Temporomandibular Joint Disorders
Maxillofacial treatment for trauma, pathology and dysfunction of the TMJ
Case Examples
Maxillofacial treatment for trauma, pathology and dysfunction of the TMJ
Watch the videos below to learn more about the most common TMJ conditions and the surgical approaches used to treat them.
Jaw Pain, Trauma and Dysfunction: Causes and Consequences
The temporomandibular joints (TMJ) are the paired joints of the facial skeleton that allow the lower jaw to move in three planes of space.
They are anatomically complex structures: as paired joints, they must function in perfect coordination with one another, and each contains a fibrocartilaginous structure — the articular disc — that acts as a cushion and shock absorber between the two joint surfaces (the mandibular condyle and the articular fossa).
Conditions affecting the TMJ include:
- Trauma with fractures of the mandibular condyle, ranging from simple to complex;
- Joint dysfunction involving malposition and/or deterioration of the articular disc;
- Arthritic degeneration or systemic conditions with joint involvement;
- Recurrent mandibular dislocation, with difficulty or inability to close the mouth;
- Temporomandibular ankylosis — structural changes affecting the entire joint, with loss of the articular disc and fusion of the joint surfaces (condyle and articular fossa), resulting in an inability to open the mouth
- Growth disturbances of the mandibular condyles, causing asymmetry of the jaw or lower face
- Benign or malignant neoplasms of the temporomandibular joint (rare)
TMJ Disorders: Treatment Options
Treatment varies according to the specific condition:
- Mandibular condyle fractures may be managed surgically — via an external skin incision in front of the ear or behind the jaw, or, less commonly, via an intraoral incision — or conservatively, using dental splints, orthodontic appliances and elastic traction. Active and passive physiotherapy are essential components of management in all cases.
- Dysfunctional conditions (disc malposition, arthritic degeneration, recurrent dislocation) are initially managed conservatively, with the aim of restoring normal jaw function and position.
In selected cases, a procedure known as arthrocentesis may be indicated — a joint lavage performed as an outpatient procedure under local anaesthesia. When conservative treatments fail to provide adequate relief, surgical arthroplasty may be indicated and performed via a skin incision in front of the ear. - Temporomandibular ankylosis and neoplasms — benign or malignant — invariably require surgical intervention. In particular, ankylosis cases require an extended post-operative physiotherapy programme given the risk of recurrence.
- Condylar growth disturbances with mandibular asymmetry always require a diagnostic bone scan (scintigraphy). Depending on the findings, surgical condylectomy may be indicated — performed during or at the end of the growth phase — in combination with additional surgical procedures on the upper jaw and/or mandible (see also orthognathic surgery, or corrective jaw surgery).
TMJ Arthrocentesis
What Is TMJ Arthrocentesis?
Arthrocentesis of the temporomandibular joint is a minimally invasive procedure involving the lavage of the upper joint compartment with sterile saline solution. Two fine needles are inserted through the skin into the joint space, creating a continuous irrigation circuit — saline is introduced through one needle and exits through the other. Following the lavage, hyaluronic acid is injected into the joint capsule to lubricate the articular surfaces.
Arthrocentesis is the simplest and least invasive procedure available for the treatment of temporomandibular joint dysfunction.
Indications:
- Patients with intra-articular pathology that has not responded to conservative treatment (splint therapy);
- Anterior disc displacement with or without reduction;
- Acute joint lock (closed lock) — arthrocentesis is the procedure of choice in these cases;
- Disc adhesion with restricted mouth opening;
- Synovitis or capsulitis unresponsive to conservative management;
- Arthritis or arthrosis of the TMJ;
- Painful clicking or joint noise during opening and closing movements.
How Does It Work?
The procedure aims to restore normal disc mobility by injecting saline solution between the roof of the joint cavity and the disc itself. The lavage, followed by hyaluronic acid infiltration, significantly reduces the concentration of pain and inflammation mediators within the joint (bradykinin, interleukin-9, proteins), removes an important source of intra-articular pain, improves joint function by freeing disc movement, and reduces disc interference noises. The procedure, therefore, acts on both the chemical and mechanical components of joint pain.
