Skip to main content

Advertisement

SpringerLink
Log in

Temporomandibular Joint Surgery for Internal Disorders: Decompression of the Superior Joint Space

  • Original Article
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Background

Internal disordees of the temporo-mandibular joint are an important area, represented by 20% of the maxillofacial surgeon's practice today. The patients with ITATM who would merit a surgical procedure, would represent 1 to 3% of the population worldwide, represented in its great majority by women. For their relief, they have been used from minimally invasive palliative procedures, to open surgery to obtain a definitive correction.

Purpose

This work will demonstrate the cornerstone of the definitive treatment through open surgery. It will do this by showing how to achieve internal decompression of the two most important affected structures of the temporo-mandibular joint, the articular meniscus (AM) and the mandibular condyle, through total decompression of the entire surface of the AM from the upper compartment and the articular tubercle eminectomy. It is a mechanical effect of movement and compression. The approach proposed is the Bat Wing, a modified retro-auricular approach without sectioning the external auditory canal (EAC), since it is done by providing 5 cm of space from the starting point of the EAC to the front part of the articular tubercle, without damaging the seventh frontal cranial branch nerve or tearing the AM or the joint capsule.

Methods

ITDMJ interventions were performed on 84 patients, 81 women and 3 men.

Results

The asymptomatic percentage with zero pain among the patients operated on was 94% of the total, with a success rate of 100%, on 79 patients. Light post-operative clicking was experienced by 26 patients, or 30%. Recurrence occurred in 6% of the sample, or 5 patients. Compulsory anxiety disorders and bipolarity were presented in all 5, of whom 3 had attempted suicide, and 3 also were associated with fibromyalgia. A total of 165 joints were operated on over 7 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

modified by Bramley and AI Kayat

Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28

Similar content being viewed by others

Abbreviations

AC:

Articular capsule

AM:

Articular meniscus

AN:

Auriculotemporal nerve

AT:

Articular tubercle

ATE:

Articular tubercle eminectomy

ATS:

Artery temporal superficial

EAC:

External auditory canal

GC:

Glenoid cavity

HA:

Hydroxyapatite

IDTMJ:

Internal disorders of the temporo-mandibular joint

LAS:

Lower articular space

MC:

Mandibular condyle

MRI:

Magnetic resonance imaging

TMJ:

Temporo-mandibular joint

TPF:

Temporoparietal fascia

UJS:

Upper joint space

References

  1. McCarty W, Farrar W (1979) Surgery for internal derangements of the Temporomandibular joint. J Prosthect Dent 42(2):191–6. https://doi.org/10.1016/0022-3913(79)90174-4

    Article  CAS  Google Scholar 

  2. Wilkes C (1991) Surgical treatment of internal derangements of the temporomandibular joint. A long-term study. Arch Otolaryngol Head Neck Surg 117(1):64–72. https://doi.org/10.1001/archotol.1991.01870130070019

    Article  CAS  PubMed  Google Scholar 

  3. Dolwick F (1997) The role of temporomandibular joint surgery in the treatment of patients with internal derangement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83(1):150–155. https://doi.org/10.1016/s1079-2104(97)90106-2

    Article  CAS  PubMed  Google Scholar 

  4. Garcia y Sanchez JM, Gomez PA, Vargas LD, Rengifo Lozano C (1993) Tratamiento definitivo para el dolor de la articulación temporomandibular. Pract Odontol 14(5):11–8

    Google Scholar 

  5. Mehra P, Wolford L (2001) The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int J Oral Maxillofac Surg 30:497–503. https://doi.org/10.1054/ijom.2001.0163

    Article  CAS  PubMed  Google Scholar 

  6. Dolwick F (2007) Temporomandibular joint surgery for internal derangement. Dent Clin North Am 51(1):195–208. https://doi.org/10.1016/j.cden.2006.10.003

