TMJ Surgeries
Surgery of TMJ is performed to get relived from the various disorders of the temporomandibular joint.Surgery is last and very important treatment protocol that is done after all other treatment options are not helpful
Age for surgical intervention
Good results of the TMJ surgeries can be best achieved when the growth of the mandibular joint complete.Girls usually have their facial growth complete by the age of 15 yrs whereas boys by the age of 17-18 yrs. Surgery performed at the earlier ages result ing the deformity after growth completes additional surgery is required to correct resultant deformity.
Indications
Indications of TMJ surgeries involve two aspects absolute and relative.Absolute indications for surgeries are those indication in which surgery is very important and the involved disease is not treated without surgical management.There are three absolute indications for TMJ surgery
- Ankylosis
- Tumors
- Growth anomalies
In relative indications surgery has a less clearly defined role in treatment procedure.Relative indications include
- Disc positioning
- Osteoarthrosis of TMJ
- Internal derangement
Artherocentesis
In this procedure needle is inserted at the TMJ region and fluid is irrigated though the needle to remove the debris and other inflammatory products.
Injections
Corticosteroid injections are used to relieve pain and chewing problems. Injections are used commonly used to provide temporary relief before the surgery is scheduled.
Arthroscopy
This procedure include small incision in the front of the ear under general anesthesia. Small video camera is inserted though the incision to see TMJ. Another tiny cut is made to pass fine instruments to perform surgical procedure. Minimum scar is formed and healing phase is fast.
Open procedures
In open surgical procedure incision is given in the tissue so as to access the joint region. The area of incision is large and is performed in the following
- Disc repositioning
- TMJ reconstruction
- Condylectomy
- Meniscectomy
- Condylotomy
Arthrotomy
Disk repair is performed with minimal disc perforations. Arthrotomy is avoided if there is reciprocal clicking beyond 25mm,Repeated episodes of locking,Any bony changes visible in the radiograph.
Diskectomy
This procedure is performed in the large disc perforation and when there is obstruction in the condylar movement. Disadvantage of this procedure is that the joint become more prone to degenerative changes.
Diskectomy with reconstruction
The main aim of this surgeries to prevent direct contact of bony articulating surfaces.Grafts used in this procedure can be autologous and alloplastic.
lateral pterygoid myotomy
Moyotomy of the lateral pterygoid muscle is done by intraoral incision. Fibrous tissue is removed to reduce the dislocation. Silicon sheet is interposition is done.
condylotomy
Condylotomy is used in the patients with condylar fracture.Rationale of condylotomy include
- Segment gets inferiorly displaced
- Pull of the Pterygoid muscle reduces
- Restoration of disc-condyle relation to the normal changed
Tmj reconstruction
Reconstruction of the TMJ is done when all other treatment options fails.
Indications include
- Younger patient
- Infection
- Failed previous surgery
- Developmental deformity
Chances rejection by the host toTMJ reconstruction procedure is high.
Tmj replacement
This is performed in the patients with non-responsive to any treatment. Customized TMJ’s made up of various metals(titanium,cobalt,nickel) are available is surgically inserted in the correct position. This is very complex and expensive surgery.
Non-surgical and closed TMJ treatment
Non-surgical treatments such as orthodontics,boifeedback,acupuncture,physical therapy may help TMJ symptoms but not eliminate permanently. TMJ disorders such as disc dislocation, arthritis,condylar resorption or condylar hyperplasia usually used along with orthognathic surgery.