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The temporomandibular joint (TMJ) is either one of the two joints connecting your lower jaw (mandible) to your skull.
TMJ disorders (TMDs) are problems with one or both of these joints. TMD symptoms include:
The exact causes of most TMDs aren’t well understood, but experts have found associations with certain genetic and hormonal factors.
Your genes play a role in how you perceive pain, both physically and psychologically, and differences in these processes may affect the development of TMDs. Higher estrogen levels have also been associated with TMDs.
An injury to the jaw or TMJ may also contribute to the development of a TMD.
TMDs often come on suddenly and resolve on their own just as quickly. But in some cases, they are persistent (chronic) and require professional attention.
If more conservative treatments fail to relieve jaw pain or dysfunction, that professional attention may include TMJ surgery.
Doctors and dentists are unlikely to recommend TMJ surgery as a first-line treatment. Surgical procedures are most often considered a last resort meant for severe cases where other treatments have failed.
TMJ surgery is generally irreversible. Anything that involves a permanent change to the way your teeth or jaw bones fit together may not necessarily solve the problem.
For these reasons, experts generally recommend people suffering from TMDs to try conservative, non-invasive treatments first. But surgery may be a logical next step in cases where other treatments have failed to resolve serious TMJ dysfunction. Your doctor can help you decide if surgery is necessary.
They might recommend orthognathic surgery, which corrects bite problems, if your TMJ issues are related to other bite problems. However, even if you are a candidate for surgery, your doctor will likely want to begin with the least invasive procedure(s) possible.
Before recommending surgery, your doctor or dentist may provide any or all of the following:
In most cases, doctors and dentists only recommend TMJ surgery after these procedures have failed.
Five types of surgical procedures address TMJ disorders. They range from minimally invasive outpatient treatments to intensive open-joint surgery.
Keep in mind: Surgery is considered a last resort for TMJ problems that don’t respond to more conservative and less invasive treatments.
Arthrocentesis (the Greek word for “joint puncture”), also known as joint aspiration, is a minimally invasive procedure. It involves flushing the jaw joint with fluid from a syringe to clear away tissue debris and reduce inflammation.
Arthrocentesis may be performed under general anesthesia or a combination of local anesthesia and IV sedation.
It’s generally an outpatient procedure, so you'll be able to go home the same day. It may take about half an hour to perform.
During the procedure, a surgeon will:
Arthrocentesis may cost $300 or more. Talk with your doctor and insurance provider to determine the exact cost.
TMJ arthroscopy requires general anesthesia. It’s slightly more invasive than arthrocentesis and may take longer.
It’s an outpatient procedure during which a surgeon will:
Though only somewhat more invasive than arthrocentesis, this procedure may cost as much as $5,000 or more per joint. Your doctor and insurance provider can provide more information regarding the exact cost.
Rather than simply inserting tools through tiny incisions, open-joint surgery is more intensive. The joint space is opened completely in order to expose the jaw joint.
Open-joint TMJ surgery may take 1 to 2 hours and is performed under general anesthesia. You may need to spend the night in the hospital afterward. During the procedure, your surgeon will:
The cost of open-joint surgery for TMJ disorders varies widely depending on the specifics of the procedure. It may cost $5,000 on the low end or up to tens of thousands of dollars.
Insurance coverage varies for this procedure. Talk with your provider and your doctor to determine the cost.
TMJ replacement is a special kind of open-joint TMJ surgery. Once the joint is exposed, it is either replaced with bone taken from elsewhere in the body or with a prosthesis.
Joint replacement surgery is an inpatient procedure and may take more than an hour under general anesthesia. A surgeon will:
TMJ replacement costs include both open-joint surgery and the replacement material itself. It may cost several tens of thousands of dollars.
Like most open-joint surgeries, joint replacement for TMD may not be covered under insurance. Talk to your provider and doctor for more information about costs.
A condylotomy is a kind of osteotomy, which is essentially a controlled fracture.
The name condylotomy comes from the condyle, which is the rounded end of your lower jaw that fits into the TMJ. Increasing the amount of space for the condyle to move may ease TMJ pain and locking.
A modified condylotomy takes place under general anesthesia and generally lasts less than 2 hours. You may be able to go home the same day, but you’ll need several weeks to fully heal.
During the procedure, a surgeon will:
A modified condylotomy typically costs between $15,000 and $30,000. Discuss costs with your doctor and ask your insurance provider how much they will cover.
If your doctor has recommended TMJ surgery for you, they’ll provide instructions to follow before and after the procedure.
The surgery itself is only part of the process of correcting TMD. Your doctor will likely give you orthotic devices, physical therapy, and medication after surgery to help your jaw recover and heal properly.
This process can take days to months, depending on the procedure. Be prepared with soft foods, a positive mindset, and as much information as you can get from your doctor.
Complications may result from invasive TMJ procedures. These include:
In some cases, these issues may require additional surgeries. Talk to your doctor for a better understanding of the procedure and to discuss specific risk factors.
Recovery time from TMJ surgery depends on the specific procedure. Generally, the more invasive the surgery, the longer your jaw will take to heal.
|Arthrocentesis (Minimally Invasive)||After 1 to 3 days, you should be able to return to work, school, or other obligations. Your doctor might recommend jaw exercises and a soft diet.|
|Arthroscopy (Minimally Invasive)||Recovery can take anywhere from a couple of days to a week.You may receive physical therapy following recovery.You might be required to keep a soft diet for several weeks as your jaw heals.|
|Open-Joint Surgery or Joint Replacement (Invasive)||A full recovery may take anywhere from 2 weeks to several months.Recovery may be more painful than for less invasive procedures.Physical therapy will be a part of the recovery process.|
|Modified Condylotomy (Invasive)||You may need up to a week to rest before returning to work, school, or other obligations.Your doctor will use rubber bands to hold your upper and lower jaws together for several weeks.You’ll be required to follow a soft or liquid diet.|
Depending on the kind of surgery you’ve had, you may need days, weeks, or even months to fully heal and resume normal activities.
In the meantime, here are some guidelines:
Talk to your doctor about your options, surgical and otherwise. TMJ surgery may improve your quality of life if your TMD is severe. However, surgery permanently changes your jaw and is a decision you should not take lightly.