LE S LIE B. HE FFEZ, D .M .D ., M .S .
urgery for tem porom an dibular in tern al derangem ents h as undergone a m etam or phosis th a t parallels th e history of knee surgery. The driving force behind th is change is adapting arthroscopy to the TM J.1'3 Specifically, TM J arthroscopy was m ade possible by two technological achievements: ■* the invention of the Hopkins rod lens system in 1960; ■» the developm ent of the fiber optic light system in 1967. In 1970, O hnishi reported his findings of arthroscopy on the cadaver TM J.4 L ater, Hilsabeck and Laskin used an arth ro scopic system to exam ine the rabbit TM J.5Acute inflam m a tory disease, gross dam age to the condyle and disk, chronic synovial inflam m atory change and steroid-induced a rth ro pathy were studied.6 Recently, diagnostic param eters for internal derangem ents were established by comparing arthroscopic findings w ith im aging diagnoses.1'9 Sanders and others popularized arth ro scopic tre a tm e n t for closed lock in N orth America.81011 Several arthroscopic surgical techniques were developed and an interna-
ABSTRACT
Arthroscopy offers another tool in diagnosing and treating temporomandibular joint disorders. tional association was estab lished for the fu rth er study of TM J arthroscopy. This article reviews TMJ arthroscopy, current diagnostic param eters and surgical therapy. TM J ARTHRO SCO PY
Arthroscopy is rarely performed for diagnostic purposes only. Diagnostic arthroscopy usually precedes surgical arthroscopy to tre a t intracapsular pathoses such as acute and chronic lim itation of opening (closed lock), sympto m atic hyperm obility and synovial chondromatosis. We select surgery only when the preoperative TM J condition appears to be the direct cause of or a significant component of severe pain/dysfunction th a t interferes w ith the patien t’s daily functions such as talking or eating and when non-surgical
E therapy has failed. Surgical arthroscopy is only considered as an alternative to therapy w hen non-surgical therapy fails to m eet realistic treatm en t objectives such as increasing the m outh opening or m aking it easier to chew food of a regular consistency. Arthroscopy is contrain dicated when a neoplasm is suspected or if th ere is a tendency for bleeding; these medical conditions m ay resu lt in seeding of the neoplasm or in tra-articu lar bleeding (hem arthrosis). The in stru m en ts required to perform arthroscopy include:
urgery for tem porom an dibular in tern al derangem ents h as undergone a m etam or phosis th a t parallels th e history of knee surgery. The driving force behind th is change is adapting arthroscopy to the TM J.1'3 Specifically, TM J arthroscopy was m ade possible by two technological achievements: ■* the invention of the Hopkins rod lens system in 1960; ■» the developm ent of the fiber optic light system in 1967. In 1970, O hnishi reported his findings of arthroscopy on the cadaver TM J.4 L ater, Hilsabeck and Laskin used an arth ro scopic system to exam ine the rabbit TM J.5Acute inflam m a tory disease, gross dam age to the condyle and disk, chronic synovial inflam m atory change and steroid-induced a rth ro pathy were studied.6 Recently, diagnostic param eters for internal derangem ents were established by comparing arthroscopic findings w ith im aging diagnoses.1'9 Sanders and others popularized arth ro scopic tre a tm e n t for closed lock in N orth America.81011 Several arthroscopic surgical techniques were developed and an interna-
ABSTRACT
Arthroscopy offers another tool in diagnosing and treating temporomandibular joint disorders. tional association was estab lished for the fu rth er study of TM J arthroscopy. This article reviews TMJ arthroscopy, current diagnostic param eters and surgical therapy. TM J ARTHRO SCO PY
Arthroscopy is rarely performed for diagnostic purposes only. Diagnostic arthroscopy usually precedes surgical arthroscopy to tre a t intracapsular pathoses such as acute and chronic lim itation of opening (closed lock), sympto m atic hyperm obility and synovial chondromatosis. We select surgery only when the preoperative TM J condition appears to be the direct cause of or a significant component of severe pain/dysfunction th a t interferes w ith the patien t’s daily functions such as talking or eating and when non-surgical
E therapy has failed. Surgical arthroscopy is only considered as an alternative to therapy w hen non-surgical therapy fails to m eet realistic treatm en t objectives such as increasing the m outh opening or m aking it easier to chew food of a regular consistency. Arthroscopy is contrain dicated when a neoplasm is suspected or if th ere is a tendency for bleeding; these medical conditions m ay resu lt in seeding of the neoplasm or in tra-articu lar bleeding (hem arthrosis). The in stru m en ts required to perform arthroscopy include:
