DR CHRISTOPHER LIM
ORAL AND MAXILLOFACIAL SURGEON
Sydney II NSW II Australia
OSTEOARTHRITIS AFTER PRONLONGED DENTAL TREATMENT
This patient sustained an injury to her right TMJ 15 years earlier during a traumatic and prolonged third molar extraction. I suspect there was a rupture of the discal ligaments at the time. The injury was documented at the time and she underwent a multitude of non-surgical therapy to no avail which included physiotherapy, bite splints, and analgesics.
Overtime, her right TMJ deteriorated and progressive developed into a closed lock situation with osteoarthritis.
She presented 15 years after the fact and underwent an arthroscopy in the first instance.
The MRI demonstrated a perforated disc, condylar degeneration, a small fluid buildup due to the chronic inflammatory response. This is classic TMJ osteoarthritis.
She had difficulty in eating and constant pain.
In this image, we can see bone-on bone-contact. Most of the cartilage has been destroyed. There is an osteophyte(bony outgrowth) present with proliferative synovitis(this is where blood vessels are where they shouldn't be).
In this image, the disc remnant is seen that divided the joint into the upper and lower compartments. The disc is torn and destroyed and perforated. There was not much disc left and no typical normal anatomy.
Here we are undertaking a level 2 arthroscopy and "burning"away some of the diseased tissue in order to temporarily return some function. This instrument is called a coblator.
This patient had 3 years of good functional improvement and pain relief after her arthroscopy but then relapsed as expected. Her options were presented: do nothing and manage with analgesia and a myriad of other pain control measures, re-arthroscopy to see if we can have some further temporary relief of pain or a customised total joint replacement for the long term.
We then progressed with a right TMJ Total Joint Replacement as shown below. The patient is now pain free and functions normally. She can eat a steak and apple without issues and has had an optimal recovery.
These images demonstrates the accuracy of the surgery and customisation of the prosthesis. From the image on the left, the prosthesis is an exact fit to the patients anatomy minimising time in the operating theatre and optimising integration of the prosthesis to the bone.