TMJ Surgery - How to Cure TMJ Permanently
TMJ surgery & treatment is misunderstood.
The temporomandibular joint (TMJ) connects your jaw to your skull, with one joint on each side. Because the TMJ is closely linked to the rest of the body through anatomical, functional, and neurological connections, these joints are constantly at work, even if you’re not talking or chewing.
Pain or dysfunction in this area—often referred to as ‘TMJ’ or a ‘TMJ flare-up’ should really be called TMD (temporomandibular joint dysfunction). TMD treatment and TMJ surgery options are commonly misunderstood, even among dentists and oral surgeons. The root causes of TMD, along with the factors that worsen symptoms, are complex and require a thoughtful, collaborative approach for effective treatment.
What Causes TMJ Pain?
There's only two answers.
The first step in addressing TMJ pain is determining whether the issue is:
- Intraarticular: Originating within the jaw joint itself.
- Extraarticular: Occurring outside the joint, often involving surrounding structures.
This distinction is made through:
- Clinical Examination
- Imaging (e.g., MRI, CT scans)
These tools help pinpoint whether pain originates inside the jaw joint or is referred from other areas.
Why Identifying the Core Issue Matters.
- Intraarticular Problems: May benefit from jaw joint surgery.
- Extraarticular Causes: Often require alternative treatment approaches, though surgery may still play a role.
Because the TMJ is closely connected to the rest of the body through anatomical, functional, and neurological relationships, an integrative approach is essential to ensure TMJ pain does not reoccur.
Typical Intraarticular Surgery for TMJ
How problems within the joint itself, such as the articular disc, joint surfaces, and synovial components are relieved.
Arthrocentesis of the Temporomandibular Joint
Arthrocentesis is the least invasive surgical treatment for intraarticular TMD. It involves flushing the temporomandibular joint with a sterile solution to reduce inflammation and remove scar tissue or debris.
Arthroscopic Temporomandibular Joint Surgery
Arthroscopic surgery is a minimally invasive option that uses a small incision near the ear to access the joint. A fiber-optic camera (arthroscope) allows the surgeon to visualize and address internal joint issues, such as removing inflamed tissue, smoothing surfaces, or repositioning a displaced disc. This approach effectively targets structural problems while minimizing surgical trauma.
Temporomandibular Joint Arthroplasty
Arthroplasty is an open surgical procedure performed under general anesthesia to repair or reconstruct the temporomandibular joint. It involves directly addressing structural damage, such as removing bone spurs, scar tissue, or adhesions, and repositioning or repairing the joint disc. Arthroplasty is the most invasive option but is can be necessary for severe joint degeneration or significant structural issues.
Extraarticular Surgery for TMJ
Solutions for soft tissue related causes of TMJ Pain.
Orthognathic Surgery (Corrective Jaw Surgery)
Addresses skeletal or occlusal misalignments that overwork jaw muscles, leading to chronic TMD symptoms.
Occlusal Adjustments
Bite corrections through orthodontic or prosthodontic work help reduce chronic grinding and associated muscular overload.
Tongue-Tie Release Surgery
Releases restricted lingual frenulum to improve tongue mobility and reduce related jaw tension.
Muscle or Tendon Release Surgery
Surgically releases excessively tight or shortened muscles (e.g., lateral pterygoid) and surrounding soft tissue adhesions to relieve tension caused by hyperactive jaw muscles, fibrosis, or scar tissue.
Botox for TMJ (Botulinum Toxin)
Botox injections into overactive jaw muscles (e.g., masseter botox, temporalis, pterygoids) significantly reduce muscle pain and tension. This approach is especially effective for severe bruxism or myofascial pain where hyperactive muscles are the primary cause.
Intraarticular Causes
Articular Disc Displacement
- The TMJ contains an articular disc (a fibrocartilaginous cushion) that separates the joint into two compartments.
- If the disc becomes misaligned or displaced (commonly anteriorly), it can interfere with smooth joint movement, leading to clicking, popping, or locking.
Degenerative Joint Disease (Osteoarthritis)
- Osteoarthritis can develop within the TMJ due to wear and tear of the articular surfaces (condyle and fossa).
- Cartilage erosion, bony changes (osteophytes), and synovial inflammation lead to pain, stiffness, and crepitus (grating sounds).
Inflammatory Disorders
- Synovitis: Inflammation of the joint’s synovial lining causes pain, swelling, and limited function.
- Capsulitis: Inflammation of the fibrous joint capsule can result in localized pain, particularly when the jaw is moved.
- Rheumatoid arthritis (RA) or other autoimmune conditions can affect the TMJ, leading to joint destruction and deformity over time.
