Surgery isn’t a common treatment approach for TMJ disorders, but when these painful disorders arise from an issue with the bone itself, surgical solutions might be needed to restore the function of the jaw and reduce pain. Like any surgery, TMJ surgery carries some risks, though these are minimal, especially in less invasive surgical procedures like arthrocentesis. Even more extreme surgical treatments like total joint replacement carry high success rates, providing patients with long-term relief. It’s important to remember that surgery should be considered a last resort for treating TMJ disorders when these are unrelated to the underlying structure or condition of the jaw.

The temporomandibular joints are the joints where the lower jaw is attached to the upper jaw and skull, located on each side of the face. These joints hinge and slide, requiring healthy materials for efficient mechanics. Some structural issues that might require surgery are:

1. Arthritis in the jaw joint
2. Damage to the smooth mandibular bone that interferes with its movement in the joint
3. Dislocated jaw
4. Displaced or damaged discs, the cartilage cushions that protect the juncture of the jaw joint

The least invasive kind of TMJ surgery is arthrocentesis. After the affected area is numbed with local anesthetic, hypodermic needles are inserted into the joint to flush out irritants and break up fused scar tissue before injecting lubricating fluid into the joint. This procedure can help with arthritis, joint adhesions, and other mild structural issues that affect the jaw joint and may also include a steroid injection to minimize joint inflammation and reduce pain. Arthroscopy is slightly more invasive, using tiny incisions to insert specialized scopes and tools into the joint, where the tools smooth bone, reshape cartilage, and remove scar tissue to restore the mechanics of the temporomandibular joint, while the scopes allow the surgeon to see the joint. While arthroscopy requires general anesthesia, it is an outpatient procedure that shouldn’t take more than an hour or two.

Open-joint surgical procedures like arthrotomy involve removing, repairing, or repositioning one or more parts of the jaw to make it function properly. Arthrotomy involves a single incision, near the ear, that allows the surgeon to access the jaw joint, repairing or restoring disc tissue and modifying the bone when arthritic changes have occurred. This procedure is performed with general anesthesia and may involve a brief hospital stay, though some patients can go home on the same day. In some cases, all or part of the temporomandibular joint may need to be replaced entirely. To accommodate a prosthetic component, the surgeon will need to remove a small section of the jawbone before the prosthetic joint can be placed. These jaw replacement procedures can take several hours, and you can expect to stay at the hospital for a few days.

Success rates for TMJ surgery range from 85-95%, depending on the type of surgery. Open procedures like arthrotomy and total jaw replacement naturally have longer recovery times, and closely following your oral surgeon’s aftercare instructions will help you recover efficiently and completely. Any surgery has risks, though open TMJ procedures naturally carry greater risks, which could include damage to adjacent facial structures, nerve damage, or bleeding problems; these risks are rare, and your oral surgeon will review them with you closely as you plan your treatment for chronic TMJ disorder.

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