Surgical Management of TMJ Disorders

Question 1

Indications for surgical therapy.

Answer 1

• Pain
• Hypomobility
• Hypermobility
• Hypofunction

Question 2

Is TMJ surgery indicated for asymptomatic or minimally symptomatic patients, or as a preventive measure?

Answer 2

No!

Question 3

When you get arthritis as a result of an infection.

Answer 3

Infectious arthritis

Question 4

Conditions where Surgery is Indicated:

Answer 4

• Internal derangement (something wrong with the disc).
• Degenerative Joint Disease
• RA
• Infectious arthritis
• Mandibular dislocation
• Ankylosis
• Condylar hypo or hyperplasia
• Idiopathic condylar resorption

Question 5

If a patient is a surgical candidate, what do we want to eliminate before we do the surgery?

Answer 5

Myofascial pain

Question 6

Soft tissue imaging

Answer 6

MRI

Question 7

Hard tissue imaging

Answer 7

CT

Question 8

Inject a fluorescent dye into the joint.

Answer 8

Arthrotomography

Question 9

A conservative surgical approach that does lysis of adhesions, and lavage of the joint space.

Answer 9

Arthrocentesis/Arthroscopy

Question 10

Indications for arthrocentesis.

Answer 10

Disc dislocation (“closed lock”)

Question 11

Indications for arthroscopy.

Answer 11

1) Disc dislocation (“closed lock”)

2) Superior joint space adhesions

Question 12

Lysis and Lavage

Answer 12

Arthroscopy/Arthrocentesis

Question 13

Does the TMJ disc normally have perforations?

Answer 13

No

Question 14

SURGICALLY entering into the joint space.

Answer 14

Arthrotomy

Question 15

Indications for an arthrotomy:

Answer 15

• Internal derangement
• Arthritis (DJD, RA, Infectious Arthritis)
• Chronic/recurrent mandibular dislocation
• Intracapsular ankylosis
• Condylar malformation

Question 16

Most common surgical approach for TMJ surgery.

Answer 16

Preauricular

Question 17

Surgical approaches

Answer 17

• Preauricular
• Postauricular
• Hemi or Bicoronal
• Risdon (submandibular)
• Retromandibular

Question 18

Risdon surgical approach AKA what?

Answer 18

Submandibular

Question 19

Bad thing about the postauricular approach.

Answer 19

Cutting through cartilage can causes stenosis of the auditory canal from the cartilage.

Question 20

Surgical approach where you cut from one preauricular side to the other.

Answer 20

Bicoronal

Question 21

When you cut out a wedge of tissue and sew back an anteriorly displaced disc.

Answer 21

Wedge resection with plication.

Question 22

When you sew something in place.

Answer 22

Plication

Question 23

Types of disc surgery.

Answer 23

• 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.

Question 24

Bony Surgery

Answer 24

• Condylar shave (recontour condyle and sometimes eminence).
• Condylectomy
• Contouring/ Repair of fossa
• Eminectomy
• Joint replacement (Autogenous, Alloplastic).

Question 25

Treatment for recurrent dislocation.

Answer 25

Inject autologous blood into the joint space.

Question 26

You can replace the TMJ with a contralateral ______.

Answer 26

Rib

Question 27

Types of extracapsular ankylosis

Answer 27

• Coronoid hyperplasia
• Fracture malunion
• As a complication of skull base surgery

Question 28

Coronoid hyperplasia can cause what?

Answer 28

Extracapsular ankylosis