Health Library Should I Have Surgery for Temporomandibular Disorder?From Healthwise

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 physical therapist 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 nonsurgical 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 make a jaw joint problem worse. 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 nonsurgical 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 a picture of the temporomandibular joint.

What are temporomandibular disorders?

The jaw 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 joint area.

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 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 have choices for treating severe and disabling temporomandibular disorder.

• You can continue to use nonsurgical treatment for a TM disorder, including joint rest, jaw exercises, ice, heat, use of a dental splint, or medicine. Keep the following in mind when you use ice or heat:
  • Put either an ice pack or a warm, moist cloth on your jaw for 15 minutes several times a day if it makes your jaw feel better.
  • Switch back and forth between moist heat and cold, if that gives you relief.
  • Gently open and close your mouth while you use the ice pack or heat.
  • Don't use heat if your jaw is swollen. Use only ice until the swelling is gone.
• You can have arthrocentesis to wash out the joint area.
• You can have surgery to correct a soft tissue or bone-related problem.

The decision about whether to have surgery for a TM disorder takes into account your personal feelings and the medical facts.

Most temporomandibular surgeries are done arthroscopically. The following includes information about arthrocentesis, arthroscopy in general, and different types of arthroscopic TM procedures.

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.

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 doctor.

Circle the answer that best applies to you.

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.

Return to the topic Temporomandibular (TM) Disorders.

Citations

1. Eriksson PO, Zafar H (2007). Cervico-cranio-mandibular disorders. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2007, pp. 1143–1148. Philadelphia: Saunders Elsevier.

2. McKenna S (2001). Discectomy for the treatment of internal derangements of the temporomandibular joint. Journal of Maxillofacial Surgery, 59: 1051–1056.

3. Barkin S, Weinberg S (2000). Internal derangements of the temporomandibular joint: The role of arthroscopic surgery and arthrocentesis. Journal of the Canadian Dental Association, 66: 199–203.

4. Tsuyama M, et al. (2000). Complications of temporomandibular joint arthroscopy: A retrospective analysis of 301 lysis and lavage procedures performed using the triangulation technique. Journal of Oral and Maxillofacial Surgery, 58: 500–505.

Author:	Monica Rhodes	Last Updated: January 24, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Arden Christen, DDS, MSD, MA, FACD - Dentistry
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