TMJ Surgery: Everything You Need to Know

Temporomandibular joint disorder (TMJ) surgery is performed to correct the group of painful jaw conditions it's named after. The joint that causes the problem is the one that joins your jaw bone to your skull. Because of the complexity of the temporomandibular joint, which has hinging and sliding motions, TMJ disorders can be challenging to treat or correct.

TMJ jaw surgery may be a last resort treatment when at-home treatments, such as applying ice, eating soft foods, tooth guards, and dental treatment haven’t worked and you have severe pain or limited motion in your jaw.

What Is TMJ Surgery?

There are several different types of TMJ surgery, which range from minimally invasive outpatient surgeries to more complicated open-joint surgeries that require a hospital stay.

TMJ surgeries can be classified in two groups: closed procedures like TMJ arthrocentesis and TMJ arthroscopy, and open procedures like TMJ arthroplasty and joint replacement surgery.

• Arthrocentesis: This is the least invasive type of TMJ surgery. It is a minimally invasive procedure, and it's outpatient so you can go home the same day. Arthrocentesis involves inserting needles to inject a fluid that lubricates the joint and reduces friction. Your surgeon won’t need to make any incisions for this procedure.
• Arthroscopy: This is another minimally invasive procedure, but it is more invasive than an arthrocentisis. A scope is used to look at your joint and remove scar tissue, smooth the bone, or reposition the disc.
• Arthrotomy or arthroplasty: This open-joint surgery can be used to repair structural problems of the jaw joint. It usually requires a hospital stay. An incision faciliates a wide range of surgical procedures—including arthroplasty (removal of growths or adhesions in the jaw) and disc surgery.
• Joint replacement: For the treatment of severe TMJ disorder, implants can be surgically placed in the jaw to replace either part or all of the temporomandibular joint. This approach is intended for people who have severe pain or extremely limited function and have not responded to other treatments. You might want to get the opinions of more than one healthcare provider if you are considering joint replacement.

Contraindications

Your healthcare provider or dentist will advise against surgery if your TMJ responds well to at-home treatment or other non-surgical options.

TMJ surgery should not be considered when the condition doesn’t affect the joint, such as a problem with the muscles around the jaw or chronic pain syndrome.

If you’ve already had multiple TMJ jaw surgeries, you may be at a high risk of having a poor outcome from another surgery. Talk to your surgeon to understand the risks related to your condition.

Potential Risks

Complications can be more extensive with open joint surgeries than with minimally invasive surgeries. Before undergoing TMJ surgery, get multiple opinions from other healthcare providers to understand the risks and potential benefits.

Complications related to TMJ surgery include:

• Persistent pain or reduced mobility of TMJ that aren’t resolved by surgery
• Misalignment of teeth
• Facial nerve damage, weakness, or paralysis
• Deafness

Joint replacement, the most extensive type of TMJ surgery, can lead to significant complications for some people. Some artificial implants may not function correctly or can break apart in the jaw over time. More long-term clinical studies are needed to assess the safety of these surgeries, which are often irreversible.

Purpose of TMJ Surgery

TMJ disorders cause pain and decreased range of motion when you move your jaw. They may also cause a painful clicking or grating sound in the jaw joint while opening or closing your mouth.

The goals of TMJ surgery are to reduce pain and enable normal jaw function. Surgery may be considered for a jaw condition such as:

• Arthritis, which causes damage to the joints including the jaw
• Dislocated jaw
• Injury to the condyles, the ends of the lower jaw bone
• Displaced disc, which normally cushions the joint

There are some known causes of TMJ, although in many cases the cause is unknown. Some examples include autoimmune diseases, injuries to the jaw, and having your mouth open for a long time, such as during a dental procedure or when a breathing tube is inserted before surgery.

Once TMJ is diagnosed—via examination of the head, neck, face, and jaw; a review of symptoms like pain that occurs when chewing; and imaging tests like X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI)—your healthcare provider or dentist will likely advise you to first try non-surgical treatments.

