Minimally Invasive Surgery

Both research and Dr. Pehling’s experience have shown that approximately 5-10% of the time non-surgical care does not adequately treat the TMJ pain and dysfunction and therefore a surgical procedure is considered. Due to the challenges associated with open joint procedures (TMJ disk plication, arthroplasty, and replacements) in the past, we typically recommend a minimally invasive procedure which has a very low chance of creating unwanted side effects of degenerative joint changes, bite shifting and scar tissue formation. The Minimally-Invasive TMJ lysis and lavage procedure has had well documented success in both research studies and in our clinical practice. Clinical research has shown that the lysis and lavage procedure has a success rate of approximately 80%. This is better than or equal to the reported success rate for open joint procedures with much less risk. These procedures are typically done in our office under sedation by a licensed anesthesiologist. It is very important that these procedures be followed by physical medicine treatments in order to maintain the surgical gains. Dr. Pehling was residency trained in the lysis and lavage procedure and has found it to be very effective for patients refractive to non-surgical care.

TMJ Arthrocentesis

TMJ Arthrocentesis is done using one or two needles that are inserted into the TMJ and than saline is pumped through the TM joints. Typically once finished a jaw mobilization is done to increase the mouth opening. This can be an effective treatment to flush out the inflammation within the TMJ and to lubricate the structures within the TMJ. This can be an effective treatment for “frozen disk syndrome” as well. With this procedure there is no visualization within the TMJ, therefore there are certain limitations to this procedure compared to an arthroscopic procedure.

Ultrathin TMJ Arthroscopy

Dr. Pehling is the first doctor in the Northwest to be trained to employ an ultrathin arthroscope for TMJ lysis and lavage procedures. The Ultrathin arthroscope is about the size of a needle, therefore no incisions are necessary. This results in much less trauma to the joint than in traditional arthroscopy. Traditional arthroscopy requires the use of two probes about the size of a pencil to be placed into the TMJ. Arthroscopy is a procedure where a small endoscope (a high-powered fiber optic camera) is placed inside the joint for diagnostic and therapeutic purposes. This allows Dr. Pehling to treat specific areas of joint inflammation and to target articular disks that have adhesions or are “stuck” in place or displaced. Due to the fact that the scope is so small complications are rare and patients can typically return to work and daily activities within 24-48 hours.

Ultrathin Arthroscopy is used after non-surgical treatments have not been successful in conditions such as:

  • Osteoarthritis

  • Defects in joint lubrication

  • Small adhesions in the joint space

  • Dislocated disc

  • Perforation (or puncture) of the disc

A 2008 study of 344 patients suffering from their jaws being locked underwent either TMJ arthroscopy or an open joint procedure found “No statistical differences were observed between arthroscopic lysis and lavage and more invasive operative treatment in relation to postoperative pain or jaw opening at any stage of the follow-up period. It was concluded that ultra-thin TMJ arthroscopy should be considered as a first-line treatment for jaw locking of the TMJ.”

Open joint TMJ procedures: Dr. Pehling works closely with several TMJ surgeons for TM joint replacement and Arthroplasty procedures when these are indicated.