Temporomandibular joint and muscle disorders, commonly called TMJ disorders, are a group of conditions that cause pain and dysfunction in the jaw joint and in the muscles that control jaw movement. There are several treatment options available, depending on the cause and severity of ffeefqqthe disorder. We look at the symptoms, causes, and what’s involved in corrective jaw surgery or TMJ surgery, if required.
The temporo-mandibular joints (TMJs) attach the lower jaw (mandible) to the base of the skull. There are two joints (one on each side of the face), located in front of the ears and ear canals.
The TMJs are unique in that they are “bimodal,” which means they allow both hinge rotation and translation sliding. They are also via a single bone—the lower jaw. The TMJs are controlled by numerous facial muscles that help control lower jaw movement, and guide the dental bite.
A TMJ disorder can produce pain, as well as reduce the movement of your jaw (limited mouth opening). Individuals may experience pain in different parts of the face, including in the jaw joints themselves, and in the muscles that control jaw movement (temples of the skull / ears / upper neck region / cheek bones). Pain is also most commonly one-sided (although it can be on both sides of the face). It is typically associated with reduced movement of the lower jaw and affects the ability of a patient to open their mouth (hence causing problems with eating and speech).
Symptoms of TMJ disorder include:
The exact cause of a person’s TMJ disorder is often difficult to determine. Some people who have jaw pain also tend to clench, grind or gnash their teeth — a condition known as bruxism. Bruxism may not be evident (subconscious clenching of your teeth during sleep) or you may be aware (conscious bruxism) that you grind or clench your teeth during the day. Mild bruxism may not require treatment, however, if severe enough, it may lead to headaches, damaged teeth, and jaw disorders.
The temporomandibular joint combines a hinge action with sliding motions. The joint surfaces are covered with cartilage and separated by a small shock-absorbing cartilage disc, which normally keeps the movement smooth. Sometimes the cartilage disc moves out of position and leads to TMJ dysfunction.
TMJ disorders can also be due to:
In 95% of cases, the pain and discomfort associated with TMJ disorders is temporary and can be relieved with self-managed care or non-surgical treatments. These include medication, physical therapy, or lifestyle changes.
Surgery is typically a last resort after other measures have failed, although some people with TMJ disorders may benefit from surgical treatments. Non-invasive therapies include:
There are a range of exercises you can do yourself that may reduce jaw “clicking” and strengthen the muscles that pull your jaw backwards. They can also help relax the muscles that close your mouth and prevent the functioning of the muscles that pull the jaw forwards from side to side. This will reduce strain and allow your jaw to act more like a hinge. One of these involves:
Surgery is performed by an Oral and Maxillofacial Surgeon, preferably one with surgical experience and skills in TMJ surgery. Dr Tite, who works at our Gold Coast clinic, introduced TMJ surgery to the area almost 20 years ago and remains one of the most experienced providers of TMJ procedures to date.
TMJ surgery, including TMJ reconstruction surgery, may be recommended to correct your TMJ disorder if you experience:
Your Specialist Oral and Maxillofacial Surgeon may advise against jaw surgery to fix TMJ if:
The commonly performed procedures for treatment of TMJ disorders are:
An arthroscopy is the most common and least invasive jaw surgery for TMJ. It is a same-day surgical procedure performed under general anaesthesia. During surgery, the Specialist Surgeon will make two small incisions in the skin in front of the ear overlying the TMJ. A narrow port (called a cannula) is inserted through the skin and directed into the joint. The joint can then be directly inspected (via an arthroscope or small camera), manipulated and instilled with medications (pain relief and steroids).
This detailed examination helps the surgeon understand the causes of TMJ pain and dysfunction, remove inflamed tissue, and encourage tissue healing which is typically assisted by TMJ medications. Recovery time is generally short (several days) as the pain and swelling subsides.
Arthroplasty is a moderately invasive surgery for TMJ. This procedure replaces both the ball (mandibular condyle head and cartilage disc) and socket (glenoid fossa) of the TMJ with a new custom-made artificial TMJ constructed from titanium and high-density plastic. The surgery begins with an incision (above and below the ear) to expose and remove the defective TMJ. The artificial TMJ is then inserted.
During the surgery, the surgeon may remove bony growths, excess tissue or some of the diseased bone. This TMJ replacement allows the patient to regain comfortable, functional movement of the joint, including mouth opening.
An initial comprehensive surgical assessment by your Specialist Oral and Maxillofacial Surgeon will confirm whether isolated TMJ replacement surgery is needed, or whether other adjunctive procedures (such as facial reconstructive surgery) are to be combined with the TMJ procedure.
To plan for your TMJ surgery, X-rays, three-dimensional CT scans and three-dimensional images of your teeth are taken. To achieve the most optimal result, the Specialist Surgeon will use computer-based virtual surgical planning techniques to create both a customised surgical plan and guides. This process improves the accuracy of the replacement TMJ appliance and reduces both operative time and surgical complications.
After accessing the TMJ, the surgeon removes the diseased TMJ (using the surgical guides made in Stage 1), reshapes the bone, and then uses a secondary surgical guide to insert the TMJ replacement appliance. The new TMJ appliance is secured directly to the lower jaw with small titanium plates and screws.
Following your surgery, your Specialist Oral and Maxillofacial Surgeon will provide you with guidelines to follow during your recovery from surgery. These include:
It’s also worth mentioning that in contemporary practice, the wiring together of a patient’s jaws is virtually never needed. Occasionally, light elastic bands may be applied to your teeth to guide (but not lock together) your jaws and dental bite.
This surgery is reserved for severe cases of TMJ disorder where:
This is the most intensive surgery for TMJ and usually takes three to four hours to complete. The patient is under general anaesthetic and requires a three to five-day stay in hospital. In terms of recovery time, initial jaw healing typically takes around six weeks after surgery, but it will take more than a month before you can resume regular activity. Patients should plan a three to four week absence from work and complete healing can take up to twelve weeks.
Talk to the TMJ Specialists at Dental Implant and Specialist Centre to discuss surgical options for your TMJ, by contacting them on (07) 5503 1744.
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