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Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian   dental academy
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Tmj surgical anatomy and approaches (nx power lite) /certified fixed orthodontic courses by Indian dental academy

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  • 1. Temporomandibular Joint -Surgical Anatomy and Approaches INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. TEMPOROMANDIBULAR JOINT Unique features • • Covered with fibrocartilage • • Simultaneous movements Presence of teeth Bicondylar, ginglymoarthroidal, compound, complex, secondary, synovial joint. www.indiandentalacademy.com
  • 3. Evolution Agnatha Gnathostomes Osteichthyes Amphibians www.indiandentalacademy.com
  • 4. Reptiles Mammals Mammals like reptiles www.indiandentalacademy.com
  • 5. Prenatal development www.indiandentalacademy.com
  • 6. Post natal development Condyle  Mediolateral width • 9.6mm at birth • 12.4mm at deciduous point • 15mm in permanent dentition  Anteroposterior • Faster than mediolateral growth • 6.5mm - from eruption to completion of deciduous teeth. • 7.3mm - adult size www.indiandentalacademy.com
  • 7. Glenoid fossa  3 times more deeper in adult than infant.  Cartilage slowly replaced by fibrous tissue with age. Articular eminence :  Rudimentary at birth  Growth increases after eruption of permanent incisors www.indiandentalacademy.com
  • 8. Age changes in Mandible www.indiandentalacademy.com
  • 9. ANATOMY & BIOMECHANICS OF THE TEMPOROMANDIBULAR JOINT www.indiandentalacademy.com
  • 10. TMJ BONY COMPONENTS SOFT-TISSUE COMPONENTS 1. Articular disk 2. Joint capsule 3. Ligaments 1. Glenoid fossa 2. Condylar head 3. Articular eminence  MUSCLES 1. Muscles of mastication 2. Muscles attached to the joint 3. Muscles of facial expression 4. Muscles of the neck www.indiandentalacademy.com
  • 11. BONY COMPONENTS www.indiandentalacademy.com
  • 12. CONDYLAR HEAD  Oval – mediolaterally – ‘Rugby ball’  15-20 mm long (M-L); 8-10 mm wide (A-P); 8-120 mm thick  Medial pole > lateral pole  Posterior surface > anterior surface  Articulating surface – Fibrous tissue  140o with line connecting EAM on both sides  Axes – meet anterior to foramen magnum www.indiandentalacademy.com
  • 13. ARTICULAR EMINENCE • Sigmoid shape, Anterior & posterior slopes • Saddle – shaped in coronal section – concave mediolaterally – path of condyle • With disc, guides mandibular movement during jaw opening • Has 3 layers − Fibrocartilagenous layer (gradually diminishes with age but persists) − Undifferentiated connective tissue − Fibrous connective tissue www.indiandentalacademy.com
  • 14. JOINT CAPSULE / CAPSULAR LIGAMENT  Fibrous, non-elastic membrane surrounding the TMJ Functions:  Seals joint space  Provides passive stability  Active stability - proprioceptive nerve-endings in capsule www.indiandentalacademy.com
  • 15. Articular Disc www.indiandentalacademy.com
  • 16. Attachments of articular disk – 1. Anteriorly – Joint capsule, Lateral pterygoid muscle fibres – ‘Sphenomeniscus’ fibres - stabilize disk during mastication & deglutition 2. Posteriorly disc attached Retrodiscal tissue www.indiandentalacademy.com
  • 17. Discal ligaments www.indiandentalacademy.com
  • 18. Retrodiscal tissue  loose connective tissue  Between bilaminar zone of disc  SRL – Meniscotemporal frenum  IRL – Meniscomandibular frenum  Rich blood supply & nerve supply, Compressible www.indiandentalacademy.com
  • 19. SYNOVIAL MEMBRANE  Lines inner surface of capsule – villi  Functions: 1. Medium for metabolic exchange to avascular articulating surfaces 2. Lubricant – minimizes friction www.indiandentalacademy.com
  • 20.  Lubrication by 2 mechanisms – 1. BOUNDARY LUBRICATION - primary mechanism - moving joint - synovial fluid forced from one area of cavity to another 2. WEEPING LUBRICATION: - Compressed but not moving joint - synovial fluid forced in & out of articular surfaces by compression - prolonged loading will exhaust fluid - mechanism of www.indiandentalacademy.com metabolic exchange
  • 21. LIGAMENTS  Non-elastic collagenous structures - restricts and limits movements a joint  Maintains – joint spaces, without causing tissue damage  True ligaments: 1. COLLATERAL / DISCAL LIGAMENTS 2. CAPSULAR LIGAMENT 3. TEMPOROMANDIBULAR / LATERAL LIGAMENT  Accessory ligaments: 1. SPHENOMANDIBULAR LIGAMENT www.indiandentalacademy.com 2. STYLOMANDIBULAR LIGAMENT
