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Temporomandibular disorders. Part 5: surgical management Charles Crawford Emma Foster-Thomas Funmi Oluwajana Peter Clarke Martin James Sunil Khandavilli Athanasios Kalantzis Dental Update 2024 49:8, 707-709.
Authors
CharlesCrawford
Lead Clinician TMD Clinic, University Dental Hospital of Manchester
The temporomandibular joint (TMJ) is a complex arrangement with high functional requirements. Surgery is therefore only considered when conservative management has not been successful. Surgery may not always benefit and carries the risk of the condition worsening. There is a range of techniques available to the surgeon. The most commonly used is arthrocentesis and this is also the least invasive. The end-stage option for patients is total joint replacement. Whichever surgery the patient has received, it is likely that they will be in need of careful management by the primary care team for their continuing care. This article, the fifth in a series of six, outlines the scope of TMJ surgery.
CPD/Clinical Relevance: A range of techniques is available for TMJ surgery, and many post-surgery patients will require routine dental management in the primary care setting.
Article
For some patients with a temporomandibular disorder (TMD), the conservative management techniques discussed in this series so far will not provide adequate relief of pain, or acceptable function, and therefore a surgical intervention may be considered.
This article discusses the main surgical options for the management of TMD. These are described to demonstrate the range of techniques available to address conditions such as internal derangements of the joint, arthritic degenerations or congenital abnormalities.
The temporomandibular joint (TMJ) is a synovial joint atypical in its range of movements and the functions that are required of it. No other joint in the body is equipped with the kind of functionality required for the precise and repetitive movements needed for mastication and speech, plus the ability to endure the heavy load of the maximum bite force. Surgery for this joint has specific challenges to overcome in order for these functions to be maintained or improved.
Surgical options range from relatively conservative to complex and extensive. An overview list of the different techniques and their indications is found in Table 1. It should be stated that the general expert consensus is to reduce the number of surgeries that a patient undergoes, so as not to compromise the outcome of a joint replacement where this is predicted as the inevitable endpoint. The three main techniques discussed are:
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