TMJ Surgery
Evaluation and treatment for temporomandibular joint dysfunction, from conservative injections to total joint replacement.
TMJ anatomy
How the ear and teeth connect to TMJ disc problems
The temporomandibular joint does not work in isolation — its disc, condyle, and surrounding ligaments sit at the intersection of the ear and the bite. Understanding these connections helps explain why disc-displacement problems can show up as ear symptoms, bite changes, or both.
Ear symptoms and tinnitus
The TMJ sits directly in front of the ear canal, sharing ligaments and vascular structures with the middle ear. When the disc slips out of its normal position, the altered joint mechanics and nearby inflammation can affect the ear itself — leading to ringing (tinnitus), a feeling of fullness, or ear pain unrelated to infection. This overlap is why TMJ disorders are sometimes mistaken for, or missed alongside, ear conditions.
Bite alignment and occlusal problems
How the upper and lower teeth meet directly influences the load and movement passing through the jaw joint. An uneven bite, missing teeth, grinding, or a recent dental or orthodontic change can shift the condyle’s position within the joint, stressing the disc and its supporting ligaments over time. Correcting the occlusal relationship is often part of managing disc displacement, alongside joint-directed treatment.
Before considering surgery
80%
of TMJ symptoms improve with conservative management alone — before surgery is ever needed.
Anti-inflammatory medication
Over-the-counter or prescription NSAIDs reduce inflammation and swelling inside the joint capsule, often the main source of TMJ pain. They’re typically used for a short, defined course alongside the other steps here, not as a long-term fix on their own.
Joint rest
Limiting wide jaw movements — smaller bites, avoiding gum and hard or chewy foods, and easing back on wide yawning or talking — gives the inflamed joint and disc time to settle, much like resting a sprained joint elsewhere in the body.
Occlusal guard
A custom-fitted night guard from your dentist cushions the joint and redistributes bite forces, reducing the clenching and grinding that often aggravate TMJ symptoms during sleep. It’s one of the most effective long-term conservative measures for many patients.
Our surgical scope of care
What TMJ joint surgery we offer — and when we refer out
Arthrocentesis — for acute closed lock
At this time, arthrocentesis is the joint procedure we offer for acute closed lock — a sudden mechanical block where the jaw becomes stuck and won’t open. It uses needles to flush the joint space and release the trapped disc, and is typically done under light anesthesia.
Open joint surgery — for the most limited cases
Open joint surgery is only considered when the jaw is unable to open or close, or when chronic pain is truly debilitating and has not responded to conservative care. It is a more significant procedure, so we reserve it for these limited circumstances rather than as a routine option.
TMJ replacement — by referral to OHSU
For end-stage joint disease that requires total joint replacement, referral to OHSU is an option. Their team specializes in TMJ replacement, and we coordinate with them to help you get to the right specialist for this level of care.
TMJ Surgical Treatment Options
TMJ injections
Arthrocentesis (acute closed lock)
Arthrocentesis is a minimally invasive procedure that uses needles to flush the joint space, releasing fluid and inflammatory buildup that can trap a displaced disc. It is offered specifically for acute closed lock — a sudden mechanical block that prevents the jaw from opening — and is typically done under light anesthesia.
Open joint surgery
Open joint surgery is reserved for more significant cases — when the jaw cannot open or close, or when chronic pain is debilitating and has not responded to conservative care or arthrocentesis. Because it is a larger procedure, it is only considered after these criteria are met.
TMJ replacement
Total joint replacement is reserved for severe degeneration, ankylosis, failed prior surgery, or advanced joint damage. We do not perform this procedure in-house; instead, we refer patients to our colleagues at OHSU, who specialize in TMJ replacement.
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WHAT TO EXPECT
Thoughtful care at every step
Your visit is planned around clarity, comfort, and a recovery path that feels manageable before you ever sit in the chair.
Specialist-led planning
Treatment details are reviewed with the surgical team so timing, anesthesia, and next steps are clear.
Clear preparation
You’ll know what to bring, what to avoid, and how to plan your day around the procedure.
Guided recovery
Post-op instructions focus on comfort, swelling control, and knowing when to reach out.