Problems TMJ (temporomandibular joint)

The Dr. Javier Mareque Good specialist in oral and maxillofacial surgery at the Valle Hebron Hospital and Head of Department of the International University of Catalonia, was recently elected President of the Society Catalano-Balearic of Oral and Maxillofacial Surgery. Currently developing their daily work in various private clinics in Barcelona.

One of its main areas of activity is the treatment of disorders of the temporomandibular joint (TMJ ). This is a double joint in front of our ears. Thanks to its normal operation performed such everyday activities such as eating or talking.

The problems associated with this joint are one of the most frequent queries in the services of oral and maxillofacial surgery in our country.

The number of changes that can be developed is huge. They can be problems in the mandibular bone, cartilage, in the muscles or teeth.

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The symptoms experienced by patients are diffuse and include headaches, ear, tinnitus, muscle aches ( masticatory and neck muscles ) or inability to open the mouth. Sometimes these symptoms take years presenting for timely and at peak stress a more intense pain erupt.

These patients often have visited an ENT specialist, neurologist and other specialists without finding on physical examination or testing significantly relevant changes.

The diagnosis of the origin of the problem is the physical examination and radiological studies help of Nuclear Magnetic Resonance (MRI ) and Computed Axial Tomography (CT ).

An early diagnosis allows a faster and less aggressive than if the diagnosis is made at an advanced stage solution.

Sometimes, the origin is mixed, there is a component of anatomical alteration of the masticatory system (teeth, maxillary disposal, cartilage, meniscus or bone) and other emotional ( for some peak stress). To resolve this pathology have several therapeutic strategies:

• Splints download:in most cases is the initial treatment and adjusts a specialized dentist. It may be used alone overnight or 24 h according to the case.

• Physiotherapy:is also a first-line treatment and functional reeducation great control of the symptoms of muscular origin is achieved

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• arthrocentesis and infiltrations of hyaluronic acid is a minimally invasive solution that relieves the symptoms of patients and can be repeated periodically without side effects. It is performed on an outpatient basis.

• Arthroscopic Surgery:Like other joints, can make an accurate diagnosis of intra-articular problems and often correct in situ. It can be performed in ambulatory regimen of surgery and the patient usually improves in 90% of cases.

• Surgery Orthognathic:When there is a problem with the fit of the upper teeth to the lower, some patients are subjected to combined orthodontic treatment and surgery to correct their occlusion. Besides making aesthetic improvements and respiratory quality. Generally, these procedures require a day's income and postoperative physiotherapy support.

• Surgery open:In cases that do not improve with the above treatments or they are already in advanced stages, can be performed open surgery and correction of joint deformities. Generally, these procedures also require a day's income and postoperative physiotherapy support.

• Replacement articular prosthesis ATM:This option is gaining ground in the therapeutic algorithms ATM problems. Usually reserved for extreme cases of ankylosis, but has been seeing the early joint replacement yields better results and shortens the period of suffering of patients.