Temporomandibular Joint Disorders: Principles and Current Practice

Foreword
Preface
Contents
List of Contributors
About the Editor
1: Temporomandibular Joint from the Pyramids to Total Joint Replacement and Beyond
	References
2: Importance of Identification of Temporomandibular Joint Disorders and Appropriate Referral
	References
3: Anatomy and Basic Biomechanics of the Temporomandibular Joint
	3.1	 Introduction
	3.2	 Embryology of Temporomandibular Joint
	3.3	 Anatomy of TMJ
	3.4	 Articular (Bone) Surfaces
	3.5	 Articular Disc/Meniscus
	3.6	 Cartilage, Synovium and the Ligaments
	3.7	 Retrodiscal Tissue
	3.8	 Blood Supply
	3.9	 Nerve Supply
	3.10	 Musculature
		3.10.1	 Masticatory Muscles Controlling the Mandibular Movement (Figs. 3.9, 3.10, and 3.11)
		3.10.2	 Supra Hyoid Muscle Group Aiding the Mandibular Movement (Figs. 3.11 and 3.12)
	3.11	 Post-Natal Growth of Temporomandibular Joint
	3.12	 Biomechanics of Temporomandibular Joint
	References
4: Incidence of Temporomandibular Joint Pathology and Disorders
	4.1	 Introduction
	4.2	 Epidemiology of TMDs
	4.3	 Incidence for fractures of the TMJ
	4.4	 Incidence for tumors associated with the TMJ
	4.5	 Conclusion
	References
5: Understanding Temporomandibular Joint Disorders
	5.1	 Etiology of Temporomandibular Disorders
		5.1.1	 Trauma
		5.1.2	 Anatomical Factors
		5.1.3	 Pathophysiologic Factors
		5.1.4	 Psychosocial Factors
	5.2	 Intra-Articular Disorders of TMJ
		5.2.1	 Joint Pain
			5.2.1.1	 Arthralgia
			5.2.1.2	 Arthritis
		5.2.2	 Joint Disorders
			5.2.2.1	 Disc-Condyle Complex Disorders
				Disc Displacement with Reduction (Fig. 5.3)
				Disc Displacement with Reduction with Intermittent Locking (Fig. 5.3)
				Disc Displacement without Reduction with Limited Opening (Fig. 5.4)
				Disc Displacement without Reduction without Limited Opening (Fig. 5.4)
			5.2.2.2	 Hypomobility Disorders
				Adherence/Adhesions
				Ankylosis
					Etiopathology of Ankylosis
					Fibrous Ankylosis
					Osseous Ankylosis
			5.2.2.3	 Hypermobility Disorders
				Subluxation (Partial Dislocation)
				Luxation (Dislocation, Open Lock)
					Types of Dislocation
		5.2.3	 Joint Diseases
			5.2.3.1	 Arthritides of the Temporomandibular Joint
				Traumatic Arthritis
				Osteoarthritis
				Osteoarthrosis
				Rheumatoid Arthritis
				Osteoarthritis Vs Rheumatoid Arthritis
				Juvenile Idiopathic Arthritis
				Psoriatic Arthritis
				Ankylosing Spondylitis
				Reiter Syndrome
				Septic (Infectious) Arthritis
				Metabolic Arthritis
				Systemic Arthritides Associated with Connective Tissue Diseases
			5.2.3.2	 Condylysis (Idiopathic Condylar Resorption)
			5.2.3.3	 Osteochondrosis Dissecans
			5.2.3.4	 Osteonecrosis
			5.2.3.5	 Neoplasm
			5.2.3.6	 Synovial Chondromatosis
		5.2.4	 Fractures
			5.2.4.1	 Sources of Condylar Injuries
