This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
DEFINITION, ANATOMY, AND FUNCTIONS OF TEMPOROMANDIBULAR JOINT.
Joint between the head (condyle) of the mandible and the undersurface (articular fossa)of the squamous part of the temporal bone is the temporomandibular joint.
Type of joint : synovial joint (condylar variety).
Capable of providing-hinging (rotation) -gliding (translation) movement.
Sustains incredible forces of mastication.
articulating surfaces-articualar tubercle, mandibular fossa.
functions-Chewing
Sucking
Swallowing
Phonation
Facial expressions
Breathing Protrusion,
Retrusion,
Lateralization of the jaw
Opening the mouth
Maintain the correct pressure of the middle ear
Blood supply- Branches from superficial temporal and maxillary artery.
Veins follow the arteries.
Nerve supply-Auriculotemporal nerve (branch of mandibular nerve) and masseteric nerve (motar branch of anterior division of mandibular nerve).
movemnets of tmj- protraction, retraction, elevation, depression, side to side grinding.
examination of tmj- preauricular method and intraauricular method.
Temporomandibular joint is the most complex and unique joint of the body and to understand its surgical anatomy is very important in the surgical management of its disorders .
Temporomandibular joint anatomy and its prosthodontic implicationsFALAKNAZ121
Temporomandibular joint described in detail along with prosthodontic implications under the headings INTRODUCTION
DEFINITION
PECULIARITY OF TMJ
DEVELOPMENT
ANATOMIC COMPONENTS
VASCULAR SUPPLY
INNERVATIONS
MOVEMEN
BIOMECHANICS
PROSTHODONTIC IMPLICATIONS
REFERENCES
Similar to Tmj surgical anatomy and approaches (20)
An overview of Trismus which is also called as Lock Jaw. Trismus is a symptom in various condition. In this seminar i will be discussing about the various condition and diagnostic modalities and management
an overall overview in corticosteroids and its application in oral and maxillofacial diagnostic medicine and pathology drawing to the conclusions of the limitations and drawbacks of these medicines. i have also included the precautions to be taken in dental therapeutic procedures fo
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
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Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
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2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Tmj surgical anatomy and approaches
1.
2. DEVELOPMENT, ANATOMY & SURGICAL
ANATOMY
BY : JOEL D’SILVA
PG STUDENT
DEPARTMENT OF ORAL & MAXILLOIFACIAL SURGERY
3. The most important functions of the
temporomandibular joint (TMJ) are mastication
and speech and are of great interest to dentists,
oral surgeons, orthodontists, clinicians, and
radiologists.
The TMJ is a ginglymoarthrodial joint, a term
that is derived from ginglymus, meaning a hinge
joint, allowing motion only backward and
forward in one plane, and arthrodia, meaning a
joint of which permits a gliding motion of the
surfaces.
4. The right and left TMJ form a bicondylar
articulation and ellipsoid variety of the synovial
joints similar to knee articulation.
The common features of the synovial joints
exhibited by this joint include
a) Disk
b) Bone
c) Fibrous capsule
d) Fluid
e) Synovial membrane
f) Ligaments.
5. However, the features that differentiate
and make this joint unique are:
Its articular surface covered by
fibrocartilage instead of hyaline cartilage
6. Bilateral diarthrosis – right & left function
together
Articular surface covered by fibrocartilage
instead of hyaline cartilage
Only joint in human body to have a rigid
endpoint of closure that of the teeth
making occlusal contact.
7. In contrast to other diarthrodial joints
TMJ is last joint to start develop, in about
7th week in utero.
Develops from two distinct blastema
10. An ovoid process seated atop a
narrow mandibular neck. It’s the
articulating surface of the
mandible.
It is convex in all directions but
wider latero-medially (15 to 20
mm) than antero-posteriorly (8 to
10mm).
11. The medial pole is directed
more posteriorly.
Thus, if the long axes of two
condyles are extended
medially, they meet at
approximately the basion on
the anterior limit of the
foramen magnum, forming an
angle that opens toward the
front ranging from 145° to
160°
It has a medial and lateral pole
12. The lateral pole of the condyle is
rough, bluntly pointed, and
projects only moderately from the
plane of ramus, while the medial
pole extends sharply inward from
this plane.
