ORTHOPEDIC SURGERY OF THE JAW JOINT

            There are many misconceptions of jaw joint surgery and its objectives.  Much of the problem comes from the unique biomechanics of the jaw joint and that the dynamic soft tissue parts of the joint are dense fibrous tissue and not cartilage as found in other joint systems.

            Orthopedic instability of the joint (jaw popping, clicking and locking) is due to in coordinated movement between the boney components and the fibrous disc and capsule of the TM joint.  At the first operation or surgical intervention (including arthrocentesis), it is necessary that the managing surgeon appreciate the magnitude of influence of bone pathology of either the socket (fossa) or ball (condyle) prior to choice of surgery.  If the bone pathology is minimal, joint space is adequate, and there is no significant lateral impingement, arthroscopy can be a very viable and successful therapy.

            In advanced cases, a surgeon has better opportunity to appropriately contour bone surfaces and make them compatible with one other during the gliding function of the joint with an open joint procedure (arthroplasty).  If the bone contours are good, but the joint is grossly collapsed, a condylotomy can be an option.

            With gross arthritic destruction of the joint from rheumatoid or other destructive processes, a total joint replacement may be the appropriate choice especially if the fit of the teeth has deteriorated.

            In summary, all options that are considered by orthopedists with surgical management of disease or injury of other joints of the body are considered with the joint system as well.

 Dr. William S. Kirk Jr. DDS

Tags: jaw joint, orthopedic surgery of jaw, surgery, tmj