Unroofing of the disc surgery refers to an open surgical procedure primarily performed on the temporomandibular joint (TMJ), commonly known as the jaw joint. It involves creating direct access to the joint to address issues with the articular disc, a small, oval-shaped piece of cartilage located within the joint. While the term “unroofing” might suggest simply removing a covering, it specifically describes the removal of a portion of the bone overlying the joint to allow the surgeon to see and work on the disc directly. This procedure is typically considered when other, less invasive treatments have not provided sufficient relief for severe jaw joint problems.
Understanding the Jaw Joint and Disc Problems
The temporomandibular joint (TMJ) connects the lower jawbone (mandible) to the temporal bone of the skull, located just in front of the ear. This complex joint facilitates essential movements like chewing, talking, and yawning through a combination of hinge and sliding motions. A key component within the TMJ is the articular disc, a flexible and elastic cartilage that acts as a cushion between the two bone surfaces, ensuring smooth, pain-free movement.
Problems arise when this disc becomes displaced from its normal position relative to the jawbone’s condyle and the temporal bone’s fossa. The most common type is anterior displacement, where the disc slips forward. When the disc moves forward, the retrodiscal tissue, which is rich in nerves and blood vessels, can get pinched between the bones, leading to pain. Symptoms frequently include jaw pain, a clicking or popping sound when opening or closing the mouth, limited jaw opening, or even the jaw locking in an open or closed position. Headaches and ear pain are also common complaints associated with TMJ disc issues.
What Happens During Unroofing of the Disc Surgery
Unroofing of the disc surgery, also known as open-joint surgery or arthrotomy, is an invasive procedure generally performed under general anesthesia. The surgeon creates an incision, often along the crease in front of the ear, to gain direct visual access to the temporomandibular joint. This incision allows the surgeon to open the joint capsule and examine the internal structures, particularly the articular disc and the joint surfaces.
The “unroofing” aspect refers to the careful removal of a small section of the temporal bone that forms the “roof” of the joint socket, providing an unobstructed view and working space for the surgeon. With this enhanced access, the surgeon can then address the disc problem. This may involve repositioning a displaced disc and stabilizing it with stitches or small anchors, or in cases of severe damage, the disc might be removed entirely. If the disc is removed, some surgeons may use a graft from another part of the body, such as the temporalis muscle or ear cartilage, to replace it, while others may not place anything in its stead. The procedure typically takes about an hour per joint.
Life After Surgery
Following unroofing of the disc surgery, patients experience some swelling and discomfort, which may be most noticeable within the first two days. Pain medication is prescribed to manage this, and ice packs can help reduce swelling in the initial 48 hours. While some patients might go home the same day, an overnight hospital stay for observation may be necessary, especially with general anesthesia.
A soft or liquid diet is recommended immediately after surgery to allow the jaw joints to rest and heal. Patients are gradually transitioned back to a regular diet over several weeks, with very chewy foods often avoided for at least four weeks. Physical therapy and jaw exercises are prescribed to help restore the range of motion and prevent stiffness, with some patients using an oral therapy device multiple times a day for several months. Stitches may be dissolvable or removed after about one week. Recovery time varies, but patients can expect to take one to two weeks off work, with full healing taking several weeks to months depending on the extent of the surgery.
Other Treatment Approaches
Before considering unroofing of the disc surgery, various non-surgical and less invasive surgical options are explored for temporomandibular joint disc problems. Conservative management often includes pain relievers and anti-inflammatory medications, along with the use of oral splints or mouth guards to reduce jaw stress. Physical therapy, incorporating jaw exercises, stretching, massage, and heat or cold therapy, can also help improve jaw function and reduce pain. Lifestyle modifications, such as avoiding hard or chewy foods and managing stress, are recommended.
When conservative methods are insufficient, minimally invasive surgical procedures may be considered. Arthrocentesis involves flushing the joint with a sterile solution to remove inflammatory byproducts and release scar tissue, often done in an office setting. Arthroscopy, a more invasive procedure, uses a small camera to visualize the joint interior, allowing for washing, scar tissue removal, or disc repair. Open-joint surgery, including unroofing of the disc, is reserved for severe cases where less invasive treatments have not been successful and a structural problem within the joint needs direct repair.