Temporomandibular Joint Disease Surgery

MPD vs. Intra-articular Disease

This page is likely the most controversial on this entire site. You may "surf the net" and find about as many opinions as you would like on this subject.........does your doctor think that surgery is the answer? Splint therapy the answer? Is the splint made correctly?? Etc, etc, etc........

BASIC  DEFINITIONS -

1. Intra-articular disease - this is the damaging changes that occur to the jaw joint, such as degenerative joint disease (DJD), unusual growth and development, and other rarer causes. These are changes to the bony and soft tissue components - changes that for the most part are irreversible.

2. Myofascial pain disease (MPD) - in a very simple explanation - the muscular and ligament pains that occur due to overuse and tearing. This is quite often reversible.

These two entities above are often grouped together as "TMJ". They may exist at the same time, but they are NOT the same. 

TREATMENT OPTIONS -

Intra-articular disease - most often approached as being surgical. 

1. Arthrocentesis - needles are placed into the joint and a solution is washed through the joint space. This is meant to primarily break up adhesions in the joint and hopefully "free up" the disc. Big limitation is that there is NO direct visualization of the joint. This procedure is most often performed in the office.

2. Arthroscopic surgery - As the name implies - a "scope" is used to look directly into the joint space. There are minimal incisions made to perform this procedure. Most often used for disc problems such as adhesions and dislocations. This surgery does require general anesthesia and all the associated costs that go along with that.

3. Open joint surgery - Much more invasive than arthroscopic procedures but required when performing any of the following -
   a. Joint reconstruction.
   b. Prosthetic joint replacement.

Myofascial pain disease (MPD) - nonsurgical in approach.

1. Physical therapy.

2. Drug therapy - non-steroidal anti-inflammatory and muscular relaxation meds most commonly.

3. Splint therapy - to allow the jaw joint (TMJ) to assume its most correct position which in turn will allow the muscular and ligament tissues to "relax". For much more detailed information on splint therapy click here. 
   NOTE - splint therapy cannot reverse the damages caused by intra-articular disease. If a joint is not badly damaged, a person may be able to avoid further breakdown and surgery with correct splint therapy and associated bite corrections. 

Conclusions 
This conclusion is based on my personal experiences and those of practitioners that have been my mentors for the past 20 years. In my opinion, surgery is never the first choice of therapy. There are always exceptions to this - one coming to mind is acute macrotrauma (such as severe whiplash) where there has been instantaneous intra-articular change that has taken place. But, the most common TMJ patient that is seen is a person who has had problems for a long while with pain and\or dysfunction with both MPD and intra-articular disease. The major problem with surgery is that it treats the symptom NOT the cause. Almost always the cause of problems is a persons occlusion (bite) and surgery does NOT address this in anyway.

I am NOT saying that TMJ surgery is NEVER required...... there are times it is. But at the same time  most surgeries that I have been exposed to have been after the fact and had failed to achieve stability or long-term success.  There is no such thing as non-invasive surgery. All surgery is invasive by nature and I have seen the failures much more than I have seen successes. There are certain muscular and orthopedic truths that can not be addressed in this limited forum that leads towards non-surgery. Splint therapy is both therapeutic and diagnostic when administered correctly.