TMJ Fractures After Car Accident: Treatment Options and Concerns

Temporomandibular joint fracture due to a car accident?

Hello Doctor, I was in a car accident on September 22, where I sustained fractures in the area of the bilateral mandible and temporomandibular joint (TMJ) (the doctor mentioned that the small fragments on both sides are not aligned).
Initially, I was sent to China Medical University Hospital, where an oral and maxillofacial surgeon evaluated my condition.
However, surgery was not performed because the doctor presented me with two options: 1.
Surgery that would involve incisions on both sides of my face, which would leave scars and could potentially damage the facial nerve; 2.
Non-surgical reduction followed by the use of a dental splint for 1-2 months, as the doctor felt the surgical risks were too high and initially believed that the bones would return to their original position with reduction.

Now, it has been over six months, and I have been experiencing ongoing joint pain, facial asymmetry, mouth opening deviation, and malocclusion (resulting in an open bite).
I have returned to China Medical University Hospital several times, but they have reassured me that my ability to open my mouth indicates there is no problem, yet these issues continue to trouble me.
I also consulted an orthodontist who assessed my condition and stated that my chin has shifted backward due to the joint fracture, leading to the open bite.

1.
Should I pursue orthodontic treatment for improvement, or is surgery necessary to address the joint bone issue?
2.
If orthodontic treatment normalizes my bite, the joint-related problems will still persist, correct?
3.
Do you recommend that I undergo surgical reduction for my current condition? I am genuinely concerned about potential future joint issues if I do not have surgery.

4.
Is it still feasible to have surgery now, or would there be complications? I found that many TMJ specialists primarily diagnose joint pain and treat it with splints.

5.
Regarding the joint fracture, should I seek treatment from an oral and maxillofacial surgeon or a plastic surgeon?
6.
Additionally, do you know any specialists in temporomandibular joint disorders who could help me resolve these issues? Thank you, Doctor.

Bobo, 20~29 year old female. Ask Date: 2023/02/25

Dr. Zeng Guanghui reply Dentistry

1.
A joint discussion should be conducted by oral and maxillofacial surgeons and orthodontists to propose possible treatment options for further discussion.
2.
If normal occlusion cannot be restored solely through orthodontic means, displacement should be considered.
3.
It is recommended to consult both oral and maxillofacial surgeons and orthodontists for a collaborative discussion.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/02/25

More Info

TMJ (temporomandibular joint) fractures can lead to a variety of complications, especially following trauma such as a car accident. Your situation, involving fractures at both sides of the mandible near the TMJ, presents a complex challenge that requires careful consideration of treatment options.
1. Surgical vs. Non-Surgical Treatment: It seems that your initial treatment plan involved a non-surgical approach, which is often chosen to minimize risks associated with surgery, such as scarring and potential nerve damage. However, the ongoing symptoms you describe—joint pain, facial asymmetry, and malocclusion (improper bite)—suggest that the non-surgical approach may not have fully addressed the underlying issues.
2. Orthodontic Treatment vs. Surgical Intervention: If your orthodontist has indicated that your bite is affected due to the position of your jaw, it may be beneficial to pursue orthodontic treatment to correct the alignment. However, it’s crucial to understand that if the TMJ itself is not functioning properly due to the fractures, orthodontic treatment alone may not resolve the underlying joint issues. Therefore, a comprehensive evaluation by a specialist in TMJ disorders is essential to determine whether surgical intervention is necessary to restore proper function.

3. Concerns About Future Issues: Your concern about potential future problems if the fractures are not surgically addressed is valid. TMJ fractures can lead to chronic pain, arthritis, and further joint degeneration if not properly managed. If the joint is misaligned, it can lead to abnormal wear and tear, resulting in long-term complications.
4. Timing for Surgery: It is generally advisable to address TMJ fractures sooner rather than later, as delaying treatment can lead to complications. If you are still experiencing significant symptoms, consulting with a maxillofacial surgeon who specializes in TMJ disorders may provide clarity on whether surgery is still a viable option.
5. Choosing the Right Specialist: For TMJ fractures, it is typically best to consult with an oral and maxillofacial surgeon, as they have specialized training in treating conditions related to the jaw and facial structures. They can assess the fractures and determine the best course of action, whether that involves surgical repair or other interventions.

6. Finding a Specialist: If you are looking for a TMJ specialist, consider seeking referrals from your current healthcare providers or searching for accredited oral and maxillofacial surgeons in your area. Many dental schools also have clinics that specialize in TMJ disorders and may offer comprehensive evaluations and treatment options.

In summary, your ongoing symptoms warrant a thorough reevaluation of your treatment plan. It is essential to consult with a specialist who can assess the current state of your TMJ and provide tailored recommendations. Whether through surgical intervention or orthodontic treatment, addressing the underlying issues is crucial for restoring function and alleviating pain. Don't hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your health and quality of life are paramount, and you deserve a treatment plan that effectively addresses your needs.

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