			5.2.4.2	 Classification of Condylar Fractures
			5.2.4.3	 Diagnosis/Management
		5.2.5	 Congenital/Developmental Disorders
			5.2.5.1	 Aplasia
			5.2.5.2	 Hypoplasia
			5.2.5.3	 Hyperplasia
	5.3	 Masticatory Muscle Disorders (Extra-Articular)
		5.3.1	 Etiologic Factors for Myogenous TMD [78, 79]
		5.3.2	 Pathophysiology of Masticatory Myogenous Pain [78, 79]
		5.3.3	 Muscle Pain Limited to Orofacial Region
			5.3.3.1	 Myalgia [16, 83]
				Local Myalgia
				Myofascial Pain with Spreading
				Myofascial Pain with Referral
			5.3.3.2	 Tendonitis
			5.3.3.3	 Myositis
			5.3.3.4	 Spasm
		5.3.4	 Contracture
		5.3.5	 Hypertrophy
		5.3.6	 Neoplasm
		5.3.7	 Movement Disorders
			5.3.7.1	 Orofacial Dyskinesia [16, 83]
			5.3.7.2	 Oromandibular Dystonia [16, 83]
		5.3.8	 Masticatory Muscle Pain Attributed to Systemic/Central Disorders
			5.3.8.1	 Fibromyalgia
			5.3.8.2	 Centrally Mediated Myalgia
	5.4	 Headache Disorders
		5.4.1	 Headache Attributed to TMD
	5.5	 Associated Structures
		5.5.1	 Coronoid Hyperplasia
	References
6: Clinical Evaluation of the Temporomandibular Joint
	6.1	 Introduction
	6.2	 Clinical Examination
		6.2.1	 Ergonomics for Patient and Operator
		6.2.2	 Stabilization of Head/Cervical Spine
		6.2.3	 Inspection of TMJ
		6.2.4	 Palpation of TMJ
		6.2.5	 Range of Motion (ROM)
		6.2.6	 Mid-Line Shift
			6.2.6.1	 Extra-Capsular Source
			6.2.6.2	 Intra-Capsular Source
		6.2.7	 End Feel
		6.2.8	 Joint Sound
		6.2.9	 Examinations when Crepitation is Felt for Clinical Diagnosis
		6.2.10	 Muscle Examination
			6.2.10.1	 Temporalis Muscle
			6.2.10.2	 Masseter Muscle
			6.2.10.3	 Geniohyoid Muscle
			6.2.10.4	 Digastric Muscle
			6.2.10.5	 Sternocleidomastoid
			6.2.10.6	 Posterior Cervical Muscles and Other Structures
			6.2.10.7	 Trigger Points
			6.2.10.8	 Referred Pain
			6.2.10.9	 Functional Manipulation
		6.2.11	 Auscultation of the TMJ
		6.2.12	 Percussion for TMJ Examination
		6.2.13	 Intraoral Examination
		6.2.14	 Other Methods of Clinical Assessment of TMJ
	6.3	 Goals of Examination
	6.4	 Case History Format (For a Temporomandibular Joint Disorder Patient)
	References
7: Temporomandibular Joint Imaging in Health and Disease
	7.1	 Introduction
	7.2	 Hard Tissue Imaging of TMJ
	7.3	 Reverse Towne View (Open Mouth) (Fig. 7.1)
	7.4	 Mandibular Lateral Oblique Projections (Fig. 7.2)
	7.5	 Sub-Mentovertex (SMV) Projection
	7.6	 Trans-Pharyngeal View (Infra-Cranial/McQueen Dell Technique) (Fig. 7.3)
	7.7	 Trans-Orbital View (Zimmer Projection) (Fig. 7.4)
	7.8	 Transcranial View (Fig. 7.5)
	7.9	 Panoramic Imaging (Orthopantomogram/OPG) (Figs. 7.6 and 7.7)
	7.10	 TMJ Tomogram: Open/Closed Mouth (Fig. 7.8)
	7.11	 Conventional Tomography
	7.12	 Cone Beam Computed Tomography (CBCT)
	7.13	 Arthrography
	7.14	 Ultrasonography (USG) (Fig. 7.9)
