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Arthroscopic treatment of internal derangements
Symposia Symposium: Management of TMI Internal Derangements (cont’d)
heightassociatedwith anterioropenbite canbe restored with irradiatedcadavercartilage.Surgicalapproachesto the TMJ include severalmodificationsof the preauricular incision, the endaural and the postauricular. A submandibularor retromandibularapproachis added for somereconstructiveprocedures.Avoidanceof facial nerveinjury is a primary considerationin all approaches to the TMJ. The goals of arthrotomy are to improve mandibular motion and reduce or relieve pain. These are achieved in 85% to 90% of properly selected patients, but follow-up in most clinical studies is less than 3 years. Indications for arthrotomy as surgical treatment of TMJ internal derangementshavebeen modified by the recent reported successof arthroscopyin managing various problems (eg, disc displacementand defects, adhesions,osteoarthrosis)previouslytreatable only by open TMJ surgery.Up to 80% of patients previously requiringarthrotomyfor internal derangementsarenow successfullytreated by arthroscopy.Therefore, currently, arthrotomy is but one stagein a continuum of treatment for TMJ internal derangementswhich also includes nonsurgicalmodalities, arthroscopyand open surgicalprocedures. Why arthrotomyis successfulin treatingTMJ internal derangementsis not entirely clear.Long-termfollow-up of 5 or more yearsis neededto documentwhetheror not early clinical successof a particular arthrotomy technique persists. Control of parafunctional masticatory muscle activity, stabilizationof dental occlusion,establishment of physiologiccondylarposition,and identiflcation and treatment of psychologicalfactors are all important in the TMJ surgicalcandidate.Which aspect or aspectsof arthrotomyarecritical to success(matching the optimal procedureto the stageof disease,denervation of the joint, creationof a smoothpath for condylar motion, removalof adhesionsandosseousinterferences, repositioning,repair or removalof the disc,alterationof the characterof the synovialfluid, placeboeffect) await studieswhich haveyet to be completedandshoulddirect our effortsin the 1990s. References McCarty, W.L., Farrar, W.B.: Surgery for internal derangements of the temporomandibular joint. J Prosthet Dent 42:191-1%,1979 Merrill, R.G. (ed): Disorders of the TMJ II: Arthrotomy. Oral Maxillofac Clin North Am l(2), 1989 Wilkes, C.H.: Internal derangement of the temporomandibular joint. Arch Otolaryngol115:469-477,1989
Arthroscopic Treatment of Internal Derangements David C. Hoffman,DDS, StatenIsland,NY Correctionof internal derangementsof the temporomandibular joints has been listed as one of the true 8
indications for temporomandibularjoint surgery.Disc position,shapeandform haveall beenfactorsindicating the type of surgeryto be performed.With the adventof small joint arthroscopy,the TM joint has had a new avenueof treatment. Severalarticles have been published presentingarthroscopictreatment of TMJ patients with a high degreeof success.As a result of the successdescribedin the early publications,there has been an increasedinterest in both mechanismsof the diseaserelatedto the TM joint and the typesof surgery that can be performed both through arthrotomiesand arthroscopicprocedures.This lecture will addressthe current thoughtson arthroscopicsurgeryin its attempt to treat TMJ pathology-internalderangements.Attention will be directedto the function of discal apparatus and how to restore this with the use of arthroscopic procedures. An overall review of the availabletechniqueswill be discussedincluding the authors’ experienceusing disc suturingfor stabilizationand repositioning.Techniques will be presenteddemonstratingthe arthroscopicoperative proceduresand their results.The useof KTP laser asan arthroscopicsurgicaltool will alsobe explained. Results of approximately300 arthroscopicsurgeries havebeen followed for treatment of internal derangements.This diagnosiswill be divided into three groups; reducing discs, nonreducing discs and perforations. Arthroscopicmodalities will be categorizedas follows: 1) suturing techniques,2) nonsuturingdisc repositioning, and3) lysisand lavage(increasingdiscmobility with recapture)and 4) aggressivetreatmentof perforations. The overallresultswill be evaluatedboth preoperatively andpostoperativelyreviewinga varietyof factorsincluding subjectiveandobjectiveparameters. This presentationwill attempt to establishthe useof arthroscopicsurgicalsuturingas a viable alternativeto openjoint surgerywith a significantincreasein success ratesand decreasein untowardeffects. The final segmentwill addressthe inter-relationship of arthroscopicsurgeryandopenjoint surgeriesandhow eachfield may effectivelychangethe proceduresbeing performed.The ultimate ability to perform open joint proceduresthroughan arthroscopeaswell as the useof an arthroscopein conjunction with open procedures may be a cornerstonein the surgicaltreatment of TMJ problems. References Parisien, Arthroscopic Surgery, McGraw-Hill Johnson, L., Arthroscopic Surgery, Volumes I& II, Mosby DeBont, L., Temporomandibular Joint Articular Cartilage Structure & Function, PhD Thesis Department of Oral & Maxillofacial Surgery, Netherlands. Oral & Maxillofacial Surgery Clinics of North America, Volume 1.1, September, 1989.
