The temporomandibular joints (TMJs) connect your lower jaw to your skull, just in front of each ear. A TMJ disorder (TMD) is any problem affecting these joints or the muscles around them — causing jaw pain, clicking or grating, locking, restricted opening, facial pain, earache or headaches.
Pain coming from the joint itself is called arthrogenous TMD. In truth, the cause of the underlying inflammatory changes is often not known — we see them even in very young children and teenagers, so it is not simply ‘wear and tear’. Some cases are linked to identifiable conditions, including rheumatoid arthritis, psoriatic arthritis, gout, and post-traumatic arthritis after injury; many others are idiopathic, with no identifiable cause. Displacement of the cushioning disc within the joint can also drive joint pain. Accurate diagnosis — clinical examination with MRI — is essential to identify what is happening.
No. Much jaw pain is muscular (myogenous) rather than joint-related — caused by overload of the chewing muscles, often with clenching or grinding. This muscular pain is part of the wider TMD umbrella but is not arthrogenous (joint-origin) pain, and it is usually managed differently: physiotherapy, habit and bite management, and sometimes botulinum toxin. Telling muscular pain from joint pain is a key part of assessment, because the right treatment depends on the distinction.
No. Most jaw problems improve without surgery. We begin with the least intervention likely to help — physiotherapy, bite and habit management, and, where needed, a minimally-invasive joint wash-out. Surgery is reserved for clear indications, for suitable patients.
Arthroscopy is keyhole surgery of the jaw joint through 2–3 mm punctures using a fine camera. It ranges from washing out the joint (lysis and lavage) to advanced Level 2 and Level 3 procedures that reposition and stabilise the disc. Most people go home the same day.
Arthrocentesis is a needle wash-out of the joint, often combined with an injection such as platelet-rich plasma (PRP). Arthroscopy uses a camera and fine instruments to see and treat inside the joint. Arthrocentesis is gentler and lower cost; arthroscopy allows more targeted treatment.
After keyhole surgery, discomfort is usually mild to moderate and controlled with simple painkillers, with most people back to light activities within one to two weeks. Recovery after a total joint replacement is longer — over several weeks — and is supported by structured physiotherapy.
National guidance (NICE) reserves total jaw joint replacement for joints that are effectively unsalvageable — end-stage disease that has not responded to conservative management. In our practice we go a step further first: using advanced Level 3 arthroscopy we aim to salvage the natural joint, and in suitable patients this can achieve good results even in advanced (Wilkes stage 5, end-stage) disease. Replacement — increasingly with a custom, patient-specific prosthesis designed from your CT scan — is reserved for joints that remain refractory to arthroscopic repair.
Yes. When both joints are affected they can be treated together or in stages, planned carefully with detailed imaging.
The risks depend on the procedure. For keyhole surgery (arthroscopy) — the most common operation — we consent for pain, bleeding, swelling, infection, a scar, and numbness or altered sensation, together with temporary weakness of some of the facial muscles, temporary dullness of hearing, and a temporary change in the bite (malocclusion). Some patients have persistent symptoms, and around 8% may need a further (repeat) operation. The small incisions are closed with dissolving stitches; keeping them clean in the first week avoids the occasional stitch abscess. If regenerative cells are used, the harvest site — the lower abdomen for fat-derived (adipose) stem cells, or the bone-marrow site for BMAC — may bruise. Exceedingly rarely — fewer than 1 in 100,000 cases (under 0.001%) — serious complications affecting vision or hearing have been reported; we mention these because of their seriousness despite how unlikely they are. Larger procedures such as open surgery or total joint replacement carry additional risks, explained separately and in full. Mr Komath will discuss the risks relevant to your specific procedure before you decide.
The regenerative cells we use are your own (autologous) — harvested during the same operation, under a single anaesthetic, so there is no separate procedure. They are not genetically modified in any way, so the risks associated with genetically engineered cell therapies do not apply. The cells are concentrated and placed directly into the joint to make the most of their natural regenerative potential. As with any procedure there are still ordinary surgical risks, such as bruising at the harvest site, which we explain beforehand.
Yes. Mr Komath sees mid- to late-teenage patients with advanced TMJ disease, which needs specialist assessment that few clinics can offer.
Yes — both insured and self-funding private patients are welcome, from across the UK and Europe.
Mr Komath takes a full history, examines your jaw, reviews or arranges imaging such as MRI, and explains the likely diagnosis and your options — honestly, including what can and cannot be offered.
We keep a secure, confidential record of your treatment and how you get on afterwards, so we can monitor and continually improve the quality of our care. Any information used for teaching, research or publication is fully anonymised, so you cannot be identified — and this never affects your care in any way. If you would prefer your anonymised information not to be used for these purposes, simply let us know; you can opt out at any time.
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