Temporomandibular joint disc reduction and fixation

As early as the beginning of the 20th century, European and Japanese scholars had used endoscopy for knee joint examination. By the early 1970s, small synovial joint endoscopy was carried out due to the appearance of small arthroscopy. In 1975, Daxi Zhengjun first reported the endoscopic technique and clinical research of the temporomandibular joint. At that time, it did not attract widespread attention until the mid-1980s. Temporomandibular joint endoscopic observation can directly observe the surface of the joint cavity and joint structure, especially the morphological changes of the synovial membrane, which is of great value in the diagnosis of temporomandibular joint disease. It is an examination method such as X-ray, CT and magnetic resonance imaging. Can not be replaced. Temporomandibular arthroscopy is also a treatment that allows the introduction of microsurgical instruments into the joint cavity and the intracapsular surgery under endoscopic direct vision. This type of therapeutic arthroscopy has developed rapidly in recent years, such as joint adhesion and lavage, intracapsular sacral dressing, anterior discectomy, articular disc reduction, disc distraction , intra-articular soft tissue laser and electrocautery, subserosal sclerotherapy, etc. have been used in clinical, have a good therapeutic effect on temporomandibular joint disease, especially early disorders of internal disorders, and less trauma than open joint surgery, Postoperative reaction is light and function recovery is fast, so temporomandibular arthroscopy is of great value in the treatment of temporomandibular joint disorders. Treatment of diseases: temporomandibular joint dislocation Indication 1. Displacement of the joint disc. 2. The sacral subluxation. Contraindications The disc is displaced with the deformer. Preoperative preparation 1. Preoperative patients should be treated with non-surgical treatment. Patients with symptoms that cannot be improved can be treated with arthroscopy. 2. Shave the skin on the hairline 10cm in the ear, pay attention to clean the ear and the external auditory canal. 3. Prepare special surgical equipment for scrubbing and disinfection. Arthroscopy and optical fiber can be fumigated in 40% formalin glass jar for 12h. Metal equipment is sterilized by high pressure steam. The camera can be disinfected. It is connected to the arthroscope to achieve isolation and reduce camera wear. Surgical procedure 1. Complete upper arthroscopic examination, adhesion release and lavage (see "Joint adhesion release and lavage"). 2. When the adhesion has been loosened, the articular disc has been restored by arthroscopy, the disc can be reset, that is, a blunt inner core needle is inserted into the trocar, and the double plate area of the articular disc is pushed back. Pressing, while the assistant grips the mandible to pull down, forward and opposite sides, so that the axillary space is increased, and the articular disc can be retracted backward and reset. If the degree of motion of the articular disc has not been restored, the anterior discectomy should be performed first, that is, the surgical cannula puncture is performed at the third puncture point before the joint nodule, and the proximal joint disc is observed after the anterior tibial attachment of the synovium. The front belt is about 2mm. The synovial membrane and the muscle fibers on the upper part of the pterygoid muscle are cut with a joint knife to reduce the tension before the disc to increase the mobility of the shifting disc, and then the disc is reset. 3. In order to enhance the stability of the articular disc after resetting and prevent re-displacement, the articular disc can be fixed by electrocoagulation, laser ablation or injection of a hardener in the double plate area to cause scar contraction under direct vision; Through the articular disc traction suture, a special needle is used to pass through the articular disc tissue, the suture is introduced, and the skin is knotted, and the disc is pulled and fixed at a later position. 4. After the operation, the joint cavity was lavaged with a large amount of normal saline, and 12.5 mg of strong prednisone and strong pine was injected into the joint. The puncture trocar was taken out and the wound was wrapped. complication 1. Cheek swelling Due to the leakage of perfusate into the surrounding soft tissue during surgery, it usually disappears after 2 days. 2. Bleeding According to the anatomical measurement, the distance from the posterior point of the tragus to the superficial temporal artery is 8 to 15 mm, and the 80% arthroscopic puncture point is located 8 to 17 mm before the apex of the tragus. Therefore, the puncture has the risk of damaging the superficial blood vessels, and the superficial temporal artery wall It is thick and elastic, and the chance of injury is very small. The wall of the superficial vein is thin, and the trocar can be damaged when it is puncture. When puncture is clinically performed, pay attention to the needle insertion point and avoid touching the superficial blood vessels by touching the finger. If the bleeding or hematoma occurs in the stab wound, immediately put the gauze on the hand for a while, and if necessary, percutaneous suture can stop the bleeding. In addition, the small blood vessels in the joint capsule are damaged by bleeding, and they can disappear by irrigating and pressing. 3. Facial nerve branch injury After arthroscopic surgery, there may be symptoms of disappearance of the frontal pattern or closed eyes, which are mostly temporary and can be self-healing in a short period of time. The cause may be related to the injury during puncturing of the trocar, the swelling of the cannula during surgery, and the swelling of the lavage fluid to the tissue surrounding the joint. 4. External ear canal and middle ear injury The posterior wall of the superior cavity is adjacent to the external auditory canal, and the cartilage portion of the external auditory canal is inclined forward, so that the trocar puncture may cause perforation of the cartilage of the external auditory canal. Once perforation occurs, the patient may have pain in the external auditory canal, and bleeding in the external auditory canal may be seen during the examination. If there is no autonomic reaction in patients with general anesthesia, if the surgeon mistakes the feeling of falling through the external auditory canal as a penetrating joint capsule, continuing to advance the trocar may cause perforation of the tympanic membrane, so the trocar puncture should be tilted forward 20 °, and pay attention to the depth to prevent ear complications. 5. Other Such as the skull base through, epidural hematoma, permanent facial paralysis, etc. are occasionally reported, mostly due to incorrect operation methods.