RAG rating
Document type
Clinical policy
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions

Temporomandibular Joint Replacement

July 2022 v1.0

Temporomandibular Joint Replacement is not normally funded due to limited evidence of clinical effectiveness. Exceptional cases may be considered by the NHS Hertfordshire & West Essex ICB IFR team. 


There is limited evidence of effectiveness for this procedure. There are no RCTs, no agreed diagnostic classification scheme or universally accepted outcome measures or evidence on the relative cost effectiveness of total TMJ replacement. The research community in the USA have expressed caution about using irreversible surgery for TMJ disorders.

In very rare cases of patients with extremely severe cases of TMJ disorder with re-ankylosis who cannot open their mouth and who are at great risk from failure to maintain the airway, there may be a case for total TMJ replacement. If this surgical service development were to proceed then it must be on the condition that all patients should give full informed consent and be included in a national register using valid outcome measures. The surgery should only be offered by specialist reconstructive maxilla-facial units and funding on the grounds of exceptionality must be sought from the ICB.


  • Temporomandibular Joint – The hinge joint of the lower jaw