MOMS
.
1991
heightassociatedwith anterioropenbite canbe restored with irradiatedcadavercartilage.Surgicalapproachesto the TMJ include severalmodificationsof the preauricular incision, the endaural and the postauricular. A submandibularor retromandibularapproachis added for somereconstructiveprocedures.Avoidanceof facial nerveinjury is a primary considerationin all approaches to the TMJ. The goals of arthrotomy are to improve mandibular motion and reduce or relieve pain. These are achieved in 85% to 90% of properly selected patients, but follow-up in most clinical studies is less than 3 years. Indications for arthrotomy as surgical treatment of TMJ internal derangementshavebeen modified by the recent reported successof arthroscopyin managing various problems (eg, disc displacementand defects, adhesions,osteoarthrosis)previouslytreatable only by open TMJ surgery.Up to 80% of patients previously requiringarthrotomyfor internal derangementsarenow successfullytreated by arthroscopy.Therefore, currently, arthrotomy is but one stagein a continuum of treatment for TMJ internal derangementswhich also includes nonsurgicalmodalities, arthroscopyand open surgicalprocedures. Why arthrotomyis successfulin treatingTMJ internal derangementsis not entirely clear.Long-termfollow-up of 5 or more yearsis neededto documentwhetheror not early clinical successof a particular arthrotomy technique persists. Control of parafunctional masticatory muscle activity, stabilizationof dental occlusion,establishment of physiologiccondylarposition,and identiflcation and treatment of psychologicalfactors are all important in the TMJ surgicalcandidate.Which aspect or aspectsof arthrotomyarecritical to success(matching the optimal procedureto the stageof disease,denervation of the joint, creationof a smoothpath for condylar motion, removalof adhesionsandosseousinterferences, repositioning,repair or removalof the disc,alterationof the characterof the synovialfluid, placeboeffect) await studieswhich haveyet to be completedandshoulddirect our effortsin the 1990s. References McCarty, W.L., Farrar, W.B.: Surgery for internal derangements of the temporomandibular joint. J Prosthet Dent 42:191-1%,1979 Merrill, R.G. (ed): Disorders of the TMJ II: Arthrotomy. Oral Maxillofac Clin North Am l(2), 1989 Wilkes, C.H.: Internal derangement of the temporomandibular joint. Arch Otolaryngol115:469-477,1989
Arthroscopic Treatment of Internal Derangements David C. Hoffman,DDS, StatenIsland,NY Correctionof internal derangementsof the temporomandibular joints has been listed as one of the true 8
indications for temporomandibularjoint surgery.Disc position,shapeandform haveall beenfactorsindicating the type of surgeryto be performed.With the adventof small joint arthroscopy,the TM joint has had a new avenueof treatment. Severalarticles have been published presentingarthroscopictreatment of TMJ patients with a high degreeof success.As a result of the successdescribedin the early publications,there has been an increasedinterest in both mechanismsof the diseaserelatedto the TM joint and the typesof surgery that can be performed both through arthrotomiesand arthroscopicprocedures.This lecture will addressthe current thoughtson arthroscopicsurgeryin its attempt to treat TMJ pathology-internalderangements.Attention will be directedto the function of discal apparatus and how to restore this with the use of arthroscopic procedures. An overall review of the availabletechniqueswill be discussedincluding the authors’ experienceusing disc suturingfor stabilizationand repositioning.Techniques will be presenteddemonstratingthe arthroscopicoperative proceduresand their results.The useof KTP laser asan arthroscopicsurgicaltool will alsobe explained. Results of approximately300 arthroscopicsurgeries havebeen followed for treatment of internal derangements.This diagnosiswill be divided into three groups; reducing discs, nonreducing discs and perforations. Arthroscopicmodalities will be categorizedas follows: 1) suturing techniques,2) nonsuturingdisc repositioning, and3) lysisand lavage(increasingdiscmobility with recapture)and 4) aggressivetreatmentof perforations. The overallresultswill be evaluatedboth preoperatively andpostoperativelyreviewinga varietyof factorsincluding subjectiveandobjectiveparameters. This presentationwill attempt to establishthe useof arthroscopicsurgicalsuturingas a viable alternativeto openjoint surgerywith a significantincreasein success ratesand decreasein untowardeffects. The final segmentwill addressthe inter-relationship of arthroscopicsurgeryandopenjoint surgeriesandhow eachfield may effectivelychangethe proceduresbeing performed.The ultimate ability to perform open joint proceduresthroughan arthroscopeaswell as the useof an arthroscopein conjunction with open procedures may be a cornerstonein the surgicaltreatment of TMJ problems. References Parisien, Arthroscopic Surgery, McGraw-Hill Johnson, L., Arthroscopic Surgery, Volumes I& II, Mosby DeBont, L., Temporomandibular Joint Articular Cartilage Structure & Function, PhD Thesis Department of Oral & Maxillofacial Surgery, Netherlands. Oral & Maxillofacial Surgery Clinics of North America, Volume 1.1, September, 1989.
MOMS
.
1991