The articular surface lies on its
anterosuperior aspect, thus facing
the posterior slope of the articular
eminence of the temporal bone.
13.
14. The articular surface of the temporal
bone is situated on the inferior aspect of
temporal squama anterior to tympanic
plate.
15. ARTICULAR
EMINENCE
• This is the entire transverse bony
bar that forms the anterior root of
zygoma. This articular surface is
most heavily traveled by the condyle
and disk as they ride forward and
backward in normal jaw function.
ARTICULAR
TUBERCLE
• This is a small, raised, rough, bony
knob on the outer end of the
articular eminence.
• It projects below the level of the
articular surface and serves to attach
the lateral collateral ligament of the
joint.
16. PREGLENOID
PLANE
• This is the slightly hollowed,
almost horizontal, articular
surface continuing
anteriorly from the height of
the articular eminence
19. The articular disc is the most
important anatomic structure of the
TMJ.
It is a biconcave fibro cartilaginous
structure located between the
mandibular condyle and the
temporal bone component of the
joint.
Its functions to accommodate a
hinging action as well as the gliding
actions between the temporal and
mandibular articular bone
20. The articular disc is a roughly oval, firm, fibrous
plate.
1. anterior band = 2 mm in thickness,
2. posterior band = 3 mm thick,
3. thin in the center intermediate band of 1 mm
thickness.
More posteriorly there is a bilaminar or retrodiscal
region.
21. It is shaped like a peaked cap that divides
the joint into a larger upper compartment
and a smaller lower compartment.
22. Hinging movements take place in the
lower compartment and gliding
movements take place in the upper
compartment.
The superior surface of the disc -
saddle-shaped
to fit into the cranial
contour,
The inferior surface - concave
to fit against the mandibular
condyle.
23. The disc is attached all around the joint capsule
except for the strong straps that fix the disc directly
to the medial and lateral condylar poles, which
ensure that the disc and condyle move together in
protraction and retraction.
24. The anterior extension of the disc is attached
to a fibrous capsule superiorly and inferiorly.
In between it gives insertion to the lateral
pterygoid muscle where the fibrous capsule is
lacking and the synovial membrane is
supported only by loose areolar tissue.
25. The anterior and posterior bands have
predominantly transversal running fibers,
while the thin intermediate zone has
anteroposteriorly oriented fibers.
Posteriorly, the bilaminar region consists of
two layers of fibers separated by loose
connective tissue.
26. The upper layer or temporal lamina is composed of elastin
and is attached to the postglenoid process, medially
extended ridge, which is the true posterior boundary of
the joint. It prevents slipping of the disc while yawning.
The inferior layer of the fibers or inferior lamina curve
down behind the condyle to fuse with the capsule and
back of the condylar neck at the lowest limit of the joint
space. It prevents excessive rotation of the disc over the
condyle.
27. In between the two layers, an expansile, soft pad of
blood vessels and nerves are sandwiched and
wrapped in elastic fibers that aid in contracting
vessels and retracting disc in recoil of closing
movements
The volume of retrodiscal tissue must increase
instantaneously when the condyle translates
anteriorly.
28.
29. Thin sleeve of tissue completely surrounding the joint.
Extends from the circumference of the cranial articular
surface to the neck of the mandible.
30. anterolaterally to the articular tubercle,
laterally to the lateral rim of the mandibular
fossa,
posterolaterally to the postglenoid process,
posteriorly to the posterior articular ridge,
medially to the medial margin of the temporal
fossa,
anteriorly it is attached to the preglenoid plane
31. MANDIBULAR NECK -
Laterally- the lateral condylar pole but
Medially - dips below the medial pole.
On the lateral part of the joint, the capsule is a
well-defined structure that functionally limits the
forward translation of the condyle.
32. This capsule is reinforced more laterally by an
external TMJ ligament, which also limits the
distraction and the posterior movement of the
condyle.
Medially and laterally- blends with the
condylodiscal ligaments.
33.
34. Anteriorly, the capsule has an
orifice through which the lateral
pterygoid tendon passes. This area
of relative weakness in the
capsular lining becomes a source
of possible herniation of intra-
articular tissues, and this, in part,
may allow forward displacement of
the disk.
35. The synovial membrane lining the capsule covers
all the intra-articular surfaces except the pressure-
bearing fibrocartilage.