	7.15	 Computed Tomography
	7.16	 Magnetic Resonance Imaging (MRI)
	7.17	 Imaging in Diseases
		7.17.1	 Articular Disc Displacement (Fig. 7.10a–d)
		7.17.2	 Degenerative Joint Diseases (Fig. 7.11a, b)
		7.17.3	 Rheumatoid Arthritis (RA)
		7.17.4	 Juvenile Rheumatoid Arthritis
		7.17.5	 Septic Arthritis (Infectious Arthritis) (Fig. 7.12)
	7.18	 Articular Loose Bodies
	7.19	 Injury to the Temporomandibular Joint
		7.19.1	 Effusion (Fig. 7.13)
		7.19.2	 Fracture of TMJ
		7.19.3	 Neonatal/Paediatric Condyle Fracture
		7.19.4	 Dislocation (Luxation) of the Condyle (Fig. 7.14)
	7.20	 Ankylosis (Fig. 7.15a–c)
	7.21	 Tumours of TMJ
	7.22	 Developmental Disturbances of TMJ (Figs. 7.16a&b, 7.17, 7.18a&b)
	7.23	 Nuclear Medicine Studies (Fig. 7.19)
	7.24	 Newer Advancements
	7.25	 Goals for Imaging
	Appendix
	References
8: Psychological Assessment for Temporomandibular Joint Disorders
	8.1	 Introduction
	8.2	 Aetiology
	8.3	 Diagnostic Criteria
	8.4	 Conclusion
	References
9: Non-surgical and Pharmacological Management of the Temporomandibular Joint Disorders
	9.1	 Introduction
	9.2	 Non-surgical Therapy
		9.2.1	 Patient Education/Cognitive Awareness Training
		9.2.2	 Diet Modification
		9.2.3	 Dental Occlusion
		9.2.4	 Occlusal Appliance Therapy
		9.2.5	 Physiotherapy
			9.2.5.1	 Passive Jaw Exercise
			9.2.5.2	 Active/Assisted Jaw Exercises
			9.2.5.3	 Isometric Exercises
		9.2.6	 Thermal Therapy
		9.2.7	 Ultrasonography
		9.2.8	 Phonophoresis
		9.2.9	 Iontophoresis
		9.2.10	 Electrical Stimulation
		9.2.11	 Muscle Injection
		9.2.12	 Stress Reduction Techniques
		9.2.13	 Acupuncture
		9.2.14	 Psychotherapy
		9.2.15	 Pharmacotherapy
			9.2.15.1	 Analgesics
			9.2.15.2	 Selective Cox-2 Inhibitors
			9.2.15.3	 Corticosteroids
			9.2.15.4	 Opioids
			9.2.15.5	 Anxiolytics
			9.2.15.6	 Muscle Relaxants
			9.2.15.7	 Anti-Depressants
			9.2.15.8	 Anti-Histamines
			9.2.15.9	 Anticonvulsants
			9.2.15.10	 Injectable Medications
	9.3	 Summary
	References
10: Occlusion and Temporomandibular Joint Disorders
	10.1	 Introduction
	10.2	 Origin of Occlusion
	10.3	 Various Concepts of Occlusion
		10.3.1	 Gnathological Concept
		10.3.2	 Schuyler’s Concept
		10.3.3	 Wiskott and Belser’s Concept
		10.3.4	 Hobo’s Twin Table Concept
		10.3.5	 Hobo’s Twin Stage Concept
	10.4	 Types of Occlusion
		10.4.1	 Dawson’s Classification
		10.4.2	 Unilaterally Balanced Occlusion/Group Function
		10.4.3	 Long Centric Occlusion
		10.4.4	 Mutually Protected Occlusion
		10.4.5	 Optimum Occlusion
	10.5	 Determinants of Occlusion
	10.6	 Aetiology of TMDs
	10.7	 Occlusal Indicators
	10.8	 Methods of Occlusal Corrections
		10.8.1	 Position of the Mandible
		10.8.2	 Canine Protected Occlusion (Group Function Occlusal Scheme)
		10.8.3	 Group Function
		10.8.4	 Tripodal Cusp Contacts
