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Temporomandibular Joint: Open Joint Surgery

In some cases, where the bone and cartilage structure of the joint is severely compromised, open surgery will be necessary. Open surgery, also called arthroplasty, allows surgeons a better view of the joint than any other approach.

Usually, procedures such as major repair or removal of the disc, disc replacement (with a prosthetic implant), and surgery to the bone is done by arthroplasty. These procedures are described in detail below.

Arthroplasty, done under local or general anesthesia, involves making a small incision on the face over the TMJ (just in front of the ear) to expose the joint space. Surgeons position incisions to leave little or no visible long-term scarring on the face.

Although in-hospital recovery is quite short, full recovery from the surgery may take several weeks. Patients will have to make changes in their diet (to soft foods only) and will probably require a period of physical therapy during that time.

Disc Repair

The articular disc is a piece of piece of cartilage that lies between the two bones of the joint. Its purpose is to separate and cushion the bones, and prevent them from rubbing together when the jaw opens and closes. The most common structural cause of TMD is internal derangement (slipping or moving) of the disc, which can also lead to the disc tearing or fraying. In such cases, a surgeon can often surgically repair or reposition the disc, easing the painful symptoms of TMD.

Sometimes, disc repair can be done using arthroscopic surgery, but in many cases arthroplasty is necessary because it allows a better view of the joint space. Arthroplastic disc repair is done under local or general anesthesia. The joint is opened, and surgical instruments are used to reposition the disc or repair torn sections. The incision is then closed. Surgeons position incisions that leave little to no visible long-term scarring on the face.

Menisectomy (with and without implant)

The meniscus is another name for the articular disc. In cases where TMD is caused by a displaced or damaged disc, your oral and maxillofacial surgeon will determine the extent of damage to it. If the disc is too badly damaged to be repaired, part or all of it may need to be removed in a surgical procedure called a menisectomy.

Many partial menisectomies can be done with arthroscopic surgery, but if the damage is very extensive, or if the whole meniscus needs to be removed, open surgery will probably be necessary. The surgeon will make a small incision over the TMJ (just in front of the ear) to carefully expose the jaw joint, and will remove the disc. Generally, if the disc is removed completely, it must be replaced with an implant, a piece of synthetic material that will keep the bones of the joint from rubbing together. The incision is then closed.

Osseous Surgery

Osseous surgery is a procedure that reshapes bone. Disorders of the TMJ can sometimes be caused by ankylosis or poorly-formed or misshapen bone in the area of the joint. Osseous surgery attempts to correct this structural problem.

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