Temporo mandibular joint

Disorders and clinical surgical treatment in Maxillofacial Surgery

The temporomandibular joint

The temporomandibular joint (TMJ) is one of the most complex structures in the musculoskeletal system, allowing opening, closing and latero-deflection movements of the jaw.

TMJ disorders can cause pain, restriction of movement, and reduced quality of life, often leading to additional complications such as chronic high intensity headaches, sleep and concentration disorders, cervical rachialgia, and even trigeminalgia (i.e., trigeminal nerve syndrome.

In some cases, Maxillofacial Surgery is indicated to treat these disorders. In this article, we will review the main causes of TMJ disorders and the available clinical and surgical treatment options.

    Causes of TMJ disorders

    TMJ disorders can have several anatomo-functional causes, including:

    • Trauma – fractures, dislocations, edentulousness (loss of dental elements) and ligament injuries can cause TMJ dysfunction;
    • Arthritis – wear and tear of joint surfaces and inflammation of surrounding structures can cause pain and restriction of movement;
    • Joint disc dislocation-the disc may move anteriorly or posteriorly, causing blockages and pain during jaw movements;
    • Structural abnormalities-congenital or acquired deformities can alter TMJ function and cause dysfunction.

    Non-surgical treatments

    Nonsurgical clinical treatments for TMJ disorders include:

    • Pharmacotherapy-analgesics, anti-inflammatories, and muscle relaxants can be used to relieve pain and inflammation;
    • Physiotherapy-mobilization exercises and stretching can help improve mobility and reduce pain;
    • Occlusal therapy–devices such as splints and plates can be used to correct occlusion abnormalities and reduce stress on the TMJ.

    Surgical Treatments

    When conservative treatments are not effective or the cause of the disorder is structural in nature, Cranio-Maxillofacial Surgery may be indicated. Major surgical procedures for TMJ disorders include:

    • Arthrocentesis – involves inserting thin needle cannulas into the joint to aspirate inflammatory fluid and inject hyaluronic acid, or physiologic solutions to improve mobility;
    • Arthroscopy-uses an endoscope inserted into the TMJ to directly visualize and treat the internal structures of the joint, such as removing adhesions or repairing the joint disc;
    • Arthroplasty – involves opening the joint and removing or repairing damaged anatomical structures, such as in the case of disc dislocations or degenerated joint surfaces;
    • Arthrodesis – is surgical immobilization of the TMJ, used only in severe cases and when other treatments have failed;
    • TMJ replacement-in extreme cases, when the joint is severely damaged and cannot be repaired, it may need to be replaced with an artificial joint, similar to what is done for the hip or knee.

    Post-surgical recovery and rehabilitation

    Recovery and rehabilitation after TMJ surgery vary depending on the type of procedure performed and the severity of the disorder. In general, rehabilitation may include:

    • Pain management-the use of analgesics and anti-inflammatories, or supplements (vitamins and minerals), may be necessary to relieve postoperative pain and inflammation;
    • Temporary restriction of movement-the patient may be asked to limit mouth opening and lateral movements for a period of time to allow joint structures to heal;
    • Physiotherapy-Advanced physical therapy treatments (Pain Neuromodulation, K-LASER, INDIBA-Tecar therapy) and in the second phase of treatment mobilization exercises and stretching may be prescribed to improve TMJ mobility and strength after surgery;
    • Occlusal therapy: it may be necessary to continue using devices such as splints and plates to maintain proper tooth alignment and reduce stress on the TMJ.

    Conclusion

    Temporomandibular joint disorders can cause pain and restriction of movement, significantly affecting patients’ quality of life. In some cases, Cranio-Maxillofacial Surgery may be indicated to treat these disorders, especially when conservative treatments are not effective or the cause is structural in nature. Surgical treatment options range from less invasive procedures, such as arthrocentesis and arthroscopy, to more complex operations, such as arthroplasty, arthrodesis, and TMJ replacement. Post-surgical recovery and rehabilitation are critical to ensure successful treatment and return to full and proper function of the joint.

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