		10.8.5	 Occlusal Adjustments to Remove Traumatic Occlusion
		10.8.6	 Avoidance/Correction of Occlusal Interferences
		10.8.7	 Centric Interference
		10.8.8	 Working Side Interference
		10.8.9	 Non-working Side Interference
		10.8.10 Protrusive Interference
	10.9	 Occlusal Consideration for Dental Implants
	10.10	 Role of Tekscan (T-Scan) in Occlusion and TMJ Disorders
	10.11	 Applications of T-Scan in Dentistry
	10.12	 Terminologies [4]
	References
11: Occlusal Splint Therapy in Temporomandibular Disorders
	11.1	 Introduction
	11.2	 Definition
	11.3	 Splint Types, Uses, Indications, Contraindications and Theories
	11.4	 Stabilization Appliance
		11.4.1	 Duration for Wearing the Splint
		11.4.2	 Review of Literature
	11.5	 Anterior Repositioning Appliance (ARA)/Orthopaedic Repositioning Appliance
		11.5.1	 Review of Literature
	11.6	 Soft/Resilient Appliance
		11.6.1	 Review of Literature
	11.7	 Anterior/Posterior Bite Plane
		11.7.1	 Review of Literature
	11.8	 Pivoting Appliance (Distraction Splint)
		11.8.1	 Review of Literature
	11.9	 Permissive Splints (Muscle Deprogrammers)
		11.9.1	 Non-permissive Splint (Directive Splints)
		11.9.2	 Pseudo-permissive Splints
	11.10	 Materials Used for Fabrication of Occlusal Splints
	11.11	 Mechanism of Action of Occlusal Splint Therapy
		11.11.1 Goals of Treatment
	References
12: Synovial Fluid Analysis for Temporomandibular Joint Disorders
	12.1	 Introduction
	12.2	 Synovial Fluid
	12.3	 Synovial Fluid in TMJ Disorders
	12.4	 Sample Collection
	12.5	 Synovial Fluid Analysis in TMJ Disorders
	12.6	 Micro-organisms in Synovial Fluid
	12.7	 Conclusion and Future Directions
	References
13: Surgical Classification for Temporomandibular Joint Disorders
	13.1	 Introduction
	13.2	 The Importance of a Surgical TMJ Classification
	13.3	 Essential Criteria for a Practical Classification (Table 13.1)
	13.4	 Category 1: TMJ Arthralgia (Table 13.3)
	13.5	 Category 2: TMJ Minor Changes (Table 13.4)
	13.6	 Category 3: TMJ Moderate Changes (Table 13.5)
	13.7	 Category 4: TMJ Severe Changes (Table 13.6)
	13.8	 Category 5: TMJ Catastrophic Changes (Table 13.7)
	13.9	 Discussion
	References
14: Surgical Approaches to the Temporomandibular Joint
	14.1	 Introduction
	14.2	 Surgical Anatomy
		14.2.1	 Facial Nerve (Fig. 14.1)
		14.2.2	 Auriculotemporal Nerve (Fig. 14.2)
		14.2.3	 Parotid Gland (Fig. 14.2)
		14.2.4	 External Auditory Canal (Figs. 14.2 and 14.3)
		14.2.5	 Superficial Temporal Vessels (Fig. 14.2)
		14.2.6	 Masseteric Vessels
		14.2.7	 Layers of Temporoparietal Region
	14.3	 Classification of Approaches
	14.4	 Approaches and Incisions
		14.4.1	 Approach to the Joint Proper
			14.4.1.1	 Preauricular
			14.4.1.2	 Preauricular—Blair 1917 [4] (Fig. 14.5a)
			14.4.1.3	 Preauricular Incision—Thoma (1945) (Fig. 14.5b, b1 and b2)
