TMJ Surgical Treatment

TMJ Surgical Treatment

Temporomandibular Disorder (TMD) is the general term used to describe the pain and/or dysfunction of the temporomandibular joint (TMJ) and its associated structures.  Over 5% of the population is affected by TMD; it is found more commonly in women.  The cause of TMD may include clenching/grinding, changes in someone’s bite, trauma, joint overload, arthritis and psychological factors.

The critical step in treating Temporomandibular Disorders is to identify the cause.  The most common causes of TMD are muscular disorders, which are referred to as myofascial pain and dysfunction.  These disorders are managed non-surgically with a variety of reversible treatment methods.  Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

TMD Signs & Symptoms:

• Clicking and popping of the jaw
• Difficulty or painful opening and closing of the jaw
• Locking of the jaw
• Clenching and grinding when stressed
• Frequent headaches and neck pain
• Stiff, sore muscles of the jaw
• Teeth that are no longer touching or come together differently
• Aching pain around the ear

• Dr. Arango believes in non-surgical treatment when at all possible and minimally invasive surgery only when indicated.  No single treatment can solve TMD completely and treatment takes time to become effective.
• Dr. Arango specializes in all treatment modalities of TMD and will work closely with your medical and dental implant providers.  Call 214-269-1244 to schedule a consultation.

Insurance Coverage for TMJ:

Dr. Arango is an in network physician with most medical insurance companies. He will work with all insurance providers except Medicare/Medicaid.  Dr. Arango and is staff will work diligently to assure the surgery is covered by your medical insurance company.

 Non-surgical Treatments:

Dr. Arango’s primary goal in the treatment of TMD is to alleviate pain and/or jaw dysfunction.  TMD can significantly impact a patient’s quality of life, Dr. Arango will provide you with all the different options to alleviate your pain.

Surgical Treatment: 

The surgical management of the TMJ disorder is complex and should be performed by an Oral and Maxillofacial Surgeon with a medical and dental background.  The advent of arthroscopy, a minimally invasive surgical technique, has significantly improved the results of temporomandibular joint surgery.  The goal of surgical treatment is to alleviate pain and/or jaw dysfunction that could not be alleviated with non-surgical treatment.

Surgical Treatments:

• Arthroscopy (minimally invasive)
• Arthroplasty (disc repositioning)
• TMJ total joint replacement surgery

Arthroscopy:

• Arthroscopic surgery was first used in the Orthopedic Surgery field to examine knees and shoulder joints and has since been adopted in Oral and Maxillofacial surgery to treat TMD. Dr. Arango is highly trained in arthroscopic surgery and performs these surgeries in an outpatient surgical center. Studies have shown >92% success rate when evaluating pain relief.
• The indications for arthroscopic intervention include patients who have pain and jaw dysfunction not responsive to nonsurgical management.

Arthroscopic Surgery Advantages:

• No skin incision or scar
• Reduced incidence of facial nerve injury
• Diagnostic and therapeutic capabilities

–Arthroplasty (disc repositioning):

• An arthroplasty is an open join procedure that is reserved for individuals who have not responded favorably to other measures.  Open surgical exploration of the TMJ follows after conservative (non-surgical) techniques and minimally invasive procedures (arthroscopy) have failed.  The goal of an arthroplasty is to repair, reposition or replace the disc (cartilage) of the joint.  Often times a damaged or displaced disc leads to clicking/popping and significant pain in the joint. The position and condition of the disc is identified prior to surgery with an MRI.
• Disc repositioning is a common surgical procedure performed to correct anterior disc displacement that has not responded to non-surgical treatment and results in painful clicking joints or closed locking.  The displaced disc is identified during surgery and repositioned to it correct anatomical position.  Disc repositioning has shown to improve jaw function and has successful results >90% of the time.

• Ideally all surgical efforts should be made to retain the disc but this is no always possible.  A discectomy, removal of the disc, is done if the disc is determined to be unsalvageable due to perforation, calcification and/or deformation. If the disc is removed, Dr. Arango will place a temporalis muscle graft in its place to provide cushion/support to the joint.  This procedure has also show successful results >85-90% of the time.
• These procedures are done under general anesthesia and patients usually go home the same day. Dr. Arango specializes in TMJ surgery has performed hundreds of these surgeries.  Call us today for a consultation at 214-269-1244.

–TMJ Total Joint Replacement Surgery:

• In some severe cases, pathologic conditions of the joint results in destruction of the joint structures and in loss of vertical dimension of the condyle leading to malocclusion, limited opening and severe pain.  Like any other joint in the body, the TMJ is affected by any and all of the end-stage joint disease.
• The disease processes may result from developmental disorders, trauma, arthritic diseases, failures from previous surgeries, bony/fibrous ankylosis or neoplasia.   The goal of any reconstructive joint surgery includes reduction of further pain and disability; improvement of mandibular form and function; prevention of further morbidity.

• Knee and hip replacements are common surgeries performed by our Orthopedic Surgery colleagues and TMJ replacements have become more common in the Oral & Maxillofacial Surgery practice.  These surgeries are complex procedures performed by only a few surgeons in the country. Dr. Arango is one of the few surgeons with extensive experience with these surgeries, being involved in hundreds of TMJ total joint replacements.

Custom Total Joint Replacement

• Using the most up to date technology, Dr. Arango will have joints fabricated specific to each patient’s anatomy using specialized CT scans, facial scans and intraoral scans.  Afterwards, Dr. Arango will have a virtual surgical meeting with engineers from the company fabricating the joints.

The Surgical Procedure and Medical Insurance Coverage

• The surgeries take place in a hospital setting and most patients can expect a 1 to 2 day stay the hospital. The surgery takes place through 2 small incisions located along the tragus of the ear and in a crease in the neck to hide the scars. Physical therapy for 3-4 weeks post-operatively may be necessary along with at home exercises.  Dr. Arango has privileges at Medical City Dallas, Medical City Plano, Presbyterian Dallas, Baylor Dallas Hospital and Methodist Dallas Hospital.
• Dr. Arango is a in network physician with most medical insurance companies. He  will work with all insurance providers except Medicare/Medicaid.  Dr. Arango and is staff will work diligently to assure the surgery is covered by your medical insurance company.