What are temporomandibular disorders?
joint, or temporomandibular (TM) joint, connects the lower
jawbone (mandible) to the skull. TM disorders can affect the jaw joint as well
as muscles in the face, shoulder, and neck. Common symptoms include joint pain,
muscle pain, headaches, joint sounds, difficulty with fully opening the mouth,
and jaw locking.
Most cases of TM disorder are mild, and about 65%
to 95% of people with TM disorder improve with nonsurgical treatment.1 The most common cause of TM disorder symptoms is muscle
tension triggered by stress. Nonsurgical treatment therefore focuses on
relieving stress and muscle tension and spasm, resting the jaw joint, and
reducing any inflammation and swelling.
In rare cases, severe pain
or joint function problems become long-term (chronic) and disabling.
What types of surgical procedures are used to treat temporomandibular disorders?
Temporomandibular procedures are
most often done
arthroscopically, rather than through a large incision
(open-joint surgery). Arthroscopy is most commonly used to remove scar tissue
(lysis) that is blocking joint movement and then flush out the joint area
(lavage). Lysis and lavage pose a minimal risk of irreversible damage to the
Arthrocentesis is not a true surgery since there is no
incision, but it is an invasive procedure. In arthrocentesis, the doctor uses a
needle to inject fluid into the joint area (lavage). This common procedure
successfully treats a painfully locked jaw in up to 94% of people who have the
procedure. This is similar to the success rate for arthroscopic lavage.3
TM procedures are sometimes used to alter or
remove an articular disc, connective tissue, muscle, or bone. Open-joint
surgery is used when the joint can't be viewed or accessed arthroscopically.
Such procedures include:
- Disc reduction, disc removal (discectomy), or
- Bone reconstruction in the TM joint area
(condylar reduction or augmentation).
- Release or tightening of
muscle or connective ligament that is pulling the joint in too tightly or is
too loose, causing jaw dislocation.
- Partial joint replacement,
using synthetic or metal parts.
When is surgery used to treat a temporomandibular disorder?
Surgery is rarely used to treat temporomandibular (TM)
disorders. Surgical treatment does not guarantee a cure and can further damage
Surgery is considered when both of the following
- Other treatments have failed, and chronic jaw
pain and dysfunction have become disabling.
- There are specific,
severe structural problems in the jaw joint.