About the TMJ Center
The mission of the Penn Center for Temporomandibular Joint Disease at the Department of Oral & Maxillofacial Surgery is to advance the understanding and treatment of temporomandibular joint disease through research and education. Our primary focus is on improving treatment for patients with dysfunction of the temporomandibular joint (TMJ).
The prevailing symptom of TMJ disorders is discomfort, which ranges from acute irritation to chronic, debilitating pain. Other common symptoms include clicking or popping at the joint, crepitus (or grinding noises) and difficulty opening the jaw. The pain associated with TMJ disorders is unique in that the TMJ is served by the trigeminal nerves that innervate the face and sinus. Thus, pain originating in the teeth, muscles, sinus or nervous system can radiate to the TMJ.
TMJ disorders are divided into conditions affecting the muscles and those affecting the bones and cartilage of the joint. The most common diseases affecting the TMJ include myofascial temporal mandibular disorder (TMD, a muscle/ligament disorder) and internal derangement of the TMJ (osteoarthritis, a joint disorder). Often these two conditions occur concomitantly. Many other conditions can affect the TMJ, including rheumatoid arthritis, gout, or juvenile idiopathic arthritis.
Diagnosis
Because the nerves that serve much of the face and sinus also innervate the TMJ, the origin of TMJ pain can be difficult to diagnose. Finding the source of the pain to define the etiology of TMJ is one of the key services of the Penn TMJ Center. In addition to practical evaluations, diagnostic tools include Panorex, MRI and CT imaging.
Treatment
Treatment at the Penn TMJ Center is directed at the origin of pain. Short-term conservative management, which may include a night mouth guard, medication and physical therapy, is first line therapy and often beneficial. Patients who continue to have symptoms of TMJ disease or progression of their disease despite optimal medical management may benefit from interventional treatment.
Patients with TMJ disease involving the muscle may benefit from injections of medication (botox or steroids) into the affected muscle or the addition of stronger medications.
Patients with advanced disease affecting the bone or cartilage of their TMJ may benefit from an arthroscopy (minimally invasive surgery) arthroplasty (open joint surgery) or total joint replacement.
Arthroscopy is a minimally invasive surgical procedure, which involves introducing a camera into the joint via a small “nick” incision in front of the ear. This procedure allows for improved diagnosis, surgical manipulation of the disk, removal of scarring in the joint, as well as the introduction of medication into the joint via direct visualization.
Arthroplasty involves opening of the joint for surgical reconstruction. This is typically performed with an incision within or in front of the ear. This procedure allows your surgeon to repair or remove the disk in the TMJ. This procedure may also be performed to repair the bone to prevent jaw dislocation.
Patients with severe arthritis, bony fusion (ankylosis), tumors or trauma (broken bone) may benefit from complete replacement of the joint with an alloplastic or total joint replacement. During these procedures, an incision is placed in front of the ear and under the jaw line to allow for replacement of the ball and socket component of the joint.
The Penn Difference
The faculty at Penn Oral & Maxillofacial Surgery includes internationally known surgeons and pioneers in TMJ surgery. Penn surgeons have extensive experience in treating conditions involving the temporomandibular joint, including complex joint and combined jaw surgeries, and see one of the highest volumes of joint surgery in the country. The combined experience and volume translate into improved surgical outcomes. Penn physicians and researchers are at the forefront of medical and surgical science, involved in basic science and clinical research to improve treatment outcomes, prognosis, and prevention of temporomandibular disease.
Access
The TMJ Center welcomes patients with the symptoms of TMJ disorders at the following locations:
Perelman Center for Advanced Medicine
South Pavilion, 4th Floor
3400 Civic Center Boulevard
Philadelphia, PA 19104
To make an appointment, please call 215-662-3586.
Prior to visiting the TMJ Center, patients are encouraged to obtain and bring previous imaging studies (MRI, CT, Panorex) and surgical reports. If applicable, please also bring any occlusal splint or night guard. A history and physical exam will take place at the initial visit. This will include a review of previous notes, tests, and x-rays. Additional imaging studies may be ordered, and can often be obtained in office.