Surgery may be advised if conservative treatments do not relieve pain and help you move your jaw better. These earlier treatments may include splints, physical therapy and medicines to treat pain and inflammation.

Sometimes structural problems are the cause of pain and limited jaw movement. Surgery can correct such problems. Your dentist and your oral and maxillofacial surgeon will determine whether you have a structural problem.

Before you have any surgery, be sure to get a second opinion. Consult another surgeon who treats temporomandibular disorders (TMD). Surgery is successful in most patients. Sometimes, however, it may result in more pain and problems with jaw function.

Be sure your surgeon clearly explains why you should have surgery. Ask about the risks and benefits of the proposed surgery. Also discuss other possible treatment options.

The temporomandibular joint (TMJ) is a small ball-and-socket joint. It consists of the following parts:

• The ball, called the condyle
• The socket, called the glenoid fossa
• A small disk of cartilage and fibrous tissue that sits between the condyle and the glenoid fossa

There are two main types of surgery for TMD: arthroscopy and open joint surgery.

Arthroscopy
Arthroscopy usually requires general anesthesia. First, the surgeon makes a small cut in front of the ear. Then he or she inserts a small, thin instrument equipped with a lens and a fiberoptic light. This is connected to a video screen and monitor that allow the surgeon to see the TMJ. Another tiny cut is made to allow the surgeon to pass very fine instruments. The exact type of surgery will depend on the cause of the jaw problem. The surgeon may realign the disk or remove scar bands that are preventing the joint from moving properly.

Open Joint Surgery
There are many types of open joint surgeries. In all of them, the surgeon operates without special equipment like video monitors. Instead, the surgeon makes a cut in a skin crease just in front of the ear. This exposes the jaw joint. 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
• Arthroscopy is not possible or has not succeeded in the past

Healing from open surgery takes longer than healing from arthroscopy. There is also a greater chance of scarring and nerve injury. These problems are rare, however.

A very small number of people may need total joint replacement. This is similar to what orthopedic surgeons perform for the knee, hip and other joints.

After either type of surgery, your surgeon may prescribe physical therapy to help you regain your range of motion.