Surgery & TMD
Surgery for TMJ requires preoperative therapy to reduce causes for tearing lateral ligament or surgery will fail.
Like other orthopedic surgeries, TMJ surgery requires post operative therapy by Orofacial Pain Specialist to have best opportunity for healing.
Why meniscus plication surgery failed to manage damaged TMJ in past ?
- Surgeons focused on damage, not cause
- Surgery focus on damage joint, ligaments, retrodiscal tissue
- Muscle damage was not concern surgeons
- Temporomandibular joint & meniscus is a complex joint
- Surgery did not remove causes of damage before surgery
- At time, we lack research on how lateral lateral ligament of disc got torn
- 4 main causes of tearing were not managed before surgery a) Tension muscles b) Grinding/clenching c) Trauma’s d) Head n Neck pain
- If causes can tear a healthy lateral ligament, it can tear suture line
- Solution: manage cause of tearing ligament to disc before surgery, then the surgery to recapture the meniscus (disc) would have been successful
Simple test to see If jaw joint is major source pain ? Have Orofacial Pain Specialist, numb Auriculotemporal Nerve and see how much pain goes away. If all pain goes away, the joint proper is source of pain, but before surgery is ever considered chewing system orthopedics must be passionately implemented.
Three types of jaw surgery: 1) Menicus plication, 2) Orthognathic surgery
Two types of TMJ surgery: 1) Menicus plication, 2) Arthrocentesis
What is arthrocentesis? 1) Flushing TMJ to remove inflammation chemicals & tissue tags 2) Two syringe are place in the fossa of TMJ 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 close to normal and only after all causes have been managed.
Guideline: Menicus plication surgery is not recommend for TMD at this time.
What is meniscus plication surgery ?
- Repositioning of a displaced disc
- Utilized in early days of TMJ treatment
- Did not treat cause displacement
- TMJ disc displacment 8 different causes
- Pulling by Superior Lateral Pterygoid tore lateral ligament
- Did not stop pulling & Tearing lateral ligament before surgery
- Suturing lateral ligament to condyle temporarily reposition disc
- If 8 pullings on ligament were still present, would they not tear surture
- IF Chewing system orthopedics was to be implemented before surgery, would it stay ?
Future of meniscus plication: 1) Healing of Jaw joint structures will be required before reposition disc 2) New science of laboratory regeneration of fibrocartilage will be available 3) Improve techniques of robotic surgery
Arthrocentesis will be considered:
- Chewing system orthopedics been successfully implemented
- TMJ tissues been given ample time to heal
- Every orthopedic tool implemented & perfected
- Orthopedic team implement all healing tools
- Orthopedic care been milked for benefits
- Anxiety has been managed by patient to reduce muscle pull
- Child abuse & PTSD (body remembers) has been managed properly before surgery
Why did meniscus plication fail to “fix” in 90’s
The damaging forces that torn lateral ligament in first place were allow to continue unabated, tearing the suture lines and allowing disc displaced again after surgery.
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 ofdisc to biconcave shape before suturing it into place. The rectangular shaped donut or disc has biconcave form.
Is chewing system orthopedics (CSO) successful today? Yes
Is surgery ever necessary in TMD treatment? Rare, mainly in Osteoarthritis w/ High anxiety and cartilage or bone chips inside joint
If surgery is required today, what is type surgery: Arthrocentesis
- Bone & cartilage chips are reason
- flushing joint is purpose
- cases severe osteoarthritis
Why do some patients still request TMJ Surgery:
- Demanding a quick fix
- Not aware meniscus plication failed
- Not aware success of chewing system orthopedics
- Not realizing cut 15 tissues to get to lateral ligament is not ideal
- Why would you invade joint w/ surgery, when orthopedic therapy is so successful
- Orthopedic therapy is only successful on patients with passion to manage anxiety
Surgery failed in late 80’s & 90’s, why? 1. Chewing System Orthopedics was not available 2. Tearing suture line after surgery was not prevented 3. Causes were not adequately studied by science 4. Surgical success in knee/hips influenced surgeons 5. Surgical techniques are always improving
Will Menicus Plication come back ?
Research at UF and other universities are making meniscus replacement surgery a possibility in future. This outstanding research of growing meniscus in lab and transplanting into jaw should be possible in near future.
Why did surgery fail in High anxiety-PTDS-Panic attacks-Emotional Hyjacking ?
- High anxiety sets up massive contraction pterygoid muscle
- High contraction lateral pterygoid causes failure of lateral ligament
- Stretching then tearing lateral ligament causes disc displacement
- Progressive tearing sets up completely displacement disc
- Complete displacement causes significant pain chewing-talking
Arthrocentesis (flushing joint) recommend: 1. If Chewing system orthopedics cannot relieve all pain 2. In cases severe damage TMJ: Osteoarthritis 3. If TMJ MRI Tellsa 3 = fragments in joint space (future) 4) If extensive adhesions TMJ, arthrocentesis recommend 5) May use several arthrocentis to reduce adhesion
Wisdom teeth & TMD
Wisdom tooth extraction is not a treatment for TMD, jaw pain, or atypical toothache.
- Wisdom teeth are unlikely to be cause of jaw joint pain
- Wisdom tooth extraction should be delayed until after stabilize jaw joint
- Moderate damage TMJ is susceptible to a open mouth procedure, thus, causing jaw pain flare
- Oral surgeons will tell you to stabilize jaw joint before open mouth procedures
- Mild damage TMJ is usually strong enough to handle wisdom tooth extraction