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1. Overview of TMJ SurgeryOverview of TMJ Surgery
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

2. TMJ SURGERYTMJ SURGERY
IntroductionIntroduction
TMJ Surgery has a small butTMJ Surgery has a small but
important role in the managementimportant role in the management
of Temporomandibular Disorders.of Temporomandibular Disorders.

3. TMJ SurgeryTMJ Surgery
IncidenceIncidence
Only 1 in 20 patients (5%)Only 1 in 20 patients (5%)
treated for TMD aretreated for TMD are
suitable for surgery.suitable for surgery.

4. TMJ SurgeryTMJ Surgery
Applied AnatomyApplied Anatomy
• MeniscusMeniscus
– Anterior &Anterior &
PosteriorPosterior
bandsbands
– Dense fibrousDense fibrous
diskdisk
– Insert SupInsert Sup
head Lat Pthead Lat Pt
MuscleMuscle

5. TMJ SurgeryTMJ Surgery
Applied AnatomyApplied Anatomy

6. TMJ SurgeryTMJ Surgery
Applied AnatomyApplied Anatomy
• NervesNerves
– MotorMotor
– SensorySensory
• VesselsVessels
– ArteriesArteries
– VeinsVeins

7. Temporomandibular DisordersTemporomandibular Disorders
(TMD)(TMD)
• CommonCommon
– Myofascial Pain & Dysfunction (MPD)Myofascial Pain & Dysfunction (MPD)
– Internal Derangement (ID)Internal Derangement (ID)
– Osteoarthrosis (OA)Osteoarthrosis (OA)
• UncommonUncommon
– Dislocation, ankylosis, tumour, trauma,Dislocation, ankylosis, tumour, trauma,
inflammatory arthritis, infectioninflammatory arthritis, infection

8. Uncommon TMJ DisordersUncommon TMJ Disorders
Surgery is the primeSurgery is the prime
treatment modalitytreatment modality

9. Uncommon TMJ DisordersUncommon TMJ Disorders
TMJ ankylosisTMJ ankylosis

10. Uncommon TMJ DisordersUncommon TMJ Disorders
TMJ TumoursTMJ Tumours

11. Common TMJ DisordersCommon TMJ Disorders
The role of Surgery isThe role of Surgery is
less clearly definedless clearly defined

12. Myofascial Pain & DysfunctionMyofascial Pain & Dysfunction
MPDMPD
• Primarily a muscle disorderPrimarily a muscle disorder
• Diffuse, intermittant painDiffuse, intermittant pain
• History of clenching/bruxismHistory of clenching/bruxism
• Sleep disturbanceSleep disturbance
• SURGERY HASSURGERY HAS NONO ROLEROLE

13. Common TMJ DisordersCommon TMJ Disorders
TMJ TraumaTMJ Trauma

14. Internal Derangement IDInternal Derangement ID
• Disk displacementDisk displacement

15. Internal Derangement IDInternal Derangement ID
• Disk displacementDisk displacement
• Interference withInterference with
joint functionjoint function
• Clicking, locking, MdClicking, locking, Md
deviationdeviation
• Pain well localised toPain well localised to
TMJTMJ

16. Osteoarthrosis OAOsteoarthrosis OA
• DegenerativeDegenerative
disease of condylardisease of condylar
headhead
• TMJ stiffness &TMJ stiffness &
crepituscrepitus
• Not always painfulNot always painful
• Often IdiopathicOften Idiopathic
(primary)(primary)

17. Muscle vs JointMuscle vs Joint
Diffuse vs localised symptomsDiffuse vs localised symptoms

18. Treatment AimsTreatment Aims
1. Alleviate Pain1. Alleviate Pain
2. Improve Jaw Function2. Improve Jaw Function
3. Reduce adverse Joint3. Reduce adverse Joint
LoadingLoading

