Surgery and Treatment of TMJ Disorders

The temporomandibular joint is known as the "jaw joint" and is a small joint formed by the mandible and temporal bone in front of the ear. In addition, there is a cartilage tissue between these two bones that facilitates joint movements and prevents the wear of the bones that make up the joints. The jaw joint plays an important role in the fulfillment of daily functions such as chewing, speaking, breathing and stretching by enabling the lower jaw to move. The jaw joint is in constant motion not only up and down, but also to the right and left, and it should not be forced while moving. A healthy person uses this joint 1500-2000 times a day. With the synchronized movement of the neck and jaw muscles, the movements of the lower jaw muscles are shaped. Any malfunction in this mechanism will herald various diseases such as jaw joint disorder. 

What is Jaw Joint Discomfort (Temporomandibular Joint Disease)? 

This discomfort occurs as a result of incompatibility between the jaw joint and the surrounding tissues in order to protect this joint against abrasions. Incompatibility may occur over time or suddenly. If left untreated, it can cause serious problems such as jaw locking. For this reason, the sooner you apply to your doctor and start treatment from the moment the disease is noticed, the higher your treatment success rate and other serious problems that may occur can be prevented. Jaw joint diseases caused by incompatibility and working disorders between the joints are as follows;

• Jaw dislocations and chin locking
• Fractures resulting from traumas
• Congenital articular structures that develop little or no cuts
• Tumors developing in the jaw
• Jaw joint inflammation
• Rheumatic ailments affecting the jaw
• Neurological and psychological disorders affecting the jaw
• Functional disorders in the jaw; pain in the jaw joint, restricted jaw opening, difficulties in biting and plucking.

What are the Causes of Jaw Joint Disorders? 

In order to determine which treatment should be applied, the cause of the joint discomfort should be determined first. One of the symptoms of this joint disease is joint inflammation, namely “arthritis”. Joint inflammation develops as a result of clenching and grinding teeth at night or injuries. The other most important reason is the displacement or displacement of the disc between the socket and the jawbone. A disc that has been displaced for any reason may cause popping or clicking sounds. In addition, it restricts jaw movements and may cause pain during mouth opening and closing. The source of jaw joint disorders can be joint, muscle or both. Jaw joint disorders can be caused by any of the following reasons;

• Bruxism, that is, teeth clenching and grinding
• Using one side continuously while chewing
• Missing teeth
• Tumors affecting the head and neck region
• Traumatic and faulty dental procedures; Excessive strain of the jaw in anesthesia, incorrect fillings and coatings
• Postural disorders such as excessively tilted shoulders and neck forward
• Neurological and psychiatric problems
• Hereditary anatomical disorders
• Accidents that negatively affect the chin and face
• Habits such as biting hard objects such as pencils and biting nails.

What are the Symptoms of Jaw Joint Disorders? 

Although it may be mild at first, it can cause severe symptoms over time if left untreated. Symptoms of jaw joint diseases are as follows;

• Painful contractions in the jaw muscles
• Head and neck pain concentrated in the temples
• Difficulties in opening the jaw, up to chin locking, and the problem of sound when opening the jaw
• Shifting of the chin towards one direction in mouth movements
• Impairment of eating functions such as chewing, biting, cutting and tearing
• Teeth cracking, sensitivity, wear, breakage and shaking
• Jaw dislocations

How is Jaw Joint Treatment Performed? 

First of all, the diagnosis of the disease must be made. For this, a detailed examination of the teeth and closure system, joint and chewing muscles is performed by oral-maxillofacial surgeons. If necessary, intra-articular imaging is performed by MR. In addition, when necessary, computed tomography, normal radiographs, endoscopic procedures used for intra-articular imaging, PET or scintigraphy can also be applied. After the diagnosis is made, the treatment process begins.

The main purpose of the treatment is to ensure that the patient regains normal jaw functions, and the methods used for this purpose are shaped according to the degree of the disease. First of all, the patient's habits are reviewed. If one-sided chewing is in question, it should be trained to discourage this habit, and night splints should be used by those who have teeth clenching and grinding problems. In cases where the dental plaque does not work, "botolinium toxin", that is, "botox", can be applied. The aim here is to reduce the load on the lower jaw joint by preventing clenching. In some cases, drug treatments, elimination of dental problems, physical therapy and exercise applications suitable for chewing and joint muscles are solutions for many jaw joint diseases.

In painful cases, arthrocentesis can be performed to reduce pain. Surgical treatment is applied in cases called tumor, trauma, ankylosis and fusion of the lower bone to the temporal bone. Depending on the method to be applied, physical therapy, otolaryngologists, psychiatrists, maxillofacial surgeons and orthodontists act together. Muscle relaxants and pain relievers are prescribed to relieve muscle pain and prevent contraction of the jaw muscles. Open joint surgery is applied if there is tumor or degeneration around the joint, or in cases of serious injuries and fractures. It can be difficult sometimes to recover fully after open joint surgery.

To relax the facial muscles and jaw joint, the TENS method, that is, Transcutaneous electrical nerve stimulation, can be performed. In this method, low-level electrical current is used, which may cause pain in some patients.