The temporomandibular joint (TMJ) is a hinge-like joint located where your jawbone and skull meet. The TMJ allows your jaw to slide up and down, letting you talk, chew, and do all sorts of things with your mouth.
一个TMJ障碍causes pain, stiffness, or lack of mobility in your TMJ, keeping you from using your jaw’s full range of movement.
Surgery can be used to treat a TMJ disorder if more conservative treatments, such as oral splints or mouthguards, don’t help to reduce the severity of your symptoms. For some people, surgery may be necessary to restore full use of their TMJ.
Read on to learn more about TMJ surgery, including:
- who’s a good candidate
- the types of TMJ surgery
- what to expect
Your doctormay recommendTMJ surgery if:
- 张开或闭上嘴时，您会感到一致，紧张的疼痛或温柔。
- 您不能一直张开或闭上嘴。
- You have trouble eating or drinking because ofjaw painorimmobility。
- Your pain or immobility gets progressively worse, even with rest or other nonsurgical treatments.
- You have specific structural problems or diseases in your jaw joint, which have been confirmed radiologically with imaging, such as an MRI
Your doctormay advise againstTMJ surgery if:
- Your TMJ symptoms aren’t that severe.For example, you may not need surgery if your jaw makes a clicking orpoppingsound when you open it, but there’s no pain associated with it.
- 您的症状不一致。有一天，您可能会出现严重，痛苦的症状，而下一步就消失了。这可能是由于某些重复的动作或过度使用的结果（例如，在给定的一天比平时多说话，咀嚼很多艰难的食物或不断的口香糖咀嚼 - 会导致TMJ疲劳。在这种情况下，您的医疗保健提供者可能建议您下巴停留几个小时或几天。
- You can open and close your jaw all the way.Even if you have some pain or tenderness when you open and close your mouth, your doctor may not recommend surgery because of the risks involved. They may instead suggest medication, physical therapy, or lifestyle changes to reduce symptoms.
It’s important to be evaluated by a dentist or oral surgeon who’s trained in TMD.
他们将对您的症状病史，临床表现和放射学发现进行彻底检查，以确定手术是否对您的症状有益。如果非手术替代方案失败，手术被认为是最后的手术。
Several different types of TMJ surgery are possible, depending on your symptoms or their severity.
一个rthrocentesis
一个rthrocentesisis done by injecting fluid into your joint. The fluid washes out any chemical byproducts of inflammation and can help reduce pressure that causes the joint to be stiff or painful. This can help you regain some of your jaw’s range of motion.
This is aminimally invasive procedure。You can usually go home the same day. The recovery time is short, and the success rate is high. According to a
关节色素通常是一线治疗方法，因为与其他一些更复杂的程序相比，它的侵入性较低，成功率很高。
一个rthroscopy
一个rthroscopy is done by opening a small hole or a few small holes in the skin above the joint.
一个narrow tube called a cannula is then inserted through the hole and into the joint. Next, your surgeon will insert an arthroscope into the cannula. The arthroscope is a tool with a light and camera that’s used to visualize your joint.
Once everything is set up, your surgeon can then operate on the joint using tiny surgical tools that are inserted through the cannula.
一个rthroscopy is less invasive than typical open surgery, so recovery time is faster, usuallyseveral days to a week。
它还使您的医疗保健提供者有很多自由，可以在关节上执行复杂的程序，例如：
- scar tissue removal
- joint reshaping
- medication injection
- pain or swelling relief
开放式手术
开放式手术consists of opening an incision a few inches long over the joint so your healthcare provider can operate on the joint itself.
This type of TMJ surgery is usually reserved for a severe TMJ disorder that involves:
- a lot of tissue or bone growth that stops the joint from moving
- 关节组织，软骨或骨的融合（钙化）
- inability to reach the joint with arthroscopy
通过进行开放性手术，您的外科医生将能够去除骨质生长或多余的组织。如果光盘不合适或损坏，他们还可以修复或重新定位光盘。
如果您的光盘无法修复，则可以进行椎间盘切除术。您的外科医生可能会用人造盘或自己的组织完全替换椎间盘。
When the bony structures of the joint are involved, the surgeon may remove some of the diseased bone of the jaw joint or the skull.