  • 22. COLLATERAL / DISCAL LIGAMENT Functions: 1. Restricts movement of disc away from condyle 2. Hinge movement between condyle & disc 3. Disc moves passively with condyle www.indiandentalacademy.com
  • 23. TEMPOROMANDIBULAR / LATERAL LIGAMENT  FUNCTIONAL LIGAMENT  Fan-shaped reinforcement of lateral wall of capsule  2 parts 1. Outer oblique – outer surface of condylar neck resists excessive dropping of condyle limits extent of mouth opening www.indiandentalacademy.com
  • 24.  Horizontal part – lateral pole of condyle & lateral margin of disk • • • limits posterior movement of condyle & disc protects RDT from trauma protects lateral pterygoid from over lengthening or extension Functions:  Prevents lateral (same side) & medial (contralateral) dislocation www.indiandentalacademy.com
  • 25. Accessory Ligaments  Sphenomandibular L igament – no role • Remnants of Meckel’ s cartilage • Important landmark during surgery  Stylomandibular L igament – limits excessive protrusive movements  Retinacular ligament www.indiandentalacademy.com
  • 26. MUSCLES INVOLVED IN JAW-MOVEMENTS www.indiandentalacademy.com
  • 27. Classification: 1. Jaw-closing group – 1. Temporalis 2. Masseter 3. Medial pterygoid 2. Jaw-opening group – 1. Lateral Pterygoid 2. Suprahyoid muscles 3. Infrahyoid muscles www.indiandentalacademy.com
  • 28.  TEMPORALIS  Three parts • Anterior part – almost vertical – elevation • Middle part – oblique – elevate & retrude • Posterior portion – almost horizontal - retrusion & joint loading shared with pterygo massetric sling www.indiandentalacademy.com
  • 29.  MASSETER • Origin  superficial – • Ant 2/3rd of zygomatic arch  Middle layer• ant 2/3rd of deep surface and post 1/3rd of lower border of Z arch  Deep layer• Deep surface of Z arch • Insertion  Angle of mandible and ramus  Lower part of lat surface of ramus  Middle & deep fibers – middle and upper part of ramus www.indiandentalacademy.com
  • 30. MEDIAL PTERYGOID: OriginSuferficial – tuberosity of maxilla and adjoining bone deep – medial surface of lat pterygoid plate Insertion roughened medial surface of angle of mandible Functions Elevation  Protrusion  Unilateral – Mediotrusive  With masseter – muscular sling to support angle of mandible www.indiandentalacademy.com
  • 31.  LATERAL PTERYGOID:  Origin• Upper head- Crest of greater wing of sphenoid. • Lower head- lat surface of lateral pterygoid plate.  Insertion• Pterygoid fovea • Ant margin of articular disc & capsule www.indiandentalacademy.com
  • 32. SUPRAHYOID MUSCLES: Digastrics Mylohyoid  Stylohyoid FUNCTIONS Jaw opening & swallowing  Pull mandible downward & hyoid backward www.indiandentalacademy.com
  • 33. BIOMECHANICS OF TMJ www.indiandentalacademy.com
  • 34. At Rest  Occlusion - physiological rest position  Tonus of elevators – maintain constant contact  Intra articular pressure www.indiandentalacademy.com
  • 35. 1. INFERIOR JOINT CAVITY    Tightly bound – discal ligaments Condyle + disc Rotational / Hinge 2. SUPERIOR JOINT CAVITY  Disc not tightly attached to fossa  Translatory / sliding movements www.indiandentalacademy.com
  • 36. Jaw Movements www.indiandentalacademy.com
  • 37. www.indiandentalacademy.com
  • 38. TMJ Relations Superficial relations  Skin, superficial fascia and branches of the facial nerve  Auriculo-temporal nerve  Superficial temporal artery  Glenoid lobe of the parotid gland Superior relations  Temporal lobe of brain  Tympanic cavity  Chorda tympani and anterior ligament to malleus www.indiandentalacademy.com
  • 39. Inferior relations  Parotid gland  Lower head of the lateral pterygoid.  Venous channels.  Branches from the pterygoid venous plexus Anterior relations  The lateral pterygoid.  The masseteric and deep temporal nerves www.indiandentalacademy.com
  • 40. Posterior relations  Auriculo-temporal nerve  Superficial temporal artery.  Parotid gland  Styloid process Medial relations  squamo-tympanic fissure, chorda tympani nerve  spine of the sphenoid, sphenomandibular ligament.  middle meningeal artery, carotid sheath.  auriculo-temporal nerve, mandibular nerve.  middle, inner ear, auditor tube. www.indiandentalacademy.com
  • 41. Distances of important structures medial to TMJ. Structures from zygomatic arch Mean mediolateral Mean anteroposte rior Middle meningeal artery 31mm 2.4mm Carotid artery 37mm -6.5mm Internal jugular vein 38.3mm -8.7mm Mandibular nerve (from GF) 18.7mm 9.2mm Nojan et al [OOO 1999; 88: 674-8]. www.indiandentalacademy.com
