TMJ Procedures / Arthrocentesis / TMJ Replacement / Botox

TWO bones form a joint. TMJ stands for TEMPOROMANDIBULAR JOINT. TEMPORO is for the TEMPORAL BONE or the upper bone of the joint. MANDIBULAR refers to the lower jaw or the lower bone of the joint. You may have heard of the term CONDYLE. The CONDYLE is the part of the MANDIBLE that forms the joint.

Here you can find:

  • General Description
  • Videos:
  • FAQ: Frequently Asked Questions
  • Postoperative Instructions
  • Physical Therapy Program


Dr. Heffez was one of the innovators of these techniques for the TMJ. They have replaced many of the radical surgical procedures.

ARTHROCENTESIS: Is a procedure by which two needles are placed in the joint for flushing its contents, manipulating the joint and depositing some medication. The procedure is usually performed win conjunction with intravenous anesthesia.

ARTHROSCOPY: Is a procedure used to diagnose and treat the joint using a small telescope.

Both procedures are used to treat CLOSED LOCK or the sudden inability to open the mouth. They are also used to treat a very painful arthritic joint. Before surgery you will have obtained an MRI to determine the position of the articular disk or cushion that sits between the bones of the joint. The disk is usually dislocated out of position. These procedures do not reposition the articular disk. Once the disk is displaced, it is usually considered permanently dislocated. The tissue behind the joint (a ligament) now serves as your cushion. We use the term PSEUODO-DISK to describe its new function. With time, the PSEUDO-DISK becomes a scar. Both procedures are performed under intravenous anesthesia.

CLOSED LOCK is due to a constellation of #3 factors:
1. Position of the disk or conformational change of the disk blocking the opening of the jaw. This is the least important factor.
2. Poor or inadequate amount of lubrication of the joint. A fluid called SYNOVIAL FLUID lubricates joints. The tissues behind the disk produce synovial fluid. These are the tissues that stretch forward as the disk gets displaced and that become the PSEUDO-DISK. The result is a stickiness in the joint that does not allow the jaw to glide smoothly over the parts.
3. Muscle Spasm. Muscle spasm may occur from a grinding or clenching of the teeth habit. The muscles become tight not allowing the jaw to jump over the displaced blocking disk. The muscles are like tight elastic bands. The tighter they get, the harder it is to get around the displaced disk. The tighter the muscles, the louder the joint noise as your jaw jumps around the displaced disk and slams back upward. This is one of the reasons why you may experience louder noise than at other times.

Dr. Heffez will need to examine you to determine which of those three factors are the most important factors in your case. ARTHROCENTESIS is used to treat #2 Poor or inadequate amount of lubrication of the joint.

Medication and Bite Appliances are used to #3 Muscle Spasm.


Typically, your jaw will immediately open up in the Closed Lock situation. You will not keep the entire gain in opening. However, you will be able to open more comfortably to a greater mouth opening. Do not get fixated on a magical number for opening. Your comfort is more important. For example, while a normal mouth opening may be 40-55mms you may need up opening to 35mms. This is more than adequate. Remember that joints get into trouble when they function in the extreme ranges of motion. Keeping the jaw opening at 35 mm usually keeps it out of trouble. MANY TIMES, the procedure converts a situation in which your jaw used to be able to jump around the displaced disk to a situation where it simply pushes it further forward or out of the way. This is a better result than one in which you resume the clicking by jumping around the displaced disk. In the latter situation you may develop Closed Lock again.

Sometimes the opening will gradually increase over a month period of time.

Patients they are sore for two weeks after the surgery. They feel like a bruise in front of their ears where the joints are located. Patients typically miss 1-2 days of work.

You have no diet restrictions. You are encouraged to chew gum and eat hard food immediately after surgery. Eating is a form of physical therapy. Once you attain the desired mouth opening you will be asked to restrain from very chewy foods.

Rarely patients will bruise in front of their ear. The bruise will turn green and yellow and eventually fade away. If it develops, it will take about 1-2 weeks to resolve. In older patients, a bruise may take much longer to resolve.

You may be prescribed an antibiotic and an anti-inflammatory agent like Ibuprofen. A narcotic is prescribed for the first few days.

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