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Post Operative TMJ
P-L Westesson, MD, PhD, DDS Neuroradiology
University of Rochester, Rochester, NY
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 1 of 25
Normal TMJ
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 2 of 25
•! Disc Displacement Arthritis
Disorders Affecting the TMJ
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 3 of 25
Treatment of TMJ Disorders
•! Self limiting disease - 50% •! NSAID and Muscle relaxants - 25% •! Oral Appliances - 20% •! Surgery - 1-2%
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 4 of 25
TMJ Surgery •! Arthroscopic lysis and lavage •! Disc Reposition •! Mandibular Osteotomy •! Discectomy •! Disc Replacement Implant •! Rib grafts •! Total Joint Prosthesis
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 5 of 25
Athroscopic Surgery
•! Do not change compared to presurgical imaging
•! No special postoperative imaging features
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 6 of 25
Disk reposition Before
After
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 7 of 25
Disk reposition does not works so well
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 8 of 25
Discectomy •! Removing the disk via a
small preauricular incision
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 9 of 25
MRI after succesful Discectomy
•! Decreased joint space •! No disk •! No adhesions •! Diskectomy has 85% 6-
year succesrate for eliminating pain
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 10 of 25
Discectomy Specimen
Posterior Anterior
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 11 of 25
MRI after Failed Diskectomy
Intra Articular Adhesions Capsule Adhesions
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 12 of 25
MRI after Failed Diskectomy
Coronal Lateral Capsule adhesions
Sagittal Complete Fibrous Ankylosis
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 13 of 25
TMJ Implant
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 14 of 25
MRI of TMJ Implant Closed Mouth
Open Mouth
Proplast-Teflon Implant
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 15 of 25
Typical Joint Condition for TMJ Implant
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 16 of 25
Typical Condition Predisposis for implant
Failure
Preoperative MRI
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 17 of 25
Silastic Implants after functioning 2-3 months
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 18 of 25
Sequella of TMJ Implant
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 19 of 25
Sequella of TMJ Implant
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 20 of 25
Mandibular Osteotomy
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 21 of 25
Disk Repositioning via mandibular Osteotomy
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 22 of 25
Before
After
Vertical Ramus Osteotomy - can be used to correct disk displacement
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 23 of 25
Mandibular Osteotomy
•! Requires intermaxillary fixation
•! Extra articular procedure
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 24 of 25
TMJ Reconstruction with Rib Graft in Failed TMJ surgery
Presentation material is for education purposes only. All rights reserved. ©2002 URMC Radiology Page 25 of 25