TMJ Arthroplasty
The arthroplasty, or sometimes called arthrotomy, is an open joint procedure done under general anesthesia in the hospital. This is, in my opinion, the first “big” surgery. The recovery is significantly longer and more painful than the TMJ arthrocentesis or TMJ arthroscopy.
An incision is made similar to a face lift incision (along the ear), and the joint space is exposed for the surgeon to see. This allows for the removal of adhesions, osteophytes (bone spurs), fibrous or bony ankylosis (fusion), tumors, etc. The surgeon can also repair discs by suturing them into place, implant anything from a temporalis muscle graft to ribs. “Arthroplasty” is a general term meaning “open joint.” Here are some of the types of arthroplasty:
- Temporalis Muscle Graft - a piece of your temple (temporalis) muscle is slid between the joint to prevent it from being bone on bone.
- Temporary Silicone Implants - Silicone sheeting has been used in the past to act as a pseudo-disc. Silicone sheeting specifically marketed for the TMJ was voluntarily withdrawn from the market in 1993. After the TMJ implant fiasco of the early 90’s, the FDA asked for pre-market approval on ALL devices to be implanted in the TMJ. No companies submitted the required safety testing or pre-market approval paperwork for silicone. If a doctor mentions using silicone, he is doing it off-label. Beware! The FDA says on it’s Consumer Information page, “FDA is presently working with manufacturers to appropriately label silicone sheeting with warnings against its use in the TMJ implant.”
- Rib Grafts
Like I mentioned above, the recovery for the arthroplasty is significantly longer than both the arthroscopy and arthrocentesis. It has varied among the type of arthroplasty I have had, but the recovery can be anywhere from 2 weeks to 6 weeks.
Depending on the surgeon, you might stay in the hospital overnight. I recommend this highly. When I have stayed in the hospital, my recovery has been shortened by two to three weeks compared to the arthroplasties without hospital stay. If staying less than 24 hours, this is still considered ‘outpatient’ by insurance.
Aggressive physical therapy is often started soon after a TMJ arthroplasty. This can be done by seeing a physical therapist, or by the patient with a device that opens and closes the mouth, similar to continuous passive motion devices used for knee surgery patients.
