Open-joint arthroplasty for TM disorders

Surgery Overview

Open-joint arthroplasty is surgery to repair, reposition, replace, or remove parts in a joint. When used to treat temporomandibular (TM) joint disorder , this usually involves the articular disc that cushions the jaw joint.

During open-joint arthroplasty of the jaw, an incision is made in the skin to expose the jaw joint. The surgeon may repair, reposition, or replace the disc with your own tissue or an artificial disc. Scar tissue or bony growths in the jaw joint can also be removed.

Open-joint arthroplasty is done under general anesthesia . You can normally expect to go home the same day.

When jaw joint movement cannot be regained because the disc has changed too much or the joint has broken down, the surgeon may need to remove the disc (discectomy) and replace it with an artificial disc.

What To Expect After Surgery

After surgery, medicines are prescribed to relieve pain and reduce swelling.

You can start physical therapy within 48 hours to maintain movement and prevent scar tissue from forming.

You may be given a mouthpiece (splint) to wear while rehabilitating your jaw.

Why It Is Done

Open-joint arthroplasty is used when:

• There are bony growths within the jaw joint. Such growths are difficult to reach with arthroscopic methods.
• Complications from a previous surgery occur, such as the failure of an artificial joint replacement.
• The joint is fused together by bony growth (ankylosis).
• The joint is not accessible with arthroscopic surgery.

How Well It Works

When open-joint surgery is the best option, it is usually helpful. Disc repositioning surgery, sometimes combined with reshaping the disc and bone, has good results 80% to 95% of the time. ¹ Other procedures, such as those using implants, have had less success, but are the only option for some patients. ²

Risks

Possible complications include:

• Loss of jaw movement. Everyone has some decrease in jaw mobility after surgery because the jaw heals with scar tissue, which is harder and tighter than normal tissue. But jaw exercises will help jaw movement.
• Adverse reaction to the materials in an artificial disc. The risk of tissue rejection is higher if artificial materials, rather than your own tissue, are used.

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.

• Researchers have found that surgically repositioning a displaced disc is not necessary for treatment success. Rather, flushing out the joint area (arthrocentesis) or using arthroscopy to remove scar tissue and flush out the joint (lysis and lavage) is usually an effective treatment for a painfully locked jaw. ³
• After disc replacement, an adverse reaction to an artificial disc is possible.

Repeat surgery is less likely to produce positive results.

Surgeries performed using open-joint arthroplasty require more recovery time than do arthroscopic surgeries.

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

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. Tucker MR, Ochs MW (2003). Management of temporomandibular disorders. In LJ Peterson et al., eds., Contemporary Oral and Maxillofacial Surgery, 4th ed., pp. 672–696. St. Louis: Mosby.
2. Management of Temporomandibular Disorders. NIH Technology Assessment Statement (1996 April 29–May 1). Available online: http://text.nlm.nih.gov/nih/ta/www/018txt.html.
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.