A Modified Technique of Temporomandibular Joint Arthroscopic Operative Surgery of the Superior and Inferior Joint Spaces
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ORIGINAL ARTICLE
A Modified Technique of Temporomandibular Joint Arthroscopic Operative Surgery of the Superior and Inferior Joint Spaces I. Rosenbrg1,2 • A. N. Goss3,4
Received: 8 September 2019 / Accepted: 18 September 2019 Ó The Author(s) 2019
Abstract Purpose This paper describes in detail the first author’s technique of performing arthroscopic surgery in both the superior and inferior joint spaces of the temporomandibular joint. Methods The key is careful measurement of sagittal and coronal tomograms to determine the individual size and shape of the joint. The joint is then distracted to allow 3-port video arthroscopy. Results The detailed steps in the procedure are described and illustrated. Conclusion This modified technique is safe and allows procedures in both joint spaces and surgical access to the fossa, condyle and disc. Keywords Temporomandibular joint Arthroscopy Superior joint space Inferior joint space Glenoid fossa Disc Condyle Operative procedure Abbreviations TMD Temporomandibular disorders TMJ Temporomandibular joint CT Computerised tomography MRI Magnetic resonance imaging & A. N. Goss [email protected] 1
St John of God, Mount Lawley Hospital, Mount Lawley, Australia
2
Suite 11, Medical Centre, Ellesmere Road, Mount Lawley, WA 6050, Australia
3
Oral and Maxillofacial Surgery Unit, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
4
The Royal Adelaide Hospital, Adelaide, Australia
Introduction Arthroscopic examination of the temporomandibular joint was first described by Ohnishi [1] in Japanese and subsequently in Western literature [2]. Initially, it was described as a diagnostic technique with simple lysis, lavage and medicament insertion. The technique was then applied to relatively simple operative surgical procedures within the superior joint space [3]. Unless there was a large central disc perforation or absent intra-articular disc, the lower joint space could not be visualised. As at least 50% of the pathology and the predominant site of translational movement is in the inferior joint space, this limited the value of the technique. Arthroscopic surgery has now expanded to include multiple procedures: [4]. Synovectomy in the upper and lower joint compartments. Disc repositioning and stabilisation. Exploration of the lower joint compartment with lysis and lavage. High condylar shave and osteoplasty for chondromalacia and osteoarthritis. In this paper, we describe, in step sequence, a modified technique of operative surgical approach to the temporomandibular joint, which has been developed over many years by the first author (IR) [5].
123
J. Maxillofac. Oral Surg.
Method Preoperative All TMD patients must have a full evaluation including a medical workup, and non-surgical treatment of splints, exercises, physiotherapy and psychological assessment must have been tried over time and failed. The patient must have demonstrated intra-articular temporomandibular joint pathology as demonstrated by joint tenderness, limitati
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