Dr. Florencio Monje
Abstract. Minimally Invasive TMJ Surgery
Minimally invasive surgery is a logical intervention in the teatment of internal derangement. Since other major joints (i.e knee, shoulder) have minimally invasive surgery it was obvious a small and delicate joint as TMJ can obtain benefit with this sort of treatment. By means of arthroscopy we can move through the articular surfaces. We can appreciate different types of synovitis, adhesions, chondromalacia as well as different signs of disc position abnormalities. We can´t forget that we explore the upper compartment of TMJ and otherwhise we study the part of this compartment. For this reason the specificity is higher than sensitivity and we have risk of underdiagnosis with this technique.
In 1986 appears a historical paper. Bruce Sanders showed that the patients improved the symptoms after diagnostic arthroscopy because of washing the joint and moving throughout the articular surfaces. It was the starting point to other more sophisticated techniques. TMJ arthroscopy surgery has become a common procedure, with a great variety of surgical techniques and instruments. Disc-repositioning techniques, capsular release, synovial coagulation, chondroplasty, discoplasty, and fibrous debridement can be performed with manual instruments (forceps, scalpels, scissors, files, probes, and so on) and/or with rotary mechanical shavers, monopolar or bipolar electrocautery, and lasers. We could classify the techniques in three main groups: Lysis and lavage, the most popular and easy method , disc repositioning techniques and others that we could add to previously mentioned techniques. Is there any panacea for the surgical treatment of this complex pathology? The decision making for surgical intervention, arthroscopy for example, must be based primarily upon the combination of the clinical and radiological findings in conjunction with other factors such the impact of the disease on the welfare of the patient and the prognosis of the disease when no treatment is provided.