Arthroscopy for TM disorders

Surgery Overview

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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 perform surgery on the joint, preventing the need for additional surgical incisions. This technique is used to diagnose and treat temporomandibular (TM) disorders.

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 medication.

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

What To Expect After Surgery

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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

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

Arthroscopy can be used to treat TM disorders involving:

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

This procedure may also be used to diagnose a TM disorder (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

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Arthroscopy is considered a minimally invasive and safe temporomandibular surgery technique.¹ The surgery is about 80% effective in treating joints with painfully limited motion.¹

Risks

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Complications of arthroscopic temporomandibular surgery are uncommon but include:²

• 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

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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.¹
• After disc replacement, an adverse reaction to an artificial disc is possible.

If your health professional 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

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Citations

1. 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.

2. Tsuyama M, et al. (2000). Complications of temporomandibular joint arthroscopy: A retrospective analysis of 301 lysis and lavage procedures performed using the triangulation technique. Journal of Oral and Maxillofacial Surgery, 58: 500–505.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Arden Christen, DDS, MSD, MA, FACD - Dentistry
Last Updated	January 24, 2008