Contents - 2006 - Oral and Maxillofacial Surgery Clinics of North America

MODERN SURGICAL MANAGEMENT OF THE TEMPOROMANDIBULAR JOINT
CONTENTS
Preface ix
A. Thomas Indresano
Dedication xi
A. Thomas Indresano
History of Temporomandibular Joint Surgery 283

A. Thomas Indresano and Daniel A. Mobati
This article reviews past surgical treatments for TMJ and their rationale. Because of poor
outcomes with alloplastic materials in the 1980s, many experts believed TMJ surgery had
failed. Those who advocated nonsurgical treatment condemned the entire discipline
without recognizing the benefits of many surgical approaches. Only after 20 years of
‘‘good science’’ has TMJ surgery reemerged with many procedures proven highly
effective.
Evaluation of the Patient for Temporomandibular Joint Surgery 291

Larry J. Moore
Temporomandibular joint (TMJ) surgery is the preferred treatment for tumors, neoplasms,
and selected injuries and infections of the TMJ. It is also an appropriate and effective treat-
ment for subsets of temporomandibular disorders (TMDs) that are characterized by me-
chanical disruption of joint function. Careful and systematic clinical evaluation and
imaging is required to determine if painful TMD with altered range of motion is amenable
to surgery of the TMJ. This article offers a rational approach to evaluation of patients for
TMJ surgery.
Nonsurgical Treatment as an Adjunct to Surgery 305

Samuel J. Razook
Although some temporomandibular joint problems require surgical intervention, non-
surgical modalities are essential in the treatment of most joint afflictions, including inter-
nal derangements, inflammatory conditions, and arthritides. These approaches are crucial
for presurgical management of these conditions and are an important adjunct in post-
surgical care.
VOLUME 18 Æ NUMBER 3 Æ AUGUST 2006 v

Arthrocentesis—Incentives for Using This Minimally Invasive Approach
for Temporomandibular Disorders 311
Dorrit W. Nitzan
TMJ arthrocentesis is a nonarthroscopic lavage performed through two needles that are
introduced into the upper compartment of the joint. Complemented by joint unloading
and physiotherapy, this procedure often replaces surgical intervention in the TMJ. The
procedure is highly efficient for resolving TMJ disorders caused by adhering forces or
friction that are eliminated by lavage, such as intermittent clicking, anchored disc phe-
nomenon, and open lock, and releases approximately 70% of the symptomatic TMJ
osteoarthritis. The outcomes are sufficiently effective to prevent further surgical inter-
vention. Arthrocentesis is a valuable diagnostic tool and the aspirated fluid can be used
efficiently for diagnosis, therapy, and research of TMJ disorders.
Advanced Arthroscopic Surgery 329

Michael G. Koslin
Improvements in camera and lens technology have advanced the ability to diagnose
a multitude of pathologic conditions within the temporomandibular joint. Laser ad-
vances have allowed for precise surgical procedures to be performed in small joints with
limited access. The creativity and ingenuity of oral and maxillofacial surgeons has taken
these technologic advances and applied them to the treatment of this important joint.
A Biomechanical Basis for Primary Arthroplasty

of the Temporomandibular Joint 345
William S. Kirk, Jr and Benjamin S. Kirk
Biomechanical principles of temporomandibular joint (TMJ) loading are unique, partic-
ularly in an orthopedic system that exhibits curvilinear general plane motion. Certain
type-specific derangements can be surgically challenging and may primarily require
open arthrotomy techniques rather than arthroscopy. This article discusses the basic bio-
mechanical principles in normal and pathologic function. Three-dimensional preopera-
tive imaging of TMJs is necessary for appropriate assessment of all patients and when
open techniques are necessary as the initial surgical procedure.
Modified Mandibular Condylotomy 369

Samuel J. McKenna
Modified condylotomy is a technically simple extra-articular procedure for the surgeon
who is comfortable with intraoral vertical ramus osteotomy for orthognathic surgery. In-
creasing joint space frequently promotes disc reduction in joints with disc displacement
with reduction or recent progression to disc displacement without reduction; improves
pain even if disc position remains unchanged; and seems to favorably alter the natural
course of internal derangement.
Distraction Osteogenesis in Reconstruction of the Mandible

and Temporomandibular Joint 383
Daniel B. Spagnoli and Steven G. Gollehon
The purpose of this article is to review the origins of temporomandibular joint disease
that require joint reconstruction. We discuss our experience with this alternative proce-
dure as an option in patients with pre-existing failed total joints, autoimmune degener-
ation, traumatic destruction, or congenital hypoplasia or aplasia. We also discuss the
procedure as an autogenous alternative to prosthetic reconstruction in patients in whom
reconstruction of the mandibular condyle and meniscus is indicated.
vi CONTENTS
Total Joint Reconstruction—Autologous or Alloplastic 399
Louis G. Mercuri
The functional goals of temporomandibular joint (TMJ) reconstruction are the same re-
gardless of whether they are accomplished with autogenous tissues or alloplastic ma-
terials. Which of these reconstruction modalities is best suited for an individual case
should depend on the nature of the defect, the pathology that created that defect, the his-
tory of the course of the patient’s prior nonsurgical and surgical interventions and the
response to each, and most importantly on the evidence from refereed literature that
supports the choice of alloplast verses autogenous reconstruction based on scientific data.
This article provides an evidence-based review of the autogenous and alloplastic TMJ
reconstruction literature. The reader can then more accurately determine which of these
two modalities provides the most appropriate option for the management of the above
conditions so as to achieve the functional goals.
Management of Surgical Failures 411

Peter D. Quinn, Helen Giannakopoulos, and Lee Carrasco
Surgical intervention is appropriate in a small percentage of patients with temporoman-
dibular joint disorders when it is based on a specific diagnosis of intracapsular pathol-
ogy not amenable to nonsurgical modalities. Expected advances in our understanding
of the complex molecular, biochemical, and genetic factors that influence these disease
states clearly will allow less invasive techniques and even obviate the need for some
open arthroplastic interventions altogether in the future. In the meantime, reasonable,
well-intentioned surgeons must rely on the current body of surgical knowledge to use
surgery as judiciously as possible.
Index 419
CONTENTS vii

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Contents - 2006 - Oral and Maxillofacial Surgery Clinics of North America

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MODERN SURGICAL MANAGEMENT OF THE TEMPOROMANDIBULAR JOINT

History of Temporomandibular Joint Surgery 283

Evaluation of the Patient for Temporomandibular Joint Surgery 291

Nonsurgical Treatment as an Adjunct to Surgery 305

VOLUME 18 Æ NUMBER 3 Æ AUGUST 2006 v

Advanced Arthroscopic Surgery 329

A Biomechanical Basis for Primary Arthroplasty

Modified Mandibular Condylotomy 369

Distraction Osteogenesis in Reconstruction of the Mandible

Management of Surgical Failures 411

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