Temporomandibular joint surgery is considered when jaw joint symptoms interfere with normal jaw functions or if the jaw gets stuck or locked when eating, talking or yawning. Surgery is not generally considered if a person has painless clicking or when pain is thought to be coming from muscles instead of the joint. Surgical procedures to treat TMJ symptoms include arthrocentesis – simply removing joint fluid -- and/or arthroscopic surgery -- looking into the joint and flushing and removing scar tissue. After surgery, limited mouth opening is common, as is pain and swelling.
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Pain after TMJ surgery is normal and is different from the pain before surgery. Pain after surgery comes from tissues that become inflamed from the surgery. This pain is often managed with opiates -- powerful painkillers -- and steroids during the first week and then, if needed, ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Muscle relaxants and sedatives may also be prescribed for about a month to reduce tooth grinding and clenching and to improve sleep. In the first 24 hours after surgery, ice packs are repeatedly applied to help with inflammation and pain. Beyond 24 hours, moist heat is used.
Limited Mouth Opening
Limited mouth opening after TMJ surgery is common and is attributed to inflamed joint tissues and protective nonuse of the surrounding muscles to avoid pain. This is in contrast to any mouth restriction that may have existed before surgery, which was related to improper joint function. Assorted jaw exercises may be performed several times a day to slowly improve mouth opening. A common exercise involves placing the thumbs against the biting edges of the upper front teeth and the index against the biting edges of the lower front teeth and then gently stretching the mouth open with the fingers. Achieving normal mouth opening can take several months to a year.
Experiencing difficulty with chewing is very common after TMJ surgery. A soft food diet or liquid diet, which may involve using a straw, is usually advised for up to a couple of weeks. During this time, regular foods can be placed in a blender or mashed up by hand. Also available are prepackaged nutritional shakes and drinks -- such as Ensure and Boost -- which can help maintain proper nutrition.
Weekly dental visits to monitor progress after TMJ surgery can go on for months. During these visits, adjustments may be made to the removable splint as well as to the jaw exercises and physical therapy regimen. Physical therapy such as ice packs, moist heat packs, ultrasound and gentle jaw stretching is effective in reducing pain and regaining normal movement after surgery. Strenuous physical activities such as lifting weights, and recreational activities as scuba and playing wind instruments, may need to be postponed to avoid clenching the jaw and stressing the joint.
Complications and Results
Although infections are rare after TMJ surgery, swelling is more common with arthroscopic surgery. Possible adverse effects mainly involve the ear. They include blood clots and cuts in the ear canal or temporary decreased hearing. Infrequently, nerve damage can occur around the joint. Most people who have TMJ surgery report better jaw function and less pain after 6 months to 1 year.