Patients with Temporomandibular joint disorders who do not respond to conventional treatment might need TMJ surgery. TMJ jaw surgery is usually our last resort to manage jaw joint disorders. In general, we start with self-treatment protocol such as avoidance therapy, muscle stretching and thermal therapy. However, occlusal splints, laser therapy, medications and injections are our next treatment options. We recommend TMJ jaw surgery whenever other medical and noninvasive treatment options are exhausted. Above all, the cost factor is not the most important consideration for recommending TMJ surgery. In fact, it is the benefits vs. the risks of the surgical procedure that drive our decisions and recommendations.
What is TMJ Surgery?
Jaw joint surgery is a surgical procedure to correct a problem in your joint that did not respond to noninvasive treatment. However, it is not a one kind surgery, there are many surgical techniques used for TMJ problems. Some of the surgical techniques are simple and can be performed in an outpatient setting while others are complex and require hospitalization for days or weeks.
What TMJ Disorders Might Need Surgical Treatment?
Jaw joint surgery is just a tool to restore the TMJ’s normal function and improve patient’s symptoms. The following are some of the indications for TMJ surgery:
- TMJ ankylosis. Here, the joint is frozen and cannot move because of boney or fibrous adhesion of the joint structures. A maxillofacial surgeon will access the joint and cut the adhesion to free the joint and allow normal jaw function.
- Painful TMJ disc displacement without reduction which is not responding to none-surgical treatment. This is also called close lock jaw.
- Fracture of the Joint condyle or the neck of the condyle. When left un-treated, it might cause restricted mouth opening and face deformity.
- Severe resorption or deformation of the TMJ condyle. This might be caused by systemic conditions such as rheumatoid arthritis, and other types of arthritis.
- Progressive bite changes caused by TMJ disorder. Idiopathic Condylar Resorption also called Cheer Leader Syndrome is just an example of TMJ condition causing bite changes. Usually, this condition affects teenage girls and is associated with severe and fast resorption of the TMJ condyle.
- Benign and malignant tumor involving the temporomandibular joint
- Developmental growth problems affecting the TMJ and the jaw. An example of these conditions is condylar hyperplasia where the condyle on one or both sides continue to grow pushing the mandible down and forward. This might cause serious bite, functional and cosmetic problem to the patient. Another example of TMJ growth problem is condylar hypoplasia where the TMJ condyle fail to grow normally and stay very small causing the lower face to look small and positioned far to the back.
What are the Types of Temporomandibular Jaw Joint Surgeries?
As stated earlier, jaw joint surgeries are of many kinds. While some are simple, others are very complex. Generally speaking, TMJ surgeries are divided into 3 categories:
- Arthroscopic surgery. Small microsurgical tools are inserted into the TM joint through a tiny 3-5mm incision. A second incision is made to insert a micro camera to visualize the joint compartments and help perform the surgical procedure. This type of surgery is relatively not very invasive and is usually performed in an outpatient setting. Moreover, this surgery works best for simple joint problems such as locked jaw, reshaping irregularities caused by arthritis, to free joint adhesions, etc.
- Open joint surgery. Some joint problems require a bigger incision to access the TMJ and perform a surgical procedure. Among these problems are complex TMJ fractures, small and medium size benign tumors, condylar hyperplasia, etc.
- Total joint replacement. Some TMJ conditions require removing the mandibular condyle and replacing it with a titanium or resin prosthetic joint. Total joint replacement is used to replace joints damaged by severe active arthritis and advanced forms of Idiopathic Joint Resorption. Additionally, joint destruction by primary or metastatic tumors requires total joint replacement.
What are the Risks and Complications of TMJ Surgeries?
All surgical procedures small or big have risks associated with them. These are some of the most frequent risks and complications associated with TMJ jaw surgeries.
- Scar formation
- Pain that might be transient or permanent
- Nerve damage causing facial paralysis and other sensory, motor and autonomic nerve damage symptoms such as, facial paralysis, paresthesia, anesthesia and Fry’s Syndrome
- TMJ ankylosis
- Facial deformities
- Limited mouth opening due to scar formation or hard and/or soft tissue adhesion
- Difficulty chewing and speaking
- Bite changes
How Much TMJ Surgery Cost?
Because jaw joint surgery is not one kind, the cost varies. It could be few hundreds to several thousand US dollars depending on the complexity of the procedure and the center location. The high cost of TMJ surgery may be justified for some patients because it may be the only solution for their TMJ problems.
Are there any Recommendations to Improve the TMJ Health and Avoid Surgery?
Yes, you can do many things that improve your TMJ health. Things like:
- Eat healthy food rich in fibers
- Brush and floss your teeth daily
- Visit your dentist regularly
- Avoid ice chewing
- Avoid nail biting
- Sleep well
- Wear sport guard when playing sports
- Wear seat built where driving or riding in a car
- Eat smaller bites
- find the right TMJ specialist if you need one
At our Los Angeles TMJ, Orofacial Pain and Headache Specialty Center, we strive to help our TMJ patients avoid TMJ surgery. Dr. Khalifeh’s goal is not only to save you the high cost associated with getting TMJ jaw surgery. He is aiming to deliver the simplest and least invasive treatment that works for the majority of TMJ patients and help protect your jaw joint to progress to surgery only treatment option. Sometime, TMJ surgical treatment is a must. When needed, Dr. Khalifeh will refer you to the best specialist in the field.