The Temporomandibular joint (TMJ) is the "connection" point between your mandible and your skull. It is responsible for many different functions, including opening and closing your mouth, chewing, speaking, and yawning. If the joint becomes irritated (a condition known as TMJ disorder), it can make all of these functions very difficult and extremely painful. At Olney Center for Oral and Maxillofacial Surgery, we can provide you with the treatment you need to alleviate the pain in your TMJ, giving you back your quality of life. The most common diseases affecting the TMJ include:

• Myofascial temporomandibular disorder (TMD), also known as myofascial pain syndrome, is caused by tension, fatigue or spasms in the masticatory muscles.
• Internal derangement of the TMJ, is a disruption or displacement of the disc within the joint.

What Causes TMJ Disorder

• Misalignment of your teeth and/or jaw
• Mouth or jaw tumors
• Jawbone infections
• Bruxism, or the grinding and clenching of your teeth. These actions place excessive pressure on your jaw muscles and the joint, tiring them out.
• Facial trauma. This includes injuries to the face near the jaw and joint, as well as temporary dislocation as a result of whiplash.
• The joint's cartilage is damaged by arthritis, particularly osteoarthritis (when your cartilage wears down), and rheumatoid arthritis (chronic inflammation of joints).
  

Symptoms of TMJ Disorder

Common symptoms of TMJ disorder include:

• Pain or tenderness of your jaw
• Pain in one or both of the temporomandibular joints
• Aching pain in and around your ear
• Difficulty chewing or pain while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth

TMJ Treatment

The exact course of treatment for your TMJ disease will depend on the diagnosis given to you by Dr. Tebyanian. For the two most common diseases affecting the TMJ (myofascial TMD and osteoarthritis), your initial treatment will include Anti-inflammatory and pain medications (typically NSAIDS or Tylenol), physical therapy and a night guard/occlusal splint to wear at night. Most doctors recommend a trial of these therapies for a minimum of two months before considering other interventions.

The second line of treatment will depend on the exact diagnosis of TMJ disease given to you by Dr. Tebyanian. Most conditions can be managed with minimally invasive or reversible interventions. These therapies should be fully exhausted before surgery is considered.
Patients with TMJ disease involving the muscle may benefit from injections of medication (Botox or steroids) into the affected muscle or the addition of stronger medications.

Those with an advanced disease, affecting the TMJ bone or cartilage, may benefit from one of the following surgical procedures:

Arthrocentesis:

Arthrocentesis is often the first surgical procedure that will be done for a patient who has a displaced disc. It can be done as an in-office procedure, when it involves merely the placement of two hypodermic needles into the joint. It can be done either under local anesthesia and IV sedation, or general anesthesia. Once the joint is numbed and patient is sedated, the needles are placed into the joint, and it is flushed with a sterile saline solution or a lactated Ringers solution. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation. Dr. Tebyanian will also manipulate the jaw to remove scar tissue adhesions that may have formed. At the end of the procedure, steroids will be injected into the joint space to facilitate healing.

Arthroscopy:

Arthroscopy is a minimally invasive surgical procedure, which involves introducing a camera into the joint via a small “nick” incision in front of the ear. This procedure will be performed in hospital settings under general anesthesia and allows for improved diagnosis, surgical manipulation of the disk, removal of scarring in the joint, as well as the introduction of medication into the joint via direct visualization.

Arthroplasty:

Arthroplasty is done in hospital settings and it involves the opening of the joint for surgical reconstruction. This is typically performed with an incision within or in front of the ear. This procedure allows Dr. Tebyanian to repair or remove the disk in the TMJ. This procedure may also be performed to repair the bone to prevent jaw dislocation.

Total Joint Replacement:

Patients with severe arthritis, bony fusion (ankylosis), tumors, or trauma (broken bone) may benefit from complete replacement of the joint with an alloplastic or total joint replacement. A custom-made temporomandibular joint that matches the exact anatomy of the patient is used to reconstruct the new joint.

Dr. Tebyanian, at Olney Center for Oral and Maxillofacial Surgery, is highly trained in diagnosing and treating complex TMJ disorders. If you suspect you have a TMJ disorder or have questions about any of the treatment modalities we offer at our practice, please contact us to schedule a consultation with Dr. Tebyanian.

Consultation Visit

Prior to your appointment at Olney Center for Oral and Maxillofacial Surgery, please obtain and bring previous imaging studies (MRI, CT, panoramic x-ray). If possible, please also bring previous surgical reports.

At your initial visit, Dr. Tebyanian will perform a history and physical exam. This will include reviewing previous doctors notes, tests and x-rays. Dr. Tebyanian may order additional imaging studies as well. Please be sure to bring any occlusal splint or night guard you are using. Diagnosis and treatment options will be reviewed and discussed.

Preparing for Surgery

Once a decision for surgery has been made, our office will work with your insurance company to obtain authorization. You may be asked to obtain additional lab and blood work prior to the surgery. You may also be asked to obtain medical clearance from your primary care physician.
The day before surgery, you will be contacted by the OR team with additional instructions, including the time you need to arrive at the hospital or outpatient center.