ARTHROSCOPY FOR TMJ DYSFUNCTION

For arthroscopic surgery, the surgeon inserts a thin, lighted tube (arthroscope) into the jaw joint through the skin near the TMJ. The major advantage is that this is a minimally invasive procedure. Arthroscopic surgery can effectively treat a temporomandibular joint conditions with fewer and less severe complications compared with an open-joint surgery.  The arthroscope is connected to a small camera outside the body that transmits a close-up image of the joint to a TV monitor. Below are photos of various pathology one may see within the joint. 

Arthroscopic images inside a temporomandibular joint

   
 Perforated Articular Disc(end stage disease) Severe Synovitis

During arthroscopy, the surgeon can insert surgical instruments through the arthroscope for surgery on the joint or another portal, preventing the need for open joint surgery.

During arthroscopic surgery, the surgeon may:

  • Remove scar tissue and thickened cartilage
  • Reshape parts of the joint
  • Reposition the disc and tighten the joint to limit movement
  • Flush (lavage) the joint
  • Insert an anti-inflammatory or lubricating medicine

Arthroscopic Anatomy and Surgery

 

Procedures are done under general anaesthesia and usually take 30 minutes or longer depending upon the type of procedure.

Why is it done?

This procedure is used to diagnose a TMJ disorder (diagnostic arthroscopy).

At the same time, arthroscopy can be used to treat disorders involving:

 

Arthroscopy will also flush out the joint (lavage) and the surgeon can inject an anti-inflammatory medicine or lubricating fluid. This can be especially helpful to people who have TMJ pathology associated with rheumatoid or osteoarthritis and internal derangement. 

What to Expect After Surgery?

  • There will be an element of pain as with any surgical procedure. This is well controlled with baseline paracetamol and ibuprofen with the option of an opioid such as codeine.
  • You may have stitches around the joint to secure the wounds for 5 days.
  • Frequently, you will have numbness around the surgical site with swelling and an occasional “droopy” face due to temporary facial nerve weakness. In the majority of cases, this resolves within a short period of time.
  • After surgery, you may start physical therapy within 48 hours in order to maintain movement and prevent scar tissue from forming.
  • Your jaw movement may be limited for at least a month. And you may need to follow a diet of liquid and soft foods

Arthroscopy is not done when there is:

  • Swelling in the jaw that has not been diagnosed
  • Infection (surgery could cause infection to spread)
  • A tumor near the jaw joint. A procedure such as arthroscopy could cause the tumor to spread (metastasize)
  • Stiffening or fusion of the jawbones (bony ankylosis)
  • An affected joint next to the only ear with which the person can hear (surgery could accidentally damage the ear)
  • Obesity, making the jaw joint difficult to access under the skin

Risks

Complications of arthroscopic temporomandibular surgery are uncommon but include:

  • Outer, middle, or inner ear damage
  • Temporary or permanent hearing loss
  • Temporary nerve damage to the facial nerve leading to temporary or permanent loss of facial movement(rare)
  • Numbness around the surgical site which frequently resolves within one month
  • Joint infection
  • Cerebrospinal fluid leak(rare) due to accidental perforation into the middle cranial cavity(brain)
  • Instrument fracture
  • Any surgical changes to the bone and soft tissue are irreversible and can create new problems in the joint's delicate balance. Scar tissue results from surgery that involves muscles, tendons, and ligaments and can restrict jaw movement to some extent.