January 28, 2021
The temporomandibular joint (TMJ) is one of the most important joints of the body which allows us in proper functioning with respect to speech and chewing. This joint is present near the ear and joins the lower jaw with the skull. At the ends of the lower jaw bone (mandible) are structures called the condyles that corresponds the temporal bone of the skull. Thus, the TMJ is an area of immense significance in the facial region.
The TMJ is located at a region around which there is a dense network of blood vessels and nerves, major salivary glands, muscle attachments and ligaments. Any dysfunction in the joint can cause multiple problems. Some of these problems include osteoarthritis, locked jaws, dislocated mandible, traumatic injuries, tumours, etc. In order to correct any deformities related to the TMJ, it is important to have a good look at the internal structures. These structures can be viewed through a process called arthroscopy.
Arthroscopy involves viewing the structures of the TMJ through a device called arthroscope. In order to perform an arthroscopy, the patient is kept under general anaesthesia. The area where the arthroscope needs to be inserted is first palpated and located. The purpose of this introduction of the arthroscope can be only for diagnosis or surgery. The surgical intervention includes insertion of cannulas (a thin tube) in the region of TMJ. The rest of the procedure is based on what deformity needs to be corrected.
There is a disc in the TMJ which allows the lower jaw to move. The motion is smooth because of the presence of a liquid called synovial fluid. Inflammation in this fluid or discal injuries can be rectified by TMJ arthroscopy. In cases where there is injury in the TMJ, then the scar tissue can be removed through arthroscopy. Furthermore, in cases of swelling, the infected fluid can be removed through arthroscopy.
Arthroscopy also allows medications to be injected inside the TMJ. These medications are injected in cases where there is pain, clicking sound of the TMJ and limited mouth opening. The overall procedure of TMJ arthroscopy is a minimal one and not invasive. An arthroscopic surgery usually is completed under two hours. However, the effects after the surgery and the precautions that need to be taken are very crucial.
Following an arthroscopy, a patient is likely to feel pain in the region of TMJ. Any movement or activity that causes strain or stress in the TMJ must be avoided for the first couple of weeks. During this period, normal, limited movement of the jaw must not be restricted. After a week, a physiotherapist will guide you in order to begin some more intensive movement of the TMJ. This will help in regaining the natural strength and mobility of the jaw. An advantage of arthroscopy is that it leaves no post-operative scar or incision on the face. Besides, unlike other TMJ procedures, arthroscopy has minimal risk of injuring the nerves in that region.
TMJ Arthroscopy has its limitations too. Since instruments inserted through an arthroscope are extremely thin, chances of instrument breakage are high. Moreover, an injury to the capsule of TMJ can result in leakage of unwanted fluid. Hemorrhage due to blood vessels injury and hearing complications may also arise.
These limitations can be overcome by using recent headways in TMJ arthroscopy. One is video arthroscopy. This involves a camera attached to arthroscope through which the internal structures can be seen clearly. Microinstruments are also available that help in taking biopsies, open cysts, remove foreign materials and smoothen cartilages with much precision. Articular discs can be repositioned through arthroscopy by inserting a water-jet scalpel. Finally, laser induced arthroscopy can also help in better removal of fibrous and scar tissues.
Oral health maintenance after TMJ Arthroscopy can be challenging since mouth opening is restricted. In these case toothbrushes with longer handles and softer bristles can be used to reach deeper areas in the mouth that are difficult to reach.
TMJ Arthroscopy was introduced in the 1970s and is till date one of the most crucial procedures in resolving TMJ deformities. Its diagnostic and therapeutic advantages allow it to be one of the best conservative procedures in the field of orofacial surgery.