TMJ Surgery

Temporomandibular Joint

Surgery for temporomandibular joint (TMJ) disorders is usually considered only after a thorough trial of non-surgical treatments. This typically involves a multidisciplinary approach, including:

  • Dentist: To assess your bite and jaw alignment.  

  • Oral Medicine Specialist: To diagnose and manage TMJ disorders and associated pain.  

  • Physiotherapist: To improve jaw movement and reduce muscle tension.

Non-surgical treatments may include:

  • Oral splint (mouthguard): To reposition the jaw and reduce clenching.

  • Botox injections: To relax jaw muscles.  

  • Medications: Such as pain relievers and anti-inflammatories.  

  • Other therapies: Like acupuncture, relaxation techniques, and lifestyle changes.  

If these conservative measures fail to provide adequate relief, surgical intervention may be an option. Here's an overview of different TMJ surgical procedures:

Minimally Invasive Procedures:

  • Arthrocentesis: This is the least invasive procedure. It involves washing out the joint with sterile fluid to remove inflammatory substances and improve mobility.  

  • Arthroscopy: A small camera (arthroscope) is inserted into the joint to visualise the internal structures. This allows the surgeon to diagnose problems and perform minor procedures, such as removing scar tissue or repositioning the disc.  

Open Procedures:

  • Arthroplasty: This involves making a small incision to access the joint and modify the joint components. This may include reshaping the bones, removing bone spurs, or repositioning the disc.

  • Total Joint Replacement: In severe cases where the joint is severely damaged, a total joint replacement may be necessary. This involves replacing the damaged joint with an artificial one. This can often be done using a minimally invasive endoscopic approach, which results in minimal scarring and a quicker recovery.  

Choosing the Right Procedure:

The most appropriate surgical procedure for you will depend on the specific nature of your TMJ disorder, the severity of your symptoms, and your overall health. Mr Saha and A/Prof Delpachitra are highly experienced in TMJ surgery and will discuss the best options for your individual needs.

What to expect with TMJ Surgery

All TMJ surgeries are performed under general anaesthesia in a hospital setting. Depending on the type of surgery, your hospital stay may vary:

  • Day Procedure: Arthrocentesis, arthroscopy, and sometimes arthroplasty are typically day procedures, meaning you'll return home the same day.

  • Overnight Stay: Temporomandibular joint replacement usually requires a 2-3 night stay in the hospital.

Before your surgery:

  • Fasting: You will need to fast for 6 hours prior to your procedure. This usually means no food or drink after midnight for a morning operation, or from 6am for an afternoon operation.

  • Hospital Arrival: Please arrive at the hospital 1-2 hours before your scheduled procedure to allow time for admission and preparation.

  • Hospital Admission: You will be checked in by hospital admission staff. Completing any necessary paperwork online beforehand can often streamline this process.

After your surgery:

  • Recovery: After the procedure, you will spend some time in the recovery room before being discharged.

  • Discharge: You must have a responsible adult pick you up from the hospital (not a taxi or ride-share service).

  • Medications and Instructions: You will receive prescriptions for any necessary medications and detailed written post-operative care instructions.

  • Follow-up: Our team will be in contact to monitor your recovery. You can also contact your surgeon or the clinic with any concerns.

Specific Post-Operative Instructions:

  • Diet: After TMJ surgery, you should be on a soft diet for 2 weeks.

  • Mobilisation: It is very important to start mobilising the joint as much as possible soon after your procedure.

  • Physiotherapy: Continue with physiotherapy and your occlusal splint if you already have one.

  • Joint Replacement: With temporomandibular joint replacement, try not to open your mouth too wide for the first 2 weeks and support your jaw when yawning during this period.

Risks

While TMJ surgery can significantly improve your quality of life, it's essential to be aware of the potential risks and complications. These complications are typically temporary but can be permanent in some cases.  

It's important to understand that the likelihood of these complications varies depending on the complexity of the TMJ surgery. Simpler procedures like arthrocentesis carry very low risks, while more complex procedures like joint replacement have higher risks.  

Potential Complications:

  • Nerve damage: Injury to facial nerves can lead to temporary or permanent numbness, tingling, or weakness in the face. This can affect your facial expressions and sensation.  

