Post Operative TMJ

P-L Westesson, MD, PhD, DDS Neuroradiology

University of Rochester, Rochester, NY

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Normal TMJ

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•! Disc Displacement Arthritis

Disorders Affecting the TMJ

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Treatment of TMJ Disorders

•! Self limiting disease - 50% •! NSAID and Muscle relaxants - 25% •! Oral Appliances - 20% •! Surgery - 1-2%

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TMJ Surgery •! Arthroscopic lysis and lavage •! Disc Reposition •! Mandibular Osteotomy •! Discectomy •! Disc Replacement Implant •! Rib grafts •! Total Joint Prosthesis

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Athroscopic Surgery

•! Do not change compared to presurgical imaging

•! No special postoperative imaging features

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Disk reposition Before

After

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Disk reposition does not works so well

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Discectomy •! Removing the disk via a

small preauricular incision

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MRI after succesful Discectomy

•! Decreased joint space •! No disk •! No adhesions •! Diskectomy has 85% 6-

year succesrate for eliminating pain

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Discectomy Specimen

Posterior Anterior

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MRI after Failed Diskectomy

Intra Articular Adhesions Capsule Adhesions

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MRI after Failed Diskectomy

Coronal Lateral Capsule adhesions

Sagittal Complete Fibrous Ankylosis

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TMJ Implant

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MRI of TMJ Implant Closed Mouth

Open Mouth

Proplast-Teflon Implant

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Typical Joint Condition for TMJ Implant

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Typical Condition Predisposis for implant

Failure

Preoperative MRI

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Silastic Implants after functioning 2-3 months

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Sequella of TMJ Implant

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Sequella of TMJ Implant

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Mandibular Osteotomy

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Disk Repositioning via mandibular Osteotomy

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Before

After

Vertical Ramus Osteotomy - can be used to correct disk displacement

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Mandibular Osteotomy

•! Requires intermaxillary fixation

•! Extra articular procedure

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TMJ Reconstruction with Rib Graft in Failed TMJ surgery

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