- Arthrocentesis: This is a minimally invasive procedure that involves insertion of one or two needles into the joint (no skin incisions are made). Depending on surgeon experience and preference, this procedure can be performed under sedation in the office or in the hospital under general anesthesia. The joint is washed to remove debris and inflammatory byproducts. Some surgeons will also manipulate the joint under anesthesia and/or inject a therapeutic medication in the joint. Recovery is quick and most patients can resume work in 1-2 days after surgery.
- TMJ arthroscopy: Arthroscopic surgery is a minimally invasive procedure that involves placement a thin metal tubes (cannulas) (usually through small skin incisions). The cannulas have a camera through which the surgeon can visualize the joint live and perform the indicated procedures (washing, disc repair, bone spur removal, etc.) with specially designed small surgical instruments. Like arthrocentesis, this procedure can be performed in the office or hospital and patients go home on the same day .
- Modified Condylotomy: This procedure addresses the TMJ indirectly. Surgery is performed from within the mouth on the lower jaw, and not in the joint itself. It may be helpful for treatment of pain and locking.
- Open-joint surgery (Arthrotomy):Â If joint pain does not resolve with conservative treatments and it appears to be caused by a structural problem in the joint, your surgeon may suggest open-joint surgery to repair the joint. This open procedure is typically performed under general anesthesia and some patients require inpatient stay in the hospital. Recovery usually takes two to six weeks, depending upon the extent of surgery. With this procedure, a longer incision is made along the ear, exposing the joint. There are different forms of this open surgery and your surgeon may recommend a combination of the options mentioned below:
- Arthroplasty: procedure aimed to remove adhesions, bone spurs and other growths in the jaw that are causing joint dysfunction and pain.
- Disc Surgery: In cases where the joint problem is in the disc itself, your surgeon may recommend a procedure to reposition (disc plication), remove (diskectomy), or replace (disk replacement) the diseased cartilage
- Joint Replacement: The TMJ can be replaced partially (less common) or completely (more common). Historically speaking, bone was taken from the patient themselves (e.g.: ribs, collar bone, skull bone, etc.) and then used to replace specific structures within the joint. Over the last few years, artificial joint replacement has become much more common, and this procedure is commonly referred to as Total Temporomandibular Joint Replacement (TMJR). Patients with end-stage pathology and severe physiologic dysfunction benefit most from TJR. There are two types of prosthesis available in the USA: 1) Stock (universal), and, 2) Patient-fitted (individually manufactured for a patient). Most patients are required to have a CT scan for both types prior to surgery to assess the joint. Two separate incisions are required for this procedure since the joint replacements have two separate components: one that is fixed to the skull, and the other which is fixated to the lower jawbone. The patient-fitted prostheses requires time for design and manufacturing whereas the stock prostheses are readily available. The goal of TJR is to improve TMJ function, and several studies have documented the significant improvement in the quality of life of patients with severe TMJ disease.
Adjunctive treatments like orthotics (mouth guards, occlusal appliances), physical therapy, targeted pharmaceutical therapy, education and counseling to help patients understand the factors and behaviors that may aggravate pain are often used together with all above-mentioned types of surgery to maximize success.