*4.7.1 Management of TMJ osteoarthritis*

In mild cases with pain and difficulty of mastication, my colleagues and I administer the intra-articular steroid methylprednisolone (injection of 80 mg 2 ml) to the superior and inferior compartments of the joint. We repeat this technique three times at two-week intervals.

**Figure 1.** *Hippocratic technique for reducing dislocated condyles.*

*Surgical Reconstruction of the Temporomandibular Joint DOI: http://dx.doi.org/10.5772/intechopen.108713*

In severe cases, surgical exploration of the TMJ is applied by full thickness fasciocutaneous flap from the periauricular area with an extension to temporal region as? Flap. An L-shaped incision is made in the capsule to expose the condyle.

Irregularities of the condyle are removed by a pear-shaped surgical bur for removing the abnormal osteophyte, lavage of the joint, and inserting a sialastic implant shaped like the meniscus to prevent any friction between the glenoid fossa and the condyle.

#### **4.8 TMJ dysfunction**

TMJ dysfunction involving clicking of the jaw with or without pain is more prevalent in women than men. Jaw clicking is due to lack of coordination between movement of the disc and head of the condyle caused by hyperactivity of strong lower muscle fibers of the lateral pterygoid muscle with upper fine muscle fibers that attach to the anterior part of the disc. Other causes include irregularities in teeth position and occlusion disturbance. In severe cases, it may be associated with muscle spasm, which can limit mouth opening, deviate the jaw, and cause pain.

Radiological examination can be conducted via arthrography by injecting radiopaque material into the lower compartment of the TMJ to demonstrate reversible or irreversible disc movement and displacement of the disc or inferior-medial movement

#### **Figure 2.**

*a. John Hunter in his book the natural history of the human teeth stated that the condyle is a primary growth center. b. section of a newborn's condyle showing active mesenchymal stem cells. c. newly born rabbit with jaw and facial deformity three months later due to excision of condyle and prove to be a growth center.*

#### **Figure 3.**

*a. A five-year-old female with ankylosis of the left TMJ. b. tomography of the left ankylosed TMJ. c. one year after reconstruction of the TMJ by chondro-osseous graft restoring normal face and normal mouth opening. d. tomography of the TMJ showing normal condyle movement created by chondro-osseous graft.*

of the meniscus. Injection of radiopaque material to lower compartment of the TMJ can demonstrate disc perforation.

MRI has also been used to study changes in the head of the condyle and disc movement; however, MR is used mainly for viewing soft tissue of the TMJ.

Management of early cases of TMJ dysfunction with jaw clicking involves construction of a bite raising appliance to raise the bite or mouth opening between 2 and 3 mm to obtain proper relation between the head of the condyle and the disc where the posterior band of the disc cited on the top of the condyle. The patient should wear the bite *Surgical Reconstruction of the Temporomandibular Joint DOI: http://dx.doi.org/10.5772/intechopen.108713*

#### **Figure 4.**

*Composite of four photos showing an 18-year-old man with ankylosed TMJ. First photo is preoperative and shows limited mouth opening. Second photo shows Kummoona two-part prosthesis replacing the TMJ. Third photo shows xerography X-ray of the jaw demonstrating the two-part prosthesis replacing the TMJ. Fourth photo shows the patient after 10 years with normal mouth opening.*

**Figure 5.**

*a. Baby born with first arch syndrome treated with distraction techniques with poor results. b. photo showing same child at age 4 years. c. CT scan of female child showing missing ramus and zygomatic arch of temporal bone. d. two-year postoperative photo after series of operations.*
