Total temporomandibular joint (TMJ) replacement

What is total temporomandibular joint replacement?

Total temporomandibular joint (TMJ) replacement, or total jaw joint replacement, is a surgery to treat severe TMJ disorders. It involves replacing the damaged joint with a prosthetic one to improve jaw function, relieve pain, and enhance quality of life.

Penn Medicine Oral and Maxillofacial Surgery is internationally known for expertise in TMJ dysfunction and performs some of the highest volumes of joint surgeries in the country. Our level of experience has refined our techniques and enhanced our precision, enabling us to deliver high-quality care with confidence for even the most complex cases.

Who is a candidate for total jaw joint replacement?

Jaw replacement surgery is typically recommended for people with:

  • Severe arthritis in the jaw joint
  • Limited mouth opening (ankylosis)
  • Jaw joint tumors
  • Jaw injuries from facial trauma
  • Advanced TMJ disorders that haven’t responded to other treatments or surgeries

What to expect from jaw replacement surgery

Before your total jaw replacement surgery, you’ll have a thorough health check-up, including blood tests and scans. You’ll be asked about the medications you take and any allergies you may have. Some medicines, like blood thinners, may need to be stopped before the operation. Because smoking can slow down healing, you’ll be advised to stop well in advance of the procedure. It’s also recommended to avoid alcohol for a few days before surgery. Be sure to follow instructions about when to stop eating and drinking, usually starting the night before surgery.

Shortly before surgery, you’ll be given general anesthesia to ensure you are asleep and comfortable. During the procedure:

  • The surgeon makes small incisions in front of the ear and underneath the jawline.
  • The damaged joint and any bone or tissue affected by disease or injury are carefully removed.
  • The prosthetic components are inserted to replace the removed joint. These include a fossa (socket) and a mandibular (jawbone) component.
  • The components are secured to the bone using screws or other fixation methods.
  • The incisions are closed with stitches, and the surgical site is cleaned.
  • You’ll be moved to a recovery area to wake up from anesthesia.
  • You’ll receive medications to manage pain and ice packs to control swelling.
  • You may remain in the hospital for a day or two for monitoring.

Recovery from total jaw replacement for TMJ

Jaw replacement surgery recovery may vary based on your age, overall health, the severity of your condition, and the complexity of your surgery, but here are some general milestones during the healing process.

In the first few days after discharge from the hospital:

  • You’ll be prescribed pain relievers and possibly antibiotics to prevent infection.
  • Stick to a soft or liquid diet to avoid straining the jaw.
  • Use ice packs to manage swelling.
  • Rest and avoid strenuous activities, but as you feel able, walk and gently move to promote circulation.

During the first four weeks:

  • Attend follow-ups with your surgeon to monitor healing.
  • Following your surgeon’s instructions for how much you should move your jaw.
  • Continue with soft foods, gradually reintroducing more textures as advised.
  • Keep incision sites clean and watch for signs of infection, such as redness or excessive swelling.

Between one and three months post-surgery:

  • You may begin physical therapy to restore jaw mobility and strengthen surrounding muscles.
  • Exercises are introduced gradually and tailored to your progress.
  • As healing continues, you may expand your diet further under medical guidance.

From three to six months and beyond:

  • Jaw movement improves, and you’ll gradually return to normal function.
  • Attend regular follow-ups to confirm the prosthesis remains in good condition.
  • Some lifelong care, such as avoiding excessive jaw strain, may be necessary.

Enhanced Recovery After Surgery (ERAS) for jaw replacement surgery

Penn Medicine offers Enhanced Recovery After Surgery (ERAS) to streamline your treatment from preparation to recovery and help ensure the best possible outcomes for your total jaw joint replacement surgery.

ERAS includes protocols for pain management that aim to reduce opioid use and side effects. This includes non-opioid medications, regional anesthesia, and local anesthetics. For TMJ surgery, techniques like nerve blocks and corticosteroid injections may be used. Patients receive education before surgery, and pain control continues after with early movement and multimodal pain relief. This approach helps manage pain effectively while lowering opioid risks and improving recovery.

Evidence-based programs such as ERAS have been shown to improve surgical outcomes, patient care, and satisfaction.

Risks of a total temporomandibular joint replacement procedure

Total jaw replacement surgery, like any major procedure, carries some risks and potential complications.

  • Infection at the surgical site
  • Bleeding or blood clots
  • Nerve damage leading to numbness or tingling
  • Prosthesis issues, such as loosening or misalignment
  • Scar tissue formation that may limit jaw movement
  • Chronic pain or joint stiffness

Your surgeon will discuss your specific risks with you and take steps to minimize them before your surgery.

Leaders in care for complex TMJ disorders

At Penn Medicine, our oral and maxillofacial surgeons are recognized worldwide as leaders in TMJ surgery. Penn Medicine’s Center for Temporomandibular Joint Disease handles some of the highest volumes of joint surgeries in the country, giving us extensive experience with complex cases and combined jaw surgeries.

Our physicians and researchers are at the forefront of medical and surgical science, conducting research to continuously improve treatment, outcomes, and prevention of TMJ disorders.

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