The temporomandibular joint (TMJ) connects the lower jaw to the skull, functioning as a sliding hinge essential for movements like chewing and speaking. Temporomandibular disorders (TMDs) cause pain and dysfunction in this joint and the surrounding muscles. Common symptoms include persistent jaw pain, tenderness, clicking or popping sounds, and limited ability to open or close the mouth. While most TMD cases are managed with non-surgical treatments, surgery is considered when conservative therapies fail to provide relief.
When Surgical Intervention is Necessary
TMJ surgery is reserved for patients whose conditions have not improved after extensive non-surgical efforts. These conservative treatments typically include pain medications, physical therapy, oral splint devices, and stress management techniques. Patients are usually considered candidates for surgery after enduring at least six months of severe, persistent pain and dysfunction despite adherence to these therapies.
Surgical treatment relies on diagnostic findings that indicate structural damage within the joint. This damage often includes severe joint degeneration, chronic displacement of the articular disc, or structural damage from trauma or advanced arthritis. Surgery may be recommended to restore function when restricted movement significantly impairs daily activities, aiming to correct mechanical problems non-invasive methods cannot address.
Primary Surgical Specialists Who Treat TMJ
The primary surgical specialists who treat temporomandibular joint disorders are Oral and Maxillofacial Surgeons (OMFS). OMFS professionals are trained to operate on the entire craniomaxillofacial complex, including the jaw, face, and skull. Their comprehensive background involves a four-year dental degree (DDS or DMD) followed by a minimum of four years in a hospital-based surgical residency program. This extensive training provides expertise in both dental and medical disciplines, qualifying OMFS professionals to perform the full spectrum of TMJ procedures, from minimally invasive techniques to complex joint reconstruction.
While other specialists, such as Otolaryngologists (ENT) or Plastic Surgeons, may manage complex cases, the OMFS remains the most common and specialized provider for TMJ surgery.
Procedure Complexity and Specialized Expertise
Minimally Invasive Procedures
The specific type of surgery dictates the necessary level of a surgeon’s expertise. The least invasive approaches include arthrocentesis, which involves flushing the joint space with a sterile solution to remove inflammatory byproducts, and arthroscopy. Arthroscopy uses a small camera and instruments inserted through tiny incisions to visualize and treat minor issues like removing scar tissue or repositioning the disc. These procedures are generally within the scope of a general Oral and Maxillofacial Surgeon.
Open Joint Surgery and Total Joint Replacement
More complex interventions fall under open joint surgery, or arthroplasty, which requires a larger incision for direct access to the joint. This allows the surgeon to repair or replace a severely damaged disc, remove bone spurs, or correct structural deformities. The most specialized procedure is total joint replacement (TJR), reserved for end-stage joint disease caused by severe arthritis, trauma, or congenital deformities. TJR requires a surgeon—almost exclusively an OMFS—who has completed an additional, specialized fellowship focused on TMJ reconstruction, as it involves replacing the damaged joint with a custom prosthetic.
Vetting and Selecting the Right Surgical Professional
Patients considering surgery must ensure the surgeon possesses the appropriate credentials and experience. The first step involves verifying board certification, such as with the American Board of Oral and Maxillofacial Surgery, which confirms rigorous training and examination standards have been met. Seeking a referral from a dentist or a physician specializing in orofacial pain can also direct patients toward reputable surgical professionals.
Patients should inquire about the surgeon’s specific experience and the volume of TMJ surgeries they perform annually. For complex procedures like total joint replacement, confirm whether the surgeon has completed a dedicated fellowship in TMJ reconstruction. A high-volume surgeon with specialized fellowship training is better equipped to handle the unique anatomical challenges and potential complications of advanced TMJ surgery.