			14.4.1.4	 Standard Preauricular Incision—Dingman 1946 (Fig. 14.5c)
			14.4.1.5	 Preauricular—Dingman 1966 [6], 1974 (Fig. 14.5d, e, e1)
			14.4.1.6	 Straight Line Preauricular Incision—Rowe and Killey 1968 (Fig. 14.5f)
			14.4.1.7	 Preauricular with Temporal Extension—Al Kayat and Bramley 1979 [1] (Fig. 14.5g, g1)
			14.4.1.8	 Preauricular with Lazy “S” Modification (Fig. 14.5h, h1 and h2)
			14.4.1.9	 Endaural Approach (Fig. 14.6)
			14.4.1.10	 Post-auricular Approach [10] (Fig. 14.7)
			14.4.1.11	 Sub-mandibular (Fig. 14.8a–c)
			14.4.1.12	 Endoscopic Approach
		14.4.2	 Exposure of Joint Space and Disc
		14.4.3	 Dissection Planes
			14.4.3.1	 Suprafascial, Subfascial and Deep Subfascial Dissections (Fig. 14.10)
	14.5	 Approaches for the Management of Condylar Fractures
		14.5.1	 Retromandibular Approach (Fig. 14.11a, b)
		14.5.2	 Periangular Approach (Fig. 14.12a–c)
		14.5.3	 Rhytidectomy Approach [11] (Fig. 14.13)
		14.5.4	 Access Osteotomies (Fig. 14.14)
	14.6	 Choosing the Ideal Incision
	References
15: Internal Derangements of Temporomandibular Joint
	15.1	 Introduction
		15.1.1	 Various Types of Disc Displacement
	15.2	 Aetiology of Internal Derangement
	15.3	 Diagnosis of ID of TMJ
		15.3.1	 Clinical Examination
	15.4	 Imaging in ID of TMJ
	15.5	 Management of ID of TMJ
		15.5.1	 Conservative or Non-surgical Management
			15.5.1.1	 Patient Education
			15.5.1.2	 Pharmacological Management
			15.5.1.3	 Thermotherapy
			15.5.1.4	 Physiotherapy
			15.5.1.5	 Intraoral Appliance
			15.5.1.6	 Occlusal Splints
			15.5.1.7	 Diagnostic Blocks
			15.5.1.8	 Ultrasound Therapy
			15.5.1.9	 Trans-cutaneous Electrical Nerve Stimulation (TENS)
			15.5.1.10	 LASER (Light Amplification by Stimulated Emission of Radiation)
			15.5.1.11	 Acupuncture
		15.5.2	 Surgical Treatment
			15.5.2.1	 Arthrocentesis
			15.5.2.2	 Arthroscopy
			15.5.2.3	 Diagnostic Arthroscopy
			15.5.2.4	 Surgical Arthroscopy
			15.5.2.5	 Open Surgical Methods
			15.5.2.6	 Disc Plication
			15.5.2.7	 Discopexy
			15.5.2.8	 Discectomy (Meniscectomy) Without Replacement
			15.5.2.9	 Discectomy with Replacement
			15.5.2.10	 Condylotomy
			15.5.2.11	 Orthognathic Surgery
	15.6	 Conclusion
	15.7	 Definitions
	References
16: Temporomandibular Joint Trauma
	16.1	 Introduction
	16.2	 Incidence of Condyle Fracture
	16.3	 Aetiology
	16.4	 Mechanism of Injury
	16.5	 Pathophysiology
	16.6	 Classification of Condylar Fractures
		16.6.1	 Lindhal’s Classification
		16.6.2	 Classification proposed by Strasbourg Osteosynthesis Research Group (Loukota et al., 2005) (Fig. 16.2)
		16.6.3	 Classification for Management of Sub-condylar Fractures
	16.7	 Diagnosis of TMJ Injuries
		16.7.1	 Imaging of TMJ Injuries
	16.8	 Treatment of Condylar Fractures
		16.8.1	 Conservative Management
		16.8.2	 Surgical Management of Condyle Fractures
