Contemporary Management of Temporomandibular Disorders: Surgical Treatment

380 Pages·2019·23.508 MB·English

by  S. Thaddeus Connelly, Gianluca Martino Tartaglia, Rebeka G. Silva

Contemporary Management
of Temporomandibular
Disorders
Surgical Treatment
S. Thaddeus Connelly
Gianluca Martino Tartaglia
Rebeka G. Silva
Editors
123
Contemporary Management of
Temporomandibular Disorders
S. Thaddeus Connelly
Gianluca Martino Tartaglia
Rebeka G. Silva
Editors
Contemporary
Management of
Temporomandibular
Disorders
Surgical Treatment
Editors
S. Thaddeus Connelly Gianluca Martino Tartaglia
Oral and Maxillofacial Surgery Department of Biomedical Sciences
San Francisco VA Health Care System for Health, Functional Anatomy
University of California San Francisco Research Center (FARC)
San Francisco, CA Universita degli Studi di Milano
USA Functional Anatomy Research Center
Milano
Private Practice, Dental Implant and
Italy
Oral Surgery of San Francisco
San Francisco, CA
USA
Rebeka G. Silva
Oral and Maxillofacial Surgery
San Francisco VA Health Care System
University of California San Francisco
San Francisco, CA
USA
Private Practice, Dental Implant and
Oral Surgery of San Francisco
San Francisco, CA
USA
ISBN 978-3-319-99908-1 ISBN 978-3-319-99909-8 (eBook)
https://doi.org/10.1007/978-3-319-99909-8
Library of Congress Control Number: 2019930094
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Foreword
The majority of patients presenting with signs and symptoms of temporomandibular
disorders (TMD) have extra-articular conditions which should be managed nonsur-
gically, as reviewed in Volume II.
The management of early definitive intra-articular TMD pathology often involves
minimally invasive or open-joint surgical procedures. However, patients with com-
promised mandibular form and function resulting from end-stage joint disease are
more appropriately managed with joint replacement or combined joint replacement
and maxilla-mandibular orthognathic surgical procedures.
Volume III begins with a historical perspective of temporomandibular joint sur-
gery. As the nineteenth-century American physician Alfred Stille wrote, “Medicine,
like all knowledge, has a past as well as a present and a future, and in that past is the
indispensable soil out of which improvement must grow.”
The most important phase in the management of any disease is diagnosis. If a
surgeon operates having made the right diagnosis, on the right patient, in the right
way, using the right equipment, the outcome should be very predictable. However,
a misstep at any of these stages will often lead to unexpected or adverse
consequences.
Knowledge and mastery of surgical anatomy and the approaches to the temporo-
mandibular joint and associated structures are critical. The important anatomical
structures that occupy the region require constant review and reinforcement, since
merely a casual understanding of the anatomy can have serious functional and
esthetic consequences.
Minimally invasive temporomandibular joint procedures, such as arthrocentesis
and diagnostic/arthroscopic surgery, have revolutionized the management of early
intra-articular disease. They have also provided surgeons with a more comprehen-
sive view of the pathophysiology of early TMJ disorders leading to a more profound
understanding of the biology of the synovial, articular bone and fibrocartilage com-
ponents of this joint.
Progression to invasive open reparative joint procedures such as arthroplasty,
disc repositioning, and discectomy has definite diagnostic and performance criteria.
For patients with form and functional end-stage joint disease, the option of total
joint replacement utilizing autogenous tissue, alloplastic, or in the future bioengi-
neered constructs should be based on the pathology, state of the host bone, and the
experience of the surgeon.
v
vi Foreword
Alloplastic total joint replacement, a biomechanical answer to a biological prob-
lem, has been successfully utilized in orthopedic surgery for over 50 years in the
management of end-stage joint disease. In fact, the modern practice of orthopedic
surgery would be impossible without the availability of these devices. There is now
documented greater than 20 years success with TMJ alloplastic total joint replace-
ment constructs and ever-increasing clinical and laboratory reports demonstrating
their safety and efficacy.
Bioengineered tissue TMJ constructs, presently in the conceptual and laboratory
stages of development, may one day provide another viable option for the manage-
ment of end-stage TMJ disease. However, these basically autogenous tissue con-
structs may have the same disadvantages as transplanted autogenous tissue grafts
when challenged by local or systemic bone-damaging diseases like high-
inflammatory arthritis.
No one knows what advances in surgical techniques, equipment, and constructs
lie ahead for TMJ surgeons. However, one thing is certain, as C. William Pollard has
said, “The arrogance of success is to think that what you did yesterday will be suf-
ficient for tomorrow.” Therefore, it is up to future clinicians and researchers to “till
the soil” that has been fertilized by the work of their predecessors.
Louis G. Mercuri
Department of Orthopedic Surgery
Rush University Medical Center
Chicago, IL, USA
Preface
The invasive treatment of temporomandibular disorders is simultaneously challeng-
ing and rewarding. Whether the joint is appreciated through a scope or through
open-joint surgery, the anatomy is beautiful, and one is always inspired by its intri-
