TMJ Disorders

Temporomandibular Disorder Surgery covers a wide range of painful oral and facial symptoms involving the joint and surrounding facial muscles. Some cases are treated with orthotic appliances to deter bruxism, while other cases involve surgical procedures on the joint itself.

Surgical Options

The surgical options range from arthroscopy to total joint replacement. Care is coordinated with physical therapy and stress management. The goals of treatment include relief of pain and headaches and return to normal diet.

Tmj Replacement

Depending upon age, amount of damage to the temporomandibular joint, and previous surgeries, replacement of all (total) or part (partial) of the joint structures may be indicated. Indications for this surgery include:

Severe Arthritis of TMJ

Inflammatory arthritis that has not responded to other therapies If the tissues of the joint fuse (ankylosis) causing loss of motion in the joint, resulting in inability to open the mouth properly If bite changes and/or facial appearance has changed as a result of a tmj problem Severe internal worsening (internal derangement) that does not respond to other therapies If previous attempts at surgery by opening the joint have failed to resolve the problem Loss of normal anatomy of the joint due to trauma or pathology of the tmj

Types of Joint Replacements

Depending on the patient’s age and condition, joint replacement can be performed with either natural or artificial materials. For an actively growing patient, the use of a patient’s own rib is preferred. For an adult, we prefer the use of a metal joint replacement, which has been shown to have long lasting success in many patients. Joint replacements can be used of standard sizes or customized to fit each individual patient.

Partial Replacement Joint

Stock Replacement Joint

Custom Replacement Joint

The Custom Joint Replacement Process A specially formatted ct scan is taken of the facial bones, and the data is sent to the joint manufacturer. An extremely accurate anatomic model is manufactured from the computerized data that is used to design the implants. Once the design process is approved by both the surgeon and the manufacturer, the joint material are cast in metal and prepared to be sent to the hospital for insertion.

Wax Up Custom Joint Custom Replacement Joint

The Surgical Procedure

Although each replacement is unique for each patient’s condition, most patients can expect a 1-2 day stay in the hospital. Many times surgical braces are applied to line up the teeth during the procedure, and are removed in the office. Although the jaws are not wired shut after the surgery, physical therapy is required as soon after the procedure as possible. This will involve the use of a hand held jaw excerciser and frequent visits to the physical therapist. A non-chew diet can be expected for the first 2-4 weeks following surgery.

Dr. Sultan has been specially trained in the use of both partial and total joint replacements. He has taken part in educational meetings and performed surgery both nationally and abroad. He is one of the few surgeons in South Florida experienced to perform these procedures.