What to Expect from TMJ Surgery
Can you use surgery to treat TMJ?
The temporomandibular joint (TMJ) is a hinge-like joint located where your jawbone and skull meet. The TMJ allows your jaw to slide up and down, letting you talk, chew, and do all sorts of things with your mouth.
A TMJ disorder causes pain, stiffness, or lack of mobility in your TMJ, keeping you from using your jaw’s full range of movement.
Surgery can be used to treat a TMJ disorder if more conservative treatments, such as oral splints or mouthguards, don’t help to reduce the severity of your symptoms. For some people, surgery may be necessary to restore the full use of their TMJ.
Read on to learn more about TMJ surgery, including:
- who’s a good candidate
- the types of TMJ surgery
- what to expect
Who’s a good candidate for TMJ surgery?
Your doctor may recommend TMJ surgery if:
- You feel consistent, intense pain or tenderness when you open or close your mouth.
- You can’t open or close your mouth all the way.
- You have trouble eating or drinking because of jaw pain or immobility.
- Your pain or immobility gets progressively worse, even with rest or other nonsurgical treatments.
- You have specific structural problems or diseases in your jaw joint, which have been confirmed radiologically with imaging, such as an MRI
Your doctor may advise against TMJ surgery if:
- Your TMJ symptoms aren’t that severe. For example, you may not need surgery if your jaw makes clicking or popping sound when you open it, but there’s no pain associated with it.
- Your symptoms aren’t consistent. You may have severe, painful symptoms one day that vanish the next. This may be a result of certain repetitive motions or overuse — such as talking more than usual on a given day, chewing a lot of tough food, or constant gum chewing — that caused fatigue in your TMJ. In this case, your healthcare provider may recommend that you rest your jaw for a few hours or days.
- You can open and close your jaw all the way. Even if you have some pain or tenderness when you open and close your mouth, your doctor may not recommend surgery because of the risks involved. They may instead suggest medication, physical therapy, or lifestyle changes to reduce symptoms.
It’s important to be evaluated by a dentist or oral surgeon who’s trained in TMD.
They will perform a thorough examination of your symptomatic history, clinical presentation, and radiological findings to determine if surgery will be beneficial for your symptoms. Surgery is considered a last resort if nonsurgical alternatives are unsuccessful.
What are the types of TMJ surgery?
Several different types of TMJ surgery are possible, depending on your symptoms or their severity.
Arthrocentesis is done by injecting fluid into your joint. The fluid washes out any chemical byproducts of inflammation and can help reduce the pressure that causes the joints to be stiff or painful. This can help you regain some of your jaw’s range of motion.
This is a minimally invasive procedure. You can usually go home the same day. The recovery time is short, and the success rate is high. According to a 2012 study, arthrocentesis averages an 80 percent improvement in symptoms.
Arthrocentesis is usually the first-line treatment because it’s less invasive and has a high success rate when compared to some of the other, more complicated procedures.
Arthroscopy is done by opening a small hole or a few small holes in the skin above the joint.
A narrow tube called a cannula is then inserted through the hole and into the joint. Next, your surgeon will insert an arthroscope into the cannula. The arthroscope is a tool with a light and camera that’s used to visualize your joint.
Once everything is set up, your surgeon can then operate on the joint using tiny surgical tools that are inserted through the cannula.
Arthroscopy is less invasive than typical open surgery, so recovery time is faster, usually several days to a week.
It also allows your healthcare provider a lot of freedom to do complex procedures on the joint, such as:
- scar tissue removal
- joint reshaping
- medication injection
- pain or swelling relief
Open-joint surgery consists of opening an incision a few inches long over the joint so your healthcare provider can operate on the joint itself.
This type of TMJ surgery is usually reserved for a severe TMJ disorder that involves:
- a lot of tissue or bone growth that stops the joint from moving
- fusion of the joint tissue, cartilage, or bone (ankylosis)
- inability to reach the joint with arthroscopy
By performing open-joint surgery, your surgeon will be able to remove bony growths or excess tissue. They are also able to repair or reposition the disc if it’s out of place or damaged.
If your disc is beyond repair, a discectomy may be performed. Your surgeon may replace your disc completely with an artificial disc or your own tissue.
When the bony structures of the joint are involved, the surgeon may remove some of the diseased bone of the jaw joint or the skull.