  • 42. IMPORTANT STRUCTURES Auriculotemporal nerve  Runs from deep to superficial layers as it reaches preauricular region.  Inevitable damage – preauricular approach. Superficial temporal artery  Deep to parotid.  Posterior to neck of condyle and crosses zygomatic process  Runs in superficial fascia www.indiandentalacademy.com
  • 43. Maxillary artery  Beneath – condylar neck.  Immediate posteromedial relation.  Subperiosteal guard.  Endangered in condylotomy and resection of bony ankylosis. www.indiandentalacademy.com
  • 44. Facial nerve www.indiandentalacademy.com
  • 45. www.indiandentalacademy.com
  • 46. Mandibular and cervical branch www.indiandentalacademy.com
  • 47. Approaches   Many approaches have been proposed. Can be grouped as follows • • • • • • • • Pre-auricular Endaural Post auricular Submandibular Intra-oral Closed condylotomy Rhytidectomy incision Horizontal incision along the lower border of the malar arch • Through soft tissue lacerations or scars. www.indiandentalacademy.com
  • 48.  Ideal approach characteristics. • Be based on sound anatomical principles. Have clear anatomical landmarks. • Be designed to give protection to both the facial and the auriculo-temporal nerves, and to the external auditory canal. • Provide a relatively bloodless field. • Provide excellent visibility of the lesional site without flap tension. • Be rapidly and confidently executed. • Be uncomplicated in its repair. • Give a good cosmetic result with minimal functional sequelae. www.indiandentalacademy.com
  • 49. www.indiandentalacademy.com
  • 50. Pre-auricular  Started by Risdon in 1934 www.indiandentalacademy.com
  • 51. www.indiandentalacademy.com
  • 52. •Popularized by Blair (1936) – inverted L shape. •Dingman used Blairs modification - obtuse angulated vertical incision. Vertical component – anterior to tragus. Superior leg – obliquely anterior to pinna. www.indiandentalacademy.com
  • 53.  1979 extensive study by Alkayat and Bramley – the first modified preauricular incision www.indiandentalacademy.com
  • 54. www.indiandentalacademy.com
  • 55. Indications  When maximum exposure is required.  When lateral and anterior exposure is desired. Advantage:  There is minimal bleeding and less sensory loss. • Spares the main branches of vessels and nerves.  Fascial planes are easily identified.  There is excellent visibility.  The potential complications of muscle herniation and fibrosis are avoided. • The muscle is never exposed. www.indiandentalacademy.com
  • 56. Disadvantages:  Scarring present.  Threat of damage to facial nerve branches.  Sensory loss over post-auricular skin.  Frey syndrome.  Damage to superficial temporal artery. www.indiandentalacademy.com
  • 57. Endaural approach     Introduced by Shanbaugh – middle ear surgeries. Lemperts – use for TMJ. Different from Dingman that it involved external auditory meatus to a greater depth. Davidson modification – superior preauricular component. www.indiandentalacademy.com
  • 58. Surgical approach I-part  • Anterior endaural incision in superior meatal wall (depth-bony cartilagenous junction). • Then outward incision for 3-5mm at conchal cartilage. II-part  • Extends from superior extent endaural incision directly upwards to a point about halfway between meatus and upper edge of the auricle. III-part  • Continuous superiorly in the inter cartilagenous cleft and becomes the facial www.indiandentalacademy.com
  • 59. Indications:  When lateral and posterior exposure is required.  To avoid scarring. Advantages:  Excellent lateral and posterior exposure.  Scar exposure is less. Disadvantage:  Limited anterior visibility.  Demands greater skills.  Tragal cartilage degeneration. www.indiandentalacademy.com
  • 60. Post-auricular approach  Introduced by Bockenheimer (1920)  Modified by Axhausen. www.indiandentalacademy.com
  • 61. www.indiandentalacademy.com
  • 62. Indications:  When lateral and posterior exposure is required.  Normal scar formation in the patient's history.  Healthy ear apparatus and absence of aural sepsis.  Normal width of the external auditory canal.  Absence of infection or inflammation of the joint structures.  General health of the patient does not restrict length of operating period. www.indiandentalacademy.com
