Anaesthetic implications of temporomandibular joint disease

The purpose of this article is to review the functional anatomy of the temporomandibular joint (TMJ) mechanism in man, to discuss the various types of TMJ dysfunction and to suggest a plan for assessment, anaesthesia and airway management when reconstructive or unrelated surgery is required. Patients with restricted mouth opening, who require critical care treatment of severe upper airway obstruction or impending ventilatory failure are a special risk group. Regional anaesthesia or the use of a laryngeal airway should be considered. When tracheal intubation is essential and mouth opening is less than 25 mm, it is unlikely that the larynx will be visualized by direct laryngoscopy. Fibreoptic intubation is then indicated. All patients with severe TMJ dysfunction require assessment by an oral surgeon.