Disc Anchoring with an Orthodontic Mini-Screw for Chronic Meniscocondylar Dislocation of TMJ.

Abstract

Various surgical modalities have been tried for the correction of chronic recurrent dislocation of the temporomandibular joint. However, most of these techniques are aimed at creating an artificial block or removing any interference in the path of the translating condyle. Chronic dislocation can also be classified as meniscotemporal and menisocondylar, depending upon whether the dislocation occurs between the condyle-disc unit and temporal bone (meniscotemporal), or between the disc and condyle (meniscocondylar). Very few procedures address the primary issue of a malpositioned disc, which is the cause of meniscocondylar dislocation. This study was conducted on 17 patients (27 joints) who reported with chronic dislocation of the temporomandibular joint, with MRI-proven meniscocondylar dislocation. After exposure of the condyle and disc through a standard pre-auricular incision, an orthodontic mini-screw was fixed to the posterior aspect of the condylar head and a 1-0 Prolene suture passed through the screw-head eyelet, plicating the posterior edge of the disc to the condyle. This ensured that the condyle and disc would move in unison. All the patients showed improvement in their symptoms of dislocation in the postoperative period, including seven patients in whom only a unilateral procedure was carried out. None of the patients had any recurrence till the 1-year followup. Our procedure addresses the fundamental etiology of meniscocondylar dislocation by anchoring the disc to the condyle by using an orthodontic mini-implant and correcting the condyle-disc disharmony. This technique is reliable, technically feasible, and cost-effective in the Indian set up.