Transcription
In this video, we will discuss about temporomandibular joint arthroplasty. First, let's give a brief overview of the treatment options for TMJ ankylosis. During treatment, the treatment options for TMJ ankylosis are: the first one is condylar resection, and the second one is TMJ arthroplasty.
Arthroplasty is nothing but the creation of a gap between the condylar head and the glenoid fossa. After the creation of the gap, the TMJ ankylosis will be relieved. The treatment options also include TMJ arthroplasty, which aims to restore the joint function, restore the gliding function, and improve the opening. It aims to restore the opening of the mouth, which is restricted due to TMJ ankylosis. It promotes bone growth and improves facial symmetry.
In children, during the growth period, TMJ arthroplasty is done. The last one is restoration of the function, restoration of the joint function, and restoration of the mouth opening.
Treatment of any facial asymmetry requires proper treatment. The indications for TMJ arthroplasty are mainly for the improvement of the mandibular gap. If there is a gap between the condylar head and the glenoid fossa, then we are going to remove the bony mass.
Let's discuss surgical procedures. There are many surgical procedures by which we can make the TMJ joint. The basic one is the condylar resection, followed by arthroplasty. There are also other approaches like the interpositional arthroplasty, and the costochondral graft arthroplasty.
So, the interpositional arthroplasty is a procedure, but condylar resection is the basic one. So, in this video, we are going to do the condylar resection, followed by arthroplasty.
The first step is to make an elliptical skin incision at the junction between the zygomatic arch and the coronoid process. This kind of incision is made in the zygomatic arch and the coronoid process.
The zygomatic arch and the coronoid process are the bony structures. So, we make a skin incision at the junction of the zygomatic arch and the coronoid process. After you take the initial skin incision, you have to dissect the temporalis fascia. The temporalis fascia contains the superficial layer of the temporal muscle.
So, in this dissection, we dissect the temporalis fascia, the superficial layer of the temporalis fascia, and then the deep layer of the temporalis fascia. After incising the fascia, you carry out the dissection.
You dissect the superficial layer of the temporalis fascia, and the zygomatic arch. You can also dissect the coronoid process. So, you dissect up to the level of the superficial layer of the temporalis fascia.
As you dissect the zygomatic arch, you will directly incise the fascia to expose the zygomatic arch. After exposing the zygomatic arch, you are going to dissect the TMJ capsule. So, you can see in this diagram, these are the condylar head, the zygomatic arch, and the coronoid process.
After dissecting the superficial layer of the temporalis fascia, you will see the zygomatic arch. These white lines are the zygomatic arch. So, you are going to make an incision into the TMJ capsule. These black lines display the TMJ capsule. This is the condylar head, this is the zygomatic arch, and below this is the coronoid process.
We have to incise the TMJ capsule. This capsule connects down to the condylar neck. The intervening red colored structure is the articular artery. And you will be decided to go into the condylar neck and superiorly. This is the temporalis muscle.
So, in this diagram, after dissecting the TMJ capsule, you can see a gap. But we are going to create a gap. So, after incising the TMJ capsule, and after dissecting down to the condylar neck, you can see the condylar head, the glenoid fossa, and the coronoid process are completely fused.
This is the zygomatic arch, and this is the condylar neck. The bony mass is completely fused. So, after making and after knowing this bony mass, you are going to remove this bony mass.
You can use a bone rongeur or a bone cutting burr. After you have completely removed this bony mass, then you can see the glenoid fossa, the condylar head, and the coronoid process.
So, we have made a gap between the glenoid fossa and the condylar head. The gap is about 1 to 1.5 centimeters. After the gap is created, you can use a mouth gag. The mouth opening is more than 60 mm. Then, the productivity is increased.
If the mouth opening is not more than 35 mm, then the productivity is reduced. If the mouth opening is increased, then it is required to do other procedures accordingly. So, this is basically TMJ arthroplasty.
The procedure is almost completely done. After creating the gap, what you are going to do is interpositional arthroplasty. You are going to use temporalis fascia, temporalis fascia, temporalis muscle, and then put it in the gap.
So, this is generally about TMJ arthroplasty. After confirming the bony mass, the most important point is to remove the bony mass completely. Otherwise, there are chances of recurrence, especially in the medial aspect.
You must plan how much you have to go. There are many important steps. You must take care about the superficial temporal fascia. You must take care about the facial nerve. You must take care about the middle meningeal artery.
After confirming the bony mass, the incision must be done in layers. First, you have to approach the zygomatic arch, and after that, you have to approach the temporalis fascia. So, you must dissect in layers.
After dissecting the temporalis fascia, you will come back to the TMJ capsule. This is the temporalis fascia, which is inserted into the coronoid process. So, it is simpler than the technique.
The interpositional arthroplasty is the next step. This is the most common procedure. So, this is the chance of recurrence and complications.
The disadvantages are the changes in the TMJ. Especially, if you do not want to reduce the amount of gap, 1 to 1.5 centimeters.
The main contraindications will be doing arthroplasty. The creation of a perforation into the middle cranial fossa. You have to understand not to perforate the middle cranial fossa.
There are some communications also, which can be seen after the procedure. Otherwise, there is damage to the middle meningeal artery and veins.
So, these are some of the complications of the arthroplasty. If you like this video, hit the like button, share it, and subscribe to the channel. If you have any doubts, message in the comment box.