The published literature demonstrates that arthrocentesis has an excellent success rate, particularly in improving mouth opening and reducing joint noises — especially in conditions of especially in earlier-stage conditions.
It can also be repeated at intervals throughout a patient’s lifetime, making it a treatment of choice for many patients who undergo it during acute exacerbations.
Post-Procedure Care:
In the days following the procedure, it is important to wear a Michigan splint (bite guard) to allow the joint to rest, follow a soft diet, and carry out mandibular physiotherapy exercises consistently.
Side Effects:
Arthrocentesis carries no risk of drug-related side effects, as only saline solution and hyaluronic acid are used.
Possible post-procedural effects include localised swelling at the injection site due to subcutaneous fluid accumulation, which resolves spontaneously within a few hours or days. Pain is uncommon and can be managed with standard analgesia. More frequently, patients report a mild sense of soreness and the presence of fluid in the ear canal, which reabsorbs within a few days. Temporary numbness of the surrounding area has occasionally been reported. In rare cases, the facial nerve may be transiently affected, causing temporary difficulty moving the eyelids, forehead or lips — this effect is always short-lived, typically resolving within a few hours.
Would you like more information?
Frequently Asked Questions
Clear answers to the most common questions about when to seek specialist advice, what oral and maxillofacial surgery involves, and what treatment options are available.
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The appropriate investigations depend on the clinical picture — whether the concern involves pain, restricted movement, trauma or joint dysfunction. In many cases, a specialist assessment and any existing imaging will provide a useful starting point. When further investigation is required, targeted imaging such as an OPT or CT/CBCT may be indicated. The most precise and informative examination is an MRI of the temporomandibular joints, performed in both closed-mouth (static) and open-mouth (dynamic) positions
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Diagnosis begins with a thorough clinical assessment: a detailed history (symptoms, duration, triggering factors), functional examination of the jaw (range of opening, deviation, tenderness, joint sounds) and, where relevant, an assessment of the dental occlusion. Imaging is frequently used to support the diagnosis — MRI is particularly valuable for evaluating soft tissue and articular components, while CT/CBCT provides a detailed assessment of bony structures. Accurate diagnosis is essential for distinguishing between conditions that share similar symptoms but require different treatment approaches.
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TMJ dysfunction — also referred to as temporomandibular dysfunction (TMD) — encompasses a range of disorders affecting the temporomandibular joint and the mechanisms that govern jaw movement. It may present as pain near the ear or jaw, clicking or crepitus, a sensation of locking, restricted mouth opening, fatigue on chewing and muscle tension. TMD is not a single diagnosis: a specialist assessment is essential to identify the underlying cause and determine the most appropriate course of treatment.
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TMJ conditions can be managed by a range of healthcare professionals depending on their nature and complexity. Where problems are complex, persistent or require thorough investigation, assessment by an oral and maxillofacial surgeon with specific experience in TMJ and TMD disorders is indicated.
In the majority of cases, management is multidisciplinary and may involve a dentist or an occlusal specialist, an orthodontist, a physiotherapist, a neurologist, a radiologist, or a psychologist. The critical first step is always establishing an accurate diagnosis and clear clinical indication — to avoid repeated attempts and poorly targeted treatments.
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Effective management of TMJ problems begins with identifying the specific type of dysfunction and its underlying cause — there is no single solution that applies to all cases. In many instances, treatment starts with conservative measures: managing joint load, using appropriate devices, physiotherapy and functional rehabilitation, and addressing parafunctional habits such as jaw clenching. Clinical response is monitored, and further options are considered, as needed, based on diagnosis and severity. The purpose of a specialist consultation is to provide clear guidance on what is appropriate, what to avoid, and which steps are genuinely beneficial in each individual case.
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