Open temporomandibular joint (TMJ) surgery (arthroplasty)

What is open surgery?

In a very small minority of patients, the degenerative changes in the joint may preclude minimally invasive treatments. I will always enter into a full and frank discussion with patients about the risks and benefits of taking the next step in surgery, which is open arthroplasty.

In these cases, the joint is opened through an incision in front of the ear. I make sure to keep this incision as small as possible and as aesthetic as possible, mimicking a rhytidectomy (facelift) incision to minimise the scarring. The joint is identified and any work that is required is then completed on a case-by-case approach, bespoke to your individual requirements. This may include reshaping the head of the condyle (lower jaw), clearing out any adhesions or interferences, fixing the intra-articular disc (meniscopexy) or removing the disc entirely (meniscectomy).

This surgery is reserved for challenging cases and represents a halfway house between arthroscopy and total joint replacement, avoiding some of the risks of the latter. I will generally discuss the relative risks and benefits of open arthroplasty against total joint replacement to enable you to make a full and informed decision.

Are there any complications?

Open joint surgery is more risky than minimally invasive treatment, but as a surgeon with a subspecialty practice in TMJ surgery, I am accessing the joint on a regular basis and have a significant volume of activity in my surgical logbook. This enables me to keep those risks to an absolute minimum. Risks will include pain, swelling, bleeding, infection, failure to improve symptoms, scarring, temporary/permanent sensory alteration and/or facial paralysis, changes to the occlusion (bite) and progressive degenerative changes necessitating joint replacement.

Again, I would stress that my expertise in this particular field will aim to keep these risks to the absolute minimum, ensuring that you stand the very best chance of making an uneventful recovery.

What is recovery like?

In this surgery, I will generally arrange for you to spend one night in hospital on an inpatient ward. This enables me to monitor any drains from your surgical sites, as well as providing adequate pain relief in those crucial few hours. I will see you within two weeks following surgery to start post-operative physiotherapy with a Therabite® Jaw Motion Rehabilitation System™ and continue to monitor your recovery closely over the next few months. Things are generally settling by around two to three months post-operatively when we would expect to see improvements in function and pain in the majority of patients carefully selected for this procedure.