TMJ Replacement
This is a complex but reliable surgical procedure that is undertaken for disorders of the jaw joint(s) (TMJ) that have failed to respond to other treatments including arthroscopy. Surgery is used to remove, clean out and replace a damaged or diseased jaw joint. Surgery aims to reduce symptoms such as pain and to improve jaw function including mouth opening and chewing.
General Anaesthesia
Because of the delicate nature of the surgery, the procedure is undertaken under general anaesthesia. That is, the patient is put to sleep so that they may remain perfectly still throughout the surgery. The procedure may last anywhere between 1.5 to 4 hours depending on the severity of the pathology.
Hospital Stay
In most patients, the procedure only requires an overnight stay in the hospital. On occasions where the surgery is complex, the hospital stay may be up to 3 days.
Incision
Dr Kim will approach the jaw joint via a cosmetically placed 3cm incision in front of the ear skin fold that often heals well with minimal scarring. Whilst the traditional approach also requires an additional incision in the neck or face below the jaw line, Dr Samuel Kim specialises in minimally invasive TMJ replacement surgery which does not require the neck incision in most cases.
Jaw Wiring/Immobilisation
Dr Kim will use custom-made implants secured with screws to place your lower jaw into a specific position during the operation and after the surgery. These do not restrict your mouth opening and are not wired together. These will be removed by Dr Kim in hospital based on your occlusion.
Surgical Site & Dressings
There are combination of stitches and skin glue which do not need to be removed. The area is often covered with small steristrips and getting the area wet should be avoided for the first week. Steri strips can be removed after 2 weeks if still present. Warm water will normally aid the removal.
Post-Op Imaging and Repositioning Surgery
CT scan or xray may be carried out if the position of the implant needs to be checked post-operatively. In the very unlikely case the prosthesis needs to be repositioned, this will not incur an additional charge.
Recovery
The operated side of the face will be swollen and sore for up to 3 weeks although the greatest swelling and soreness usually starts subsiding after the first 2 weeks. Strong painkillers will be prescribed and these should be taken on a regular basis, especially during the first week after surgery. Because of the swelling, the ear on the side where the surgery is performed will feel stuffy and blocked for up to 2 weeks. The bite will also feel different, but this will improve as the swelling subsides. Tingling and numbness in the temple above the ear and around the cheeks are normal following TMJ surgery and may last up to 18 months.
Time off work is usually up to 3-4 weeks for TMJ prosthetic total joint replacements. Please ensure you schedule an appointment with your GP for the week after surgery should you require further pain medications.
Ear Symptoms
Due to the shared sensation nerves between the TMJ and the ear, you may experience continued or new earache, ear fullness and tinnitus. The ear blockage is often due to the betadine used during the surgery and can be flushed out at 6 week mark by your GP if required. Other ear symptoms can continue to persist but is generally at a similar level as before the surgery.
Soft Diet & Jaw Rest
Patients are advised to maintain a soft non-chewing diet for the first 4-6 weeks after surgery to allow healing of the joint tissues and the titanium screws to osseointegrate with the underlying bone.
Physiotherapy
You may be advised to visit a physiotherapist based on your post-operative progress. Usually, no physiotherapy is required in the first 6 weeks.
Speech
Patients can speak as soon as they wake up from the surgery. Due to the different mechanics of the artificial jaw joint which has limited protrusion (moving the jaw forward), a lisp is often noticed by the patient. This is generally only noticeable to the patient but some may elect to work with speech pathologist until it improves.
Complications
All patients undergoing TMJ surgery will experience altered sensations in the area around the ear and the temple above. It is most noticeable when brushing or combing your hair. This is often temporary with a slow return of normal sensation that may take up to 18 months after surgery. Other potential complications following TMJ surgery are uncommon but can be serious. Infection of the incision site may present as a draining sinus in front of the ear which requires immediate attention by the surgeon Dr Kim.
Long-term potential complications such as chronic pain, abnormal bone growth, limited mouth opening, prosthesis loosening or failure and the requirement for further surgery are present although uncommon.
Facial Nerve Weakness/Dry Eye
Transient weakness of the facial nerve may present with the inability to properly shut the eye or lift the eyebrow on the affected side in up to 20% of patients.
The inability to shut the eye completely can cause dry eye with tearing and blurred vision which may affect the ability to drive or use a computer screen until this resolves. During recovery, your face may also look drooped and smiling may be asymmetrical. Temporary weakness can take up to 6 months to recover and you dry eye care with frequent eye drops and tape to close the eye at night time may be required.
Whilst rare, permanent facial nerve weakness is possible in any TMJ procedure. In such cases, eyelid procedures to help the affected eye to close completely may be required.
Preview
VIDEO OF DR KIM’S TMJ REPLACEMENT SURGERY CAN BE VIEWED VIA THE FOLLOWING LINK. PLEASE BE WARNED OF THE GRAPHIC NATURE.
https://www.youtube.com/watch?v=aaVqthobNF0&ab_channel=TMJSurgery
Queries
Please contact Dr Kim’s rooms on 02 9157 2777 or info@tmjsurgery.com.au during office hours.
If any post-operative problems arise after hours, please attend the ED at Prince of Wales
Hospital and ask for the Maxillofacial team who will contact Dr Kim.