve physical therapy, the use of a hand held device to help your range of motion in your jaws, and home exercises. The prognosis of these procedures is really dependent upon the severity of the disease to begin with, the patient’s overall health condition, and the patient’s dedication and compliance with postoperative instructions and physical therapy.

During consultation, you can ask your Oral & Maxillofacial Surgeon any questions you may have. The Doctor and Surgery Assistant will review your health history with you and explain what to expect. If you have any further questions regarding any of these procedures please do not hesitate to contact any one of our offices directly. We also encourage you to watch our informed consent video on TMJ.

Contact Us At: