Understanding Jaw Surgery and Its Impact on TMJ Pain

If you’ve been told you need jaw alignment surgery or bi-jaw (bimaxillary) surgery but are worried your TMJ pain could become worse, YOU ARE NOT ALONE.

Many patients with TMJ pain or TMD's share this exact fear AND for a good reason.

Let’s clear up the myths and explain what clinical experience may actually be like.

Model showing upper and lower jaw alignment before surgery

What Is Bi-Jaw Surgery vs Single Jaw Surgery?

Bi-jaw surgery, also known as bimaxillary osteotomy, involves repositioning both the upper jaw (maxilla) and the lower jaw (mandible). Unlike single-jaw surgery, which adjusts only one jaw, bi-jaw surgery addresses misalignments in both jaws simultaneously. Both these procedures are designed to correct issues such as:

• Severe overbite or underbite

• Crossbite affecting both jaws

• Facial asymmetry

• Breathing problems related to jaw position

• Airway issues

  
  

The surgery typically requires careful planning using 3D imaging and models to ensure precise movement of the jaws. Surgeons make cuts in the jawbones, reposition them, and secure them with plates and screws. Recovery can take several weeks, with swelling and discomfort gradually subsiding.

How TMJ Pain Relates to Jaw Alignment

The temporomandibular joint (TMJ) connects the lower jaw to the skull and allows essential movements such as chewing, speaking, and yawning. When the jaws are repositioned during bi-jaw (orthognathic) surgery, the relationship between the jaw joint, muscles, and bite changes. As the body adapts to this new alignment, the TMJ may be subjected to altered or abnormal stress, which can lead to pain or dysfunction in some patients.

Common TMJ-related symptoms after jaw repositioning surgery may include:

• Jaw clicking or popping

• Difficulty opening or closing the mouth

• Facial pain or muscle tenderness

• Headaches or ear-related pain

• Joint inflammation or arthritic changes, which may develop during the initial alignment and healing phase and, in some cases, persist long-term

  
  

As the jaw joints adapt to their new position after surgery, the body undergoes a normal process of bone remodeling, in which new bone is formed and existing bone is resorbed to accommodate functional loading of the joints. During this initial adaptation and healing phase, the temporomandibular joints may be subjected to increased stress, which can result in TMJ pain, stiffness, discomfort and limited mouth opening.

In most cases, these symptoms are short-term and improve as the joints, muscles, and bite adjust to the new alignment. Close monitoring is important, but therapeutic intervention is rarely required during this early phase.

However, if TMJ pain or dysfunction persists beyond 3–6 months after surgery, further evaluation is warranted to assess for underlying joint, disc, or muscle-related conditions.

What precautions should you take if you have TMD before any jaw surgery?

If you have a history of temporomandibular disorder (TMD), taking certain precautions is important to reduce the risk of worsening jaw pain after surgery. While bi-jaw surgery is not performed to treat TMJ pain, changes in jaw position can temporarily affect the joints and surrounding muscles. Proper evaluation, symptom stabilization, and realistic expectations before surgery can significantly improve postoperative comfort and long-term outcomes.

1. Get a TMJ-focused diagnosis (not just a bite evaluation)

Before surgery, it is important to understand why you have jaw pain. Temporomandibular disorders can be:

• Muscle-related (myofascial pain)

• Joint-related (disc displacement, inflammation, degenerative or arthritic changes)

• Nerve-related or part of a chronic pain condition

A TMJ-focused evaluation may include a detailed clinical examination, imaging such as CBCT

or MRI when indicated, and assessment of associated factors such as headaches, neck pain, posture, sleep quality, and stress. This helps distinguish structural jaw alignment issues from pain-driven TMJ conditions.

2. Stabilize TMJ symptoms before surgery

If you have active jaw pain, jaw surgery should ideally be postponed until symptoms are reasonably stable and well controlled.

Pre-surgical stabilization may involve:

• TMJ-specific orthotic therapy

• Physical therapy for jaw and cervical muscles

• Habit and behavioral modifications (clenching, posture, sleep habits)

• Targeted treatments such as trigger point therapy or medications when appropriate

Patients whose TMJ symptoms are stable prior to surgery generally experience smoother recoveries.

3. Discuss TMJ risks openly with your surgeon.

Have a clear discussion about:

• The possibility that TMJ pain may improve, remain unchanged, or worsen after surgery

• Any existing disc displacement or degenerative joint changes

It is important to understand that single-jaw or bi-jaw (orthognathic) surgery is performed to correct skeletal alignment and facial or functional concerns. These procedures are not treatments for temporomandibular disorders (TMD).

While jaw surgery may result in changes to the bite, improvement in occlusion (bite) alone has not been proven to reliably treat TMD or TMJ pain. Current scientific literature does not support bite correction as a predictable or definitive treatment for TMD.

TMD is a complex condition influenced by multiple factors, including muscle dysfunction, joint pathology, nervous system sensitization, and psychosocial contributors, and it requires a comprehensive, multidisciplinary approach rather than a purely structural correction.

4. Avoid surgery during an active pain flare

Proceeding with jaw surgery during an active TMJ pain flare increases the risk of:

• Post-operative muscle guarding

• Persistent joint pain

• Prolonged or delayed recovery

Pain should be stable and manageable, not escalating, before surgery is undertaken.

5. Set realistic expectations

Even with careful planning:

• TMJ pain may improve

• TMJ pain may remain unchanged

• TMJ pain may worsen

The goal of surgery is to improve jaw alignment and function, not to treat chronic pain mechanisms. Realistic expectations help reduce post-surgical frustration and disappointment.

6. Plan for post-surgical TMJ monitoring

If you have a history of TMD, your post-operative care should include:

• Monitoring of TMJ symptoms during healing and bone remodeling

• Early evaluation if joint or muscle pain persists

• Coordination between your surgeon and a TMJ-focused provider when needed

Early recognition of persistent symptoms allows timely intervention and reduces the risk of long-term pain persistence.

How we help at Advanced TMJ Maxillofacial Pain & Sleep Center

At Advanced TMJ Maxillofacial Pain & Sleep Center, we focus on the comprehensive evaluation and non-surgical management of TMJ disorders, orofacial pain, headaches, and sleep-related jaw conditions.

For patients considering bi-jaw surgery for facial asymmetry or airway concerns who also have a history of TMD, our goal is to ensure that jaw joint health is properly assessed, stabilized, and monitored throughout the surgical journey.

Dr. Hemamalini Chandrashekhar is an internationally trained Oral and Maxillofacial Surgeon with advanced training in Orofacial Pain. She understands both the surgical aspects of jaw alignment and the pain-related mechanisms of TMJ disorders, allowing her to guide patients toward appropriate, evidence-based therapies tailored to their individual needs.

Whether surgery is part of the treatment plan or conservative pain management is more appropriate, patients receive balanced guidance focused on long-term comfort and function.

We take a TMJ-first, pain-focused approach, recognizing that jaw pain is not always related to bite or jaw position alone.

Our evaluations are designed to identify muscular, joint-based, and nerve-related contributors to pain, helping patients make informed decisions and set realistic expectations prior to undergoing major jaw surgery.

When appropriate, we work collaboratively with orthodontists, oral and maxillofacial surgeons, sleep physicians, and physical therapists to support coordinated care. Our goal is to reduce the risk of persistent TMJ pain, support smoother recovery, and address ongoing symptoms early if they arise.

Jaw surgery in patients with pre-existing TMD often need collaborative care

If you have TMJ pain and are considering single or bi-jaw surgery, a comprehensive TMJ evaluation can help clarify your risks and guide the safest path forward.

Key takeaway

If you suffer from TMD (TMJ Disorder) and are considering bi-jaw surgery:

• Obtain a TMJ-specific diagnosis

• Stabilize pain before surgery

• Understand that surgery corrects jaw alignment—not TMJ pain

• Plan for close follow-up during recovery

A thoughtful, TMJ-first approach leads to better outcomes and fewer surprises.