The temporomandibular joint, or TMJ, is a small joint located in front of the ear where the skull and lower jaw meet. This joint allows the lower jaw (mandible) to move and function and is the most constantly used joint in the body. The TMJ is a “ball and socket” joint, and the round end, or “ball” is called the condyle; the “socket” is called the fossa. Between the condyle and the fossa is a disc made of cartilage that acts as a cushion to absorb stress and allows the condyle to easily move when the mouth opens and closes.
Ligaments hold the disc and condyle in place, and muscles surrounding the TMJ help stabilize the joint as well as move the lower jaw during chewing speaking and other functions.
The teeth themselves are also important for proper TMJ function, because if they don’t fit together properly, stresses can be generated that can displace the condyle and damage the disc, ligaments and muscles. Trauma can also damage the TMJ and inhibit proper function.
TMJ disorders can be relatively minor, or they can be extremely painful and potentially debilitating. Emotional stress, with attendant habits such as grinding or clenching the teeth, can trigger TMJ symptoms as well as muscle spasms around the joint and jaws. Malpositioned jaws also may produce TMJ problems and, in some cases, arthritis may be the cause of TMJ disorders. Injury, such as a blow to the chin or jaw, can displace the condyle or disc, this causing problems. In some cases the TMJ disorder the disc is displaced to the front of the joint which interferes with its ability to properly interface between the “ball” and “socket”. This front displacement of the disc to make a clicking sound when the joint functions, and joint uses sensitive soft tissue to function on as opposed to smooth cartilage. In some cases the disc may move so far forward that the mouth cannot be widely opened. This can cause a condition known as degenerative joint disease.
TMJ sufferers can display a variety of symptoms, and certain signs may indicate the potential for TMJ disorders to develop. Following are signs and symptoms that are possible in patients with TMJ problems:
Presence of some of these signs and symptoms could also indicate a specific type of disorder known as myofascial pain dysfunction syndrome or MPD. This disorder is accompanied by muscle pain and tenderness, limitation in range of jaw motion, and local pain usually limited to one side of the face. Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward can diagnose this disorder when evaluating your need for TMJ surgery.
When symptoms of TMJ trouble appear Dr. Lignelli, Dr. Smith, Dr. Lignelli, II or Dr. Ward should be consulted. They are oral and maxillofacial surgeons specialized in the area of the mouth, teeth, and jaws and can diagnose TMJ problems using a variety of tools and techniques.
Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward will review your medical history, physically examine you head and neck, including the TMJ, and a variety of tests that may be used to confirm or eliminate a diagnosis of a TMJ disorder. These tests may include x-rays, MRI, CT scans, or arthrograms. Your teeth will also be examined. If necessary referrals to other dental or medical specialists such as an orthodontist, restorative dentist, neurologist, or physical therapist may be suggested.
When discussing you history with one of the doctors, make sure you give details about the following important areas:
In the treatment of TMJ disorders you will be working in partnership with your surgeon and in some cases your orthodontist and restorative dentist. It is important to know that most types of TMJ disorders can be treated, in whole or at least in part by “conservative therapy” or self care. Other problems require more extensive therapy, sometimes including surgery. The following are treatment options that will be reviewed by Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward with you to determine the specific treatment needed in your case:
In almost all cases it is important to rest the jaw by keeping the teeth apart for periods of time and to practice good posture. It may be necessary to avoid hard foods that strain the jaw when chewing. Just as resting the jaw can be beneficial, proper exercise of the jaw may also be helpful at appropriate times. Exercises can help restore normal range of motion in cases where jaw movement is restricted by a TMJ disorder. These exercises should consist of gentle opening and closing movements to avoid stressing the joint. Moist heat can be used to help relax muscles of mastication. Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward may prescribe medications such as muscle relaxants and/or anti-inflammatory drugs that can help relieve discomfort, reduce inflammation, and break the cycle of pain.
There are a variety of physical therapy techniques that can be used to treat certain types of TMJ disorders and these may require referral to the appropriate specialist. These techniques include jaw exercises, posture training, electrical stimulation, ultrasound, biofeedback, and others.
Dr. Lignelli, Dr. Smith, or Dr. Lignelli, II or Dr. Ward may recommend the construction of a nightguard device, or occlusal splint to be worn for varying amounts of time, depending on the nature of your TMJ problem. There are many types of splints to help reposition the jaw, prevent clenching and grinding of the teeth, rest the jaws, and help relax the jaw muscles. Orthodontic treatment or dental treatment such as restorations to correct a defective bite may be necessary and potentially therapeutic as they restore proper harmony between the teeth, muscles, and joint. If the position of the jaws is incorrect, corrective jaw surgery to reposition the upper and/or lower jaw may be indicated to restore balance and be potentially helpful in resolving the disorder.
In cases where the diagnosis indicates a specific problem with the TMJ or where several attempts at non surgical intervention have failed, joint surgery may be an appropriate treatment. TMJ surgery is designed to treat and fix a specific problem including removal of scar tissue, repair and reposition of the disc, alter the anatomy of a joint, remove pathology or degenerative tissue. TMJ disorder often presents with overlying MPD therefore, surgical and non-surgical management must be performed in conjunction to gain the maximum benefit. Following are surgical options you and your doctor may consider:
An arthroscope is a miniature telescopic instrument, like that used for many years with knee joints, through which the contents of the jaw joint can be viewed. Pottstown Oral and Maxillofacial Surgery was the first oral surgery practice in the area to begin using this technology and helped train the “big city” hospitals in this procedure. Using a special arthoscope small enough to enter the TMJ, Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward can visualize the joint and can perform minor surgical procedures such as treating cartilage damage. Arthoscopic surgery is performed at Pottstown Memorial Medical Center operating room outpatient pavilion under general anesthesia. Once you are asleep, the joint is flushed out with numbing medicine and fluids.. The TMJ is then carefully entered with the arthroscope though a small, five millimeter incision, in front of the ear. After the arthoscope has been placed, your surgeon can view the magnified anatomy of the joint on a television screen. Dr. Lignelli, Dr. Smith, Dr. Lignelli, II, and Dr. Ward can perform the needed treatment through the scope using specialized instruments such a laser to remove scar tissue, reduce swollen, inflamed tissue, and reposition an out-of-place disc.
In some cases arthroscopic surgery may be incapable of correcting a TMJ problem and other surgical procedures need to be considered. For example, if a disc is displaced and can not be moved back into proper position, then open surgery may be neede to expose the joint and allow more complex treatment procedures to be performed. Arthroplasty involves making an incision in front of the ear to expose the joint so the surgeon can repair a disc or ligament. Your surgeon can also remove any diseased condyle as a result of degenerative joint disease, any boney interferences can be smoothed out or removed, and the disc can be secured into its correct position with the help of stitches.
TMJ PROSTHETIC JOINT REPLACEMENT
In the event of severe joint deterioration , such as may occur in certain types of arthritis affecting the TMJ, more extensive surgical procedures are available to treat the problem. Much like a knee or a hip joint can be replaced with a prosthetic, the TMJ can also be replaced. Using a computer generated image of your CT scan, a three-dimensional model of your skull can be fabricated out of plastic. Using this model a prosthetic joint of metal and plastic can be custom made to your model and surgically inserted by your doctor. This procedure would be performed at Pottstown Memorial Medical Center in the operating room under general anesthesia.