TMJ replacement surgery, or total temporomandibular joint replacement is a relatively new surgical procedure that involves replacing the joints between the lower jaw and the base of the skull with custom-made prosthetic joints. Mr Luke Cascarini is one of only a few of the UK specialists able to offer it.
How common are jaw problems?
Jaw problems are relatively common; these range from mild jaw clicking to more serious jaw locking and joint degeneration or traumatic damage. The range of problems can be as extensive as with any joint in the body, and while hip and knee replacement surgery has been perfected over many years, being confident of success with jaw joint procedures has only been possible in the last 10-15 years.
Do I need TMJ jaw replacement surgery?
TMJ jaw replacement surgery is usually required in patients who have:
- Jaw damage through osteoarthritis
- Damage due to an accident
- Had part of the jaw bone removed due to a cancerous tumour, bone infection, rheumatoid or psoriatic arthritis.
Jaw replacement surgery is not required for all kinds of jaw problems. Some problems can be solved by looking inside the joint with a scope and washing the joint out.
Mr Cascarini uses the very latest tiny scopes that are just over 1mm in diameter and can be used to examine the inside of the joint directly.
Injections are also offered to relieve inflammation and pain that may provide enough relief for the patient. Surgery remains an option if the symptoms return in the future.
Patients who have a seriously damaged TMJ experience limited movement and pain that can be debilitating. With severe TMJ disorder the patient usually can’t talk or swallow their own saliva without severe pain. A TMJ replacement can be a huge benefit to these patients.
What does TMJ replacement surgery consist of?
To replace the TMJ, the knuckle of the joint has to be cut off and a titanium replacement installed. A little of the bone at the base of the skull is sometimes removed, and replaced with a high-density type of plastic that screws onto the side of the skull. The titanium knuckle sits into the plastic and allows the jaw its full range of movements.
How long does the procedure take?
The planning and custom manufacture for joint replacement is complex and takes approximately 3 months. This stage begins with the patient undertaking a special very fine slice CT scan which is then used to create draft designs by the implant manufacturer. These designs will be discussed and amended until Mr Cascarini is completely happy that they are perfect. Following this, a date will be booked at the hospital, and once funding is agreed between the hospital and the insurance company, the 6-week process of the building of the joint can begin.
The surgery itself takes approximately 1.5 hours per side. The patient usually remains in hospital as an inpatient for one week and will require some recovery time before returning to work. The patient will be regularly reviewed and patients with chronic pain may require longer admissions.
What are the risks of the procedure?
- As with any joint replacement procedure, one of the main risks is of infection.
- Allergic reaction to implant components.
- Specific to TMJ replacement, risks include facial swelling and facial nerve weakness.
- Heterotopic bone formation (bone found in an abnormal place).
- Neuroma formation (abnormal growth of nerve tissue).
- Ear problems.
- Replacement of one joint can cause detrimental effects to the opposite joint.
- Misalignment of the teeth after surgery is possible.
- Patients with long term pain prior to surgery may continue to experience pain. In this case, the patient will be referred to a chronic pain specialist.