TMJ Surgery Flashcards
There are two approaches for open TMJ surgery, what are they?
- Preauricular approach
- menisectomy (without replacement)
- menisectomy (with replacement)
- eminectomy - Modified retro-mandibular approach
- subcondylar ostectomy for correction of ankylosis
What study/scan do we use for the join in order to study an anterior displaced disk?
MRI - enchanted resolution, static and kinetic images. MRI will show soft tissue –> internal aspects of joints
We do not use CT
What does clicking/popping mean for the TMJ?
Pop is from the articulate disk popping out of place and then popping back.
When you close the disc gets displaced anteriorly, the condyle then gets popped back posteriorly when you open
What does it mean if popping and clicking are painful?
There might be pain because the retrodiscal tissue gets stretched out (richly innervated) –> pain
What does reducing and non-reducing mean?
Reducing means that the disc pops back into place when the mouth opens.
Non-reducing means that the disc stays far forward without going back.
There is a lot of pain for non-reducing
What is the criteria for open joint surgery?
- imaging techniques demonstrate anatomical change
- clinical symptoms that disturb daily living
- conservative (less invasive) treatments unsuccessful
What is arthrotomy?
It is a surgical procedure that creates an opening in the joint
What are the candidates for TMJ arthrotomy?
- Symptomatic internal derangements
- meniscal dislocation (with or without reduction)- anatomical changes of the meniscus including morphogenesis and tearing
- narrowing of joint space
- bony changes of the glenoid fossa and condylar head
- recurrent dislocation
- Fibrous and bony ankylosis
- Fracture dislocation of condylar neck
What are the current goals to open joint surgery?
- Decrease pain
- treating inflammatory changes
- Restore normal physiologic function without altering occlusal relationships
- awareness of static and kinetic relationship of joints
- Reduce potential for arthritic degeneration
- preservation of existing structures with reverence for fibrocartilage and synovial tissue
- Minimize aesthetic deformity
What is menisectomy?
It is the surgical removal of all or part of a torn meniscus
Can be done with or without a replacement
What can you replace the meniscus with after a meniscectomy with replacement?
- temporary alloplast
- vascularized autogenous grafting
- temporalis flap
- free autogenous grafts
When do you use temporary alloplast as a replacement for meniscectomy?
Utilized when the meniscus is torn or morphological lay nonfunctional, with normal fibrocartilage of the condylar head and glenoid fossa
When do you use temporalis muscle graft (temporalis flap?) in meniscectomy?
It is utilized with severe internal derangement with discharge and a fibrocartilage of the condylar head and glenoid fossa
Patient complains of intermittent clicking and pain of the right TMJ. Patient has limited opening of 29mm. The mass enter, temporalis, and pterygoid muscles are tender to palpation. Diagnosis and treatment?
Diagnosis - internal derangement of right TMJ – anterior dislocation of meniscus without reduction upon opening
Treatment plan - arthrotomy with meniscocondylar fusion
Patient is female with chronic pain dysfunction of left TMJ. She has a history of clicking which has no stopped and replaced with grating sound. Severe limitation of opening at 22mm with limited lateral excursions. Diagnosis and treatment?
Diagnosis - internal derangement of left TMJ with severe arthritic changes of the mandibular condyle
Treatment - arthrotomy with temporalis muscle graft and arthroplasty