	16.9	 Approaches for Open Reduction and Internal Fixation of Condyle
	16.10	 Soft Tissue Injuries of Temporomandibular Joint
	16.11	 Conclusion
	References
17: Temporomandibular Joint Ankylosis
	17.1	 Introduction
	17.2	 Aetiology
	17.3	 Pathogenesis
	17.4	 Classification of TMJ Ankylosis
	17.5	 Clinical Features
	17.6	 Growth Deformity
	17.7	 Investigations
	17.8	 Management of TMJ Ankylosis
	17.9	 Surgical Procedure
		17.9.1	 Anaesthesia
		17.9.2	 Brisement Forces
		17.9.3	 Approaches to TMJ
		17.9.4	 Condylectomy
		17.9.5	 Gap Arthroplasty
		17.9.6	 Interpositional Grafts
		17.9.7	 Reconstruction Using Autogenous Grafts and Alloplastic Prosthesis
	17.10	 Post-operative Care
	17.11	 Distraction Osteogenesis in TMJ Ankylosis
	17.12	 Complications
	17.13	 Conclusion
	References
18: Temporomandibular Joint Hypermobility Disorders
	18.1	 Introduction
	18.2	 Clinical Examination
	18.3	 Pathogenesis of TMJ Hypermobility
	18.4	 Radiographic Examination
	18.5	 Management of Hypermobility of TMJ
		18.5.1	 Conservative Method
			18.5.1.1	 Conventional Intraoral Technique (Nélaton’s Maneuver or the Hippocratic Technique)
			18.5.1.2	 External Method (Ardehali et al.)
			18.5.1.3	 Gag Reflex
		18.5.2	 Minimally Invasive Methods
			18.5.2.1	 Autologous Blood Injection
			18.5.2.2	 Sclerotherapy/Injection of a Sclerosing Agent
			18.5.2.3	 Botulinum Toxin Injection
			18.5.2.4	 Prolotherapy
		18.5.3	 Surgical Methods
			18.5.3.1	 Creation of Muscular Balance
				Lateral Pterygoid Myotomy
				Temporalis Scarification
			18.5.3.2	 Capsulorrhaphy
			18.5.3.3	 Open Surgical Methods
				Eminectomy
				Dautrey’s Procedure (Fig. 18.6)
				Mechanical Obstruction with Mini-plate Placement
				Wolford’s Procedure
	18.6	 Goals of Treatment
	Appendix
	References
19: Arthrocentesis of the Temporomandibular Joint
	19.1	 Introduction
	19.2	 Pathophysiology
	19.3	 Arthrocentesis
	19.4	 Classification
		19.4.1	 Double-Puncture Arthrocentesis (DPA)
			19.4.1.1	 Technique
		19.4.2	 Single-Puncture Arthrocentesis (SPA)
			19.4.2.1	 Technique
	19.5	 Arthrocentesis with Irrigation Pump
	19.6	 Arthrocentesis with Intrarticular Injection
	19.7	 Summary and Conclusion
	19.8	 Consideration for Arthrocentesis of TMJ
	References
20: Fundamentals of Temporomandibular Joint Arthroscopy
	20.1	 Introduction
	20.2	 Arthroscopic Anatomy of TMJ
	20.3	 Armamentarium
	20.4	 Patient and Surgeon Positioning
	20.5	 Surgeon’s Position
	20.6	 Arthroscopic Technique
	20.7	 Complications
	20.8	 Indications and Contraindications
	20.9	 Advantages of TMJ Arthroscopy
	20.10	 Limitations for TMJ Arthroscopy
	20.11	 Advanced Arthroscopy for TMJ
	20.12	 Other Additional Arthroscopic Treatment Modalities
	References
21: Temporomandibular Joint Arthroscopy Using Operative Single-Cannula Arthroscope