    Article  PubMed  Google Scholar 

  7. Abramowicz S, Dolwick F (2010) 20-year follow-up study of disc repositioning surgery for temporomandibular joint internal derangement. J Oral Maxillofac Surg 68(2):239–42. https://doi.org/10.1016/j.joms.2009.09.051

    Article  PubMed  Google Scholar 

  8. Gregory M (2011) Arthroplasty and discectomy of the temporomandibular joint. Atlas Oral Maxillofac Surg Clin 19(2):177–187. https://doi.org/10.1016/j.cxom.2011.05.003

    Article  Google Scholar 

  9. Tzanidakis K, Sidebottom AJ (2013) Outcomes of open temporomandibular joint surgery following failure to improve after arthroscopy: is there an algorithm for success? Br J Oral Maxillofac Surg 51(8):818–821. https://doi.org/10.1016/j.bjoms.2013.04.013

    Article  PubMed  Google Scholar 

  10. Martins W, Oliveira M, Bisinelli J, Franca B, Martins G (2014) Recurrent dislocation of the temporomandibular joint: a literature review and two case reports treated with eminectomy. J Craniomandib Sleep Pract 32(2):110–117. https://doi.org/10.1179/0886963413Z.00000000017

    Article  Google Scholar 

  11. Hoffman D, Puig L (2015) Complications of TMJ surgery. Oral Maxillofac Surg Clin North Am 27(1):109–124. https://doi.org/10.1016/j.coms.2014.09.008

    Article  PubMed  Google Scholar 

  12. Garcia y Sanchez J, Davila J, Pacheco G, Gomez C (2014) ‘Bat wing surgical approach for the temporomandibular joint.’ J Maxillofac Cirugía Oral 14(3):875–81. https://doi.org/10.1007/s12663-014-0724-7

    Article  Google Scholar 

  13. Dongmein, He y Yang, Chi En el (2014), Temporomandibular Joint Disc Repositioning by suturing through open incision: a technical note

  14. Ruiz Valero CA, Fragoso Mendoza JF, María RGA (2014) Abordaje endaural modificado para la Articulación Temporomandibular: 20 años de experiencia. Descripción de la técnica quirúrgica 10(3):116–121

    Google Scholar 

  15. Candirli C, Demirkol M, Yilmaz O, Memis S (2017) Retrospective evaluation of three different joint surgeries for internal derangements of the temporomandibular joint. J Cranio-Maxillo-Facial Surg 45(5):775–780. https://doi.org/10.1016/j.jcms.2017.02.003

    Article  Google Scholar 

Download references

Funding

No funding was needed.

Author information

Authors and Affiliations

  1. Maxillofacial Surgery Department, Medical Specialities Hospital, Centro Medico Nacional Century XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, México

    García y Sánchez José Manuel, Elizalde Monroy Martin, Estrada Orozco Juan José & Jairo Pedraza Jimenez

  2. Private Practice, Mexico City, México

    Valdés Martínez David Abisay & Vera Castellanos Sindy Katerine

  3. Regional Hospital of Zone #1 IMSS, Villa de Alvarez, Colima, Mexico

    Reynaga Martínez Jorge Alfredo

  4. Regional Hospital #2, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico

    Grecia Daniela Arce Fernandez

Authors
  1. García y Sánchez José Manuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valdés Martínez David Abisay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizalde Monroy Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Estrada Orozco Juan José
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reynaga Martínez Jorge Alfredo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jairo Pedraza Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vera Castellanos Sindy Katerine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Grecia Daniela Arce Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of interest

There are no conflicts of interest within the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 15416 kb)

Supplementary file2 (MP4 4234 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manuel, G.y.S.J., Abisay, V.M.D., Martin, E.M. et al. Temporomandibular Joint Surgery for Internal Disorders: Decompression of the Superior Joint Space. J. Maxillofac. Oral Surg. (2022). https://doi.org/10.1007/s12663-022-01693-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12663-022-01693-7

Keywords

Search

Navigation