Jaw Surgery

Maxillofacial surgery is a branch of medicine that diagnoses and treats all kinds of diseases and disorders related to the soft tissues of the mouth, such as the tongue, lips, cheeks, salivary glands, teeth, jaw, and temporomandibular joint. Services provided in the maxillofacial surgery branch include:

• All kinds of surgical treatment applications on teeth
• Impacted tooth surgery
• Tooth extraction or surgical intervention using general anesthesia
• Implant  application and all kinds of surgical interventions performed within the scope of implant treatment
• Treatment of abscesses and inflammations originating from teeth
• Treatment of advanced infections such as osteonecrosis and osteomyelitis in the jaw
• Treatment of cysts and tumors in the jaw
• Surgical or non-surgical treatments for fractures in the lower and upper jaw
• Treatment of fractures in the jaw joint
• Treatment of jaw joint disorders
• Surgical treatment of anomalies in the jaw such as jaw advancement and jaw recession

The temporomandibular joint (TMJ) is a bilateral joint located just in front of the ears, between the lower jawbone and the temporal bone, and comprises the articular cartilage between the two bones. It is the only joint in our body capable of gliding, forward-backward movement, and limited rotation due to its unique structure. Due to its unique structure and location, the temporomandibular joint interacts with surrounding tissues such as the chewing muscles and teeth. Disorders in these structures can lead to joint problems.

What are the causes of jaw joint disorders?

Temporomandibular joint disorders can arise from a variety of causes. However, these are often difficult to pinpoint. For example, individuals may experience problems such as opening their mouth too wide when yawning, holding their mouth open for extended periods during dental treatment, excessive strain on the jaw joint, or constantly clenching their teeth due to stress or anger. Various factors encountered in daily life can cause joint problems, and the resulting symptoms may not be immediately obvious. In some cases, a joint problem triggered by a blow to the jaw can also cause abnormal jaw movement, creating a locking effect. These can be quite noticeable. Other causes of temporomandibular joint problems can include jaw-related factors such as ill-fitting dentures, joint tumors, and involuntary contractions of the chewing muscles. Sometimes, psychological factors such as long-term stress, depression, or sadness, or diseases such as rheumatoid arthritis and psoriatic arthritis, which can affect the body and other joints, can also cause jaw problems. Among these, joint problems are known to be the most common problem in society.

Is treatment necessary if there is a sound coming from the jaw joint?

A sound heard only when opening and closing the mouth, without accompanying symptoms such as jaw dysfunction, pain, or locking of the jaw when opened or closed, is not considered a serious problem. These problems do not require treatment. The goal of treatment for joint problems is not to eliminate the sound. Even after surgical treatment, the sound may reoccur. Therefore, treatment should be considered if the above symptoms accompany the jaw sound.

Do jaw joint disorders affect mouth opening?

Disorders of the jaw joint can affect mouth opening. In this case, a decrease in mouth opening may be observed. This restriction is a sudden onset and is accompanied by severe pain. It is often affected by the forward displacement of the joint cartilage and the failure of the cartilage to replace it. If the jaw joint is dislocated, the mouth remains noticeably open. In this case, the jaw joint must be repositioned by a doctor. Additionally, some disorders of the masticatory muscles or ankylosis, a shift between the jawbone and the temporal bone, can cause a restriction in mouth opening.

Do jaw joint disorders cause pain in the ear area?

The jaw joint is in close anatomical proximity to the ear. Therefore, pain caused by jaw joint disorders can be confused with earache.

How can symptoms of jaw joint disorders be diagnosed?

The jaw joint is one of the most important joints in the body. The primary function of the lower jaw is to assist with speech and chewing. During maximum jaw opening, the jaw joint performs two distinct movements: a simple hinge movement and forward gliding and rotation.  Occlusions that cause deviations from the normal position of the mouth  cause spasms in the masticatory muscles. This is among the most significant causes of dysfunction in the jaw joint. The classic presentation of pain arising from dysfunction in the jaw joint is:

• Pain
• Sound coming from the jaw joint
• Limited jaw movement

The onset of jaw pain can often provide clues about its cause. Pain that begins in the early morning hours can be caused by unconsciously clenching your teeth during sleep. These pains can cause pain in the jaw muscles. Pain that begins later in the day can be caused by jaw movement. This type of pain is usually caused by a problem within the jaw joint. Pain in the jaw joint worsens with movement and can be constant. Pain in the jaw muscles can worsen with stress and can be intermittent.

The type of sound coming from the jaw joint also provides information about the condition. If a single clicking sound is heard in the jaw, it is usually a minor sound, occurring in 40% of the population, and it resolves on its own. If a clicking sound is heard both when the mouth is opened and closed, it is due to the displaced articular disc being compressed during opening and closing. If a clicking sound is heard from the jaw joint, it may indicate degeneration of the joint due to crushing of the joint surface and the resulting loss of softness.

In case of restricted jaw movement, irreversible anterior dislocation of the joint disc, joint adhesions, joint calcification and cheekbone fractures may also occur.

Jawbone disorders present a complex challenge, both in terms of determining their cause and planning appropriate treatment. Diagnosis may involve comparative joint radiographs, computed tomography (CT), or magnetic resonance imaging (MRI). Treatment options include medication, physical therapy, closed joint irrigation, and open joint surgery.

How are jaw disorders treated?

As with other joint problems, treatment for jaw joint problems begins with simple methods. If these treatments are insufficient or ineffective, the next stage of treatment is initiated. Initially, medication, night guards or splints, and physical therapy are used. If necessary, the second stage may include minor surgical procedures such as joint irrigation, intra-joint injections, and arthroscopy. If these treatments fail, open joint surgery may be considered in rare cases. However, some joint problems may require immediate surgical intervention. These conditions include jaw joint tumors and jaw ankylosis, a condition where the jaw fuses with the head. The doctor determines the treatment method based on the type and severity of the joint problem.