TMJ Arthroscopy
This is a highly advanced and minimally invasive surgical procedure which is used to visualise inside the jaw joint in order to establish or confirm the presence of disease, and to help reduce joint pain and improve jaw function. Arthroscopy involves the use of a miniature telescope that is inserted into the jaw joint. The telescope is attached to a camera that shows video pictures of the inner surface of the jaw joint which is displayed on a television monitor during the surgery.
General Anaesthesia
Because of the delicate nature of the surgery and the complex instrumentation involved, the procedure is undertaken in hospital under general anaesthesia. That is, the patient is put to sleep so that they may remain perfectly still throughout the surgery, since any movement may result in damage to both the instruments and the insides of the jaw joint. The procedure may last anywhere between 20 minutes up to an hour depending on the severity of the pathology.
Hospital Stay
In healthy patients, the procedure only requires a DAY STAY admission to hospital whereby the patient is discharged the same day. On rare occasions where the patient reacts poorly to the general anaesthetic, then they may be required to stay in hospital overnight for observation.
Procedure
The arthroscope is inserted into the jaw joint via a small 2mm puncture hole in front of the ear that heals and disappears completely in 2 weeks, hence there is no scar for the patient to worry about. Once inside the jaw joint, the surgeon will first make a thorough inspection of the joint cavity, paying particular attention to any pathology or abnormalities that may be present.
The joint is then thoroughly washed out to reduce the inflammatory chemicals and minute debris that may be responsible for the symptoms of pain and joint dysfunction. Small arthroscopic instruments may also be used to help break up the scar tissue and allow better mobility of the disc.
After the Surgery
A bandage is wrapped around the head at the completion of the surgery while the patient is still asleep. The bandage must be removed by the patient the same evening following surgery. The sticky dot band-aids in front of the ear should be removed the next morning after surgery. It is important for the patient to keep the puncture sites of the surgery meticulously clean with warm water, soap and antiseptic solution applied over the area twice daily for 3-4 days.
What to Expect
The jaw joint will be swollen and sore for up to 5-7 days although the greatest swelling and soreness usually starts subsiding after the first 24 hours. Pain killers will be prescribed and these should be taken on a regular basis as instructed on the packet. An anti-inflammatory such as MOBIC or VOLTAREN will also be prescribed.
Because of the swelling, the ear on the side where the surgery is performed may feel stuffy and blocked for up to 2 weeks after which it disappears. The bite may also feel a little different but this too will return to normal as the swelling subsides.
Bleeding is unusual following temporomandibular joint arthroscopy. If the wound oozes or bleeds rest quietly with your head elevated and place a pressure pack over the wound. If bleeding persists beyond 30 minutes please contact Dr. Kim or the hospital in which you were treated.
Soft Diet
It is important that the patient maintains a soft non-chewing diet for the first 2 weeks after the procedure to allow healing of the joint tissues.
Splint
If you are currently undergoing splint (bite guard) therapy, the splint may not fit comfortably in the first 2 weeks after surgery because of the swelling and the bite change. If so then it is best to wait until after seeing Dr Kim.
For those patients without a bite splint, the surgeon may recommend that one be fitted after surgery depending on the patient’s progress and prognosis. If arthroscopy shows that your TMJ is salvageable then Dr Kim may recommend a TMJ splint to help preserve the joint.
Physiotherapy
Jaw manipulation and exercises may be required after arthroscopy for patients who has limited mouth opening. Dr Kim will arrange for the patient to see a TMJ physiotherapist who specialises in jaw joint rehabilitation.
Possible Side-Effects or Complications
Complications following TMJ arthroscopy are uncommon. Infection of the arthroscopy puncture site may present as a draining sinus in front of the ear which requires immediate attention by the surgeon. Transient weakness of the facial nerve may present with inability to properly shut the eye or lift the eyebrow on the affected side. This is usually mild and heals completely within 24 hours. Numbness around the ear, temple and cheek may also be experienced by some patients and will often resolve spontaneously in due course. Ear infection, bleeding and partial deafness is also uncommon.
Will Arthroscopy Permanently Cure My Jaw Problem?
TMJ arthroscopy on its own is rarely curative and requires diligent co-operation from the patient in order to derive the maximum benefit from the procedure. Therefore, it must be stressed that the patient pays close attention to their physiotherapy rehabilitation program, wear their bite-splint if prescribed, take the prescribed medications, avoid stress and stick to a soft diet during the recovery.
Arthroscopy cannot reverse or “fix” degenerative jaw joints. Degenerative TMJ is much more likely to need further surgery in the future than a non-degenerative joint. No surgical intervention including arthroscopy can return the disc to “original” place permanently and that is not the aim of the arthroscopy. However, many arthritic joints still improve significant in their pain and function following arthroscopy.
What is the Arthroscopy Fails to Fix the Problem?
If TMJ arthroscopy fails to improve the condition of the jaw joint within 6 months after the arthroscopy, then Dr Kim will discuss other options including the possibility of open joint surgery where the whole joint is exposed via an incision in front of the ear in order to replace the diseased joint structures. The options will be determined on an individual case basis, with the correlation of clinical, radiological and arthroscopic findings.
Queries
If any problems or queries arise please contact Dr Samuel Kim’s rooms.