Spectrum of TMJ Disorders

Objectives: To describe the various disorders of TMJ and their surgical management.
Methods: A total of 80 patients of various types of TMJ disorders requiring surgical management were selected from OPD of our Oral & Maxillofacial Surgery Unit and were classified into two main types’ i.e. articular and non-articular disorders. Various articular disorders include TMJ dysfunction syndrome, disk displacement disorders, TMJ dislocation, TMJ Ankylosis, condylar neoplasia, condylar hyperplasia/hypoplasia, joint infections, condylar trauma, etc. Non-articular disorders are myofascial pain & dysfunction syndrome, extra-articular ankylosis etc.
Surgical treatment options for disk displacement disorders were arthroscentesis, disk repositioning surgery and discectomy. Dislocated TMJ were reduced manually or by open surgery followed by immobilization. TMJ ankylosis was managed by interpositional arthroplasty followed by correction of dento-facial deformity. Condylar hyper/hypoplasia leading to facial asymmetry were managed by combined intervention of orthodontist & maxillofacial surgeon. Neoplastic condylar growth was treated by surgical resection. Displaced condylar fractures were managed by open reduction & internal fixation.
Results: Most of the patients operated surgically were with TMJ ankylosis followed by extra-capsular or sub-condylar fractures, TMJ dislocation, condylar hyperplasia and condylar tumours. Surgical approaches to TMJ were mainly modifications of pre-auricular incision. Reconstruction of TMJ was done in cases of TMJ ankylosis and neoplastic pathology. Common complications encountered during TMJ surgery were infection, facial nerve damage and scar formation.
Conclusions: TMJ is a diarthrodial, bicondylar joint of synovial variety. This joint can perform multi-directional movements and is supported by ligaments, capsule & muscles. The articular disk separates the joint into two compartments i.e. upper & lower joint space.
A clear understanding of surgical anatomy, accurate diagnosis, appropriate treatment planning, selection of proper surgical procedure, early detection of complications and close follow up can be helpful for excellent management of TMJ disorders.