Open surgery has a longer recovery time than an arthroscopic procedure, but the success rate is still pretty high. A
从TMJ手术中恢复取决于人和进行手术的类型。Most TMJ surgeries are outpatient procedures, which means you’ll be able to go home the same day as the surgery.
Make sure someone can take you home the day of the surgery, since you might be a little woozy or unable to focus, which are麻醉的副作用。
取下手术的一天。如果您的工作不需要您的嘴巴很多，则不一定需要休假一整天。但是，如果可能的话，请休假几天，让自己休息。
一个fter the procedure is done, you may have a bandage on your jaw. Your doctor may also wrap an additional bandage around your head to keep the wound dressing secure and in place.
For one to two days after the surgery, do the following to make sure you recover quickly and successfully:
- 拿nonsteroidal anti-inflammatory drugs (NSAIDS)for any pain if your healthcare provider recommends it. (NSAIDs are not recommended for people with bleeding disorders or kidney issues.)
- 一个void solid and crunchy foods. These can put strain on your joint. You may need to follow aliquid dietfor a week or more and a diet ofsoft foodsfor three weeks or so. Make sure you stay hydrated after surgery。
- 一个pply acold compressto the area to help with swelling. The compress can be as simple as a frozen bag of vegetables wrapped in a clean towel.
- 在颌骨上施加的热热也可能有助于手术后的舒适感，例如加热垫或微波湿布。
- 沐浴或淋浴前遮盖绷带，使其水密。
- 定期卸下并更换绷带。应用任何antibiotic creams or ointmentsyour healthcare provider recommends every time you replace the bandage.
- Wear a splint or other device on your jaw at all times until your doctor tells you it’s OK to remove it.
在手术后2到3天，请参阅您的医疗保健提供者，以确保您的康复良好，并收到有关照顾TMJ的任何进一步说明。
如果您的针迹不溶解，您的医生也可能需要切除针迹。此外，他们可能会建议药物治疗疼痛或出现的任何感染。
You may also need to see a physical therapist to help you regain motion in your jaw and to keep swelling from limiting your TMJ motion.
一个series of physical therapy appointments may take several weeks or months, but you’ll usually see better long-term results if you work closely with your therapist.
TMJ手术最常见的并发症是运动范围的永久损失。
其他possible complicationsinclude:
- 面部神经损伤，有时会导致面部肌肉运动的部分丧失或感觉丧失
- damage to nearby tissue, such as the bottom of the skull, blood vessels, or anatomy related to your hearing
- 感染around the surgical site during or after surgery
- persistent pain or limited range of motion
- 弗雷综合症, a rare complication of the parotid glands (near your TMJ) that causes abnormal face sweating
即使您接受手术后，TMJ疼痛也会恢复。通过关节穿牙，仅除去碎屑和过量肿胀。这意味着碎屑可以再次在关节中积聚，或者炎症可以重新发生。
如果TMJ疼痛是由抓紧或磨牙等习惯引起的（bruxism) when you’re stressed or while you sleep.
如果您有潜在的免疫疾病会导致组织发炎，例如rheumatoid arthritis，如果您的免疫系统靶向关节组织，则TMJ疼痛可能会恢复。
在决定进行TMJ手术之前，请询问您的医疗保健提供者：
- How constant or severe should my pain be before I have surgery?
- If surgery isn’t right for me, what activities should I avoid or do more of to help relieve my pain or increase my range of motion?
- Which type of surgery do you recommend for me? Why?
- Should I see a physical therapist to see if that helps first?
- Should I change my diet to exclude hard or chewy foods to help with my symptoms?
- 一个re there any complications I should think about if I decide not to have surgery?
See your healthcare provider or dentist as soon as possible if your jaw pain or tenderness is disruptive to your life or if it prevents you from eating or drinking.
You may not need surgery if nonsurgical therapies, medications, or lifestyle changes relieves your TMJ pain. Surgery is often a last resort for the most severe cases, and it doesn’t guarantee a cure.
Let your healthcare provider know if more conservative treatments aren’t helping or if your symptoms are getting worse.