TMJ Surgery

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: TMJ Pain

Published: 06 December 2015

TMJ Surgery

Explore other avenues first.

I consider TMJ surgery (TMJ standing for “tempero-mandibular joint”) to be a relatively severe type of surgery. Your mouth is your “avenue of expression” and having surgical intervention is not much fun at all. Therefore, I would strongly advice that you have consulted one or more specialist (doctor, physiotherapist, dentist) and tried one or more therapies first. There are two important reasons as to why this is:

• You have a clear diagnosis as to the underlying cause of your TMJ pain and that the surgical strategy being considered will work for this type of problem. It should also have been established that your TMJ pain is not connected to a problem in a closely related area such as your neck (see TMJ and neck pain) or your bite (muscle pain from masticatory dysfunction). Otherwise the surgery may not work!

• You have investigated tried conservative (non-surgical) therapies to ease your severe chronic jaw pain (see TMJ Treatment Options). Depending on the cause, this may involve a multi-disciplinary approach, such as Physiotherapy, Dentist, Craniosacral therapy and Stress relief techniques. This is because these therapies may be as effective (if not more so) than surgery.

If you have reached this stage, then surgery is a viable option and can be very successful and a great relief to a suffering patient.

TMJ Surgery approaches

Now - let’s go through the different approaches that you might find yourself considering with your Doctor or Surgeon:

Arthrocentesis:

I regularly treat patients in my physiotherapy practice who have had this type of surgery performed. Arthrocentesis is a relatively mild type of keyhole surgery (normally involving two needles inserted into the affected area) that involves the ‘flushing’ of your TMJ, to remove any build up of loose particles or scar tissue to reduce inflammation in the TMJ area.

If it has been determined that your jaw pain is being caused by a loosened component or scar tissue in your TMJ this procedure may be very helpful for pain relief. If it works, you will feel the difference almost immediately.

I like it because it is not too invasive and has very few, if any, risks overall. However, following up on this procedure, make sure you get with exercises to re-balance your jaw and neck muscles. A physiotherapist/physical therapist will guide you on the best exercises for your specific condition.

Arthroplasty

Arthroplasty is a term used to describe all types of open jaw surgery. Examples that I have seen are: disc repositioning, discectomies, and joint replacements - and we will go through each briefly below.

• Disc repositioning is where the disc inside your TMJ is repositioned and sutured into the correct position. Sometimes, with poor TMJ mechanics and movement, it can slip out of place and cause a lot of audible clunking and pain.

  Manual therapies such as specialised physiotherapy, working on your bite alignment and craniosacral therapry to relieve stress and tension in the jaw muscles can all help in repositioning the disc and should be tried first. However, where these approaches fail - surgery may be required.

• A discectomy is where the disc on your TMJ is removed partially or totally. If you have a degenerative disc that is causing movement problems and pain then it may have to be removed surgically. Once it is removed the body will develop scar tissue to fill the space in which the disc once was. However, I have seen many problems secondary to this surgery and in my opinion it should be a last resort. As always, seek an expert medical opinion (or more than one) first!

• A joint replacement is where your TMJ is replaced with an artificial joint or surface. I have never seen this operation, nor have I been involved in the treatment of anyone who had it. It is a major surgery and requires serious pain and dysfunction in order to be of necessity.

Pre and Post Operative care

Before you embark on such an invasive surgery, my advice is to seek an expert’s opinion prior to and following the surgical procedure on how you can help prepare and recover from surgery. Always have follow up physiotherapy to ensure the correct positioning and movement of your jaw and neck. Specific exercises may needed to help address any muscle weakness or imbalances that have resulted from the surgery.

Without it you may encounter secondary problems at a later stage. Prevention is always better than cure!

Investigating TMJ pain - the earlier the better.

A lot of clients have come to me with TMJ problems that have required sugery. The most common pattern that I see is in cases where surgery is required is where people tend to ignore a “clunking” or “clicking” jaw for years - and only seek help when it becomes very painful. If you have clicking and/or clunking in your jaw seek physiotherapy and a dental opinion immediately. You can prevent a lot of pain in the future by taking these early steps!

I’d like to finish off with a case I came across recently. It involved a girl who had fallen from a horse 2 months previously and had landed on the side of her head and face. She complained of stiffness in her jaw ever since the accident. On examination her TMJ was subluxed (partial dislocation) on one side forwards. After two treatments she was functioning perfectly and her stiffness had disappeared. My opinion on this is that if she had ignored it she would over time end up with potential degeneration and pain in her jaw - possibly leading to surgery.

So, in summary, always seek early medical/physio/dental advice with painful (or noisy!) jaw symptoms.