Date: Dec 2023
Oral & Maxillofacial Surgery - Open Surgery to Temporomandibular joint: Information for patients
This leaflet includes information about what an Open Surgery to Jaw Joint is, why you need it, what will happen before, during and after the surgery, and what to expect.
What is Open Surgery to Jaw Joint? The Jaw Joint is called Temporomandibular Joint (TMJ). Open Surgery is usually used to alter the shape of the joint. This is called Arthroplasty. TMJ Arthroplasty aims to improve the function of a degenerated joint by removing, repositioning or changing the components of the joint. This is not a keyhole surgery as it involves a skin cut in front of the ear.
Why do I need TMJ Open Surgery?
You may have advanced changes of the joint that would not respond to minimally invasive or keyhole options. You will have been diagnosed by your specialist Oral and Maxillofacial surgeon. This usually would be with a reduction in the function of your jaw.
What happens during the surgery?
Open Surgery to the TMJ is done while you are fully asleep using general anaesthetic. The surgery can take one to two hours. Where possible, all cuts to the skin will be in a skin crease to make them less visible. You will have an incision in front of your ear, which can extend into the hairline, to expose the top part of the joint. Joint components like the bones, cartilage and disc will be assessed.
There are multiple options to manage the joint. Repositioning the articulating disc by suturing in a more favourable position is usually considered first. If the disc is deemed unsuitable, it can be removed, some fat from the abdomen can be put in the area after removal of the disc. Shaving or removing part of the bone may also be done. Sometimes a small tube or drain will be inserted to collect excess fluid such as blood. This will likely be removed the day after surgery.
What happens after the surgery?
Once deemed appropriate, you will be given food and drinks. You might spend a night in hospital.
General risks and side effects
Like other surgical procedures, there are some risks involved with open jaw surgery.
- Pain: It is advisable you take pain killers regularly for the first few days
- Bruising: this can affect eyes as well as the surgical sites and can last for several weeks
- Swelling: Ice packs can be applied to help reduce it
- Infection: Measure will be taken to minimise the chances of this happening
- Bleeding: usually controlled during surgery. If it happens afterwards, it will be manged by the surgical team
- Blood clots: measures will be taken during surgery and afterwards to reduce the risk of blood clots forming
Specific risks and side effects
You may experience numbness or weakness to your face. This is because the nerve that supplies your face can be affected. This usually wears off without intervention. It can take several months to recover. There is a very small chance it can be permanent. It is usual for your bite to feel altered after surgery. Ear problems can occur due to close proximity to the joint.
Eating and drinking instructions will be provided (usually soft diet is recommended for a period of time).
Often, there will be some stitches which will need removing around 7 days after your surgery. This can be done by the practice nurse at your GP surgery.
No driving, signing legal documents or operating heavy machinery for 48 hours after a general anaesthetic. You will need some time off work. A sick note can be given to you upon discharge.
Follow up: An outpatient clinic appointment will be arranged for you with your surgeon after discharge.
Please contact your surgeon or nurse in the Oral and Maxillofacial department if you have any questions or need further advice.
Authors: Ghaly A Ghaly, Barbara Gerber, Athanasios Kalantzis