Should I have surgery for temporomandibular disorder?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Resting the jaw, relaxing jaw muscles, and doing jaw exercises recommended by your doctor or physiotherapist are always the first-line approach to managing temporomandibular (TM) disorders. About 65% to 95% of people who develop TM disorder naturally improve with simple non-surgical treatment.1
If you are one of the few people with severe, disabling TM disorder, you may be thinking about surgical treatment. Consider the following when making your decision:
- Surgery can worsen a jaw joint problem. Whenever possible, it is best to preserve the normal joint structure, rather than cutting, removing, or replacing any part of it.2
- Surgery for TM disorder is considered a last resort. Before having surgery, first try several months of dental splint therapy and other non-surgical measures to relax the muscles.
- Flushing the joint out (lavage) using arthrocentesis offers a good chance of improving joint function, without surgery.
- An arthroscopic procedure may be more effective than arthrocentesis if scar tissue is blocking the TM joint. First, the tissue is cut and removed, and then the joint area is flushed out (lysis and lavage).
- If you have a disabling structural problem, bone surgery that creates more space within the TM joint may help, though it is risky.
- Total joint replacement is rarely done and has been known to cause permanent jaw damage. The available technology for this type of surgery is considered experimental.
See an illustration of the temporomandibular joint
.
Medical Information
What are temporomandibular disorders?
The jaw joint, or temporomandibular (TM) joint
Most cases of TM disorder are mild, and about 65% to 95% of people with TM disorder improve with non-surgical treatment.1 The most common cause of TM disorder symptoms is muscle tension triggered by stress. Non-surgical 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 chronic and disabling. About 12% (fewer than 1 in 8) of people with TM disorder develops chronic symptoms.3
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 joint area.
Arthrocentesis, is not a true surgery, since there is no incision, but 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.4
TM procedures are occasionally 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 disc repositioning.
- 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 the joint.
Surgery is considered when both of the following apply:
- Other treatments have failed, and chronic jaw pain and dysfunction have become disabling.
- There are specific, severe structural problems in the jaw joint.
Your Information
Your choices for treating severe and disabling temporomandibular disorder are:
- Continue to use non-surgical treatment for a TM disorder, including joint rest, jaw exercises, ice, use of a dental splint, or medication.
- Have arthrocentesis to wash out the joint area.
- Have surgery to correct a soft tissue or bone-related problem.
The decision whether to have surgery for a TM disorder takes into account your personal feelings and the medical facts.
Reasons to have surgery for temporomandibular disorder
Reasons not to have surgery for temporomandibular disorder
- You have chronic, long-term, and severe temporomandibular joint pain.
- You cannot eat solid food because of severe pain or joint disability.
- Your jaw constantly dislocates.
- You have problem with the structure of your jaw that only surgery can correct.
- Your jaw has been broken and healed poorly, requiring bone surgery.
- You have rheumatoid arthritis, osteoarthritis, or bone growth (ankylosis) that has destroyed or changed your jawbone.
Are there other reasons you might consider having temporomandibular surgery?
- You have severe symptoms, but they are new and you are trying non-surgical treatment for several months.
- You don't like the idea of having surgery on such an important joint.
- TM surgery does not guarantee a cure of your TM disorder. Some people require more surgery.
- TM surgery may worsen your condition.
- A decrease in your jaw's range of movement often occurs after surgery. The jaw heals with scar tissue, which is harder and tighter than normal tissue. Jaw exercises do help improve jaw movement.
- The type of TM surgery that might help you would change the structure of the bone, disc, muscle, or ligament and is not well researched.
Are there other reasons you might consider not having TM surgery?
Most temporomandibular surgeries are done arthroscopically. The following includes information about arthrocentesis, arthroscopy in general, and different types of arthroscopic TM procedures.
Type of surgical procedure
Reasons to have the surgery
Reasons not to have the surgery
Arthrocentesis used to wash out (lavage) a joint area that locks closed has produced a 94% success rate with no relapse in up to 3 years.4
Arthrocentesis to collect synovial fluid for evaluation
- You haven't tried non-surgical treatments.
Arthroscopy is considered a minimally invasive and safe TM surgery technique. It is effective about 80% of the time.4
Complications of arthroscopic temporomandibular surgery are uncommon, but include:5
- Outer, middle, or inner ear damage; temporary or permanent hearing loss.
- Temporary nerve damage.
- Joint infection.
Using a highly experienced surgeon lowers your risk.
Disc surgery (reduction, removal, or repositioning)
None are currently known.
Current practise trends are to avoid altering disc position or structure.
- Researchers have found that surgically repositioning a displaced disc is not necessary for treatment success. Rather, flushing out the joint area (arthrocentesis) or using arthroscopy to remove scar tissue and flush out the joint (lysis and lavage) is usually an effective treatment for a painfully locked jaw.4
- After disc replacement, an adverse reaction to an artificial disc is possible.
Jawbone (orthognathic) surgery
Although orthognathic surgery for TM disorder is rarely done, you may consider it if you have:
- Jawbone damage (most commonly from rheumatoid arthritis).
- Ankylosis (bony growth in the TM joint).
- A structural disorder of the TM joint, as from a birth defect or poorly healed fracture.
- Recurrent, disabling TM joint dislocation related to the joint structure.
- A severe bite problem, that over time, causes TM joint tension and muscle spasm.
You haven't first tried all non-surgical treatments and arthrocentesis.
Although surgery has been used to release tight muscles and ligaments in the temporomandibular area, these techniques are not supported by research and are generally avoided.
These personal stories may be helpful in making your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for a temporomandibular disorder. Discuss the worksheet with your health professional.
Circle the answer that best applies to you.
I have used non-surgical treatment for several months.
Yes No Unsure I have severe TM joint pain and cannot eat solid food.
Yes No Unsure I have tried arthrocentesis, but it hasn't worked.
Yes No Unsure I have a structural joint problem that requires surgical reconstruction.
Yes No Unsure I am desperate to find something that will give me use of my jaw.
Yes No Unsure Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for temporomandibular disorder.
Check the box below that represents your overall impression about your decision.
Leaning toward having temporomandibular surgery
Leaning toward NOT having temporomandibular surgery
Return to the topic Temporomandibular (TM) Disorders.
| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: May 4, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Arden Christen, DDS, MSD, MA, FACD - Dentistry | |
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