Total Temporomandibular Joint (TMJ) Replacement
Jaw joint (temporomandibular joint or TMJ) disease is estimated to affect 30 million Americans, with approximately 1 million new patients diagnosed each year. Although many of these patients can be managed with nonsurgical therapies, some patients require surgical intervention. The TMJ is a unique joint in that it does not function independently but works in tandem with the joint on the other side. Therefore, disease affecting 1 joint can either directly or indirectly affect the functioning and health of the contralateral joint. When surgical intervention of the TMJ is required, the joint can be reconstructed with patient’s own bone. However, certain TMJ conditions and pathology require reconstruction with a total joint prosthesis.
Some of the conditions that may require considerations for total TMJ replacement include:
- If a patient had more than 2 previous TMJ surgeries.
- Severe TMJ degenerative arthritis.
- Facial appearance or bite changes due to resorption of the temporomandibular joint.
- Previous failed TMJ total joint replacement surgery
- TMJ pathology; connective tissue or autoimmune disease (i.e., rheumatoid arthritis, psoriatic arthritis, scleroderma, Sjögren’s syndrome, lupus, and ankylosing spondylitis); fibrous or bony ankylosis; absence of TMJ structures due to pathology, trauma, or congenital deformity; and tumors involving the condyle and mandibular ramus area.
Depending upon age, the amount of damage to the temporomandibular joint, and previous surgeries, replacement of all or part of the temporomandibular joint structure may be necessary.
What Are Possible Complications?
Complications may occur following placement of these implants and may require further treatment. The occurrence of a complication may be related to or influenced by previous surgical history or prior medical conditions. For the right candidate and if performed by an experienced surgeon, total joint replacement is a successful procedure.
Complications include but are not limited to:
- Continued or increased pain levels or worsening of other present TMJ symptoms
- Facial and jaw swelling after surgery usually lasting several days
- Temporary or chronic jaw muscle spasm
- Temporary or permanent (rare) facial muscle weakness resulting from motor nerve injury during surgery (The most common problems are an inability to wrinkle the brow, raise the eyebrow, or fully close the eyelids.)
- Temporary or permanent numbness of certain areas of the skin in the region of the joint and sometimes in more remote areas of the face and scalp
- Ear problems, including inflammation of the ear canal, middle or inner ear infections, perforation of the eardrum, temporary or permanent hearing loss, ringing in the ears, and equilibrium or eustachian tube problems
- Loss of joint mobility due to the development of scar tissue (adhesions), heterotopic bone, or ankylosis
- Dental malocclusion (improper bite) requiring bite adjustment, orthodontia, or reoperation
- Erosion of the glenoid fossa (where the jaw bone hinges onto the skull, mandible (jaw bone), or surrounding tissues
- Foreign body reaction or allergic reaction to implant components
- Wear, displacement, breakage, or loosening of implant components
What Can I Expect Following Surgery?
In the immediate post-operative period, Dr. Bolourian will provide you with the appropriate medications and care required for your recovery. In order to establish the proper relationship between the upper and lower jaws, your teeth are wired together during surgery. Depending on your specific circumstances, these fixation wires may temporarily be left in place following surgery.
Postsurgical physical therapy is very important to achieving and maintaining optimum joint function. Dr. Bolourian may recommend a jaw-exercising device for you. You must follow his instructions with regard to the use of that device in order to attain the maximum benefit from your surgery.
Continuous jaw motion, function and physical therapy are very important post surgical instructions.
What Are The Alternatives To This Type Of Reconstruction?
Alternatives to this type of reconstruction include grafts of bone, soft tissue, or cartilage. The suitability of alternative treatments will depend on the condition of the bones, cartilage, disc, ligaments, muscles, nerves, and blood vessels in and around your TMJs. Rest assured that Dr. Bolourian will discuss all the options with you and will help you decide on the best treatment approach.