Temporomandibular joint lower compartment surgery

Abstract

The temporomandibular joint is divided into upper and lower joint compartments by the intraarticular cartilage. Significant pathology occurs in the lower joint compartment and therefore the arthroscopic procedure is incomplete without the ability to operate in both upper and lower joint compartments. Pathology found in the lower joint compartment is as follows: synovitis, effusion, adhesions, osteoarthritic bone changes, stuck disc Essential to this technique is that the joint be suitably distracted. Steinman pins and special distractor is used for this purpose. Three portal surgery is necessary: An anterior portal, a posterior portal and an intermediate portal to enable manipulation of the disc with a fine probe. The procedures that can be carried out in the lower joint compartment are as follows: Investigation of lower joint compartment pathology lysis and lavage in the lower joint compartment high condylar shave. An anterior release incision made in combination with the lateral disc access incision enables the disc to be reduced and stabilised with the Prolene endaural plication suture and cauterisation. Injection of Marcaine and steroid can be done into the lower joint compartment and posterior attachment by direct vision. In severely arthritic joints where a thorough lysis and lavage of adhesions in the lower joint compartment is carried out, with postoperative physiotherapy and occlusal splint management the joints can be rendered functional and comfortable for the patient without undergoing major arthroplasty procedures.