The Tempomandibular Joint (TMJ) is a small joint located in front of the ear which allows the mandible (lower jaw) to open and close, slide forward and back, and side to side. The Tempomandibular Joint is no different from other body joints. It consists of two bones (the condyle and the glenoid fossa at the base of the skull) which articulate against one another within a joint cavity. A disc is positioned between the two bones in order to function as a shock absorber and to allow more precise movement of the two bones against one another.
**A key feature in the treatment of TMJ is that clicking and popping is often a normal phenomenon, especially if it is not associated with pain or limited opening.**
Tempomandibular disorders (TMD) are a broad classification of disorders that are characterized by muscle and joint pain in the TMJ region. Factors that cause TMD can be broken down into two categories, myofascial pain (muscle pain) and internal derangement (damage to the TMJ itself).
Myofascial Pain manifests as pain and headaches originating in front of the ear and radiating to the lower jaw and into the temple region. Myofascial pain is often caused by parafunctional habits such as grinding and clenching one's teeth. Grinding and clenching often occurs at night and is frequently associated with increased stress in one's personal life. Malocclusion (the teeth not fitting together properly, poor bite) is also associated with TMJ pain. Clenching, grinding and malocclusion places an abnormally high amount of force into the TMJ and surrounding muscles of the face. Treatment is initially directed at identifying stressors, correcting malocclusion, fabrication of a occlusal splint in order to relieve clenching/grinding and a soft diet.
Internal Derangement occurs when there is direct damage to the TMJ itself. Damage can occur from previous trauma (car accident, fall, sports accident), infection, tumors and degenerative changes within the TMJ. Degenerative changes include osteoarthritis, joint adhesions, bone spurs and disc displacement and perforation. Signs and symptoms of internal derangement (TMJ damage) include a history of limited opening, frequent dislocations, the jaw locking open or closed, deviation on opening and severe pain in front of the ear associated with opening and/or closing. Internal derangement conditions are commonly treated surgically if conservative methods fail.
The treatment of TMJ pain and dysfunction is based upon the correct diagnosis of the problem. Correct diagnosis requires a thorough patient history, examination and possibly an MRI.
Procedures offered in Our Practice
Arthrocentesis is a procedure designed to flush out the TMJ space in order to remove small adhesions, remove inflammatory mediators and to deposit medications within the joint itself.
Arthroscopic TMJ Surgery is a done by inserting a very small camera into the TMJ space. Arthroscopic TMJ surgery has all of the advantages of arthrocentesis, in addition to being able to remove bone spurs, break up large adhesions, remove damaged discs and take photographs to show the damage within the joint space. The principles of Arthroscopic TMJ surgery are the same as used in the orthopedic community for the treatment of damaged knees and shoulders.
Total Joint Replacements are performed for the severely painful and dysfunctional TMJ. Total Joint Replacements are typically employed after all other more conservative methods have failed or in cases involving rheumatoid arthritis, severe ankylosis or after tumor resection.
 |
|
Figure 3: A Total Joint before it is inserted surgically.
|
 |
|
Figure 4: Total Joints in place after surgery.
|