Study Confirms Surgical Options Reduce TMJ Pain

If nonsurgical therapies prove unsuccessful, surgery remains a good option for many who suffer from temporomandibular joint (TMJ) pain.

In fact, four surgeries-arthroscopy, condylotomy, disc repositioning and discectomy-all markedly reduced pain and improved the ability to eat solid foods in about 90 percent of patients in a recent study.

All four procedures studied yielded virtually indistinguishable outcomes, added principal author Dr. H. David Hall, an oral surgeon, physician and professor/chairman emeritus of Vanderbilt University Medical Center's department of oral and maxillofacial surgery.

The researchers compared baseline measurements with changes in overall degree of pain, hours of pain experienced daily, diet and range of motion in the jaws of patients one month and one year after surgery.

Patients in the study qualified for surgery by having severe TMJ pain and undergoing magnetic resonance imaging to confirm the presence of an "internal derangement."

Internal derangement refers to a painful disruption of the relationship between the piece of cartilage essential for smooth jaw movement (the articular disc) and the condyle (the rounded top of the lower jaw bone).

Even after standard conservative treatment such as diet changes, anti-inflammatory medications and control of bruxism—chronic tooth grinding, a common factor in the development of TMJ problems—patients' intolerable pain had persisted.

Rating pain levels a month and a year after surgery, the same patients reported lower scores than baseline, pre-surgical levels.

"It appears to be surgery, per se, that accounts for this early and sustained pain relief," said Dr. Hall. "In addition, only about 50 percent of patients with internal derangements improve after one year without surgery, in contrast to about 90 percent of the patients in this study at one month."

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