Plate 06 · Procedures
TMJ & facial pain
The most useful thing an oral surgeon can do for most temporomandibular disorder is decline to operate. The great majority of patients improve with education, load reduction, physiotherapy and time. This page exists partly to say so, because patients arrive expecting to be offered surgery and referrers deserve to know we will not offer it lightly.
For the referring practice
Assessment of temporomandibular disorders, with conservative management first and staged intervention — arthrocentesis, arthroscopy, open arthroplasty — reserved for defined failures.
In plain language
Jaw joint pain, clicking and locking. Most of it settles with treatment that does not involve surgery, and that is where we start.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Persistent arthralgia or myofascial pain not responding to three months of conservative care
- Closed lock — acute disc displacement without reduction limiting opening
- Degenerative joint disease with mechanical symptoms
- Recurrent dislocation
- Ankylosis
- Suspected joint pathology on imaging
02
How it is done
First — and usually only — line
Explanation and reassurance, load reduction, a soft diet for a defined period, heat, NSAIDs where they are safe, jaw physiotherapy with a defined exercise programme, and attention to parafunction and sleep. A stabilisation appliance where nocturnal bruxism is contributing. Cognitive behavioural approaches for chronic pain where central sensitisation is in the picture.
What we do not do
We do not perform irreversible occlusal adjustment, full-mouth rehabilitation or orthodontics as a treatment for temporomandibular disorder. The evidence does not support it and the harm is permanent.
Arthrocentesis
Lavage of the upper joint space under local anaesthetic with or without sedation. Useful in acute closed lock and in inflammatory arthralgia. Low morbidity, repeatable.
Arthroscopy
Diagnostic and operative arthroscopy for lysis and lavage, with disc repositioning in selected cases.
Open surgery and joint replacement
Open arthroplasty, discectomy, or alloplastic total joint replacement for end-stage degenerative disease, ankylosis and failed prior surgery. A small proportion of a small proportion.
- MRI is the imaging of choice for disc position and joint effusion. A CBCT will not show you a disc.
- CBCT for osseous change, condylar morphology and suspected ankylosis.
- A panoramic film as a screening view is reasonable, and often enough at first presentation.
- Please send the pain history: onset, diurnal pattern, locking, previous appliances, and what has already been tried.
A note back to you
You do not need to have exhausted every conservative option before referring — a shared plan is often better than a delayed one. But please do send what has been tried, because a patient who arrives having had nothing offered is a patient we will send back to you with an exercise sheet.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Facial nerve injury
A risk of open joint surgery and, to a much smaller degree, arthroscopy. Temporal and zygomatic branches are at risk, giving brow or eyelid weakness. Usually temporary.
Failure to relieve pain
Joint surgery treats mechanical problems. Where the pain is predominantly myofascial or centrally mediated, operating on the joint may change the click and leave the pain. This is the most important thing to be honest about before any TMJ operation.
Bleeding and haematoma
The superficial temporal vessels lie in the surgical field.
Malocclusion
A change in condylar position after open surgery or joint replacement can change the bite.
Progression despite treatment
Degenerative joint disease may continue regardless of intervention. Symptoms often fluctuate for reasons unrelated to what we do.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
My jaw clicks. Is that a problem?
On its own, usually not. A painless click that does not lock is very common and often needs nothing but reassurance. It is pain and locking that we treat, not noise.
What can I do today?
Soften your diet for two weeks. Stop chewing gum. Keep your teeth apart when you are not eating — lips together, teeth apart. Warm compress for fifteen minutes twice a day. Anti-inflammatories if they are safe for you. Most people notice a difference within a fortnight.
Will I need surgery?
Probably not. The large majority of people with jaw joint pain never have an operation, and we would rather you were one of them.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.