A wide variety of microsurgical techniques have been developed over the past 15 years. They allow precision surgery to be performed on soft and hard tissues in the temporomandibular joint. With arthroscopic TMJ surgery much the same instruments are used as with surgery on the knee or shoulder joint, just a lot smaller. These micro instruments are positioned in the joint space via a second approach, known as the working channel. With its high range magnification, the arthroscope allows surgery to be performed as it would be in the larger joints.
Mechanical hand-held instruments are used to separate adhesions and to reconstruct damaged cartilage and bone.
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Mechanical hand-held micro instruments for arthroscopic TMJ surgery: Sickle blade scalpel and micro scissors |
An electrically driven shaver is used to ream the surface of the bone where the joint cartilage is completely missing - new soft tissue can then grow on the surface which will in time develop into tissue cartilage ("micro-fracturing").
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Superficial contouring of denuded bone with the electrically driven micro shaver |
The monopolar diathermy probe or the holmium:YAG laser can cut or coagulate soft tissue without causing bleeding.
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Cutting soft tissues with the sharp monopolar diathermy probe; superficial coagulation of the synovial membrane with the laser probe |
All these arthroscopic surgical techniques can be used to treat the following dysfunctions of the temporomandibular joint:
- Disc displacement with and without reduction
- TMJ osteoarthritis
- Habitual or recurrent temporomandibular joint dislocation
- Dysfunction following fractures in the region of the temporomandibular joint
As mentioned before, the main advantage of arthroscopic surgery as opposed to open TMJ surgery is that there is no scarring either to the skin on the face or in the tissue layers below this. The risk of damaging the facial nerve is much lower than with temporomandibular joint surgery using a longer skin incision. The patient can leave the hospital on the day following surgery and can return to work immediately.