Jaw joint replacement

Mr Luke Cascarini is a specialist in problems that affect the temporomandibular joint (TMJ), the joint that allows the jaw to move. He offers private treatment for a range of jaw disorders and performs TMJ replacements and jaw reconstructions.

The jaw joint: what can go wrong?

Jaw problems are relatively common; these range from mild jaw clicking to more serious jaw locking and joint degeneration or traumatic damage.

The range of problems we see in the joints at either side of the jaw are just as extensive as with any joint in the body. Whereas we have had hip replacements and knee replacements for years now, and these are well-established and perfected techniques, being able to replace the jaw joints and be confident of success has only really been possible in the last to 10-15 years.

Not all patients have a jaw problem that is serious enough to warrant jaw replacement. It can be worth having a look inside the joint with a scope and then washing the joint out. We have tiny scopes just over 1 mm in diameter so you can get into the joint and have a look around. These have only become available quite recently and represent a significant development. We can also offer TMJ irrigation and injections to relieve inflammation and pain that may provide enough relief for the patient. Surgery remains an option if the symptoms return in the future.

Patients who have a seriously damaged TMJ experience limited movement and pain that can be debilitating. With severe TMJ disorder you can’t talk, you can’t even swallow your own saliva without moving your jaw, so it’s much harder to ignore than an arthritic knee joint. I am not saying that living with a damaged knee is a breeze, but patients with severe TMJ disorder have very poor quality of life.

When did TMJ replacements become available?

This operation has become mainstream only in the last 10 years or so. In the early days many of the replacement joints just didn’t work so there was quite a high failure rate. This also happened when surgeons first started doing hip replacements but because the number of patients who need a TMJ replacement is far lower, it has taken some time to perfect the jaw prostheses. We now have about 15 years of research that provides evidence that 2 models on the market really do work. These are both made from titanium, which is very long-lasting and well tolerated.

How is a TMJ replacement performed?

The top of the jaw joint is like a smooth knuckle with a disc above it that then articulates with the base of the skull.

To replace the TMJ you have to cut that knuckle off and put in a titanium replacement. Then at the base of the skull you drill away a little of the bone and put in a high-density type of plastic that screws onto the side of the skull. The titanium knuckle sits into that  and allows the jaw its full range of movements. For a patient that has a lot of pain and restricted movement before surgery, a TMJ replacement can be a huge benefit.

Are people aware that TMJ replacement is possible?

Generally, TMJ replacement is a relatively new surgical procedure and Mr Cascarini is one of just a few of the UK specialists able to offer it.

Most patients who need TMJ replacement have either had their jaw smashed in an accident or the joint and part of the jaw bone has been removed due to a cancerous tumour, a deep-seated bone infection or because of a destructive joint disease such as rheumatoid arthritis or psoriatic arthritis. Still’s disease, a rare form of arthritis that affects teenagers and young adults, can also damage the TMJ. Even taking all of these causes together, there is still not a huge demand for TMJ replacement, which is why the operation has possibly not been able to penetrate public awareness.

I recently treated a female patient in her 30s who has psoriasis and related psoriatic arthritis that has destroyed her jaw joints. She could have benefited from TMJ replacement 2-3 years ago; if we could have seen her earlier she would have been spared a lot of pain, but she was only referred quite recently.

It is worrying that other health professionals are not very knowledgeable about TMJ replacement. We ran a course at the Royal Society of Medicine a couple of years ago and not one of the 15 dentists present knew that we did jaw joint replacement and how successful it was. I think there is still quite a lot of marketing and raising awareness to be done among patients, the general public and health professionals.

Bilateral TMJ replacement

The following pictures show the scars on a bilateral TMJ replacement patient after one year.