TMJ Disorders

Temporomandibular Disorder Surgery covers a wide range of painful oral and facial symptoms involving the joint and surrounding facial muscles. Conditions primarily involving the soft tissues, the most common of which is bruxism (grinding) can be managed successfully with non-surgical modalities (bite guard, diet, heat, anti-inflammatories).

True problems involving the joint itself, the most common of which is a disc displacement (internal derangement) may also respond favorably to the modalities.  Those patients who continue to have persistent pain and jaw dysfunction, and fail to respond well to non-surgical modalities, may elect to consider a surgical procedure to treat the joint.

Range of Surgical Options

Surgical options fall into the following categories:

 

TMJ Replacement

Depending upon age, amount of damage to the temporomandibular joint, and previous surgeries, replacement of all (total) or part (partial) of the joint structures may be indicated. Indications for this surgery include:

• Inflammatory arthritis that has not responded to other therapies
• If the tissues of the joint fuse (ankylosis) causing loss of motion in the joint, resulting in inability to open the mouth properly
• If bite changes and/or facial appearance has changed as a result of a TMJ problem
• Severe internal worsening (internal derangement) that does not respond to other therapies
• If previous attempts at surgery by opening the joint have failed to resolve the problem
• Loss of normal anatomy of the joint due to trauma or pathology of the TMJ

Types of Joint Replacements

Depending on the patient’s age and condition, joint replacement can be performed with either natural or artificial materials. For an actively growing patient, the use of a patient’s own rib is preferred. For an adult, we prefer the use of a metallic joint replacement, which has been shown to have long lasting success in many patients. Joint replacements can be used of standard (stock) sizes or customized (patient specific) to fit each individual patient.

The Custom Joint Replacement Process

A specially formatted CT scan is taken of the facial bones, and the data is sent to the joint manufacturer. An extremely accurate anatomic model is manufactured from the computerized data that is used to design the implants.

Once the design process is approved by both the surgeon and the manufacturer, the joint is manufactured. Joint prostheses can be made as metal against polymer, designed by computer (CAD CAM) or by a direct wax, which is then cast as a metal against metal joint.

The Surgical Procedure

Although each replacement is unique for each patient’s condition, most patients can expect a 1-2 day stay in the hospital. Surgical braces, or standard orthodontic appliances, are applied to line up the teeth during the procedure and are removed postoperatively. Patients that also have a jaw deformity or bite discrepancy may also undergo jaw repositioning at the same time. Although the jaws are not wired shut after the surgery, physical therapy is required as soon after the procedure as possible. This involves use of a hand held jaw exerciser and frequent visits to the therapist. A non-chew diet can be expected for the first 2-4 weeks following surgery.

Dr. Sultan has been specially trained in the use of both partial and total joint replacements. He has taken part in educational meetings and performed surgery both nationally and abroad. He is one of the few surgeons in South Florida experienced to perform these procedures