SURGERY ON THE TMJ

An arthrocentesis is a procedure during which the jaw joint is washed out with sterile fluid. An arthrocentesis usually takes place under a general anaesthetic. While you are asleep two small needles are inserted into the jaw joint. One of these needles allows sterile fluid to be pumped into the joint under pressure. The second needle allows fluid to be drained out of the joint. Your lower jaw will also be manipulated in an attempt to encourage the disc of cartilage back into its normal position. Arthrocentesis is not always successful and even in those people who have an improvement following the procedure symptoms can return.

Arthroscopy is a form of keyhole surgery in which a small arthroscope (telescope) is inserted into a joint. This allows the inside of the joint to be viewed in detail. Arthroscopy can diagnose as well as treat problems within the jaw joint. Arthroscopy is carried out under general anaesthesia. (i.e. you are put to sleep completely). The arthroscope is introduced into the jaw joint through a small cut in front of the ear. Other fine instruments are inserted through a second small cut. The area in and around the jaw joint is often uncomfortable for a day or two after the procedure. Simple painkillers (e.g. Paracetamol) will resolve this discomfort. There may be some slight swelling in front of your ear. It may be difficult to open your jaw fully for a few weeks.

Open surgery involves exposing the jaw joint fully by making a cut in front of the ear rather than using keyhole techniques. Although the cut extends from the top to the bottom of the ear and onto the hair bearing scalp, it is placed in a skin crease so that when it heals it will be difficult to see. The wound is closed with stitches which are removed 7 days after the surgery. At the end of the operation a small tube (referred to as a drain) is also placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed the following morning. Antibiotics are routinely given through a vein in your arm whilst you are in hospital. You will be sent home with painkillers and a course of antibiotics

The area in front of your ear is likely to be sore for several days after surgery. Immediately after the operation your face may be swollen and feel tight, your jaw will be stiff and you will find that you cannot open your mouth widely. Most of the swelling will have disappeared after a week.

The facial nerve runs close to the jaw joint. It is this nerve that makes the muscles of your face work. This nerve makes the muscles of the face, forehead and eyelids move. Most nerve damage occurs as a result of bruising since the facial nerve is protected during surgery. If the facial nerve is damaged during surgery it can lead to a weakness of the face (facial palsy) on that side. In most cases the nerve works normally after the surgery. If nerve damage occurs it is usually temporary although it can take several months to recover fully.

The nerve that supplies feeling to your earlobe (great auricular nerve) can sometimes be bruised as a result of surgery. You may end up with a numb or tingling feeling in your earlobe.