Dysfunction of the temporomandibular joint (TMJ) is one of the most common causes of head and neck pain. Inside the joint is a working relationship between the condylar head (ball) and the glenoid fossa (socket) which is separated by a meniscus or disc. This thick fibrous structure allows the ball of the joint to rotate within as well as move out of the bony socket. Disruption of smooth meniscal movement is what causes clicking or joint noise to occur which can cause pain and, in more severe cases, limitation of condylar movement affecting mouth opening.
Treatment of these internal menisco-condylar derangements of the TMJ is mainly conservative. Anti-inflammatory drugs, rest, physical therapy and oral splints eventually resolve most symptoms. But some few patients will not improve and will progress to more significant internal joint problems such as meniscal sticking or dislocation which can ultimately require surgery.
TMJ surgery for meniscal dysfunction is most popularly treated by arthroscopy. Arthroscopy, however, has significant limitations in a joint that is about the size of your thumbnail. Such a small space limits what can be done to mainly fluid infusion to hopefully create release of adhesions. (adhesiolysis) In my experience an open TMJ arthroplasty is more versatile and allows a greater number of technical manuevers to e done to both the meniscus and the bone.
Open TMJ arthroscopy is more invasive than arthroscopy but if done well and in experienced hands it has no greater risks. A well placed incision offers an aesthetic outcome that would make the surgery very hard to detect. Borrowing from the preauricular portion of facelift surgery, the incision is made in a retrotragal fashion. This keeps the central portion of the resultant scar hidden both during the healing phase as well as with the final healed scar. (three week incision line results using a dissolveable suture closure)
By good incision placement in the natural attachments of the ear to the face, TMJ arthroplasty surgery can be done with good aesthetic results.