Definition & Overview
An arthrotomy of the temporomandibular joint (TMJ) is one of the many medical procedures used to treat TMJ disorders. Also known as arthroplasty, it is a traditional open joint procedure. It is painful, invasive, and followed by an extensive recovery period. The procedure is recommended for patients who do not respond to non-surgical treatments, such as arthrocentesis or arthroscopy.
Who Should Undergo and Expected Results
An arthrotomy of the temporomandibular joint is an invasive surgical procedure. Thus, it is not considered as the primary treatment option for patients with TMJ disorders. Most TMJ disorders are initially treated using non-invasive, non-surgical treatment methods, such as arthrocentesis or arthroscopy. However, these methods are not always successful 100% of the time. If they fail to bring any lasting change to the patient’s condition, traditional open surgery can be considered.
TMJ disorders are problems with the jaw joints, which are quite similar to the knee joint. Both jaw joints are made up of the condyle (the rounded upper end of the lower jaw), the fossa (the socket), and the disc. The disc, which has a tough and rubbery texture, moves in conjunction with the condyle as one opens and closes his or her mouth. Any problems with the jaw joints and their structures can cause TMJ disorders, which symptoms can include the following:
- Stiff jaw
- Clicking jaw
- Grating noise when opening and closing the mouth
- Pain when chewing
- Abnormal bite
- Reduced mouth opening
These symptoms can be caused by several possible problems, such as:
- Internal derangement, or when the disc is out of position and obstructing the movement of the condyle
- Myofascial pain, or pain involving the muscles of the face near the jaw joint
- Arthritis, such as osteoarthritis, rheumatoid arthritis, or psoriatic arthritis
- Dislocation, or when the jaw joints move out of their sockets
- Trauma, which may cause a sprain, a torn ligament, condyle fracture, fossa fracture, or any other injury to the disc and other TMJ structures
- Condylar hyperplasia, or the overgrowth of the condyle
- Ankylosis, or the fusion of the TMJ usually as a delayed complication of a traumatic injury or an infection
Not all TMJ disorders require treatment. Sometimes, simply resting the joints and making some lifestyle changes can relieve symptoms. Patients who experience jaw joint problems, for example, can simply avoid harmful habits such as grinding the teeth and chewing gums. While the problem is ongoing, patients can rest the jaw joints by going on a soft diet. Using warm compresses and pain medications can also help with the discomfort. Certain medical devices can also be used; one example is the bite-splint, which is worn at night to unload the jaw joint and help speed up its healing.
Of the above problems, only internal derangement, arthritis, and dislocation (especially when recurrent) are often treated using arthrotomy. The procedure is also often required in case a tumour is diagnosed or suspected. It is also the only effective method for the treatment of fibrous or osseous ankylosis.
In late-stage, chronic, or recurrent disorders, arthrotomy is also the preferred and more promising treatment option. The goals of the procedure are to relieve pain, improve the jaw joint function, and improve the patient’s quality of life.
An arthrotomy can be performed in conjunction with a discoplasty, a procedure wherein discs are repaired by suturing them into place. In the case of internal derangement or recurrent dislocations, the procedure is sometimes combined with an eminectomy. In an eminectomy, the height of the bone found in front of the fossa is reduced.
How is the Procedure Performed?
An arthrotomy of temporomandibular joint is an open joint procedure. It is invasive and is thus performed in a hospital operating room under general anaesthesia.
The procedure involves the following steps:
- With the patient under anaesthesia, the surgeon makes an incision along the patient’s ear. This incision is similar to the one made during a facelift, which exposes the entire jaw joint area.
- With the patient’s jaw joint exposed, the surgeon examines the area for signs of:
- Adhesions, which can restrict the movement of the disc
- Bone fusions
- The surgeon then performs the necessary treatment, such as removing tumours or releasing adhesions.
- The surgeon then closes up the incision with sutures.
The procedure takes around 2 to 3 hours, and patients are required to stay in the hospital for at least 24 hours.
The recovery period following an arthrotomy is significantly longer compared to that of an arthroscopy or other non-surgical TMJ treatments. Patients typically take three to eight weeks to make a full recovery.
Possible Risks and Complications
An arthrotomy is known to be a painful and invasive procedure. Thus, it is important for patients to be informed of the risks involved prior to undergoing the procedure. These risks include:
- Prolonged pain around the joint
- Nerve damage
- Blood vessel damage
- Allergic reactions to the anaesthesia
Potential risk factors for complications include:
- Preoperative joint collapse
- Missing molar teeth
- Skeletal malocclusion
Leibur E, Jagur O, Voog-Oras U. “Temporomandibular joint arthroscopy verses arthrotomy.” Regional Arthroscopy. ISBN 978-953-51-1044-6. Published February 27, 2013. http://www.intechopen.com/books/regional-arthroscopy/temporomandibular-joint-arthroscopy-versus-arthrotomy
Kirk WS Jr. “Risk factors and initial surgical failures of TMJ arthrotomy and arthroplasty: a four to nine year evaluation of 303 surgical procedures.” Cranio. 1998 Jul; 16(3): 154-61. http://www.ncbi.nlm.nih.gov/pubmed/9852808