Temporomandibular joint surgery · New Jersey
TMJ Surgery
Minimally invasive arthroscopy, open joint repair, and total joint replacement for temporomandibular joint pain, locking, and degenerative disease, chosen in steps and starting with the least invasive option likely to work.
Medically reviewed by Benjamin Subtelny, DDS, board-certified oral and maxillofacial surgeon
The joint
When the Joint Is the Problem
The temporomandibular joints hinge and slide to open the lower jaw as we speak and chew. A small disc of cartilage cushions each joint and allows the jaw to glide smoothly against the base of the skull. When the disc slips out of position, or the joint surfaces wear down, the result can be pain, clicking, locking, a change in the bite, or difficulty opening the mouth.
Many TMJ problems improve without surgery. Before surgery is considered, most patients are treated with an oral appliance, physical therapy, anti-inflammatory medication, and attention to clenching and grinding. Botulinum toxin injections to the chewing muscles can help when muscle pain is a large part of the problem, and can protect the joints from excessive clenching forces that wear them down further. Dr. Subtelny coordinates this care with your dentist or orofacial pain specialist and recommends surgery only when the joint itself is the source and conservative treatment has not been enough.
Before Your Consultation
TMJ consultations are surgical evaluations. They are most helpful for patients who have already tried non-surgical care, such as an oral appliance or physical therapy. If you have had an MRI or CT scan of the jaw joints, please mention it in your request.
Some joint problems call for a surgical evaluation right away: a bite that is changing significantly, erosion of the jaw joint seen on imaging, or a growth in the joint. If any of these apply, request a consultation directly.
If your symptoms are mainly pain or clicking and you have not yet tried non-surgical treatment, your dentist or an orofacial pain specialist may be the best place to start. If you are looking for an orofacial pain specialist, email us and Dr. Subtelny may be able to recommend one in your area.
Indications
Signs a Surgical Evaluation Makes Sense
- Locking open or closed, or a sudden loss of mouth opening
- Joint pain that persists despite appliance therapy and physical therapy
- Painful clicking or popping that is getting worse
- A change in the bite, such as a new open bite or a shifting jaw
- Degenerative joint disease or condylar resorption on imaging
- A joint that has not improved after previous surgery
Evaluation includes a joint examination, measurement of mouth opening and jaw movement, and imaging. MRI shows the disc and soft tissue, and cone-beam CT shows the bone. Together, these findings show how far the joint disease has progressed, which guides the choice of treatment.
Treatment
Surgical Options, From Least to Most Invasive
Arthrocentesis
The joint is rinsed through two fine needles to flush out inflammatory chemicals that can damage the joint over time, and a steroid is then injected to calm the inflammation further. Recovery is usually a day or two.
TMJ Arthroscopy
A tiny camera, only a couple of millimeters wide, is placed into the joint through puncture incisions in front of the ear that are hardly bigger than a needle. Adhesions are released, the joint is irrigated, and inflamed tissue is treated directly. Dr. Subtelny pairs arthroscopy with an injection of platelet-rich fibrin, prepared from your own blood, and with botulinum toxin to the chewing muscles to protect the joint while it heals. Most patients return to normal activity within a few days.
TMJ Arthroplasty
Through an incision hidden along the inner surface of the ear, the joint is opened, the disc is returned to its proper position, and the ligaments that hold it in place are reconstructed. The disc is secured with a small bone anchor. This is used when the disc is displaced but can still be saved. When the disc itself has been severely damaged, it is removed and a fat graft is placed to cushion the joint.
Total Joint Replacement
When the joint has been destroyed by arthritis, resorption, ankylosis, or trauma, it can be replaced with a prosthesis of titanium and medical-grade polyethylene, stock or custom-made from your CT scan. For the right candidates, joint replacement reduces pain and improves mouth opening and diet. TMJ total joint replacement
Combined TMJ and Jaw Surgery
When joint disease has changed the shape or position of the jaw, joint surgery and corrective jaw surgery are planned together and performed in the same operation.
Care team
A Team Approach to TMJ Disorders
TMJ disorders, often called TMD, usually involve more than the joint itself. Muscle pain, clenching and grinding, and poor sleep can all play a part. Dr. Subtelny works closely with orofacial pain specialists and dentists so that surgical and non-surgical care work as one plan.
- Before Surgery
- Your dentist or orofacial pain specialist leads non-surgical treatment, and Dr. Subtelny reviews your progress with them. If surgery is recommended, the plan for non-surgical care around it is agreed upon before the operation.
- Through Recovery
- Non-surgical care continues around the operation. Appliance therapy, care for the chewing muscles, and guided jaw exercises protect the repaired joint while it heals.
- Long Term
- Physical therapy and ongoing care with your dentist or orofacial pain specialist help restore mouth opening and chewing and keep discomfort down. Surgery repairs the joint, and this continued care helps you get the full benefit of it.
Questions
Common Questions
Does TMJ arthroscopy leave a scar?
The entry points are tiny punctures in front of the ear, hardly bigger than a needle, and are usually difficult to see once healed.
Will surgery stop my jaw from clicking?
Clicking without pain is common and usually does not need surgery. TMJ surgery is aimed at pain, locking, and loss of function.
How long does a total joint replacement last?
Modern TMJ prostheses have been followed in published studies for more than two decades with stable results in most patients.
Can I have TMJ surgery and jaw surgery at the same time?
In many cases, yes. Planning both together avoids a second recovery and lets the bite be corrected on a stable joint.
Is TMJ surgery covered by insurance?
TMJ surgery is billed to medical insurance, and coverage varies by plan. Our office checks your plan, prepares the documentation, and requests prior authorization before surgery is scheduled. Insurance and costs
Next step
Talk It Through in Person
Consultations in Paramus and Old Bridge, New Jersey. No referral is needed.