In most circumstances, surgery will only be recommended for a patient if more
conservative treatments have failed to yield favorable results. The patient will not feel any pain
during the process of TMJ surgery because anesthesia will be administered. The most common
forms of sedation for TMJ surgery are general anesthesia and intravenous (IV) sedation. The
practitioner will determine which form of anesthetic is appropriate based on the individual
treatment plan they have formulated for each patient. Oral surgeons are also trained in
administering general anesthesia, and they will go over the process of sedation before the
anesthetic is administered to the patient.
Once the procedure is complete and the patient awakes, they may feel some side effects
of anesthesia. Common side effects of general anesthesia are nausea and vomiting, sore throat,
muscle aches, itching, and chills. Another well-known side effect following anesthesia is referred
to as postoperative delirium. A patient experiencing postoperative delirium often feels
disoriented and may temporarily feel confused about their surroundings. Patients with congestive
heart failure, Parkinson’s disease, or Alzheimer’s disease are at a greater risk of experiencing
postoperative cognitive dysfunction and long-term memory loss following the administration of general anesthesia. In rare cases, a patient may experience malignant hyperthermia and
experience fever and muscle contractions. These aforementioned side effects are rare, and
general anesthesia is widely regarded by medical professionals as safe when carefully
administered by an experienced practitioner.
For patients who are administered an IV, there are different levels of IV sedation. A
patient may feel drowsy but conscious during the procedure (conscious sedation), or be
completely asleep and unable to remember the procedure. The practitioner may determine which
type of anesthetic should be used based on the level of intraoperative cooperation required from
the patient during the procedure.
For procedures involving aggressive jaw manipulation, the practitioner is likely to
recommend general anesthesia. According to a 2015 study titled TMJ Arthrocentesis: Outcomes
under Intravenous Sedation vs. General Anesthesia, aggressive jaw manipulation was
successfully done in 100% of patients under general anesthesia, compared to only 45% of
patients under IV sedation. The main advantages of general anesthesia over IV sedation include
the paralysis of protective reflexes and no need for patient cooperation during the procedure. In
contrast, disadvantages of general anesthesia may be a higher cost, longer operating time, longer
patient recovery time, and a greater risk of postsurgical anesthesia related complications. Dr.
Federman will see each patient for a follow-up visit or even multiple follow-up visits following
surgery until the patient is fully healed and functional.