Temporomandibular (TM) Disorders

Surgery

Surgery is rarely used to treat temporomandibular (TM) disorders. Surgical treatment does not guarantee a cure and can further damage the temporomandibular joint. Because most TM disorders can be treated nonsurgically, most health professionals believe that surgery should be the last option tried and should be avoided if possible.

Surgery may be a treatment option for you if both of the following apply:

• Other treatments have failed, and chronic jaw pain and dysfunction have become disabling.
• There are specific, severe structural problems in the jaw joint. These include scar tissue in the joint area, problems with bone alignment, broken or degenerated bones, and occasionally disc displacement or perforation.

The goals of surgery for temporomandibular (TM) disorders are to:

• Relieve pain in the jaw joint.
• Correct any structural problems.
• Restore normal jaw function.

Should I have surgery for a temporomandibular disorder?

Surgery Choices

• Arthrocentesis. This is not a true surgery, since there is no incision, but it is an invasive procedure performed by an oral and maxillofacial surgeon. In one study, arthrocentesis to wash out the joint area (lavage) was successful for 94% of people with severe closed lock of the temporomandibular joint.⁴

Surgery may include:

• Arthroscopic procedures, including washing out the joint area (lavage), cutting or removing scar tissue that is blocking joint movement (lysis), cutting tissue that has shortened and is impeding joint function, or shaving part of the disc.
• Open joint arthroplasty, used for disabling joint problems that aren't easily reached or viewed arthroscopically.

Another type of surgery, called total joint replacement, is rarely done. It has sometimes resulted in permanent jaw damage. Total joint replacement replaces the jaw joint with artificial parts. In some cases the artificial parts have not worked correctly or have broken. The available technology for this surgery is still considered to be experimental and risky.

What To Think About

Further pain complications or joint dysfunction can result from temporomandibular joint surgery.

Researchers have found that surgically repositioning a displaced disc is not necessary for treatment success. Rather, washing debris and removing any scar tissue from the joint area (lysis), whether using arthrocentesis or arthroscopy, is usually an effective treatment for a painfully locked jaw.⁴

Surgery is not necessary in most cases of disc displacement.⁵ Splint therapy (a dental treatment), jaw rest, and physical therapy, including moist heat and jaw exercises followed by an ice pack, can be very effective for treating this condition. If this and other nonsurgical treatment to relax the muscles are not successful, arthrocentesis may effectively treat your condition.

If you are thinking about surgery, get a second opinion on your condition and treatment.

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Author:	Monica Rhodes	Last Updated: January 24, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Arden Christen, DDS, MSD, MA, FACD - Dentistry
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