Minimally Invasive Arthroscopic Surgery for TMJ Disorders
Arthroscopic surgery is a treatment option for temporomandibular joint (TMJ) disorder that can be used if symptoms do not improve with non-surgical treatment. In this minimally invasive surgery, an oral and maxillofacial surgeon (OMS) inserts a small video-camera called an arthroscope into the TMJ space in order to examine the internal components of the joint to help diagnose the problem and to perform any necessary minimally invasive surgical procedures.
Your OMS may remove scarring (adhesions) and/or cartilage fragments to help restore a greater range of motion and decrease your pain. Arthroscopic surgery may be performed in an outpatient surgical center or hospital under general anesthesia.
Advantages of Arthroscopic Surgery
Arthroscopic surgery is less invasive than traditional open joint surgery. The required incisions are smaller, resulting in less scarring, less pain and faster recovery. Other advantages include:
- Direct visualization: Because an arthroscope includes a small video camera, arthroscopic surgery can provide a clear view inside the joint, allowing your OMS to more accurately identify and treat underlying problems.
- Precision treatment: Arthroscopic instruments allow an OMS to perform precise surgical procedures within the TMJ. An OMS can repair damaged tissue, remove scar tissue, realign the articular disc and address other issues that contribute to some TMJ disorders.
Types of TMJ Arthroscopic Surgery
Common arthroscopic surgical options for TMJ disorders include:
- Diagnostic arthroscopy: This type of surgery is used only to assess the condition of the TMJ. An OMS inserts an arthroscope through a small incision to examine the structures of the joint, including the articular disc and surrounding tissue to look for signs of inflammation, torn cartilage or other damage, after which they can create a treatment plan. Often, your OMS can perform the necessary repairs in the same surgery as the diagnostic arthroscopy.
- Arthroscopic disc repositioning: If the TMJ disorder is caused by a displaced or damaged disc, arthroscopic surgery can be performed to realign the disc to its proper position. An OMS can use special instruments to manipulate the disc so that it returns to its proper position within the joint.
Arthroscopic lysis and lavage: This tissue cleaning and rinsing procedure can be used to remove inflamed or diseased tissue, which can help reduce inflammation, relieve pain and improve joint function. Lavage refers to washing or cleaning out the TMJ with a sterile solution, while the lysis is removal of scar tissue.
Arthrocentesis vs. Arthroscopy
Another surgical option for TMJ disorders is arthrocentesis lysis and lavage, which is minimally invasive but does not use an arthroscopic video-camera. The joint is flushed with sterile fluid to eliminate diseased fluid and gently stretch the joint.
Arthrocentesis is less invasive than arthroscopy. While the fluid is rinsing the joint, no physical debridement is being done on the actual joint itself, unlike in arthroscopy.
After the procedure is performed, the OMS may use medications that lubricate or help reduce inflammation in the TMJ. Arthrocentesis may be performed in the OMS office or outpatient surgery center, whereas arthroscopy must be performed in a surgical center or hospital. OMSs may use local anesthesia, IV sedation or general anesthesia for arthrocentesis, while patients undergoing arthroscopy will typically always require general anesthesia.
Arthrocentesis and arthroscopy both address disc mobility, although in different ways. Surgeries that change the positioning of the disc are more invasive. Patients who do not have severe TMJ disorders may avoid open-joint surgery by undergoing either arthrocentesis or arthroscopy.
Recovery from Arthroscopy
Arthroscopic procedures do not typically produce much swelling due to the small instruments and incisions used. However, even with minimal swelling, your ears may ring and the TMJ may ache following the procedure. Your bite may take several days to readjust. Your OMS may prescribe special exercises for you, and you may need to wear an orthotic or “night guard” device.
Be sure to follow your OMS’s postoperative instructions, which may include adhering to a soft diet, using an occlusal (bite) splint, performing jaw exercises, or using over-the-counter pain medications. Regular follow-up appointments with your OMS are essential to monitor joint status and address concerns.
