Surgical Management: Obstructing the Path

Abstract

Despite a large number of conservative and surgical treatments described in the literature, management of chronic dislocation remains a challenge. Different treatment modalities with variable results have been described for treating recurrent temporomandibular dislocation. The surgical procedures can be categorized under two main headings: procedures that increase freedom of movement of the condyles (like eminectomy) and those that prevent excessive movement of the condyles by obstructing the path. This last category of treatment includes several procedures: – Minimally invasive techniques: arthroscopic scarification of the retrodiscal tissue, sclerosing agent, and botulinum toxin injections – Hard tissue surgery: down-fracture of the zygomatic arch (Dautrey procedure), articular eminence grafting procedures, and metallic obstacles (bone miniplates, mesh, and screws) – Soft tissue surgery: capsular plication, lateral pterygoid myotomy and temporalis scarification, temporal fascial flap, and anterior disc positioning – Tethering procedures: limitation of joint translation by tethering the condyle to the zygomatic arch