Open-Joint Arthroplasty for Temporomandibular Disorders
Open-joint arthroplasty is surgery to repair, reposition, replace, or remove parts in a joint. When used to treat temporomandibular disorder (TMD), this usually involves the articular disc that cushions the jaw joint.
During open-joint arthroplasty of the jaw, an incision is made in the skin to expose the jaw joint. The surgeon may repair, reposition, or replace the disc with your own tissue or an artificial disc. Scar tissue or bony growths in the jaw joint can also be removed.
Open-joint arthroplasty is done under general anesthesia. You can normally expect to go home the same day.
When jaw joint movement cannot be regained because the disc has changed too much or the joint has broken down, the surgeon may need to remove the disc (discectomy) and replace it with an artificial disc.
What To Expect After Surgery
After surgery, medicines are prescribed to relieve pain and reduce swelling.
You can start physical therapy within 48 hours to maintain movement and prevent scar tissue from forming.
You may be given a mouthpiece (splint) to wear while rehabilitating your jaw.
Why It Is Done
Open-joint arthroplasty is used when:
There are bony growths within the jaw joint. Such growths are hard to reach with arthroscopic methods.
Complications from a previous surgery occur, such as the failure of an artificial joint replacement.
The joint is fused together by bony growth (ankylosis).
The joint is not accessible with arthroscopic surgery.
How Well It Works
Disc repositioning surgery can relieve pain and improve jaw function. This surgery has good results 85% to 90% of the time.footnote 1
Possible complications include:
Loss of jaw movement. Everyone has some decrease in jaw mobility after surgery, because the jaw heals with scar tissue, which is harder and tighter than normal tissue. But jaw exercises will help jaw movement.
Adverse reaction to the materials in an artificial disc. The risk of tissue rejection is higher if artificial materials, rather than your own tissue, are used.
What To Think About
When possible, a nonsurgical approach is preferred over surgery, because:
Medical Review:Adam Husney MD - Family Medicine & Elizabeth T. Russo MD - Internal Medicine & Martin J. Gabica MD - Family Medicine
Tucker MR, et al. (2014). Management of temporomandibular disorders. In JR Hupp et al., eds., Contemporary Oral and Maxillofacial Surgery, 6th ed., pp. 627-647. St. Louis: Mosby.