  • Infection: Infections at the surgical site can cause pain, swelling, and delay healing. In severe cases, additional surgery or prolonged antibiotic treatment may be necessary.

  • Limited jaw movement: Scar tissue formation or changes in joint structure can restrict jaw movement, making it difficult to eat, speak, or yawn comfortably.

  • Persistent pain: Some individuals may experience ongoing pain even after surgery, which can impact their quality of life and daily activities.  

  • Malocclusion: Changes in bite alignment can occur, leading to further jaw discomfort and potential need for orthodontic treatment.

  • Hearing loss: This can range from temporary muffled hearing to more severe, permanent hearing loss, impacting your ability to hear conversations, music, and everyday sounds.

  • Vertigo: This is a spinning sensation that can make you feel dizzy and unsteady, impacting your daily activities and increasing your risk of falls.

  • Tinnitus: This constant ringing, buzzing, or hissing in your ears can be incredibly distracting and frustrating, disrupting your sleep, concentration, and overall well-being.

How these complications can affect your life:

  • Difficulty eating: Limited jaw movement or pain can make chewing and eating challenging, potentially leading to dietary restrictions and nutritional deficiencies.

  • Speech impairment: Nerve damage or jaw restrictions can affect your ability to speak clearly.

  • Social and emotional impact: Facial numbness, weakness, hearing loss, vertigo, and tinnitus can affect self-esteem and social interactions.

  • Work and productivity: Persistent pain or functional limitations can interfere with work or study.

It's important to discuss these potential risks with your surgeon to understand your individual risk factors and make an informed decision about TMJ surgery. The risks and benefits will be weighed against the specific procedure being considered. For example, while joint replacement has higher risks, it may be the best option for individuals with severe TMJ dysfunction who haven't responded to other treatments.

Fees

TMJ surgery fees can also be broken down into different components:

Surgical Fees:

  • These vary depending on the complexity of the procedure.

  • To give you an idea of the range:

    • TMJ arthrocentesis ranges from $1,500 to $2,000 per side.

    • TMJ replacement ranges from $17,500 to $22,500 per side.

    • Other TMJ surgeries, such as arthroscopy and arthroplasty, fall between these ranges.

  • Your private health insurance will provide a rebate for the surgical fee based on the MBS item codes listed below.

Hospital Fee:

  • This covers the hospital's facilities and resources.

  • Usually covered by your "hospital cover" with only your policy excess to pay (typically $0-$500).

  • If you've already paid your excess this year, you likely won't have further hospital fees.

Anaesthetic Fee:

  • Varies based on the complexity and length of your surgery.

  • The typical out-of-pocket anaesthetic fees range from $750 to $2,000.

Prosthetics:

  • Some TMJ surgeries, like joint replacement, may involve prosthetics (artificial joints).

  • The cost of these prosthetics can vary significantly but is typically covered by private health insurance with appropriate cover.

  • We strongly encourage patients to have adequate PHI cover ("Silver" level or higher) to ensure these costs are completely covered.

Specific Item Codes and Procedures:

  • TMJ Manipulation (individual procedure): 45851

  • Arthrocentesis: 45865

  • Arthroscopy (Diagnostic): 45855

  • Arthroscopy (Therapeutic): 45857

  • Arthroplasty (without interpositional graft): 45871

  • Arthroplasty (with interpositional graft): 45873

  • Temporomandibular Joint Replacement: 45874

Important Considerations:

  • Procedure Selection: Your specific item codes and the fees associated with them will depend on the chosen TMJ procedure your surgeon deems necessary.

  • Health Fund Consultation: We strongly recommend contacting your private health fund using the item codes provided to confirm your exact coverage and out-of-pocket expenses.

  • Anaesthetist Information: Information regarding the anaesthetist fees will be provided to you prior to your scheduled surgical date.

  • Comprehensive Care: TMJ surgery is often one part of a broader treatment plan. You may also require consultations and treatments with dentists, dental specialists (for Botox therapy, occlusal splint therapy), and physiotherapists, each with their own associated fees. Be sure to factor these potential costs into your overall plan.