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Arthroscopic osteoplasty of the medial and anteromedial wall of Temporomandibular Joint. Surgical Technique and anatomical considerations

Published:November 11, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.11.008

      Abstract

      The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely frequent pathology, there is no certainty about the etiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the etiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease.

      Materials and methods

      All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our center from January 2021 to September 2021 were reviewed and analyzed to identify specific anatomical features observed in every procedure. Results. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most frequent complication observed in our sample was the dysesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n=2), intraoperative bleeding (n=1), and postoperative malocclusion (n=1).

      Discussion

      The compression of the superior head of pterygoid lateral (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the etiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle (SPLM) allows a remodeling of the bone surfaces with minimal complications

      Keywords

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