Surgery & TMD

Surgery & TMD

Chewing system orthopedics is so successful that surgery is rarely ever requested.

TMD surgery fails if the causes of disc displacement are not resolved before surgery.

Chewing system orthopedics is required before TMD surgery is ever be considered.

Wisdom tooth extraction is not a treatment for jaw pain.

Orofacial Pain team provides the orthopedic therapy to manage 8 causes of lateral ligament tearing of disc; thus, providing  best opportunity for healing.

TMD PAIN:

1. Structures: Jaw joint, muscles, ligaments, nerves, capsule, synovial tissues
2. Movements: rotation, translation, complex movements
3. 4 major causes:
   a) Tension muscle
   b) Grind/clench
   c) Trauma
   d) Head-Neck
4. 4 minor causes:
   open locking,
   dual bite,
   occlusion,
   pain system escalation
5. TMD is joint muscle complex; therefore, management is orthopedic therapies
6. TMD is chronic pain not acute pain

Solution Mencius Plication: manage cause of tearing ligament to disc before surgery, then the surgery to recapture the meniscus (disc) would have been more successful.

Why is chewing system orthopedics (CSO so successful)

1. Chewing system orthopedics is a health care team
2. Team can focus on multiple tissues
3. Team inspired to managing all causes
4. Causes are managed simultaneously
5. Promote maximum healing
6. Use conservative therapies for healing
7. Chronic pain changes to nervous system must be address
8. CSO is so successful that surgery is rarely requested

Common sense test (to see if jaw joint is major source pain)

1. Have surgeon, numb Auriculotemporal Nerve
2. If jaw pain goes away, the joint is source pain.
3. If pain remains, there are other sources of pain
4. Even if joint is some pain, you prefer surgery over conservative therapy
5. Any TMD Surgery has higher rate failure than CSO

Types of jaw surgery:

1. Menicus plication,
2. Orthognathic surgery,
3. Arthrocentesis

What is arthrocentesis?

1. Flushing TMD to remove inflammation chemicals & tissue tags
2. Two syringe are place in the fossa of TMD
3. One presents healing fluid and other removes inflammation

Since conservative therapy works; so well, even arthrocentesis is limited to jaw pain cases that resist opening back to normal !

Future of meniscus plication: 

1. Preoperative Orthopedic therapy mandated
2. Max Healing of Jaw joint structures
3. Reposition disc in health environment
4. Regeneration of fibrocartilage will be available
5. Improved robotic micro surgery

Arthrocentesis will be more successful in future. It is flushing of joint spaces to remove inflammation & cartilage chips.

What is meniscus plication ? The surgeon takes the anterior displaced disc and rotates the disc back over the condylar head & sutures it in place. Surgeon may recontour the lateral aspect of disc to biconcave shape before suturing it into place. The disc is a rectangular shaped donut in biconcave form.

Is surgery ever necessary in TMD treatment? Rare, mainly in Osteoarthritis w/ High anxiety

Why do some patients still request TMD Surgery:

1. So busy that a quick fix sounds enticing
2. Not aware surgery has high failure rate
3. Unaware success of chewing system orthopedics
4. A lot tissues are cut to get to lateral ligament
5. Why surgery, when conservative therapy works
6. Orthopedic therapy success depends on patients with passion for health

High anxiety-PTDS-Panic-Emotional Hyjacking interferes with all TMD treatment:

1. High anxiety sets up massive contraction pterygoid muscle
2. High contraction lateral pterygoid causes failure of lateral ligament
3. Stretching then tearing lateral ligament causes disc displacement
4. Progressive tearing sets up completely displacement disc
5. Complete displacement causes significant pain chewing-talking

Wisdom tooth & jaw pain

1. Cause jaw pain should be determined before wisdom teeth extraction
2. Extraction w/ moderate damage in TMD’s can exacerbate the jaw pain
3. Simple test: numb the nerve to wisdom tooth to see if pain goes away

Guidelines:

• Wisdom teeth are unlikely to be cause of jaw joint pain
• Wisdom tooth extraction should be delayed until after stabilize jaw joint
• Damaged TMD is susceptible to open mouth procedure
• Extraction may cause flare in jaw pain
• Oral surgeons will tell you to stabilize jaw joint before open mouth procedures
• Mild damage TMD is usually strong enough to handle wisdom tooth extraction

If any symptoms of unstable jaw joint, the stability of TMD should be ascertained before wisdom tooth surgery.

Chewing system orthopedics:

1. Different for everyone
2. Multitude causes
3. Unique combinations
4. Targets all causes
5. Pain system changes
6. Team handles complexities

The heart of orthopedic care is team:

1. Physical therapy,
2. Biofeedback,
3. Orthopedic coach, and
4. Patient.

Presurgical-conservative therapy are other terms for chewing system orthopedics

Meniscus plication surgery done in 1990’s is not a recommended surgery for TMD damage at present time.

Why meniscus plication surgery failed ?

• Surgeons focused on damage, not cause
• Causes of TMD damage were not manage before surgery
• Damage occurs to all TMD structures
• TMD is a complex joint
• Lack research causes displaced disc
• If causes can tear healthy ligament disc, it can tear suture line
• Mencius plication surgery was not researched prior implementation
• Physical Therapy or Orthotics were not offered after surgery

Why surgery was first treatment for TMD ?

• Surgeons focused on damage, not cause
• Surgical focus on disc (meniscus)
• Structures: Muscle, capsule, synovial, ligament, retrodiscal tissue, nerve, disc
• Temporomandibular Joint is a complex joint
• Lack research on how disc displaced
• Causes tearing disc needed tx before surgery
• Main causes:
  a) Tension muscles
  b) Grind/clench
  c) Trauma
  d) Head n Neck
• If causes can tear a healthy lateral ligament, it can tear suture line
• Solution: manage cause of tearing ligament to disc before surgery

All specialties like oral surgery or Orofacial Pain should consider quote:

“I can teach you root canal in weekend, but it will take 3 years to teach you the exceptions”