Journal of Oral Biology and Craniofacial Research
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Health, Fitness & Wellbeing - Page 24
Luke was the first surgeon in the UK to carry out a level III jaw arthroscopy to treat jaw joint disc displacement and is dedicated to teaching other surgeons advanced TMJ arthroscopy.
In some cases, Luke may need to look around inside your jaw joint using a TMJ Arthroscope which uses a dedicated 1.9mm arthroscope. This procedure is known as a temporomandibular joint (TMJ) arthroscopy and is a diagnostic and therapeutic operation.
The arthroscope is just a couple of millimetres in diameter and is put into your jaw joint while you are asleep under a short general anaesthetic in the operating department. It is a minor procedure and you can go home the same day. You may need a short course of physiotherapy afterwards.
It is recommended for TMJ disorders that have not responded to medical treatment, or when additional diagnostic techniques are necessary.
Arthroscopy is often used in combination with arthrocentesis, a type of joint wash out. Like the arthroscopy, this wash out can help break down adhesions and flush out inflammatory particles that may be damaging to the joint. Luke sometimes uses additional agents as he flushes out the joint, such as hyaluronic acid or steroids, to help tackle the inflammation.
It can be combined with injections into the jaw joint including triamcinolone hyaluronic acid, protein rich plasma or stem cells or intra-articular laser, coblation or even suture techniques in skilled hands.
Level I Arthroscopy
This is a basic diagnostic and therapeutic procedure. Adhesions can be treated. It can be combined with intra-articular medication. It can have a diagnostic benefit. The degree of cartilage damage, synovitis or even disc perforation can be assessed, and this can affect future management. The joint is irrigated under pressure to remove inflammatory mediators and intra-articular medication can be used. It is followed by full range of movement exercises.
Level II Arthroscopy
This involves the placement of an additional port (small incision) using a technique called triangulation. It takes a little bit longer, but it allows the use of intra-articular holmium laser therapy or coblation and a biopsy is also possible. Intra articular medication can also be used. The recovery time can be a little bit longer and it may be slightly more painful afterwards.
Level III Arthroscopy
Luke was the first surgeon in the UK to carry out a level III jaw arthroscopy to treat jaw joint disc displacement, which treats a clicking jaw joint, restricted movement and pain, instead of using open surgery and disc fixation. As a result, patients experience fewer complications, less scarring and quicker recovery. He now runs an annual course on this technique in London which attracts an audience of oral and maxillofacial surgeons from across the world.
Level III arthroscopy involves three ports (small incisions). It is often combined with coblation or laser therapy to release the anterior attachment of the disc to allow it to be reduced and the disc is arthroscopically sutured. It takes a little longer and is technically very challenging. It is still a day case procedure, but it requires three weeks of limited range of movement exercises and can temporarily alter the way the teeth meet (occlusion).
Complications of TMJ Arthroscopy
Following arthroscopy of the TMJ, you should expect to suffer from swelling, discomfort and bruising. Post-operative bleeding, temporary numbness and temporary weakness of the facial muscles are all common.
Not all patients get a dramatic benefit from arthroscopic procedures. Approximately one quarter of patients do not get a significant therapeutic benefit and subsequently require more extensive surgery.
However, there is nearly always a diagnostic benefit, which can influence the choice of subsequent operation. Therefore, it is extremely unusual for a TMJ arthroscopy to not be beneficial.
There are a few rare, but significant, risks including a less than 1% change of injury of one of the small branches of the facial nerve, which could lead to some partial weakness on one side of the face.
The very small puncture wounds do not usually require suturing. There are no scalpel cuts. They require temporary dressing for a day or two.
You will be followed up in clinic by Luke two to three weeks following surgery.