This may include reducing stress, gentle jaw stretching exercises, applying ice or moist heat, eating soft foods, and avoiding big jaw movements when chewing gum or wide yawning. Your healthcare provider may also suggest over-the-counter pain medications, such as Tylenol (acetaminophen) or Advil (ibuprofen).

Oral devices, such as a stabilization splint or bite guard may be used to help relieve pressure and pain in your jaw.

Surgery is only considered if these have been tried and have failed to provide relief.

How to Prepare

Ask your healthcare provider any questions you have before the surgery. They can talk to you about the steps of your surgery and how you can expect to feel after the procedure.

You can also prepare by buying soft foods and nutrition/sports drinks to consume after surgery. Make sure to have ice packs on hand and fill any prescriptions before the surgery.

Location

Arthrocentesis can be done as an in-office procedure, with your healthcare provider placing hyperdermic needles into your joint without general anesthesia.

General anesthesia administration must be done in a hospital.

An arthroscopy is performed in an outpatient facility in a hospital or surgical center.

An open-joint surgery such as an arthrotomy or a joint replacement is performed in a hospital.

What to Wear

Wear loose, comfortable clothing to your surgery. You’ll be asked to change into a gown before the procedure.

Food and Drink

Check with your surgeon to get specific recommendations in your case. With general anesthesia, you’ll have to stop eating or drinking after midnight on the day of your surgery to make sure that your stomach is empty.

Medications

Talk to your surgeon about your current medications before the surgery. They will likely advise you to stop taking medications that can cause increased bleeding, including Coumadin (warfarin), aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs).

What to Bring

On the day of surgery, bring any needed paperwork, identification, and insurance cards. If you’ll be staying overnight at the hospital, bring a change of clothes and personal care items.

You should also make arrangements for someone to bring you home after the surgery.

Pre-Op Lifestyle Changes

If you smoke, talk to your healthcare provider about when you should quit before surgery. Smoking can interfere with healing and increase the chance of infection.

What to Expect on the Day of Surgery

On the day of surgery, you’ll check in and nursing staff will meet with you to check your vitals, ask about your medical history, and start an intravenous (IV) line.

You’ll probably also meet with the surgeon and anesthesiologist to talk about the steps in the procedure and how you should expect to feel when you wake up.

During the Surgery

Depending on the procedure, you’ll either be given local anesthesia, IV sedation, or general anesthesia. If local anesthesia is used, the surgeon will clean around the joint and numb it by injecting medicine. If IV sedation is administered, you’ll be awake but calm. General anesthesia is either given through a breathing mask or through an IV in your arm.

You may have a breathing tube inserted to protect your lungs. With each type of anesthesia, you’ll be monitored throughout the surgery.

The procedure steps may differ depending on what type of surgery you have.

Arthrocentesis: Step by Step

This surgery is typically performed with local anesthesia, but IV sedation or general anesthesia may be used as well.

• After the joint is numbed or you are asleep, the surgeon will place two hypodermic needles into the joint.
• The joint is flushed with sterile saline solution or lactated Ringer’s solution to remove anything that’s causing inflammation and pain.
• Your surgeon may adjust your jaw to help remove scar tissue adhesions if needed. The surgeon may also inject a corticosteroid to reduce inflammation in the joint at the end of the surgery.

The procedure usually takes less than 30 minutes.

Arthroscopy: Step by Step

This procedure is done with general anesthesia.

• Your surgeon will make small incisions around your jaw joint and insert cannulas. These thin metal tubes contain cameras that let your surgeon visualize your jaw joint and the surrounding structures.
• With this visualization, the surgeon can wash out the joint or perform a disc repair or bone spur removal with small, specifically designed surgical instruments.

An arthroscopy is an outpatient procedure, so you’ll go home the same day. The procedure may take between 30 minutes and two hours.

Arthrotomy: Step by Step

This procedure is an open-joint procedure that’s performed with general anesthesia.

• An incision is made along the ear, avoiding damage to the facial nerve.
• Disc repair or repositioning or discectomy or removal of the entire disc is then performed, as needed.
• The surgeon may also reshape the condyle (end of the lower jaw bone) and the fossa (socket) if you have arthritic changes.

