Surgical Treatment of TMJ Disorders

General Information

TMJ DisorderTMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have symptoms like pain you will be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment is important.

TMJ disorders develop for many reasons. You might clench/grind your teeth, tighten your jaw muscles and stress your TM joint. You may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking, grating noises when you open your mouth or trouble opening your mouth widely.

Often no one treatment can resolve TMJ disorders completely and the treatment takes time to become effective. If you have been referred to an oral surgeon for your TMJ, most likely less invasive treatment options have not provided you the relief you are striving for. An oral surgeon can provide you with the following treatment options:

  • Botox injections of facial muscles
  • Temporomandibular joint arthrocenthesis
  • Temporomandibular joint surgery

Botox of Facial Muscles


Botox is used in TMJ (temporomandibular joint) disorders and associated muscle tension and pain. These injections may be used alone or in conjunction with surgical treatments. A consultation with one of our doctors will determine if you may are a candidate for this treatment.

Located on both sides of the head at the point where the jawbone meets the skull, the temporo-mandibular joint (TMJ) is used during talking, eating, swallowing, and other everyday activities. If the muscles of the jaw are overworked through excessive teeth grinding, a person may suffer sharp pain in the muscles of the jaw. The Botox can relieve muscles tension and pain by making the muscles unable to engage in the powerful, often unconscious movement of the jaw that produces the clenching and the pain. Many patients have found relief from their symptoms with these injections.

This procedure is done in office and takes approximately 10- 30 minutes depending on how many sites and how much Botox will be used.

TMJ Disorders


Minimal to mild discomfort may be felt during the injections but generally no pain medication is required. There may be mild temporary bruising, numbness, or redness around the injection sites. If experiencing some discomfort or stiffness often an over the counter medication such as Ibuprofen (Advil) or Acetaminophen (Tylenol) can be helpful. Generally it can take a few days to a week before the positive effects of the injections can be felt.

Most patients can return to normal activities almost immediately. To avoid spreading the toxin to other muscles, patients should not rub or massage the areas injected with Botox and remain upright for a few hours.


As with any medical procedure there are possible risks and side effects when using Botox for TMJ treatment. Since this is a non-surgical treatment procedure, the risks and possible complications are infrequent, minimal and temporary.
The most common reported side-effects of Botox treatment are pain, redness or bruising at spot of injection, and muscle weakness. Less common side effects include temporary eye-lid droop.
Another limitation to Botox injection for TMJ treatments is that there is a possibility of developing antibodies that would render the TMJ treatments less and less effective over time. This resistance could be delayed by using the lowest effective dose possible over the longest intervals of time. Botox injection treatments should be avoided during pregnancy and lactation.

Temporomandibular Joint (TMJ) Arthrocentesis


An oral and maxillofacial surgeon will often recommend TMJ arthrocentesis when conservative therapies have not proven to be successful. This simple procedure is used to provide relief from temporomandibular joint pain and discomfort. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation that may have accumulated in the affected joint. Although pain relief is never guaranteed, many patients have found this procedure to be effective in managing their symptoms.

The patient is placed under a general anaesthetic. Once asleep, the surgeon inserts a sterile needle into the temporomandibular joint space. A syringe is attached to the needle and used to push sterile fluid into the joint space. A second needle is then inserted so that the joint can be washed out. Fluid enters the joint through one needle and leaves out the other. This removes the inflamed fluid from the joint. Some surgeons will also use a steroid (anti-inflammatory medication) at the end of the procedure. It is injected and left in the joint prior to needle removals.



See The Arthrocentesis Post-Operative Care.

Open Joint Surgery

There are many types of open joint surgeries. The surgeon makes a cut in a skin crease just in front of the ear. This exposes the jaw joint. The surgeon may repair, reposition, or replace the disc with your own tissue or an artificial disc. Scar tissue or bony growths in the jaw joint can also be removed. Open-joint arthroplasty is done under general anesthesia. You can normally expect to go home the same day.

