Complications of TMJ Surgery

Key points

Arthroscopic surgery

Arthroscopic surgery is probably among the safest procedures performed by maxillofacial surgeons. In its simplest form, a 1.9 or smaller arthroscope is placed in the TMJ either through a posterior puncture or an anterior puncture or portal. Scopes as long as 2.3 have been used, and even working instruments as large as almost 3 mm can be utilized with or without the protective casing. Arthroscopy can be as simple as a single puncture in the TMJ with an outflow system created with an 18-gauge

Nerve damage

The facial nerve could be considered the second most important structure at risk during arthroscopy of the TMJ. Understanding the anatomy of the facial nerve as it passes over the TMJ is key to all TMJ surgeries. Classical literature has described a safe zone approximately 0.8 to 1.8 mm in front of the tragus and approximately 10 mm inferior to the root of the glenoid fossa The concept of arthroscopic surgery with placement of a scope along the posterior portal at approximately 10 mm seems to

Temporomandibular joint arthroplasty

TMJ arthroplasties encompass surgical incisions into the TMJ through an external approach. The most common incision is the preauricular, although others have been discussed. Regardless of the diagnosis, the surgical procedure has a group of common potential complications, including damage to adjacent structures including nerves, vessels, the ear, parotid gland, base of the skull, and middle cranial fossa. In addition, infections and secondary issues such as ankylosis, functional disorders, and

Total joint replacements

Of the 3 surgical procedures discussed herein, total joint replacements are probably the most complex and demanding. Whether the surgeon is using a custom-made or stock joint, the surgical procedures are for the most part the same and the complications are nearly identical. It is not the intent of this paper to compare different prostheses. Because total joint replacements add the element of a foreign body into the equation, surgical sterility becomes paramount. Replacement of a total joint

Infections of the temporomandibular joint

The most ominous of all problems of a total joint replacement are postoperative infections. Infections can be divided into acute, subacute, or chronic. In the acute phase, it is conceivable to treat the patient with antibiotics and/or open the joint, wash it out, and reseal it. In the chronic phase, it is almost imperative that the components be removed, especially the fossa. The probability that there is a biofilm is likely. The subacute phase is somewhat less clear, and can have a mixed

Loosening of prosthesis

The joints are generally very secure. Most total joint systems involve at least 6 to 8 screws. There has been some debate in the biomedical engineering as to the total number of screws needed to secure the condylar component to the ramus. It seems that fewer than 5 screws would suffice, and some form of microlocking helps to avoid micromovement, which can lead to screw failure. An attempt to have the ramus component stay as close as possible to the existing bone is seemingly important. In the