TMJ Disorders: Is Surgery a Solution?

If you have pain in your face, especially near your jaw, and have problems opening and closing your mouth, you may have a temporomandibular joint (TMJ) disorder. The TMJ connects your lower jaw to your skull and allows your jaw to open and close. Each side of your jaw has a TMJ.

TMJ disorders make it difficult to eat and speak. Most common in middle-aged women, TMJ disorders are usually caused by arthritis, genetics, or clenching or grinding your teeth.

Most of the time, conservative treatments, such as a bite split, physical therapy, a soft diet and non-steroidal anti-inflammatory medicines (like Motrin), are enough to relieve pain and improve jaw function. But for 1 out of every 10 people with a TMJ disorder, these treatments don’t help enough.

“If you’ve tried other treatments for a minimum of three months and have had no or minimal improvement, see an oral surgeon,” says Justin M. Pisano, DDS, an oral surgeon at the Center For Oral Surgery & Dental Implants. He is one of a few TMJ surgeons in Western Michigan and the surrounding area.

Types of TMJ Surgery

“We can use minimally invasive surgery to relieve pain and improve function for many TMJ problems,” says Dr. Pisano. Arthrocentesis and arthroscopy are both minimally invasive.

In arthrocentesis, small needles are put into the TMJ to wash out inflammatory cells and debris and inject steroids. Arthrocentesis can also help reduce the pressure that causes pain or stiffness.

Arthroscopy is done through a few small holes in the skin above the TMJ, near the ear. Dr. Pisano puts a small tube into the hole, and then puts a tool with a light and camera (the arthroscope) inside to see the TMJ. He then uses tiny surgical tools, also inserted through the small holes, to do the procedure. Depending on the problem, Dr. Pisano might remove inflamed tissue and wash the area and remove debris or reshape the jaw.

Sometimes, open surgery involving an incision a few inches long in the TMJ is necessary. Usually, this is done to reposition or remove a damaged TMJ disc. In severe cases of TMJ disorder, joint replacement surgery can be done. When this is the best solution, Dr. Pisano develops a customized artificial jaw for the patient, guided by 3-D reconstructions of CT scans.

“You don’t have to live with pain and problems eating and speaking,” says Dr. Pisano. “Surgery for TMJ disorders is safe and effective.”