The surgery may last between one to two hours. You may be able to go home the same day or you may require a short hospital stay.

Joint Replacement: Step by Step

This is an open-joint procedure that requires general anesthesia and a hospital stay.

• The surgeon makes two incisions for both components to be implanted – one that’s attached to the skull and one to the lower jaw.
• The surgeon will place an artificial replacement called a prostheses.

The length of surgery depends on your individual case, but it will likely take several hours.

After the Surgery

Most TMJ surgeries are outpatient procedures, so you can usually go home the same day. You’ll be monitored in the recovery room to make sure that your vitals are stable before your medical team allows you to leave.

If you had general anesthesia, you’ll wake up in the recovery room. You’ll likely feel some pain in the jaw. Let your nurse know if you’re experiencing discomfort so they can give you pain medicine and help you feel comfortable.

If you’re staying in the hospital overnight, you’ll be taken to your hospital room. For a total joint replacement, you may be at the hospital for three to five days before you’re able to go home. Hospitals and surgery centers may differ on their discharge policies.

Your surgeon may prescribe pain medicine for you to take once you get home. Your jaw joint and the area around it will be numb or temporarily paralyzed. This is caused by the anesthetic and should last for a few hours.

Recovery

Your recovery will depend on the procedure that you had done.

Your surgeon can give you information about when you can expect to go back to work after your procedure. For minor procedures, this might be the next day. Open-joint procedures, on the other hand, may require several weeks off, depending on your job and the type of surgery.

Your healthcare provider will probably suggest you schedule a follow-up appointment about two to three weeks after surgery to make sure everything’s healing correctly and discuss how you’re feeling.

Healing

Depending on the procedure you had, you may have bandages to wear for several days afterward. Your stitches may dissolve on their own or they may need to be removed at a follow-up appointment. Your surgeon will let you know when you can remove the bandage and when you can clean the area with soap and water.

With most TMJ surgeries, you’ll experience swelling, bruising, jaw pain, and tenderness. Apply ice packs to the face for no more than 20 minutes at a time for the first day after surgery. Keep your head elevated using two or three pillows when resting to help with swelling.

After 48 hours, you can apply warm heat from a heating pad or a microwaved wet washcloth to help with any discomfort. Your jaw will probably be swollen for a week or more after surgery.

For discomfort, your healthcare provider may prescribe pain medication or suggest taking over-the-counter medicines. They may prescribe muscle relaxants if you’re experiencing any spasms.

You may notice a change in your bite or clicking in your jaw. Let your healthcare provider know if this doesn’t resolve on its own as your joint heals over the days and weeks after your procedure.

Physical therapy or jaw exercises can help to restore your jaw’s function and range of motion. Your surgeon may suggest that you see a physical therapist to start jaw exercises in the first week after your surgery.

Diet

With all TMJ surgeries, you’ll need to eat a soft diet during the healing process. This may start with liquid-based foods, like smoothies and soups. After several days, you may be able to add soft foods like yogurt, applesauce, oatmeal, soup, mashed potatoes, and eggs. Avoid hard, chewy, and crunchy food.

Your healthcare provider will let you know when you can start adding other foods to your diet. For total joint replacement surgery, this process may take up to eight weeks.

It may be easier to eat small amounts every few hours rather than large amounts at mealtimes.

Possible Future Surgeries

Total joint replacements require monitoring by healthcare providers on a long-term basis to check for structural damage or incorrect placement. While most joint prostheses will last more than 10 years, studies are limited on their longevity, and complications can occur that would require another surgery. Retrieval of this joint can be challenging, however, particularly if the new joint has integrated with the bone.

If you’ve had an open-joint TMJ surgery, be cautious about considering any additional surgeries on the jaw joint. Multiple surgeries may not be beneficial for relieving pain and restoring jaw function.

A Word From Verywell

Having surgery to alleviate your TMJ pain and other related symptoms is a last-resort measure. However, sometimes it is the best option. You may want to include your TMJ specialist, regular healthcare provider, and dentist in your decision-making process. Educate yourself about the different surgical techniques, their risks, and what you need to know about recovery so you can feel more confident that the decision you make is what's best for you.