Complications of TMJ Surgery Flashcards
What are some complications of TMJ surgery (9)
-otitis externa
-otitis media
-broken instrument during arthroscopy/arthrocentesis
-TM rupture/hemotympanium
-Violation of middle cranial fossa
-damage to temporal branch of facial nerve
-auriculotemporal nerve syndrome/ Frey syndrome
-bleeding during condylotomy
-bleeding during diskectomy
what does patient complain of when they have otitis externa and what’s treatment?
infection of external auditory canal
pain on movement or pressure of ear
tx. topical fluoroquinoline otic products
why tx topical fluoroquinolones for otitis externa?
coverage for pseudomonas- most common bacteria in otitis externa
what does otoscopy reveal for otitis externa?
edematous external auditory canal with possible discharge
what does otoscopy reveal for otitis media
full or bulging tympanic membrane or possible purulence if there is perforation
tx otitis media
amoxicillin
ent consult for myringotomy tubes
what does patient complain of with otitis media?
inflammation of middle ear structures
-ear pain, difficulty hearing and fever
how to you tx broken instrument during arthroscopy/arthocentesis?
if able to visulize and have arthroscopic training remove
if can’t visualize, obtain radiographs in muiltiple planes for identification
-open approach
Tx tympanic membrane rupture/hemotymapanium
-ENT consult
-if External auditory canal damaged place sponge impregnanted w/ antibiotic and suture to maintain opening of external auditory canal.
-antibiotic-hydrocortisone suspension x 14 days, monitor for post op granulation tissue
how to remove post op granulation tissue in tympanic membrane rupture?
bipolar cautery
-silver nitrate
antibiotic for tx of violation of middle cranial fossa
cotrimoxazole as its bactericidal and enters cerebral spinal fluid
suspect violation of middle cranial fossa, what do you do?
if you suspect Cerbrospinal fluid leak post op what do you do?
CT scan/ MRI, consult neurosurgery on desired imaging.
suspect cerbrospinal fluid,what to do with patient?
do small cerbrospinal fluid leaks heal?
HOB elevation greater than 30 degrees
cotrimoxazole
small CSF leaks heal spontaneously within 1 week
how thick is the middle cranial fossa?
0.9 mm thick
where is the temporal branch of the facial nerve ?
2 cm anterior to bony external auditory canal
what did al kayat study say facial nerve is
range of 0.8 cm-3.5 cm
what does the temporal branch of the facial nerve innervate?
frontalis
orbicularis
corrugator supercilii
what happens to injuries w/ facial nerve?
who do you consult
most resolve in 3-6 months, observation warrented.
consult opthomology
what do you need to do to the eye if there is injury with facial nerve?
lubrication and taping of eye to prevent keratoconjunctivities.
-physical therapy w/ electrical stimulation
permanent injury to facial nerve, what is tx?
gold weights implants can be placed in upper eyelid for permanent defect.
signs and symptoms of auriculotermporal nerve syndrome (frey’s syndrome)
gustatory sweating
flushing
warmth
over temporal and preauricular areas.
when does freys syndrome occur
auriculotemporal nerve damage
most commonly in arthroscopy
usually temporary and resolves w/i 6 months
how to evaluate patient with auriculotemporal nerve syndrome?
Minor test
what is minor test
starch-iodine
solution of 3 grams iodine
20 g castor oil
200 ml absolute alcohol
applied to preauricular area
gustatory sweating illicited by having patient chew on lemon drop
+ test yellow mixture turns blue
tx for + minor test
16-80 IU of botulinum A subQ injection results in resolution in 1 weeks
scopolamine ointment (anticholinergic properties)
-surgical transection of innervation
bleeding during condylotomy is from where?
internal maxillary artery and its branches
where does internal maxillary artery run?
3 mm medial from the mid sig-moid notch and 20 mm below condylar head
what is a commonly damaged vessel during condylotomy?
masseteric artery
what can cause bleeding during diskectomy?
-retrodiscal tissue
-lateral pterygoid muscle
-middle meningeal artery
where is middle meningeal artery found?
31 mm medial zygomatic arch
2.4 mm anterior from heigh of the glenoid fossa.
how to manage bleeding in diskectomy?
-visualize vessels, cauterize or ligate
-hold pressure x 5 mins
-thrombin soaked gauze, collagen sponges,tissue adhesives
-IR for embolization if bleeding not controlled by hemostatic measures.
-carotid artery cut down
explain carotid artery cut down for uncontrollable bleeding
5 cm neck incision 2 cm below the inferior border of the mandible
Sternocleidomasotid muscle is retracted posterioly
blunt dissection to carotid sheath
internal jugular vein retracted posteriorly to reveal common carotid
where does hypoglossal nerve cross
hypoglossal nerve will cross above carotid bifurcation
where to ligate carotid artery
above the facial branch, 3rd of anterior branches, blood flow has been found to be reduced by 73% when ligated.
