Do I need TMJ (jaw joint) surgery?

Key takeaways:

• Surgery is not for muscle-related TMD — TMJ surgery only applies to joint/disc-related subtypes, and is usually not a first line treatment

• It may be considered in rare cases where there’s ongoing pain and severely reduced jaw movement, especially when caused by trauma, joint fusion, or abnormal joint growth or change.

• Types of TMJ surgery include:

• Arthrocentesis (joint flushing or washout)

• Arthroscopy (keyhole surgery to clean, release, and sometimes repair)

• TMJ replacement (for severe arthritis or joint damage)

• Imaging like CBCT or MRI may be needed before surgery is considered — always consult with a specialist in oral (and maxillofacial) surgery and ensure they are an experienced TMJ surgeon.

• All surgeries carry risks, including infection or nerve damage — and success depends heavily on post-op care, including self-management, physiotherapy, exercise, and follow-up.

• Most people with joint-related TMD improve without surgery — so focus first on conservative care like splints, physiotherapy, and JawSpace-guided self-management.

TMJ surgery:

Temporomandibular Joint (TMJ) surgery is typically only very rarely indicated in TMD and only in the TMD sub-types affecting the joint or disc. It will not help in myalgia TMD (muscle-related TMD). Visiting a specialist dentist for a detailed evaluation that may include a Cone Beam CT scan or an MRI of the jaw joints can help guide the next steps of treatment. 

If surgery is being considered it is normally where there is an ongoing substantial decrease in functional movement coupled with severe pain, which is rare. Surgery tends to be more effective if these symptoms are caused by problems within the joint such as trauma, bony fusion (‘ankylosis’), growth disturbances, fibrous overgrowth restricting movement.  

The types of surgery include:

1. Arthrocentesis: A minimally invasive procedure using two needles to ‘wash’ or ‘flush’ out the joint that clears any debris and inflammatory products. It's usually a procedure performed by a surgeon and you often go home the same day.

2. Arthroscopy: Keyhole surgery, designed to clear debris and if necessary, remove adhesions limiting disc movement. Also typically a day procedure.

3. TMJ replacement: In cases of severe arthritis, a prosthesis precisely tailored to your jaw can replace the joint, much like hip or knee joint replacements. Due to their demanding technical nature, these should only be performed in highly specialist centres, so ask your surgeon how many of these types of procedures they do per year to get an indication of their level of experience.

All surgical interventions carry potential risks, such as infection, nerve damage, or a negative reaction to the prosthetic material in cases of joint replacement. The expected recovery timeline varies, and it's crucial to follow the surgeon's post-operative instructions diligently for optimal recovery. This often includes specific exercises, dietary modifications, and follow-up appointments. Post-operative physiotherapy is crucial for restoring function and movement in the jaw joint.

Although TMJ surgery can be an effective solution for chronic, unmanageable joint or disc subtypes of TMD with substantial functional limitation and or pain, it's crucial to remember that it's usually considered the last option. Many individuals with significant TMJ wear have found significant improvements with non-surgical management strategies. Nonetheless, should surgery become necessary, compliance with the post-operative plan and continued adherence to preventive measures, like stress management and regular check-ups, will significantly contribute to long-term success.

References:

1. Al-Moraissi, E. A. "Arthroscopy versus Arthrocentesis in the Management of Internal Derangement of the Temporomandibular Joint: A Systematic Review and Meta-Analysis." International Journal of Oral and Maxillofacial Surgery, vol. 44, no. 1, 2015, pp. 104–112. https://doi.org/10.1016/j.ijom.2014.07.008.

2. Dolwick, M. F., and G. Dimitroulis. "Is There a Role for Temporomandibular Joint Surgery?" British Journal of Oral and Maxillofacial Surgery, vol. 32, no. 5, 1994, pp. 307–313. https://doi.org/10.1016/0266-4356(94)90052-3.

3. The TMJ Association. "Surgery." The TMJ Association, 2022, https://tmj.org/living-with-tmj/treatments/surgery/.