Technique of functional disc repositioning in internal derangements of the temporomandibular joint

Abstract

Internal derangements of the temporomandibular joint (TMJ) are composed of several pathophysiologic entities: anterior dislocation of the disc, with or without reduction, alone or in association with degenerative changes in the condyle. In situations where the internal derangement involves a structurally intact, but chronically locked or reducible disc, treatment consists of surgical repositioning and stabilization. Several techniques have been developed to restore a proper disc-condyle relationship.1-5 One of the earlier procedures, advocated by Toiler,’ was that of “capsular rearrangement.” This consisted of releasing the lateral disc attachments to allow freedom of disc movement in association with a temporal pedicle to strengthen the lateral ligament and capsule. In 1979, McCarty and Farrar2 recommended that a small amount of tissue from the bilaminar zone be removed. The amount of resected tissue corresponded to the degree of displacement of the disc. The disc was then repositioned over the condyle and sutured to the distal and collateral ligaments. This was sometimes accomplished in conjunction with a 2-3 mm condylar resection. A modification of this technique consists of a true plication or folding over and sewing of the redundant bilaminar zone. Leopard3 has described a relatively simple operation in which the lateral border of the disc is anchored to the lateral margin of the glenoid fossa. Weinberg“ accomplished disc repositioning in conjunction with some form of arthroplasty. This involved direct plication of the fibrous disc to the ar-