What is a TMJ arthroscopy?

An arthroscopy (keyhole surgery) allows your surgeon to see inside your temporomandibular joint (TMJ, or jaw joint) using a camera inserted through a small cut on your skin.

Your surgeon can diagnose problems such as a torn cartilage and damage to the surface of the joint. They may be able to treat some problems using surgical instruments or by washing out the joint (arthrocentesis), without making a larger cut.

What are the benefits of surgery?

The aim is to confirm exactly what the problem is and for many people the problem can be treated at the same time. For 7 in 10 people the operation is successful in improving symptoms such as locking, pain and being restricted when opening your mouth.

Are there any alternatives to surgery?

Problems inside a joint can often be diagnosed using tests such as CT scans and MRI scans.

Non-surgical treatment such as rest, taking anti-inflammatory painkillers and wearing a TMJ splint can usually help.

If the problem is with the chewing muscles around the joint, muscle-relaxing medication or injections of Botox can reduce joint stiffness but do not treat the underlying cause.

A steroid injection into the joint can sometimes reduce pain for several months but may cause side effects if repeated too often.

What will happen if I decide not to have the operation?

Your surgeon may be able to recommend another treatment. However, problems such as locking, pain and being restricted when opening your mouth may get worse and you may eventually need open surgery.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes about 20 minutes for each joint. The operation can take up to 2 hours if your surgeon needs to perform any surgery within a joint.

They will insert a camera through a small cut in front of your ear to examine the inside of the joint for damage to cartilage, joint surfaces and ligaments.

Your surgeon may insert one or two needles through the cut and use them to wash out any loose material caused by wear of the joint surfaces. Or, your surgeon may make another cut to insert surgical instruments to treat scarring, improve the joint surfaces or to use a stitch to change the position of the cartilage disc.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. Stopping smoking and keeping your mouth clean significantly reduces the risk of infection.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation.
• Bruising and swelling of your face caused by fluid leaking during the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Blood clot in your leg (deep-vein thrombosis - DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Not being able to open your mouth fully (trismus) and jaw stiffness. This can take a few weeks to settle.
• Tenderness and pain in the joint (capsulitis) caused by inflammation in the joint.
• Numbness of the temple and ear. This usually recovers within a few weeks but may be permanent.
• Weak forehead movement. This usually recovers within a few weeks but may be permanent.
• Change in hearing. This usually improves over a few weeks. Rarely, your hearing may be affected permanently.
• Making a hole in your ear canal during placement of the camera.

Consequences of this procedure

• Pain.

How soon will I recover?

The swelling and discomfort is usually at its worst for the first few hours.

You should be able to go home the same day.

To reduce the risk of bleeding, swelling and bruising, do not do strenuous exercise, have a hot bath or bend down for 2 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

It is important to keep the joint moving. Your surgeon will give you stretching exercises to do to help improve how your mouth opens. You should continue to rest and wear any splints until you are told otherwise.

You should be able to return to work after a few days, depending on your type of work.

Summary

A TMJ arthroscopy is an operation to diagnose and treat problems such as locking, pain and being restricted when opening your mouth, without the need for a large cut on your skin.

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