  • 63. Advantages:  Excellent accessibility especially posterior and lateral.  Reduction in facial nerve damage.  No excessive bleeding. Disadvantages:  Limited anterior accessibility.  Perforation of cartilaginous external auditory meatus.  External auditory canal stenosis.  Infections. www.indiandentalacademy.com
  • 64. Risdon’s approach (Submandibular)  Incision about finger breadth below angle of mandible parallel to lower border.  Lies between cervical branches of facial nerve, lower boundary of bony EAM at least 3cm inferior. www.indiandentalacademy.com
  • 65. www.indiandentalacademy.com
  • 66. Indications  Usually for subcondylar procedure  Severe bony ankylosis  Direct condylar fracture fixation  Costochondral grafting Advantages:  Less chances of facial nerve damage Disadvantages:  Inadequate accessibility  Increased reflection and traction of tissue  Temporary parasthesia may be present www.indiandentalacademy.com
  • 67. Retromandibular approach  Developed by E.C. Hinds and W.J. Girotin (1967) www.indiandentalacademy.com
  • 68. www.indiandentalacademy.com
  • 69. Indications  For condylar neck fractures  Condylotomy  Vertical ramus osteotomies Advantages:  Less chances of damage to facial nerve Disadvantages:  Reduced accessibility  Parasthesia of facial nerve  Damage to retromandibular vessels www.indiandentalacademy.com
  • 70. Rhitidectomy approach  A variant of retromandibular approach. www.indiandentalacademy.com
  • 71. Indications  Esthetic is a concerned and extensive exposure is required. Advantages  Less conspicuous facial carve  Good exposure Disadvantage  Added time required www.indiandentalacademy.com
  • 72. Bicoronal flap  Incision following hair line about 4cm behind it.  Depth – till subgleal loose tissue  Inferior extent – continue as preauricular  Blunt dissection to reflect the flap till 2cm above the infraorbital rim and superior temporal line.  Pericranium is incised about 3-4cm superior to orbital rim,  Incision of Alkayat and Bramley www.indiandentalacademy.com continued
  • 73. www.indiandentalacademy.com
  • 74. Indication  Bilateral exposure  Extensive exposure required Advantages  Good exposure  Easy to get the facial phase  Reduced risk of damage to facial nerve branches  Hidden scar Disadvantages  Bleeding in initial phase  Extensive dissection required  Not esthetic in completely bald patients www.indiandentalacademy.com
  • 75. Intra-oral approach  Vertical incision in the retromolar region along the ascending ramus.  Expose the entire medial surface of the ramus protecting the lingual nerve and inferior dental bundle with a retractor.  The condylar notch is visualize.  Elevation of temporal attachment might be necessary.  Winstanely’s used a long, vertical incision from the tip of the coronoid process to the depth of the buccal sulcus.  Sear….. advocates lateral and medial exposure for condylectomy. www.indiandentalacademy.com
  • 76. Indications  Oblique subcondylar osteotomy  Open condylotomy (asymmetry) Advantages  No risk to facial and auricular temporal nerves  No scar Disadvantages  Limited accessibility  Risk of damage to lingual nerve, Inferior alveolar bundle and maxillary artery. www.indiandentalacademy.com
  • 77. Arthroscopic approach   Arthroscopy of human TMJ was first described Ohnishi (1975). 3 primary approaches • • •  Lateral posterior (most safe) Lateral anterior Endaural Landmarks • Condyle, zygomatic arch, superficial temporal artery and posterior aspect of mandible. www.indiandentalacademy.com
  • 78.  2 points are marked on tragocanthal line • 10mm and 15mm anterior to tragus  18 or 19 gauge needle is passed in the upper joint cavity from point A through posterior approach inclining 30° anterior and superior direction.  For the inferior joint cavity needle and cannula are passed at the same point and directed inferiorly and posteriorly at 45° rather than anteroinferiorly www.indiandentalacademy.com
  • 79. Indications  Joint arthritis  For diagnostic purpose  Hyperextensibility Advantages  Closed procedure  No scar Disadvantages  Risk of damage to the encountering structures  Massive bleeding  AV fistula formation  Intracranial entry www.indiandentalacademy.com
  • 80. Conclusion www.indiandentalacademy.com
  • 81. References www.indiandentalacademy.com
  • 82. Thank you… www.indiandentalacademy.com

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