Open surgery has a longer recovery time than an arthroscopic procedure, but the success rate is still pretty high. A 2013 study found a 71 percent improvement in pain and a 61 percent improvement in range of motion.
What’s recovery like?
Recovery from a TMJ surgery depends on the person and the type of surgery performed. Most TMJ surgeries are outpatient procedures, which means you’ll be able to go home the same day as the surgery.
Make sure someone can take you home the day of the surgery since you might be a little woozy or unable to focus, which are side effects of anesthesia.
Take the day of your surgery off work. You don’t necessarily need to take more than one day off if your job doesn’t require you to move your mouth a lot. However, if possible, take a few days off to allow yourself time to rest.
After the procedure is done, you may have a bandage on your jaw. Your doctor may also wrap an additional bandage around your head to keep the wound dressing secure and in place.
For one to two days after the surgery, do the following to make sure you recover quickly and successfully:
- Take nonsteroidal anti-inflammatory drugs (NSAIDS) for any pain if your healthcare provider recommends it. (NSAIDs are not recommended for people with bleeding disorders or kidney issues.)
- Avoid solid and crunchy foods. These can put a strain on your joints. You may need to follow a liquid diet for a week or more and a diet of soft foods for three weeks or so. Make sure you stay hydrated after surgery.
- Apply a cold compress to the area to help with swelling. The compress can be as simple as a frozen bag of vegetables wrapped in a clean towel.
- Warm heat applied to the jaw muscles may also help with comfort after surgery, such as heating pads or microwaving a damp cloth.
- Cover up your bandage before bathing or showering so it’s watertight.
- Regularly remove and replace bandages. Apply any antibiotic creams or ointments your healthcare provider recommends every time you replace the bandage.
- Wear a splint or other device on your jaw at all times until your doctor tells you it’s OK to remove it.
See your healthcare provider 2 to 3 days after surgery to make sure you’re healing well and to receive any further instructions on taking care of your TMJ.
Your doctor may also need to remove stitches at this time if your stitches do not dissolve on their own. Additionally, they may recommend medications for pain or any infections that arise.
You may also need to see a physical therapist to help you regain motion in your jaw and to keep swelling from limiting your TMJ motion.
A series of physical therapy appointments may take several weeks or months, but you’ll usually see better long-term results if you work closely with your therapist.
What are the possible complications from TMJ surgery?
The most common complication of TMJ surgery is a permanent loss in the range of motion.
Other possible complications include:
- injury of facial nerves, sometimes resulting in partial loss of facial muscle movement or loss of sensation
- damage to nearby tissue, such as the bottom of the skull, blood vessels, or anatomy related to your hearing
- infections around the surgical site during or after surgery
- persistent pain or limited range of motion
- Frey syndrome, a rare complication of the parotid glands (near your TMJ) that causes abnormal face sweating
Will TMJ pain return if I’ve had surgery?
TMJ pain can return even after you’ve had surgery. With arthrocentesis, only debris and excess swelling are removed. This means that debris can build up in the joint again, or inflammation can reoccur.
TMJ pain can also return if it’s been caused by a habit like clenching or grinding your teeth (bruxism) when you’re stressed or while you sleep.
If you have an underlying immune condition that causes tissues to become inflamed, such as rheumatoid arthritis, TMJ pain can come back if your immune system targets the joint tissue.
What should I ask my healthcare provider?
Before you decide to have TMJ surgery, ask your healthcare provider:
- How constant or severe should my pain be before I have surgery?
- If surgery isn’t right for me, what activities should I avoid or do more to help relieve my pain or increase my range of motion?
- Which type of surgery do you recommend for me? Why?
- Should I see a physical therapist to see if that helps first?
- Should I change my diet to exclude hard or chewy foods to help with my symptoms?
- Are there any complications I should think about if I decide not to have surgery?
See your healthcare provider or dentist as soon as possible if your jaw pain or tenderness is disruptive to your life or if it prevents you from eating or drinking.
You may not need surgery if nonsurgical therapies, medications, or lifestyle changes relieve your TMJ pain. Surgery is often a last resort for the most severe cases, and it doesn’t guarantee a cure.
Let your healthcare provider know if more conservative treatments aren’t helping or if your symptoms are getting worse.