Dentistry >>>> Surgical treatment of the jaw joint - arthroscopy

Surgical treatment of the jaw joint - arthroscopy.

To eliminate pain in the temporomandibular joint (hereinafter referred to as the TMJ joint), at the initial stages of treatment, orthopedic devices of opening, limiting and guiding actions are used to restore joint functions and arthrocentesis - punctured injection of saline solutions into the joint cavity, ensuring the sliding of the articular joints without injury. But if therapeutic and orthopedic treatment is unsuccessful, and a person is faced with the problem of the inability to fully live with impaired functions of the temporomandibular joint, they resort to surgical intervention - arthroscopy of the jaw joint.

Arthroscopy in dentistry and maxillofacial surgery is an extreme measure of restoring the anatomically correct functioning of the joint, since the developments in the field of such surgical intervention indicate that the result is not always expected, in some cases there may be a worsening of the condition, an increase in pain symptoms. There are strict indications for arthroscopy of the jaw joint, the essence of which is the impossibility of restoring the chewing function of the TMJ joint by other gentle methods.

The indications for surgical treatment of the temporomandibular joint are:

deformation of the intra-articular disc (cartilage), the functions of which cannot be restored at least partially, and the methods of opening and expanding the joint space do not bring the desired effect;
chronic dislocation of the intra-articular disc and the exit of the articular head from the range of motion within the articular joint;
fusion of the intra-articular disc with the head of the lower jaw as a result of the formation of fibrous cords as a result of chronic trauma and tissue inflammation;
proliferation of connective tissue as a result of chronic injury to the intra-articular joints;
osteoarthritis of the jaw joint, as a result of the traumatic work of the joint.

The operation of arthroscopy of the jaw joint is considered a minimally invasive surgical intervention, the process of tissue healing, the reduction of puffiness after the intervention of an arthroscope takes place within one month, but then mechanotherapy is required, which fixes a new trajectory of movement of the articular joints, and it is this period of rehabilitation, which is delayed for a year, can provoke complications.

The developing complications in the postoperative period of arthroscopic treatment are associated with the desire of patients to develop the TMJ joint as soon as possible and forced opening the jaw to an amplitude greater than the possibilities of joint movement planned after the operation. Forced limitation during the rehabilitation period gives patients inconvenience during eating and talking, which provokes them to force events, and, as a result, inflicting new injuries on the tissues of the temporomandibular joint, which in turn gives rise to newly developing inflammation and gives an impetus to the proliferation of new fibrous fibers that change the position and motor capabilities of the TMJ joint.

People who are shown the operation "arthroscopy of the temporomandibular joint" should tune in to some temporary inconveniences in the postoperative period and patiently follow the doctor's instructions on the program for developing movements in the jaw joint and restoring its functions.

The operation "Arthroscopy of the jaw joint" is performed on one or simultaneously on two joints on both sides of the jaw, depending on the indications. Considering the possible different conditions of traumatic movement of the joint from different sides, the correction of bilateral defects in the TMJ joint may have different time periods of rehabilitation, that is, healing from different sides can proceed in different ways, and this fact is taken into account when choosing the types of mechanotherapy of the TMJ joint.

The eve of the operation of arthroscopy of the temporomandibular joint is the study of the conditions for the operation: ultrasound, magnetic resonance imaging is performed, during which the possibilities of the operation and the amount of work performed using the arthroscope are specified. For a preliminary study of the intra-articular space of the TMJ joint, hydraulic pressure is performed - the upper and lower intra-articular fissures are expanded by puncturing one ml of anesthetic alternately into the upper and lower articular spaces, which allows examining the state of the tissues.

The very arthroscopy of the TMJ joint is the introduction of an arthroscope into the joint cavity and incision (or scraping) of fibrous adhesions. Next, lavage of the joint is performed - the joint cavity is washed with saline in order to cleanse the remnants of cut fibrous fibers and prevent the development of inflammation.

If it is impossible to completely restore the intra-articular structures of the TMJ joint, arthroscopy is combined with arthroplasty and endoprosthetics, that is, full-fledged surgical incisions are made, the articular joints are adjusted, and the destroyed ones are replaced with implants.

In the postoperative period, patients are prescribed antimicrobial therapy and pain relievers.