Temporomandibular joint (TMJ) arthroscopy

What is an arthroscopy?

An arthroscopy is a minimally invasive procedure in which a small camera is introduced into the TMJ. It is an innovative treatment modality that has seen significant advances in recent years. The cameras are dedicated devices for the TMJ specifically and within my practice I use the Nexus CMF 1.9mm 30-degree arthroscope system. I have specifically attended training events run by the manufacturers in Salt Lake City, Utah USA to bring the very latest concepts in minimally invasive surgery to the West Midlands region.

Arthroscopy is typically day case surgery (no overnight stay) which is done under general anaesthesia. Whilst asleep, a small puncture is made in front of the ear with the camera, entering the joint space of the TMJ. This enables flow of irrigation through the joint and injection of intra-articular supplements such as hyaluronic acid or steroid within the joint. I am proud to offer advanced arthroscopic surgery (level 2) via the introduction of a second working port anteriorly to enable synovial biopsy and synovectomy with coblation. These are advanced techniques offered by very few surgeons in the United Kingdom currently.

For patients with internal derangement of their TMJ and/or arthritis in the earlier stages, arthroscopy can provide a useful diagnostic tool, but also significantly improve pain, dietary intake, function and quality of life. It has been instrumental in delaying and, in many cases, avoiding open joint surgery, with minimal downtime and lower complication rates.

Are there any risks?

TMJ arthroscopy is day case surgery (no overnight stay) and is generally safe with a favourable risk/benefits profile in appropriately selected patients. Common risks including some swelling, increased pain initially for the first few weeks and bruising. The entry sites for the ports generally heal up with undetectable scarring, although in susceptible patients scarring may be visible, albeit small. There are risks of temporary or permanent facial paralysis, sensory alteration to the lower lip, chin and/or tongue and inadvertent damage to the skull base, ear drum, ear canal and/or airway. These risks are exceedingly uncommon and in my practice to date, I have seen no permanent facial palsy cases from this surgery.

What is the recovery like?

Patients can expect to go home the same day following this surgery. There may be some swelling and discomfort in the first few weeks and I generally recommend taking the remainder of the week to rest after surgery, gently exercising the joint to get things moving. Within a fortnight, patients can expect to be back to baseline with significant improvements in pain, function and quality of life being apparent by the initial review at around six weeks post-operatively in most instances.

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