Category Archives: Management of Temporomandibular Disorders

Total Joint Replacement

Total Joint Replacement In some cases, joint” pathology results in destruction of  [oint structures so that reconstruction or replacement ofcomponents of the TMJ is necessary (Fig. 30-30, A). Examples of such situations include severe degenerative or rheumatoid arthritic disorders, severe cases of ankylosis, neoplastic pathology, posttraumatic destruction of joint components, and multiple failed surgical

Condylotomy for Treatment of Temporomandibular Joint Disorders

Condylotomy for Treatment of Temporomandibular Joint Disorders The condylotomy is an osteotomy completed in a manner identical to the vertical ramus osteotomy described in  Chapter 25. When used fot treatment of TMJ problemsthe osteotomyis completed, but 110 wireor screw fixation is placed, and the patient is placed into intermaxillary fixation for a period ranging from 2 to 6 weeks. The the ory behind this o

Disk Repair or Removal

Disk Repair or Removal In some ~ses the disk is so severely. damaged that  remnants of disk tissue must be removed. Dlskectomy without replacement was one or the earliest surgical procedures described for treatment of severe TMJ internal erangernents. With current technology, the diskectomy procedure can be performed through arthro   scopic techniques described earlier. Although this technique  has been

Disk-Repositioning Surgery

Disk-Repositioning Surgery During the late 1970s and 1980s one of the most commonly  performed TMJ surgical procedures was disk repositioningand p)ication. The indication for this procedure is anterior disk displacement that has not responded to nonsurgical treatment and that most frequently results in persistent painful clicking joints or closed locking (i.e., anterior disk displacement with or without reducti


Arthroscopy Arthroscopic surgery has become one of the most popular and effective methods of diagnosing and treating TMJ disorders.I” This technique involves placement of a small cannula into the superior [oint space. An arthroscope with light source is then inserted through the cannula into the superior joint space (Fig, 30-26). The arthroscope is then connected to a video camera and monitor, which all


Arthrocentesis Arthrocentesis involves placing needles into the TMJ  and therefore is not actually a surgical procedure. How. ever, because it is somewhat invasive and generally performedby oral and maxillofacfal surgeons, it is discussed here,Most patients undergoing arthrocentesis do so with local anesthesia and intravenous (IV) sedation. Several techniques have been described for TMJ arthrocente- ·24The mo


TMPOROMANDJBULAR  JOINT SURGERY Despite the fact that many patients with internal joint pathology'”will improve with reversible nonsurgical treatment, some patients will eventually require surgical intervention to improve masticatory function and decrease pain. Several techniques are currently available for   of a variety of TMJ derangements.      


Splints Occlusal splints are generally considered it part of ‘the  reversible or conservative treatment phase in the management of ‘lMl) patients. Splint designs vary; however.most splints can be classified into two distinct groups: (1) autorepositioning splints and (2) anterior repositioning splints. splints. The autorepositioning splints, also called anterior guidance splints, superior rcposition

Physical Therapy’

Physical Therapy Physical therapy can be extremely useful in the management of patients with temporomandibular pain and dysfunction. The most common modalities used include EMG biofeedback and relaxation training, ultrasound, spray and stretch, and pressure massage. Relaxation training, although perhaps not physical therapy in the strictest sense, can be extremely effective in reducing symptoms caused by mus


Medication Four types of medication haw been widely used in the treatment of temporomandibular disorders: O./NSAIDs, (2) occasional. use of stronger analgesics, (3) muscular relaxants, and (-l) tricyclic antidepressants. NSAIDs not only reduce inflammation but also serve as an excellent analgesic. Some examples of TSAIDsare naproxen (Naprosyn), ibuprofen (Morrin), diflunisal (Dolobid), and piroxicarn (Feldene