	21.1	 History and Goals
	21.2	 Temporomandibular Joint (TMJ) Anatomy
	21.3	 Temporomandibular Joint Disorders
		21.3.1	 Diagnosis
		21.3.2	 Treatment Options
	21.4	 Indications for Arthroscopy
	21.5	 Contraindications
	21.6	 Surgical Tools
		21.6.1	 The Arthroscope
		21.6.2	 Cannulas
		21.6.3	 Probes
		21.6.4	 Graspers and Biopsy Forceps
		21.6.5	 Spinal Needles
		21.6.6	 Laser
	21.7	 OSCA Technique
		21.7.1	 One-Track Arthrocentesis
		21.7.2	 Standard Arthrocentesis under Visualization
		21.7.3	 Visually-Guided OSCA
		21.7.4	 Surgical Interventions Using the OSCA Technique
			21.7.4.1	 Release of Anterior and Posterior Recess Adhesions
			21.7.4.2	 Synovectomy
			21.7.4.3	 Anterior Release
			21.7.4.4	 Posterior Scarification/Contracture
	21.8	 Advantages and Disadvantages of OSCA
	21.9	 Intraarticular Drug Delivery Via OSCA
		21.9.1	 Steroids
		21.9.2	 Botulinum Toxin A
		21.9.3	 Hyaluronic Acid
		21.9.4	 Platelet Concentrates (PC)
	21.10	 Patient Management After OSCA
		21.10.1 Anti-Inflammatory and Pain Management
		21.10.2 Antibiotics
		21.10.3 Diet
	21.11	 Complications of Traditional Arthroscopy Versus OSCA
	References
22: Alloplastic Total Joint Reconstruction for the Temporomandibular Joint
	22.1	 Introduction
	22.2	 Alloplastic Prosthesis for Joint Replacement
	22.3	 Factors for Assessment
	22.4	 Patient Selection for TMJ TJR
	22.5	 Radiographic Evaluation
	22.6	 Components of Alloplastic Prosthesis
	22.7	 Alloplastic Prosthesis Design for TMJ TJR
	22.8	 Surgical Technique
	22.9	 Alloplastic Prosthesis in Young/Growing Patient
	22.10	 Prophylactic Anti-biotics for Dental Procedures
	22.11	 Identification of Risk Factors for Infection
	22.12	 Pre-operative Factors
	22.13	 Intra-operative Factors
	22.14	 Post-operative Factors
	22.15	 Complications
	22.16	 Recommended Sterilization Protocol for the Prosthesis and Its Components
	22.17	 Conclusion
	References
23: Syndromes Affecting Temporomandibular Joint
	23.1	 Introduction
	23.2	 Syndromes Associated with Craniofacial Anomalies of Genetic Origin
		23.2.1	 Chromosomal Disorders
		23.2.2	 Single Gene [Monogenic] Disorders
		23.2.3	 Multi-Factorial Disorders
	23.3	 TMJ and Associated Syndromic Conditions
	23.4	 TMJ Syndrome (Referred in occasional literature for TMD)
		23.4.1	 Introduction
		23.4.2	 Aetiology
		23.4.3	 Clinical Features
	23.5	 Ehlers–Danlos Syndrome (EDS)
		23.5.1	 Introduction
		23.5.2	 Aetiology
		23.5.3	 Clinical Features
	23.6	 Goldenhar Syndrome [Oculo-Auriculo-Vertebral Syndrome/Hemifacial Microsomia (HM)]
		23.6.1	 Introduction
		23.6.2	 Aetiology
		23.6.3	 Clinical Features
	23.7	 Treacher Collins Syndrome (Mandibulofacial Dysostosis, Bauru Type)
		23.7.1	 Introduction
		23.7.2	 Aetiology
		23.7.3	 Clinical Features
	23.8	 Hallermann–Streiff Syndrome
	23.9	 Crouzon Syndrome (Craniofacial Dysostosis)
