Surgical Management of TMJ Disorders Flashcards
Indications for surgical therapy.
- Pain
- Hypomobility
- Hypermobility
- Hypofunction
Is TMJ surgery indicated for asymptomatic or minimally symptomatic patients, or as a preventive measure?
No!
When you get arthritis as a result of an infection.
Infectious arthritis
Conditions where Surgery is Indicated:
- Internal derangement (something wrong with the disc).
- Degenerative Joint Disease
- RA
- Infectious arthritis
- Mandibular dislocation
- Ankylosis
- Condylar hypo or hyperplasia
- Idiopathic condylar resorption
If a patient is a surgical candidate, what do we want to eliminate before we do the surgery?
Myofascial pain
Soft tissue imaging
MRI
Hard tissue imaging
CT
Inject a fluorescent dye into the joint.
Arthrotomography
A conservative surgical approach that does lysis of adhesions, and lavage of the joint space.
Arthrocentesis/Arthroscopy
Indications for arthrocentesis.
Disc dislocation (“closed lock”)
Indications for arthroscopy.
1) Disc dislocation (“closed lock”)
2) Superior joint space adhesions
Lysis and Lavage
Arthroscopy/Arthrocentesis
Does the TMJ disc normally have perforations?
No
SURGICALLY entering into the joint space.
Arthrotomy
Indications for an arthrotomy:
- Internal derangement
- Arthritis (DJD, RA, Infectious Arthritis)
- Chronic/recurrent mandibular dislocation
- Intracapsular ankylosis
- Condylar malformation
Most common surgical approach for TMJ surgery.
Preauricular
Surgical approaches
- Preauricular
- Postauricular
- Hemi or Bicoronal
- Risdon (submandibular)
- Retromandibular
Risdon surgical approach AKA what?
Submandibular
Bad thing about the postauricular approach.
Cutting through cartilage can causes stenosis of the auditory canal from the cartilage.
Surgical approach where you cut from one preauricular side to the other.
Bicoronal
When you cut out a wedge of tissue and sew back an anteriorly displaced disc.
Wedge resection with plication.
When you sew something in place.
Plication
Types of disc surgery.
- Wedge resection with plication.
- Discectomy
- Discectomy with replacement (Replace with dermis, fascia, cartilage, or muscle).
- Discectomy by ITSELF WITHOUT REPLACEMENT has the best long-term results.
Bony Surgery
- Condylar shave (recontour condyle and sometimes eminence).
- Condylectomy
- Contouring/ Repair of fossa
- Eminectomy
- Joint replacement (Autogenous, Alloplastic).
Treatment for recurrent dislocation.
Inject autologous blood into the joint space.
You can replace the TMJ with a contralateral ______.
Rib
Types of extracapsular ankylosis
- Coronoid hyperplasia
- Fracture malunion
- As a complication of skull base surgery
Coronoid hyperplasia can cause what?
Extracapsular ankylosis
