The Temporomandibular Joint (TMJ) connects the skull, specifically the temporal bone, to the mandible. It is a double or bicondylar joint, formed by the mandibular condyle and the mandibular fossa of the temporal bone. Between the two there is an articular disc that functions as a cushion and divides the joint into two compartments, the upper and the lower.
In turn, the joint is surrounded by a fibrous joint capsule, muscles and ligaments that allow and limit its movements. In this way, it contributes significantly to the functions of chewing, speech, swallowing and facial expression.
What are the conditions that the TMJ can present?
Temporomandibular disorders are those organic or functional conditions that can affect the craniomandibular relationship system. Organic alterations may be traumatic, neoplastic, autoimmune or infectious. Functional disorders, on the other hand, can be muscular or articular.
The most frequent dysfunctions are alterations of the masticatory musculature, such as myofascial pain, and alterations of the articular disc, such as disc displacement with or reduction of the articular disc and condylar dislocation. In addition, there are inflammatory disorders, such as capsulitis or synovitis and osteoarthrosis.
Most frequent symptoms of TMJ disorders
The symptoms and signs that can occur when there is a temporomandibular disorder are:
- Jaw, face or neck pain:
- Localized at one point: this would be a joint process such as capsulitis, arthritis, osteoarthritis.
- Diffuse, unilateral or bilateral: it could be myofascial pain.
- Articular noises:
- Click type: indicate disc displacement
- Joint friction: related to osteoarthrosis.
- Limitation of mandibular movements:
- May start after a period of time with joint noises that disappear abruptly: would indicate disc displacement without reduction
- Abrupt onset: would indicate disc fixed to the eminence or disc displacement without reduction.
- Severe and progressive form: would indicate bony or fibrous ankylosis.
Treatments for temporomandibular disorders
When conservative treatments are not effective, i.e. do not resolve the pain or limitation of movement, surgical intervention is necessary.
There are different types of surgery and the choice will depend on the evaluation made by the specialist in maxillofacial surgery for each patient. Firstly, there is minimally invasive surgery such as arthrocentesis, which consists of washing the joint. It is performed by introducing two needles or a two-way cannula in order to wash the joint with serum and eliminate the substances that generate pain or inflammation.
Secondly, there is arthroscopy, which is also a minimally invasive technique. A camera is introduced into the joint in order to look inside it, and the intra-articular function can be visualized in real time.
Both arthrocentesis and arthroscopy allow the infiltration of beneficial substances inside the joint that are intra-articular lubricants and help healing.
Thirdly, there is open surgery of the joint, i.e. classic surgery. The condition is treated by means of a cutaneous incision to access the joint and to be able to work on the internal alterations. Currently, this type of surgery is performed only in those people in whom minimally invasive treatments have failed.
Temporomandibular Joint Surgery: Preparation and Recovery
None of these surgical procedures require special preparation on the part of the patient. However, it is important to perform an anamnesis and a clinical examination to rule out those patients who, because of their physical or psychological pathology, may carry a risk and a contraindication to surgery.
As for post-surgical recovery, it generally consists of a soft or easily chewed diet to allow the joint to rest. In addition, medication, such as anti-inflammatory drugs, analgesics and muscle relaxants, and physiotherapy are administered.
Recovery time is not exact, nor is it the same for all patients, since it depends on the condition of each person and the type of surgery performed.