		23.9.1	 Introduction
		23.9.2	 Aetiology
		23.9.3	 Clinical Features
	23.10	 Apert’s Syndrome (Acrocephalosyndactyly)
	23.11	 Sapho Syndrome
		23.11.1 Clinical Features
	23.12	 Jacob Disease
	23.13	 McCune–Albright Syndrome
	23.14	 Osteopathia Striata with Cranial Sclerosis
	23.15	 Pierre Robin Syndrome
	23.16	 Proteus Syndrome (Wiedemann Syndrome)
	23.17	 Beckwith–Wiedemann Syndrome
	23.18	 Hurler Syndrome
	23.19	 Trismus-Pseudocampylodactyly Syndrome (Hecht–Beals Syndrome)
	23.20	 Klippel–Trénaunay Syndrome
	23.21	 Other Less Common Syndromes
		23.21.1 Carey-Fineman-Ziter Syndrome (CFZS)
		23.21.2 PASH Syndrome
	23.22	 Goals of Treatment
	References
24: Paediatric Temporomandibular Joint Disorders
	24.1	 Introduction
	24.2	 Epidemiology
	24.3	 Aetiology
	24.4	 Diagnosis
		24.4.1	 Palpation of Muscles
		24.4.2	 Palpation of TMJ
		24.4.3	 TMJ Imaging
	24.5	 Embryology of TMJ
	24.6	 Classification
	24.7	 Congenital Hypoplasia/Aplasia
	24.8	 Acquired Hypoplasia
	24.9	 Condylar Hyperplasia
	24.10	 Bifid Mandibular Condyle
	24.11	 Common Acquired Abnormalities of Temporomandibular Joint in Children and Adolescents
		24.11.1	 Juvenile Idiopathic Arthritis
		24.11.2	 Idiopathic Condylar Resorption
		24.11.3	 TMJ Ankylosis
	24.12	 Conclusion
	References
25: Complications with Temporomandibular Joint Surgery
	25.1	 Introduction
	25.2	 Complications from Nerve Injury
		25.2.1	 Facial Nerve Injury
		25.2.2	 Inferior Alveolar Nerve Injury
		25.2.3	 Auriculotemporal Nerve Injury
	25.3	 Auriculotemporal Syndrome (Frey’s Syndrome)
	25.4	 Trigeminocardiac Reflex
	25.5	 Haemorrhage
		25.5.1	 Management of Haemorrhage
	25.6	 Injury to Ear and Middle Cranial Fossa
	25.7	 Aural-TMJ Communication or Fistula (Pre-auricular Sinus/Surgical Site Infection)
	25.8	 Salivary Gland Complications
	25.9	 Heterotrophic Bone Formation, Reankylosis
	25.10	 Infection of Alloplastic Joint
	25.11	 Malposition of the Prosthesis
	25.12	 Loosening of Prosthesis
	25.13	 Instrument Breakage
	25.14	 Allergic Reaction
	25.15	 Malocclusion
	25.16	 Miscellaneous
	25.17	 Conclusion
	References
26: Role of Distraction Osteogenesis in Restoration of Ramus-Condyle Unit
	26.1	 Introduction
	26.2	 History of TDO
	26.3	 Pre-surgical Evaluation and Planning
	26.4	 Imaging Modalities
	26.5	 Surgical Procedure for TDO to Restore RCU
	26.6	 Distraction Histiogenesis
	26.7	 Principle Involved
	26.8	 Advantages and Limitations
	26.9	 Goals of Treatment
	References
27: Fibreoptic Intubation for Patients Undergoing Temporomandibular Joint Surgery
	27.1	 Introduction
	27.2	 Aetiology for Difficult Intubation
	27.3	 Intubation Techniques for TMJ Surgery with Restricted Mouth Opening
	27.4	 Procedure for Fibreoptic Intubation (Figs. 27.1, 27.2, 27.3, 27.4 and 27.5)
	27.5	 Conclusion
	References