Saturday, January 22, 2011

Surgery to correct TMJ




Surgery for TMJ
Faulty Jaw and Relief from Jaw Pain
Severe cases of TMJ or Faulty Jaw are no laughing matter. Fortunately, only a small percentage of TMJer's with advanced problems will end up having surgical intervention.
When surgery is recommended be sure you seek lots of other medical opinions before proceeding.





How did we get Here?
A proper diagnosis can only be arrived at through appropriate examination and screening for structural disorder within the joint itself. A panoramic X-ray is a great screening tool used by dentist or Orthodontists and shows both jaw joints, and an unusual flattening of the joint can mean you have TMJ. The x-ray can reveal cysts, tumors, nasal area and irregularities in the bone as well as any indentation on the lower jaw (mandible) which is caused by clenching and grinding of the teeth. Depending on what these images reveal, your dentist may recommend an intra-oral appliance, orthodontia or maxillofacial surgery. You may be referred to an oral surgeon or oral and maxillofacial surgeon who will further evaluate and treat your Temporomandibular disorder.


Surgery as a Last Resort
The End Game.
Typically, surgery is considered only after all other conservative TMJ treatment options have been attempted or eliminated as viable options. However, surgery may not always resolve TMJ issues. All TMJ-related surgery is performed under general anesthesia.
Arthrocentesis
A minor cleansing procedure, an oral surgeon inserts a needle into the joint area dispensing a sterile fluid which irrigates the joint and removes debris and inflammatory byproducts. In some cases, the surgeon may insert a scalpel-like instrument inside the joint and remove any tissue adhesions and reposition the joint hinge.

Arthroscopy
The up side and The Study, Kyoto, Japan.
During this procedure, your surgeon makes an incision at the temple point in front of the ear to reach an endoscope into the surrounding area. The endoscope provides a visual guide so that your surgeon can remove any adhesions, treat inflammation or reposition the disc.



The Study , Kyoto Japan. Courtesy of Science Direct.

Outcome of arthroscopic surgery for internal derangement of the temporomandibular joint:long-term results covering 10 years


Objectives: To investigate the long-term success (10-year results) of arthroscopic surgery of the temporomandibular joint. Patients and Method: A survey was undertaken of 37 patients who had been treated with arthroscopic surgery for TMJ internal derangement from 1986 to 1990. Thirty-three patients responded, of whom 30 were women and three men, whose age at surgery ranged from 14 to 77 years (mean: 35.1 years). The mean follow-up period was 10 years and 2 months. All patients rated their pain level on a visual analogue scale (VAS), and also recorded pain, jaw dysfunction, and activities of daily living (ADL) before surgery, and at the time of the survey. Interincisal opening was self-assessed (mm). Pre- and postoperative pain, dysfunction and ADL scores were compared for outcome and statistically analyzed with the Student's t -test. Results: Intensity of pain as rated on the VAS was significantly reduced from 5.15 to 0.34 (p<0.01).>p<0.01).>

The Down Side
Although arthroscopy (arthroscopic surgery) for temporomandibular joint dysfunction or damage (TMJD) may seem like a relatively easy minimally invasive outpatient procedure, it is typically considered a "last resort" treatment option as complications occur that can result in increased pain or joint dysfunction, nerve damage and even permanent jaw mobility reduction.

Discectomy
Then next type of surgery to consider for your TMJ problems is called a discectomy. This surgery is done to remove the disk that is providing the joint with cushioning. It usually takes a few hours and recovery can take a couple of weeks. While you are waiting for the tissue to cover the joint, the bones will be grinding on each other. However, within 4-6 weeks you'll usually enjoy some pain relief and begin using your jaw once again.
Open joint Surgery ( Arthroplasty)

This procedure involves approaching the temporomandibular joint through an incision in a skin crease in front of the ear.. This may be the only option that provides access to deteriorating bony structures or chipped bone areas. Depending on the type of problem, your surgeon may use a scalpel to remove or re-sculpt the affected area.
Articular Eminence Recontouring
You'll find that this TMJ surgery is done on the socket area of your jaw joint. Sometimes the socket can be too deep, causing there to be pressure on the joint's ball. This causes swelling and pain to occur. Smoothing and shortening the articular eminence can take away this pressure, giving some relief from the pain. Usually this surgery is done if trauma to the joint has occurred, or it can be included as a part of a replacement surgery.
TMJ Replacement.
TMJ replacement surgery is done if the joint is damaged and there is no way to repair it. This TMJ surgery is to remove the old joint and put in a new one. This could be a partial replacement or a total replacement. There are many risks to this surgery and it should only be used as a last resort for those who have exhausted all their other options. There is a long recovery time and it can take a long time to get used to the replacement joint.
Partial Replacement
When only one of the components (disk, ball or socket) of the TMJ is replaced, it is called a partial joint replacement. If the temporal bone no longer provides a smooth socket (articular fossa), a metal liner (fossa replacement) is placed inside the TMJ to restore motion and flexibility in the TMJ. When the ends of the jawbone (condyles) are damaged and no longer ball-shaped, they can be replaced. Surgeons can harvest bone from another part of the patient's body, such as the ribs, and attach it with screws to the damaged section of the TMJ. A metal prosthesis is often used instead of bone because less surgery is needed, since there is no "donor" site.







Total joint Replacement
This type of surgery is reserved for those severe and chronic conditions that haven't responded to other surgical methods. This involves removing the deformed or degenerated joint and replacing it with a custom-designed TMJ prosthesis made specifically for each patient.
Due to the general risks associated with surgery, this treatment is used only after other treatment options have been considered.
Remember, it is only in rare cases that surgery will be required or recommended and doctors will always take the more conservative approaches first to relief jaw pain and joint disorders. Also important to note, is that the results achieved through surgery are not always what they are hyped up to be.
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