There are four capsular or synovial sulci situated
at the posterior and anterior ends of the upper and
lower compartments.
These sulci change shape during translatory
movements, which requires the synovial
membrane to be flexible.
36.
37. The ligament on each side of the jaw is designed
in two distinct layers.
The wide outer or superficial layer is usually fan-
shaped and arises from the outer surface of the
articular tubercle and most of the posterior part
of the zygomatic arch.
There is often a roughened, raised bony ridge of
attachment on this area.
38.
39. The ligamentous fascicles run obliquely downward and
backward to be inserted on the back, behind, and below
the mandibular neck.
Immediately medial to this layer, a narrow ligamentous
band arises from the crest of the articular tubercle
continuously, with attachment of the outer portion at
this site.
This narrow inner or deep band runs horizontally back
as a flap strap to the lateral pole of the condyle.
An upper part of this band continues on to attach to the
back of the disk, lateral to the condylar pole.
40.
41. Arises from the angular
spine of the sphenoid and
petrotympanic fissure.
Runs downward and
outward.
Insert on the lingula of the
mandible.
42. 1. Laterally - lateral pterygoidmuscle.
2. posteriorly - auriculotemporal nerve.
3. anteriorly - maxillary artery.
4. Inferiorly - the inferior alveolar nerve and
vessels a lobule of the parotid gland.
5. Medially - medial pterygoid with the chorda
tympani nerve and the wall of the pharynx
with fat and the pharyngeal veins intervening.
43.
44. The ligament is pierced by the
myelohyoid nerve and vessels.
This ligament is passive during
jaw movements, maintaining
relatively the same degree of
tension during both opening
and closing of the mouth.
45. This is a specialized dense, local concentration of
deep cervical fascia extending from the apex and
being adjacent to the anterior aspect of the
styloid process and the stylohyoid ligament to the
mandible’s angle and posterior border.
46. This ligament then extends forward as a broad
fascial layer covering the inner surface of the
medial pterygoid muscle.
The anterior edge of the ligament is thickened
and sharply defined.
47.
48. It is lax when the jaws are closed and slackens
noticeably when the mouth is opened because
the angle of the mandible swings up and back
while the condyle slides downward and forward.
This ligament becomes tense only in extreme
protrusive movements. Thus, it can be
considered only as an accessory ligament of
uncertain function.
49. The synovial fluid comes from two sources: first,
from plasma by dialysis, and second, by secretion
from type A and B synoviocytes with a volume of
not more than 0.05 ml.
However, contrast radiography studies have
estimated that the upper compartment could
hold approximately 1.2 ml of fluid without undue
pressure being created, while the lower has a
capacity of approximately 0.5 ml.
50. It is clear, straw-colored viscous fluid.
It diffuses out from the rich cappillary network of
the synovial membrane.
Contains:
Hyaluronic acid which is highly viscous
May also contain some free cells mostly
macrophages.
51. Functions:
Lubricant for articulating surfaces.
Carry nutrients to the avascular tissue of the
joint.
Clear the tissue debris caused by normal wear
and tear of the articulating surfaces.
52. The way the teeth fit together may affect the TMJ
complex.
A stable occlusion with good tooth contact and
interdigitation provides maximum support to the
muscles and joint, while poor occlusion (bite
relationship) may cause the muscles to
malfunction and ultimately cause damage to the
joint itself.
Instability of the occlusion can increase the
pressure on the joint, causing damage and
degeneration.
59. A careful dissection of 16 intact human cadaveric
head specimens revealed The location of the
masseteric artery was then determined in relation
to 3 points process:
1) the anterior-superior aspect of the condylar
neck = 10.3 mm;
2) the most inferior aspect of the articular tubercle
= 11.4 mm;
3) the inferior aspect of the sigmoid notch = 3 mm.
Journal of Oral and Maxillofacial Surgery. 2009;67 (2) : 369–371
66. Rotational / hinge movement in first 20-25mm of
mouth opening
Translational movement after that when the
mouth is excessively opened.
67. Translatory movement – in the superior part of
the joint as the disc and the condyle traverse
anteriorly along the inclines of the anterior
tubercle to provide an anterior and inferior
movement of the mandible.