Trauma or Microtrauma
- Direct trauma (e.g., a blow to the jaw) or repeated microtrauma (e.g., clenching, grinding) can damage the articular surfaces, disc, or synovial tissues.
- Trauma may also cause hemarthrosis (bleeding within the joint), further contributing to joint dysfunction.
Scar tissue formation or adhesions within the joint can restrict movement, often as a result of inflammation, trauma, or prolonged immobilization.
Joint Hypermobility
- Excessive movement of the TMJ, where the condyle moves beyond its normal range, can stress intraarticular structures and result in disc displacement or joint instability.
Extraarticular Causes
Muscle Pain and Dysfunction
- Trigger points (hyperirritable muscle knots) can cause localized or referred pain to the jaw, neck, and face.
- Muscle overuse or strain is one of the most common extra-articular causes of TMD. It affects the muscles involved in chewing and jaw movement, such as:
- Masseter
- Temporalis
- Medial and lateral pterygoid muscles
Parafunctional Habits
- Repeated, excessive use of the jaw muscles beyond normal chewing and speaking can lead to dysfunction:
- Bruxism (teeth grinding and clenching, often at night)
- Nail biting
- Chewing gum excessively
- Tongue thrusting
- Jaw clenching due to stress
Trauma to Muscles or Soft Tissues
- Direct trauma (e.g., whiplash, falls, or blows to the face) can injure the jaw’s supporting muscles and ligaments, leading to dysfunction and pain.
- Microtrauma from prolonged dental work (wide mouth opening) can also strain the muscles.
Stress and Psychological Factors
- Emotional stress often manifests as muscle tension or involuntary habits like jaw clenching or grinding, which overworks the jaw muscles.
- Anxiety and stress can exacerbate pain perception and prolong muscle dysfunction.
Cervical Spine Dysfunction
- Disorders of the neck and cervical spine, including poor alignment, muscle tension, or nerve impingement, can lead to pain that radiates to the jaw.
- Tight neck and shoulder muscles often refer pain to the TMJ region.
Neurological Causes
- Neuralgia, such as trigeminal neuralgia, can cause sharp, shooting pain in the TMJ and surrounding facial areas.
- Neuromuscular imbalances can also impair jaw coordination.
Dental and Occlusal Issues
- Misalignment of the teeth (malocclusion) can overwork the jaw muscles as they attempt to compensate for an improper bite.
- Poorly fitting dental restorations or orthodontic issues can contribute to muscle strain.
Hyperactivity of Supporting Ligaments
Excessive strain or laxity in ligaments supporting the jaw can result in instability and muscle fatigue.
Our Integrative Approach to TMJ Surgery
A Collaborative therapeutic approach is key.
TMJ disorders are multifactorial, often stemming from muscle overactivity, disk displacement, postural imbalances, and stress. Effectively addressing these underlying causes requires a multidisciplinary approach. We work closely with a network of medical professionals—including mental health specialists, rheumatologists, neurologists and other dental professionals—to ensure comprehensive care.
Role of Physical Therapy & Oral Functional Therapy for TMD
Interrupting the Symptom Cycle for Lasting Relief
Dysfunction in the tongue, airway, pelvis, spine, or neck can cause compensatory patterns that strain the jaw and TMJ. Physical therapy, myofunctional therapy, and speech therapy offer non-invasive solutions by correcting posture, breathing mechanics, and muscle imbalances to restore function and relieve TMJ strain, even after TMJ surgery.
- Pain Reduction: Rebalancing and strengthening orofacial muscles alleviates tension and overuse that cause TMD pain.
- Improved Jaw Function: Targeted therapies enhance jaw mobility and reduce stiffness.
- Postural Alignment: Correcting oral habits and tongue posture supports proper head, neck, and jaw alignment.
- Reduced Stress on TMJ: Improved swallowing, speaking, and breathing mechanics decrease unnecessary strain on the jaw joint.
- Prevention of Relapse: Addressing underlying dysfunction and habits prevents the recurrence of TMD symptoms.
- Muscle Balance: Restoring harmony between overactive and underactive muscles reduces strain and supports long-term function.
Our Partners in Integrative TMJ Surgery & Treatment
We’re happy to collaborate with your in-network providers. For those seeking care, we also have trusted partnerships with experienced physical therapists (part of the Postural Restoration Institute), speech-language pathologists, and myofunctional therapists.
- Brian Coleman PT, DPT, PRC of New Ground Physical Therapy
- Emily Iverson PT, DPT, CST, RYT, PRC of Shine Integrative Physical Therapy
- The Team of Therapists at Breatheworks, which sees patients out of our office