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Arthroscopy for Temporomandibular Disorders

Surgery Overview

For arthroscopic jaw surgery, the surgeon inserts a pencil-thin, lighted tube (arthroscope) into the jaw joint through a small incision in the skin. The arthroscope is connected to a small camera outside the body that transmits a close-up image of the joint to a TV monitor.

The surgeon can insert surgical instruments through the arthroscope to do surgery on the joint, preventing the need for more surgical incisions. This technique is used to diagnose and treat temporomandibular disorders (TMD).

During arthroscopic surgery, the surgeon may:

  • Remove scar tissue and thickened cartilage.
  • Reshape parts of the jawbone.
  • Reposition the disc.
  • Tighten the joint to limit movement.
  • Flush (lavage) the joint.
  • Insert an anti-inflammatory medicine.

Procedures are done under general anesthesia and usually take 30 minutes or longer depending upon the type of procedure.

What To Expect

After surgery, you may start physical therapy within 48 hours in order to maintain movement and prevent scar tissue from forming. You may also use a mechanical device that gently moves your jaw joint (continuous passive motion).

Your jaw movement may be limited for at least a month. And you may need to follow a diet of liquid and soft foods.

Why It Is Done

Arthroscopy can also be used to flush out the joint (lavage) or to inject an anti-inflammatory medicine. This can be especially helpful to people who have TMDs caused by rheumatoid arthritis.

Arthroscopy can be used to treat TMDs involving:

  • Joint disease that causes tissue and bone to break down.
  • Scar tissue (adhesions).
  • Cartilage that is too thick.
  • Severe disc problems in the joint.
  • A jaw joint that has loosened over time or after an injury.

This procedure may also be used to diagnose a TMD ( diagnostic arthroscopy).

Arthroscopy is not done when there is:

  • Swelling in the jaw that has not been diagnosed.
  • Infection (surgery could cause infection to spread).
  • A tumor near the jaw joint. A procedure such as arthroscopy could cause the tumor to spread (metastasize).
  • Stiffening or fusion of the jawbones (bony ankylosis).
  • An affected joint next to the only ear with which the person can hear (surgery could accidentally damage the ear).
  • Obesity, making the jaw joint difficult to access under the skin and fat.

How Well It Works

Arthroscopy is a minimally invasive surgery that can effectively treat TMDs. An arthroscopic surgery can effectively treat a TMD with fewer and less severe complications compared with an open-joint surgery.footnote 1

Risks

Complications of arthroscopic temporomandibular surgery are uncommon but include:

  • Outer, middle, or inner ear damage.
  • Temporary or permanent hearing loss.
  • Temporary nerve damage.
  • Joint infection.

Any surgical changes to the bone and soft tissue are irreversible and can create new problems in the joint's delicate balance. Scar tissue results from surgery that involves muscles, tendons, and ligaments and is likely to restrict jaw movement to some extent.

What To Think About

When possible, a nonsurgical approach is preferred over surgery, because the treatment is cheaper, safer, noninvasive, and involves less risk of permanent damage.

Current practice trends are to avoid altering disc position or structure. After disc replacement, an adverse reaction to an artificial disc is possible.

If your doctor recommends surgery, experts agree that it is best to get a second opinion.

References

Citations

  1. Tucker MR, et al. (2008). Management of temporomandibular disorders. In JR Hupp et al., eds., Contemporary Oral and Maxillofacial Surgery, 5th ed., pp. 629–649. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine

Current as ofMarch 28, 2018


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