19. Treatment OptionsTreatment Options
1. Non-surgical - 95%1. Non-surgical - 95%
2. Surgical - 5%2. Surgical - 5%

20. Non-Surgical TreatmentNon-Surgical Treatment
1. Explanation & Reassurance1. Explanation & Reassurance
2. Patient education & Self-care2. Patient education & Self-care
3. Medication3. Medication
4. Occlusal Splint4. Occlusal Splint
5. Physiotherapy5. Physiotherapy
6. Behavioural Therapy6. Behavioural Therapy
7. Psychiatric Management7. Psychiatric Management

21. TMJ SurgeryTMJ Surgery
IndicationsIndications
1. Absolute -1. Absolute - for uncommon TMJ disorders ie. tumours,for uncommon TMJ disorders ie. tumours,
ankylosis, deformities.ankylosis, deformities.
2. Relative -2. Relative - for common TMJ disorders ie. ID & OA.for common TMJ disorders ie. ID & OA.
- General- General
- Specific- Specific

22. TMJ SurgeryTMJ Surgery
General IndicationsGeneral Indications
• Failure of non-
surgical therapy
• Localised
symptoms of
pain &
dysfunction
concentrated
within the TMJ

23. TMJ Surgical OptionsTMJ Surgical Options
• Minimally InvasiveMinimally Invasive (Closed Joint Procedures)(Closed Joint Procedures)
– ArthrocentesisArthrocentesis
– ArthroscopyArthroscopy
• ArthrotomyArthrotomy (Open Joint Procedures)(Open Joint Procedures)
– ArthroplastyArthroplasty
– Joint Reconstruction/ReplacementJoint Reconstruction/Replacement

24. TMJ Arthrocentesis & LavageTMJ Arthrocentesis & Lavage
• Acute Closed LockAcute Closed Lock

25. TMJ ArthroscopyTMJ Arthroscopy
• Minimally invasive surgeryMinimally invasive surgery

26. TMJ ArthroscopyTMJ Arthroscopy
• Chronic Closed LockChronic Closed Lock

27. TMJ ArthroscopyTMJ Arthroscopy
Diagnosis of intra-Diagnosis of intra-
joint pathologyjoint pathology
1. Synovitis1. Synovitis
2. Fibrillation2. Fibrillation
3. Adhesions3. Adhesions
4. Chondomalacia4. Chondomalacia

28. TMJ ArthroplastyTMJ Arthroplasty
• Disk Plication (repositioning)

29. TMJ ArthroplastyTMJ Arthroplasty
• Surgical Approach

30. TMJTMJ
Reconstruction/ReplacementReconstruction/Replacement
• TMJ MenisectomyTMJ Menisectomy

31. TMJTMJ
Reconstruction/ReplacementReconstruction/Replacement
• Rib GraftsRib Grafts

32. TMJTMJ
Reconstruction/ReplacementReconstruction/Replacement
• Artificial JointsArtificial Joints

33. TMJ SurgeryTMJ Surgery
Risks and Side EffectsRisks and Side Effects
• Bleeding
• Infection
• Wound breakdown
• Scarring
• Deafness
• Malocclusion
• Facial n weakness

34. TMJ SurgeryTMJ Surgery
Risks and Side EffectsRisks and Side Effects
• Facial n weakness

35. PROGNOSISPROGNOSIS
• Accurate diagnosisAccurate diagnosis
• Appropriate case selectionAppropriate case selection
• ClinicianClinician
– experience & patient rapportexperience & patient rapport
• PatientPatient
– compliance, understanding, expectationscompliance, understanding, expectations
• Multidisciplinary team approachMultidisciplinary team approach

36. Take Home Message #1Take Home Message #1
• TMJ surgery is controversial because few
clinicians understand joint pathology

37. Take Home Message #2Take Home Message #2
• Those who deny that surgery has a role to
play in TMJ disorders have little
appreciation of joint pathology

38. ConclusionConclusion
• All clinicians who treat TMD must be fully
conversant with the role of TMJ surgery,
otherwise there will be patients who will be
denied access to proper treatment