68. Hinge movement – the inferior portion of the
joint between the head of the condyle and the
lower surface of the disc to permit opening of
the mandible.
73. Mainly 4 forms are
seen-
1. Convex-58%
2. Flat- 25%
3. Pointed-12%
4. Round- 3%
( mainly in children)
74. A. Early development:
Develops relatively late compared to large joints of
extremities.
At 7th prenatal week jaw joint lacks condylar
growth cartilage joint cavities, synovial tissue &
articular capsule.
75. B. Condylar cartilage development
Between 8-12 wk of I.U life cartilagenous condyles
develop anteriorly to malleus incus articulation.
Then altered by endochondral bone formation & fuses
to posterior part of bony body of mandible.
By 12th wk condyle consists of large mass of hyaline
cartilage covered by a fibrous cap.
76. C . Articular disc formation;
In 12th wk first appearance of TMJ cavity is seen
& first of 2 compartments inferior or
mandibular compartment is formed.
A split appear in synovial mesenchyme &
temporal or superior compartment is formed in
next wk.
Presence of both sup & inf compartment
develops articular disc.
77. D . Fate of meckle’s cartilage;
As mandible enlarges remnants of meckles
cartilage becomes relatively smaller.
At 18-20 i.u life it loses its function &
disappears.
78. Occurs in 14th I.U life .
Condyle grows by both interstitial & appositional
growth of condylar cartilage.
Formation of temporal fossa starts with
development of heavy spicule of temporal bone
superior to forming articular disc.
Articular disc takes its characteristic shape &
blends into articular capsule at 26th wk.
79. At 18-20 prenatal wk TMJ starts functioning.
The condylar bone increases in size & density ,
& mandible undergoes changes in shape & size
associated with differentiation & functioning of
muscles of mastication.
80. Growth continues in 2nd decade of postnatal life
a. Temporal fossa deepens as bone forms laterally &
articular tubercle enlarges.
b. Dense fibrous nature of disc & capsule becomes
apparent.
c. condyles continue endochondral like growth .
Perichondral covering of condyle consists of 2 layers.
-portion lying next to cartilage which is highly
cellular &
-outer layer which is fibrous.
83. Blair & Ivy (1936) –
“Inverted hockey stick “
incision.
Facilities exposure of
arch along with condylar
area.
84. Thoma in 1958
Angulated vertical
incision.
-carried out across
zygomatic arch infront of
ear to avoid main trunk
of facial nerve.
85. 1979.
Modified preauricular
approach.
Facial nerve divides in front of
auditory canal as near as 0.8cm
& as far as 3.5cm
Protection achieved by making
incision through temporal
fascia& periosteum down to
arch not more than 0.8cm.
86. Hoops et al (1970),
Alexander and James (1975)
Highly cosmetic incision
Disadvantage- poor access &
visibility,the risk of external
auditory meatus stenosis,
infection & deformity of the
auricle.
87. Lempart (1938)
Short facial skin incision
extending in to ext. auditory
meatus
Excellent cosmetics
Disadvantage-
Meatal stenosis or
chondritis, injury to the
branches of the facial nerve
88. Indication – surgeries of
condylar neck & ramus area.
Incision- 1cm behind ramus
of mand. and extends 1cm
below the lobe of ear.
Highly cosmetic, excellent
visibility and accessibility.
Injury may occur to posterior
facial vein and main trunk of
facial nerve.
89. Risdon (1934)
Mainly used for neck of
condyle & ramus region.
supplement to different
tmj approaches for
tunneling through the soft
tissues to place a graft
90. Hemicoronal (unilateral) or bicoronal (bilateral)
approach is used.
More extensive but versatile approach for upper
& middle regions of facial skeleton, zygomatic
arch & TMJ.
Advantage- scar is hidden in the hairline.
91.
92. GREY`S ANATOMY (38TH EDITION)
SICHER & DUBRUL`S ORAL ANATOMY (8TH
EDITION)
ANATOMY OF HEAD & NECK BY B.D CHAURSIA
TEXTOOK OF ORAL & MAXILLOFACIAL SURGERY
BY NEELIMA MALIK.
TEXTBOOK OF TMJ DISORDERS BY EDWARD F.
WRIGHT.
TEXTBOOK OF TMJ DISORDERS BY KAPLAN &
ASSAEL