Multiple Surgical Options are Available to Correct TMJ Disorders
Just as for other joints in the body, jaw joint disorders requiring surgery may be treated with a variety of surgical options. The appropriate treatment depends on the specific condition and requires adequate imaging and diagnosis.
Often teeth clenching occurs at night and is involuntary. People that chronically clench their teeth generally experience muscle fatigue/spasm pain. From an orthopedic standpoint, forces delivered to the jaw joints can be of higher magnitude and delivered for more sustained periods of time than when we eat a meal. Varying pressure delivered to the jaw joints can produce locking of the joint. A night time bite plate can be preventative. Locking that does not reverse itself within hours and sustained will usually respond nicely to a procedure called arthrocentesis. During this procedure, liquid solution is injected into the joint and hydrostatic pressure reverses the pressure lock.
Arthrocentesis is sometimes used to unlock a joint with advanced disease. However, degenerative conditions usually respond only temporarily and arthrocentesis should not be viewed as a definitive way to manage all levels of misalignments.
Arthroscopic surgery can be definitive treatment for particular types of misalignments or Wilkes derangements. The advantage of arthoscopy is that it is a less invasive procedure than an open joint procedure. In some settings, it can be performed in an office setting with less cost. Limitations with arthroscopic surgery are that the procedure may not be able to remove bone impingements or complete other “sculpting” procedures that may be necessary in some cases of bone arthrosis or joint fusion.
An open joint procedure where all surfaces of the joint can be inspected and operated on, arthrotomy or arthroplasty allows the surgeon to make all moving jaw joint parts fit together and operate smoothly. In advanced disease or in cases of fusion, this is the only option.
This procedure avoids any opening of the joint itself. Condylotomy is performed in specific cases especially when joint dysfunction appears simply to be related to joint collapse with no significant arthrosis, surface bone changes or gross deformity of the articular disc. It is a procedure that can be applied when certain facial deformities exist along with joint derangements. The premise of the operation is that a bone cut is made in the vertical aspect of the lower jaw. The condyle of the jaw “sags” or drops downward to effectively increase joint space and decompress a disc/capsule effectively decreasing abnormal bio-mechanical loading. The disadvantage of the procedure is the necessity to wire the jaws together for a short time while bone heals. Other procedures avoid this issue.
Total Joint Replacements
Gross arthritic destruction of the jaw joints creates not only significant pain, but also regression deformities of the lower jaw. The rationale for total joint replacements is similar to the decision making process followed when an orthopedic surgeon replaces a knee or hip. Presently, there are two total joint replacement systems approved for use by the Federal Drug Administration in the United States. Joint reconstruction can also be performed with rib transplantation and other options when growth and development considerations are present in children and adolescents.