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 widely used, there seems to be a wide variation in clinical results, with some joints showingminimal anatomic changes and significant clinical. improvement lo joints that demonstrate severe degenerative
changes with continued symptoms of pain and dysfunction. ” In advanced internal joint pathology, the disk-may be severely damaged and perforated but may’ have adequate remaining tissue so that a repair or patch procedure can beaccomplished (Fig. 30-28). A varietyof autogenous tissue
sources have been used for disk repair, including grafts of dermal or fascial tissue. In many cases the disk was previously replaced with alloplastic Implant material. However, significant failures have been seen with many of these implant materials, including implant fragmentation, foreign-body reaction, synovitis, and gross erosion of bony articular surfaces. These problems led to a renewed interest in autogenous tissue replacement after disk removal. Autogenous grafting techniques include the use of auricular cartilage, temporalis fascia, and the combination of muscle and fascial flaps “(Fig:30-29). 12 Although well-done long-term studies of the outcome of each of these techniques are limited, most patients realize some degree of improvement in pain and function after treatment with these’ procedures.