Glenotemporal osteotomy and bone grafting in the management of chronic recurrent dislocation and hypermobility of the temporomandibular joint

Abstract

Chronic recurrent dislocation of the temporomandibular joint (TMJ) is rare and has many causes. Although it is possible to start treating it conservatively, these treatments are usually unsuccessful. Over the years, many operations have been done including operating on the muscles, the articular capsule, the articular meniscus, and the condyle. At present, the most widely accepted techniques are those used on the articular eminence. It may be reduced (eminectomy), favouring free movement of the condyles, or an obstacle may be interposed to prevent excessive movement of the condyles. These later techniques include Norman's (glenotemporal osteotomy with interpositional bone grafting). Other techniques include Dauterey's procedure, on which onlay bone grafts or bone substitutes are inserted in a subperiosteal pocket inferior to the articular eminences. We report a prospective study of 60 patients who had a bilaterally modified glenotemporal osteotomy, 40 who had chronic dislocations of the temporomandibular joints and the other 20 who had severe hypermobility of the joints. Bone grafts, iliac or calvarial, were inserted at the osteotomy between the zygomatic arch and the articular eminence, and fixed either by wires, mini-plates or microplates, and screws. Stable results were obtained and retained during long-term follow up of 1–8 years.