Temporomandibular Joint Surgery for Internal Disorders: Decompression of the Superior Joint Space

Internal disordees of the temporo-mandibular joint are an important area, represented by 20% of the maxillofacial surgeon's practice today. The patients with ITATM who would merit a surgical procedure, would represent 1 to 3% of the population worldwide, represented in its great majority by women. For their relief, they have been used from minimally invasive palliative procedures, to open surgery to obtain a definitive correction.

This work will demonstrate the cornerstone of the definitive treatment through open surgery. It will do this by showing how to achieve internal decompression of the two most important affected structures of the temporo-mandibular joint, the articular meniscus (AM) and the mandibular condyle, through total decompression of the entire surface of the AM from the upper compartment and the articular tubercle eminectomy. It is a mechanical effect of movement and compression. The approach proposed is the Bat Wing, a modified retro-auricular approach without sectioning the external auditory canal (EAC), since it is done by providing 5 cm of space from the starting point of the EAC to the front part of the articular tubercle, without damaging the seventh frontal cranial branch nerve or tearing the AM or the joint capsule.

ITDMJ interventions were performed on 84 patients, 81 women and 3 men.

The asymptomatic percentage with zero pain among the patients operated on was 94% of the total, with a success rate of 100%, on 79 patients. Light post-operative clicking was experienced by 26 patients, or 30%. Recurrence occurred in 6% of the sample, or 5 patients. Compulsory anxiety disorders and bipolarity were presented in all 5, of whom 3 had attempted suicide, and 3 also were associated with fibromyalgia. A total of 165 joints were operated on over 7 years.

The online version contains supplementary material available at 10.1007/s12663-022-01693-7.