high temporomandibular joint arthroplasty

Temporomandibular joint high-level angioplasty is suitable for the limitation of joint stiffness between the joint socket and the condyle. Treatment of diseases: temporomandibular joint rigidity Indication Temporomandibular joint high-level angioplasty is suitable for the limitation of joint stiffness between the joint socket and the condyle. Contraindications 1. False or extra-articular rigidity. 2. Joint stiffness combined with suppurative otitis media, surgery can be performed after inflammation control. Preoperative preparation 1. Routine bilateral X-ray examination to determine the location, nature and extent of the lesion, and to identify no external joint adhesion lesions, in order to make a preoperative design. 2. Pay attention to check the presence or absence of secretions in the external auditory canal. Patients with otitis media should be treated first. 3. Plan to put the inserts in the operation, prepare the insert materials in advance, and disinfect them for use. Regular blood matching. Surgical procedure 1. Incision and exposure A cane-shaped incision is made in front of the ear to expose the joint capsule (see "Tempulus of the temporomandibular joint surgery"), and then a T-shaped or angular incision is made on the surface of the joint capsule, and the bone surface is peeled off to fully reveal the normal structure of the bone adhesion lesion and surrounding area. 2. Osteotomy A section of bone that is about 0.5 to 1 cm is cut off between the plane of the condyle and the condyle of the condyle, and the osteotomy is as high as possible according to the extent of the bone adhesion. Generally, the lower part of the bone ball is taken as the osteotomy line. First drill two rows of small holes in the carrier bone, then use the emerald chisel and flat chisel to cut the bone between the holes. When approaching the medial bone plate, use a bone chisel to shake it apart, then pull the mandible down and use a rongeur to bite the thickened bone at the cranial side. 3. Trimming the osteotomy gap Use the rongeur to repair the broken end of the bone, so that the broken end of the mandibular ascending branch is rounded, paying special attention to remove the spur of the medial margin, so that the width of the deep and shallow plane of the osteotomy is uniform. 4. Place the insert It has been suggested that a wide osteotomy gap is formed so that the two ends are no longer in contact and no interstitial is placed in the osteotomy gap. However, most scholars advocate placing interpolated objects in the osteotomy space. The purpose is to: 1 isolate the bone cross-section, prevent re-adhesion of the broken ends of the bone, and reduce recurrence; 2 fill the osteotomy space, restore the height of the mandibular ascending branch, and prevent jaw opening. The condylar neck osteotomy can be inserted into different autologous tissues and heterogeneous materials. The interposition method varies with the insert. For example, the following is the case: 1 fascia intervalal approach: the arc-shaped part of the cane-shaped incision is upward Make an auxiliary incision, turn the epidermis, and use the superficial temporal artery as the pedicle to form a 5cm × 3cm fascia with a superficial fascia. Turn the flap over, insert the free end face down, insert it into the osteotomy space, and deep with the gap. The suture fixation of the face and the anterior and posterior tissues allows the bone section to be isolated. 2 Silicone rubber interposition method: The silicone cap is prepared before operation, and the height of the cap is about 1.5cm, and it is disinfected for use. Use a little trimming, put it on the condylar end, and fix it with wire. Alternatively, a thin silicone sheet may be used to wrap the braided tip, or the silica gel block may be trimmed into a suitable shape and padded between the osteotomy sections. Since the silicone rubber is not combined with the tissue and has a fibrous film formed around it, it serves to isolate the bone cross section. 3 Titanium plate method: Take a 2.5cm × 2cm titanium plate before surgery, about 1mm thick, drill two holes at one end of the plate, trim the four corners, and disinfect for use. During the operation, the titanium plate is shaped according to the newly formed joint socket shape, and the end of the hole is bent, so that the steel plate is fitted to the joint socket and the outer edge of the joint socket, and the titanium plate is fixed on the joint nodules and the outer edge of the joint socket by screws. Or fixed by wire ligation. In addition, the inter-titanium plate can be used simultaneously with the insertion of the iliac fascia flap to isolate the section. 5. Stitching and dressing Rinse, stop bleeding, layer suture wound, pressure bandage. Place the rubber sheet for drainage if necessary. complication 1. Respiratory obstruction The rigidity of the pharyngeal cavity is narrow. After the osteotomy, especially in patients with bilateral joint stiffness, the pharyngeal cavity is further reduced due to the mandibular retreat. If the anesthesia cannula is removed after the operation, it is easy to remove the anesthesia. Suffocation occurs after falling. In addition, pediatric patients, due to blind intubation injury or long operation time, are also prone to laryngeal edema and cause airway obstruction. Therefore, it must be completely awake before extubation, at the same time prepare for tracheostomy, and actively prevent laryngeal edema, to avoid airway obstruction. 2. After the operation of the open jaw and mandibular oblique joint, the fulcrum is shortened, the fulcrum is moved forward, and the mandible is rotated backward. The bilateral patients develop open jaw, and the unilateral side mainly shows the mandibular to the affected side. Skewed. The open jaw can be improved by intermaxillary traction, and the mandibular deviation can be corrected with a beveled guide. 3. Postoperative wound infection Joint stiffness surgery If infection occurs, it may lead to postoperative recurrence. Therefore, skin preparation must be done before surgery, and strict aseptic operation should be performed during operation to actively prevent wound infection. After the operation, the wound should be closely observed, and the local swelling should be noticed. The signs of infection should be treated in time. For example, the whole body should be switched to broad-spectrum antibiotics, local drainage, blood accumulation, and effusion. If the wound has been purulent, it should be drained in time. If the foreign material is inserted, it should be taken out. 4. Recurrence of joint rigidity According to reports in the literature, the recurrence rate is between 10% and 25%. The recurrence is the most in 1 to 2 years after surgery, and the chance of recurrence tends to decrease with the prolongation of time. The cause of recurrence is not fully understood, but it is closely related to the patient's age, surgical methods, and techniques.