Better Outcomes for TMJ Disorder Surgery

Pain and restricted jaw function due to temporomandibular joint (TMJ) disorders make it difficult for patients to eat and speak, leading to significantly reduced quality of life. Usually caused by degenerative changes or mechanical disturbances, TMJ disorders are most common in middle-aged women.

In about 10% of cases, conservative therapy, such as a bite split, physical therapy, a soft diet and NSAIDS, aren’t enough to relieve pain and improve function of the TMJ. “If a patient has tried conservative therapy for a minimum of three months and has had no or minimal improvement, I recommend a consultation with an oral surgeon,” says Justin M. Pisano, DDS, an oral surgeon at the Center For Oral Surgery & Dental Implants.

One of a few TMJ surgeons in Western Michigan and the surrounding area, Dr. Pisano completed a fellowship focused on TMJ surgery with one of the foremost TMJ surgeons in the world: George Dimitroulis, MDSc, FDSRCS, FFDRCS. Dr. Dimitroulis is senior consultant maxillofacial surgeon at St. Vincent’s Hospital in Melbourne, Australia.

Predictable Surgical Outcomes

Indications for surgery include limited mouth opening, jaw locking and osteoarthritis of the TMJ. When a thorough evaluation shows that surgery is indicated, minimally invasive techniques and other advances in surgery and biomaterials enable Dr. Pisano to safely and effectively restore, repair or remove damaged or diseased TMJ tissue.

“TMJ disorder surgery has evolved a lot in the last 20 years,” says Dr. Pisano. “Today, we’re able to address disturbances in the TMJ surgically with excellent predictability and outcomes.” He uses TMJ Surgical Classification to determine which procedure is appropriate for each patient.

Minimally Invasive Surgery

Minimally invasive techniques can help relieve pain and restore TMJ function in most cases. Arthroscopy and arthrocentesis, some of the most common procedures performed by Dr. Pisano, are both minimally invasive. These procedures break up adhesions in the TMJ that limit movement, and lavage the joint with fluid to remove inflammatory cytokines and fibrous debris. Studies show that arthroscopy and arthrocentesis are both effective.1,2

Open Surgery

Discectomy and disc repositioning, a common procedure for TMJ disorders, can reposition or remove a damaged disc. These procedures can significantly reduce pain and improve function.

One study of 24 patients followed for an average of 30.8 months found that discectomy improved mandibular mobility and joint function, and reduced TMJ and muscular facial pain.³ On the Helkimo Clinical Dysfunction Index, 20 patients were either clinically symptom-free or had only small dysfunction.

In another study, 82% of the 17 discectomy patients followed had significantly improved function and reduced pain, measured as clinically symptom-free or only small dysfunction.4

Total joint replacement is reserved for extreme cases. When this is the only surgical solution, Dr. Pisano designs a customized prosthesis for the patient, guided by 3-D reconstructions of CT scans. “More than 20 years of data demonstrate the success of TMJ replacement,” says Dr. Pisano.

A study of 56 patients at a median of 21 years after undergoing a TMJ replacement found that the prosthesis continued to function well.5 Patients reported considerably less TMJ pain, improved jaw function and ability to eat solid food, and improved quality of life.

For more information about surgical treatment of TMJ disorders at the Center For Oral Surgery & Dental Implants, call 616-361-7327.


References

¹ Dimitroulis G. A review of 56 cases of chronic closed lock treated with temporomandibular joint arthroscopy. J Oral Maxillofac Surg. 2002;60:519–524.

² Holmlund AB, Gynther GW, Axelsson S. Efficacy of athro- scopic lysis and lavage in patients with chronic locking of the temporomandibular joint. Int J Oral Maxillofac Surg. 1994;23:262–265.

³ Miloro M, Henriksen B. Discectomy as the primary surgical option for internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 2010;68:782-789.

4 Miloro M, McKnight M, Han MD, Markiewicz MR. Discectomy without replacement improves function in patients with internal derangement of the temporomandibular joint. J Craniomaxillofac Surg. 2017 Sep;45(9):1425-1431.  doi: 10.1016/j.jcms.2017.07.003. Epub 2017 Jul 17.

5 Wolford LM, Mercuri LG, Schneiderman ED, Movahed  R, Allen W. Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: the Techmedica/TMJ Concepts device. J Oral Maxillofac Surg. 2015 May;73(5):952-60.  doi: 10.1016/j.joms.2014.10.032.