Your Oral Surgeon May Suggest This Type Of Surgery If:

  • Your TMJ is degenerating
  • There are tumors in or around your TMJ
  • The joint is severely scarred or contains chips of bone
  • Arthrocentesis is not possible or has not succeeded in the past.
  • The joint is fused together by bony growth (ankylosis).

Your surgeon at your consult will further discuss the procedures, risks, benefits and recovery phase with you.

Post-Operative Temporomandibular Joint Arthrocentesis Instructions

Proper care after surgery has an important effect on healing. Please read the following instructions carefully.

Pain Management

Some amount of discomfort is to be expected following any surgery. If your surgeon feels you will benefit from a prescription pain medicine, you will receive a prescription following your surgery. Please follow the instructions carefully.

  • Ibuprofen (such as Advil, Motrin) works very well for many patients and can reduce the amount of narcotic pain medicine (Tylenol 3, Percocet) needed significantly. You may find taking 400-600mg every 6 hours on a regular schedule for the first 2-3 days is all the pain medicine needed. You may alternate ibuprofen and narcotic pain medication for maximum pain medication if needed. Continue to take as directed as needed for pain. You can wean yourself off the pain medications if pain is controlled. You may or may not need to take all the pain medications for this reason.
    Those who are allergic to Aspirin or other NSAIDS cannot follow this regimen.
  • Begin taking your pain medications as directed as soon as you get home. Your pain medication can be taken with liquid only but it is important to get some soft/pureed food) in your stomach as soon as possible. Take all subsequent doses along with food to minimize nausea.

Numbness and Paralysis of Facial Muscles

Local anesthetic may infiltrate various layers of the skin, which may paralyse the facial nerve. The facial nerve may be in the vicinity of the surgery site and you may develop a temporary inability to close the eye completely or smile. This problem is temporary, however, should you feel concerned, please contact the office to speak with a nurse


  • You may notice small amounts of bleeding from the injection sites. This is usually minimal. If bleeding persists longer than 24hrs, call the office.
  • You may wash the injections sites when you are bathing.
  • You may experience fluid in the ears. This can feel like “swimmers ear” and can last for about 2-10 days. Dizziness may accompany this situation. Do not be alarmed as this feeling of fluid in the ears, will usually resolve without further treatment.


  • Some swelling and bruising in the area is expected. This is usually minor, but occasionally more pronounced swelling can occur. If this happens, it is usually a result of a sterile irrigation fluid that has entered the surrounding tissues. Most of the swelling will resolve within 24-36 hours.
  • Application of ice packs, 20 minutes on and 20 minutes off at a time for the next 48hrs is recommended, with care not to harm or freeze the skin, especially while it is numb.
  • Crushed ice in a ziplock bag or a bag of frozen peas wrapped in a moist cloth to prevent frost bite works well.
  • After the first 5 days, you can begin using a heating pad or moist heat for relief of stiffness of the jaw.
  • Apply heat 4 times/ day for 30 minute time intervals.


Following your procedure you will be on a soft or pureed diet until seen by your surgeon at the follow up appointment. At this point you will be given instructions as to when you can advance your diet.
Suggested foods include: puddings, oatmeal, smoothies, scrambled eggs, pasta, steamed vegetables , jello, and mashed potatoes


Tight facial muscles can be expected after the procedure. The application of heat as described above will help relax these muscles and relieve spasms. Exercise your facial muscles by opening and closing the mouth and massaging the sides of the face after heat application.


Your well-being is our primary concern and it is our sincere desire that you experience the least possible amount of discomfort or anxiety. Should you have any questions regarding your recovery, please do not hesitate to contact our office at (403) 948-9598.


If any unusual symptoms should occur please call our office at (403) 948-9598. If you are calling after our office hours or on the weekend, the answering machine will direct you to the oral surgeon on-call. In the event of an unexpected admission to a hospital related to a treatment at this facility, please notify us.