Plastic Surgery

Temporomandibular joint (TMJ) disorders treatment

What is the Temporomandibular joint (TMJ) disorder?

Temporomandibular joint dysfunction is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull). The most important feature is pain, followed by restricted mandibular movement, which can cause difficulty eating or speaking, and noises from the temporomandibular joints during jaw movement.

The three classically described, cardinal signs and symptoms of TMD are:

pain and tenderness on palpation in the muscles of mastication, or of the joint itself (preauricular pain - pain felt just in front of the ear). Pain is the defining feature of TMD and is usually aggravated by manipulation or function, such as when chewing, clenching, or yawning, and is often worse upon waking. The character of the pain is usually dull or aching, poorly localized, and intermittent, although it can sometimes be constant. The pain is more usually unilateral (located on one side) rather than bilateral. It is rarely severe.

limited range of mandibular movement, which may cause difficulty eating or even talking. There may be locking of the jaw, or stiffness in the jaw muscles and the joints, especially present upon waking. There may also be incoordination, asymmetry or deviation of mandibular movement.

noises from the joint during mandibular movement, which may be intermittent. Joint noises may be described as clicking, popping, or crepitus (grating).

Other signs and symptoms have also been described, although these are less common and less significant than the cardinal signs and symptoms listed above. Examples include:

• headache (possibly), (e.g. pain in the occipital region (the back of the head), or the forehead), or other types of facial pain including migraine, tension headache or myofascial pain;

• pain elsewhere, such as the teeth, neck, or shoulder;

• diminished auditory acuity (hearing loss);

• tinnitus (occasionally);

• dizziness;

• blinking;

• sensation of malocclusion (feeling that the teeth do not meet together properly).

What is the TMJ disorders treatment procedure?

Treatments for TMD range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, nonsurgical therapies first, with surgery left as the last resort.

Some basic, conservative treatments for TMD include:

• applying moist heat or cold packs;

• eating soft food;

• taking some medications. This may include non-steroidal anti-inflammatory drugs, muscle relaxants that help loosen tight jaw muscles, antianxiety medicines;

• low-level laser therapy. This is used to reduce the pain and inflammation, as well as increase range of motion to the neck and in opening the mouth;

• wearing a splint or night guard;

• undergoing corrective dental treatments (replacing missing teeth and using crowns, bridges, or braces);

• learning relaxation techniques to help control muscle tension in the jaw.

When the basic treatments listed above prove unsuccessful, your dentist may suggest one or more of the following treatments for TMD:

• Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles. This treatment can be done at the dentist's office or at home;

• Ultrasound. Ultrasound treatment is deep heat that is applied to the TMJ to relieve soreness or improve mobility;

• Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to relieve pain;

• Radio wave therapy. Radio waves create a low level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint;

• Acupuncture. For some people with TMD, acupuncture can be helpful.

Surgery for TMD should only be considered after all other treatment options have been unsuccessful. There are three types of surgery for TMD: arthrocentesis, arthroscopy, and open-joint surgery.

The type of surgery needed depends on the TMD problem:

Arthrocentesis. This is a minor procedure performed in the office under general anesthesia. It is performed for sudden-onset, closed lock cases (restricted jaw opening) in patients with no significant prior history of TMJ problems;

Arthroscopy. Compared with open surgery, this surgery is less invasive, leaves less scarring, and is associated with minimal complications and a shorter recovery time. Depending on the cause of the TMD, arthroscopy may not be possible, and open-joint surgery may be necessary;

Open-joint surgery. There are many types of open-joint surgeries. This treatment may be necessary if:
- the bony structures that comprise the jaw joint are deteriorating;
- there are tumors in or around your TMJ;
- there is severe scarring or chips of bone in the joint.

What kind of result can you expect?

Recovery period and recommendations

Compared with arthroscopy, open-joint surgery for TMD results in a longer healing time and there is a greater chance of scarring and nerve injury.

Compared with open surgery, arthroscopy is less invasive, leaves less scarring, and is associated with minimal complications and a shorter recovery time.

Possible side effects and complications

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