TMJ Total Joint Replacement

Indications: Post-tumor resection, post-trauma/fracture, microsomia, surgically mutilated joints, anklosis, serverely degenerated joints.

Description: TMJ total joint replacement (TJR) is an open joint surgery performed in patients who have intolerable and/or intractable TMJ pain and severe joint damage.  Most patients have failed multiple modalities of previous treatment including non-surgical treatment and often multiple surgeries. TJRs include replacing the condyle with metal or a rib graft, the  

A TMJ TJR surgery requires two incisions.  An upper incision is made over the joint area in front of the ear.  A lower incision is made in a skin crease (if present) in the upper neck.  The upper incision usually extends from inside the sideburn area, then in front of the top of the ear then extending into the ear itself.  The part that extends into the ear is placed there to hide incision from view.  This “skin flap” is then reflected forward to expose the underlying layers.  The fascia layer is exposed and reflected, exposing the TMJ capsule.  The capsule is opened and the bones of the joint examined, special care is taken to identify rough surfaces, sharp edges, cavities or anatomical abnormalities.  The disk (meniscus) usually has been removed during a previous surgery.

The lower incision is then made through the tissues of the neck until the mandible (lower jaw) is encountered.  This incision exposes the part of the lower jaw where the condylar prosthesis is screwed into place.  The lower incision is connected to the upper incision through a tunnel under the tissues.

The fossa (socket) is smoothed down with power tools.  The condyle is cut off to allow room for the metal replacement.  The fossa prosthesis is placed into the natural fossa and held in place with wires or screws.  The condyle is then fitted into position and attached to the lower jaw with two or three screws. Most prosthetic joints are now custom made for each individual patient.

In a rib graft, instead of prosthesis' being implanted, the condyle is cut down and a section of the patients rib is attached in its place. This rib graft acts as a new condyle within the joint.

Just before the incisions are made the patient’s jaws are often wired together.  This is done so that when the TMJ TJR procedure is done the teeth will be in the right position.  The jaws will be wired together generally for a few days to a week after surgery.

The upper incision is similar to the front part of a facelift incision and is therefore very cosmetic.  Usually the only visible part of the scar is just in front of the upper part of the ear.  The rest of the scar is hidden in the sideburn area and inside the ear.  The lower incision is usually camouflaged nicely by the skin crease in which it lies.  Usually the incisions are almost entirely undetectable.

Post-procedure care: Thermal therapy, pain medication, aggressive physical therapy including CPM, close and frequent follow up, yearly evaluation with imaging

(Please see our Post-surgical Rehabilation page for more information.)

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