cacy, even in the advanced diseased state. It is through arthroscopy or surgery that
the surgeon’s steady hand and sharp eye holds the promise of decreased pain and
improvement of function. Disease within the joint or a history of previous surgical
intervention markedly disturbs normal anatomy; thus the surgeon must appreciate
the proximity of the joint to many other critical structures and also understand every
cell layer on the way to the joint.
In this volume, which focuses on the surgical treatment of temporomandibular
disorders, respected surgeons from around the world teach us their craft and inform
us of their research outcomes through the written word. There is an incredible
wealth of information to learn. Most surgeons spend a lifetime refining skills and
learning to operate from the focused, instinctive, and creative part of the brain. It is
our hope that the reader uses these chapters as inspiration for their own development
and gains an appreciation of the evolution of TMJ surgery, as well as its future.
In Part I, we begin by learning about the history of TMJ surgery. The following
chapters take us through TMD diagnosis for surgical candidates and surgical path-
ways to the joint, which lays the groundwork for Part II. Part II delves into surgical
procedures other than total joint replacement. This includes surgical arthroscopy,
intraoral vertical ramus osteotomy, and discectomy and arthroplasty. Many of these
procedures can be considered foundational surgeries that eventually led to extraor-
dinary advances in total joint reconstruction. TMJ reconstruction for adults and
children is the topic of Part III. In great detail, the reader will understand the step-
by-s tep processes needed to successfully carry out the surgery, avoid complications,
and manage complications should they occur. Many complex cases require virtual
surgical planning, and this is especially important for those patients with comorbid
diagnoses of craniofacial deformity, obstructive sleep apnea, cancer, osteoradione-
crosis, or trauma. The chapters will give the reader a good understanding of the
application of TMJ reconstruction in these special circumstances. Lastly, we reach
the future of TMJ surgery with a fascinating look at what lies ahead in the domain
of bioengineering. The volume ends with a discussion of how to educate the next
generation of TMJ surgeons.
vii
viii Preface
The editors and contributing authors of this comprehensive textbook humbly
thank our readers for taking this journey to gain essential knowledge, to refine skills,
to inform future research directions, and, above all, to treat our TMD patients.
San Francisco, CA, USA S. Thaddeus Connelly
Milano, Italy Gianluca Martino Tartaglia
San Francisco, CA, USA Rebeka G. Silva
Contents
Part I T emporomandibular Joint Surgical Evolution, Diagnosis
and Anatomic Pathways
1 Evolution of the Modern Surgical Management
of Temporomandibular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MA Pogrel and Robert Hensher
2 The Diagnosis of Temporomandibular Disorders Leading
to Surgical Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Vincent E. DiFabio
3 Surgical Pathways to the Temporomandibular Joint . . . . . . . . . . . . . . 37
A. Abdullakutty and A. J. Sidebottom
Part II S urgical Procedures Other than Total Joint Replacement
4 Surgery of the Temporomandibular Joint: Surgical Arthroscopy . . . . 59
C. Seebauer, W. Kaduk, J. Fernandez Sanroman,
and Rebeka G. Silva
5 The Intraoral Vertical Ramus Osteotomy . . . . . . . . . . . . . . . . . . . . . . . 93
Rebeka G. Silva
6 Surgery of the Temporomandibular Joint: Discectomy
and Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Michael Han, Michael Markiewicz, Michael Miloro, Larry Wolford,
and M. Anthony Pogrel
Part III Total Temporomandibular Joint Replacement
7 Surgery of the Temporomandibular Joint: Virtual Planning . . . . . . . . 131
Larry Wolford and Jacinto Fernandez Sanroman
8 Autogenous Tissues Versus Alloplastic TMJ Condylar
Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Larry Wolford
ix
x Contents
9 Complications in Total Temporomandibular
Joint Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Rebeka G. Silva, L. Wolford, and S. Thaddeus Connelly
10 Concomitant Custom-Fitted Temporomandibular
Joint Reconstruction and Orthognathic Surgery . . . . . . . . . . . . . . . . . . 233
Rishi Jay Gupta, Steven A. Schendel, and Larry Wolford
11 Considering the TMJ in Mandibular Reconstruction:
Ablation/ORN/Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Baber Khatib, Allen Cheng, and Eric Dierks
12 Treatment of Advanced Osteoradionecrosis (ORN)
of the Mandible (Resection/Disarticulation
and Staged Reconstruction), a Protocol and Rationale . . . . . . . . . . . . . 299
S. Thaddeus Connelly, Vincent DiFabio, Rebeka G. Silva, Greg
Tentindo, and Jennifer Dean
13 Pediatric Temporomandibular Joint Surgery . . . . . . . . . . . . . . . . . . . . 317
Kathlyn Kruger Powell, S. U. Ivanov, and Shelly Abramowicz
14 Treatment of Mandibular Deformities Related to TMD
by Vertical Ramus Distraction Osteogenesis . . . . . . . . . . . . . . . . . . . . . 329
Thomas Klit Pedersen and Sven Erik Nørholt
Part IV The Future of Temporomandibular Joint Surgery
and Training the Next Generation
15 Bioengineered Constructs of the Ramus/Condyle Unit . . . . . . . . . . . . . 351
Sidney B. Eisig, Michael Forman, and Gordana Vunjak-Novakovic
16 Educating the Next Gen TMD Surgeons . . . . . . . . . . . . . . . . . . . . . . . . . 375
Vincent E. DiFabio