Temporomandibular joint management (TMJ)

What is temporomandibular joint management (TMJ)?

Temporomandibular joint management (TMJ) disorders are a broad range of conditions affecting the jaw joint and range from painless clicking to some irritating pain and aches (feels like ear ache) to severe destructive arthritis.

TMJ disorders are common and often the patients are managed by the GP or dentist by conservative means, which is usually a combination of reassurance and painkillers. However for many patients (TMJ disorders make up 5-10% of most maxillofacial out patient clinics) this is not enough and they need specialist help. This may be for a number of reasons, some just want to be sure (hear it from an expert) that it isn't something too serious and are happy with that. Others are quite disabled by the pain and they may require further tests such as radiographs, CT or MRI, in some instances further treatment which can be broadly divided into non-interventional and interventional.

How does temporomandibular joint management (TMJ) work?

I think the first thing to remember about treatments is for some, reassurance and exclusion of a sinister cause are all the treatment that is required, and this usually involves a consultation with an expert, full head and neck examination and often imaging.

The non interventional treatments include analgesics, which may be systemic, topical and/ or into the joint, physiotherapy and sometimes they may need a dental bite aid. Some benefit from mild doses of antidepressant medication, These simple treatments have about a 80% positive response rate.

Interventional treatments include various types of surgery. The surgery usually starts quite conservatively, if there is cliical and MRI evidence of internal derangement which is irreducible (closed lock) I will do an arthrocentesis under GA, in more severe and refractory cases an eminectomy or meninescectomy may be used. In very rare cases a joint replacement might be an option.

What are the benefits?

The benefits to the patient are very real. Often they want to see a specialist for a consultation, examination and imaging  to make a diagnosis, exclude cancer and to help them to understand what is the cause of their pain and discomfort. For many this is enough. Others, require non interventional help as listed above and I would expect that to benefit about 80-90% of those I see in secondary care. The remainder I would refer them to a specialist chronic pain service unless there is convincing evidence of joint destruction with disabling pain and limitation of function, for whom a joint rplacement would be the optimal treatment.

What are the risks?

There is almost no risk in physiotherapy or bite aids. The antidepressant drugs have a very low risk and are well tested and established.

Arthrocentesis is a safe option the main risks are no improvement or transient facial nerve weakness. The other surgical procedures are required rarely and their indications are quite specific but they are not dangerous procedures and have a good benefit rate if the patients are carefully chosen.

Paying for your procedure

Temporomandibular joint management (TMJ) costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.

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