Open temporomandibular joint surgery should only be used nowadays if the problems are so severe that arthroscopic TMJ surgery does not appear to be a viable option. This involves preparing a skin incision from the anterior ear helix to the temporomandibular joint. The cosmetic results of this incision are excellent - the only part that is actually visible is the approximately 3mm section that goes over the auricle.
This technique is primarily used if parts of the joint or the entire temporomandibular joint has to be reconstructed. Severe changes to the joint that require reconstruction are often the result of fractures to the mandibular condyle that have gone untreated or have been inadequately treated. In extreme cases this can result in bony fusions between the mandible and the cranial base. This is termed mandibular ankylosis.
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Posttraumatic ankylosis of left TMJ, lateral and posterior views |
Once this bone fusion has been released there are various ways of preventing the joint surfaces from growing back together again. Methods that use autologous tissues such as ear cartilage or rib cartilage are preferable. Complete joint reconstruction is required if part of the mandible is lost as a result of injury or previous surgery. Reconstruction is then carried out using autologous bone grafts, usually from the ribs, or with joint prostheses similar to those used in hip replacement - just a lot smaller.
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TMJ reconstruction with extracorporally augmented autologous rib cartilage following lysis of ankylosis. The reconstructed joint surfaces are separated by a silicone membrane for 4 months |
With any surgery on the temporomandibular joint intensive follow-up care is essential. This should be coordinated and controlled by the surgeon.