The temporomandibular joint (TMJ) is a crucial joint located between the skull base and the lower jaw, enabling mouth opening and closing. It features a ball and socket mechanism, situated immediately in front of the ear. The ‘socket’ is part of the skull base, and the ‘ball’ is part of the lower jaw. A thin but tough disc of soft tissue, acting as a shock absorber, is sandwiched between these two bony surfaces.
Like any joint in the body, the TMJ can suffer from various disorders, including arthritis, fractures, muscle sprains, and disc disorders. Disc problems, particularly prevalent in young women, are the most common issue, affecting about 1 in 4 young women. Symptoms of disc disorders can be complex, such as:
Elderly patients often experience different patterns of TMJ disease, such as arthritis or advanced disc problems (like perforation or fragmentation of the disc).
The management of TMJ disorders depends on the underlying cause, whether it’s disc-related, bone arthritis, or muscle issues supporting the joint. Sometimes, TMJ pain can be referred from other areas, such as ear disease, wisdom teeth issues, or cervical spine problems. Non-surgical measures often effectively manage these problems, including habit changes, painkillers, physiotherapy, acupuncture, mouth guards, and hypnotherapy.
When surgery is necessary, I offer a range of procedures, including joint washout, arthroscopy, debridement and smoothing of bone surfaces, and prosthetic total joint replacement.
Example: A patient with advanced TMJ disease underwent a left total TMJ replacement, as shown.
In general, the nature and extent of TMJ disorder management depend on the severity of the patient’s symptoms, with the patient actively participating in the decision-making process.
In cases where complex reconstructive surgery cannot match the functional and aesthetic outcomes of an implant-retained prosthetic facial prosthesis, the placement of small, hidden titanium screws anchoring to the facial skeleton bone is ideal. For example, an elderly woman who lost her nose and right eye to skin cancer had six titanium bone implants placed to firmly hold a facial prosthesis.
I work with a multidisciplinary team to discuss, plan, and execute surgical plans, ensuring the best clinical outcomes. My approach involves working with patients and their families as equal partners in decision-making, based on honesty, respect, and empowerment. We offer 3D-guided implant placement for optimal outcomes. After bone implant placement, the restorative specialist provides attachments like crowns, bridges, dentures, or artificial ears, noses, or eyes.
Private:
Auckland Head & Neck Specialists, MercyAscot,
100 Mountain Road Epsom.
E-mail: info@ahns.co.nz
Greville Dental (Visiting Surgeon), 18 Hauraki Crescent, Pinehill. E-mail: info@ofhnsurgery.co.nz
