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So I wanted to talk about TMJ surgery with jaw surgery. So the two typical areas that we see or the way that we’re involved in the TMJ with jaw surgery is number one significant asymmetry and number two significant resorption which is usually bilateral with arthritis or something called condular resorption where things are shrinking back. So the first example is asymmetry and this comes about from something called condular hyperplasia and one side of the condiles tends to grow more and this is postpubescent when we’re seeing them. There is an earlier uh phase that this can occur in children in the mixed dentition but by the time we’re contemplating jaw surgery they’re fully grown uh mature skeletally mature individuals. This occurs in about 80 to 90% more frequently in women, but it can occur in men as well. It’s likely more common in women because of an estradi or an estrogen component in the cartilagynous top of the condular head begins to grow more and think that it’s still growing. And as it does this, it shifts the lower jaw frequently to the other side down and over. And in a good percentage of patients, the opposite side actually starts appearing a little bit more flattened. The TMJ gets pushed back into the fossa. And about 50% of our patients have symptoms on the opposite side because as the condile goes back, the disc comes forward and they click and pop and have more pain because of the pressure. 50% have symptoms more on the affected side that’s growing. So our philosophy and the way that we treat this is by uh stopping that excess growth and we do that with what’s called a high condilectomy where you shave off the top it looks like the top of an acorn of the condile on the affected side. This enables this single bone with two joints to be equilibrated and we usually will do this at the same time as double jaw surgery in which case we can actually see the condile well seated. We can reposition the condile on the opposite side and address any of the other asymmetries that have since occurred in the upper jaw, lower jaw and chin all concurrently. The one time we may do this in a staged fashion is if a patient has significant symptoms because of this pain and the clicking is just too great that we may uh do a high condilectomy as a first phase or stage allow them to continue their pre-surgical orthodontics and then do double jaw surgery um at that point. The second scenario that we talked about is cases of condular resorption which can be idiopathic again a little more common in women and may be related to estrogen when it’s idiopathic but there can be in Connecticut we see patients with Lyme disease and Lyme arthritis can cause condular resorption we see patients with rheumatoid arthritis and rheumatism that can cause this and other autoimmune disorders but whatever the cause the frequent presentation is that the lower jaw has shrunk back. Um that the chin looks excessively small. That often that it’s a straight line from the chin down to the neck. The upper jaw may be um with an open bite or with excessive overjet, meaning the top teeth are way in front of the bottom teeth. And this needs to be addressed. So the way to address this is where we do total joint replacements. So that arthritic joint part of it is removed. We design custom 3D printed joints that reconstruct um the joints of the lower jaw. Move that in position. Nine times out of 10, we’re also moving the upper jaw at the same time because we need to flatten that accusal plane, what’s called counterclockwise movement. Nine times out of 10 too, we’re moving the chin forward. We may also be doing submental liposuction or liposuction under the neck. And uh this is really an excellent and effective treatment for bilateral temporalmandibular joint resorption with this significant convexity convex profile. And there’s not many people in the states that seem to do this surgery. Um, and we do it, you know, again, incorporating all of the elements that we abide by, which include facial aesthetics, improving the bite, opening the airway, and then obviously in this case, TMJ is one of the uh, first and foremost. So, thanks for listening. If you have any other questions, please check us out on our website. Uh, www.dereksteinbacher.com. Thanks again.

Access to the temporomandibular joint, condyle, and arch is required for numerous purposes: trauma, access to pathology, to perform high condylectomy in cases of condylar hyperplasia, for internal derangement, arthritis, or disk displacement, to name a few.

These images show examples of mandibular asymmetry from condylar hyperplasia, which required treatment. See the 3D plan and the need for the condylectomy, or high condylectomy, on the affected side.

This CT now shows erosion, loss of cortication of the condylar head, and a deep eminence. These cases now show exposure for high condylectomies. In this case, on the right-hand side, you can see the condylar head and exposure.

Here is the condylar head as a specimen, and the neocondyle prior to closure. This shows the before and after on lateral view. Here, in a close-up, you can see how well the scar heals, and it is barely appreciable.

Another similar example: after raising the skin flap, the SMAS flap is being repositioned. In this close-up view, you can see both the condyle, the disc itself, and the eminence. High condylectomy is performed. You can see the trough on the left image, and the condylar specimen that is removed.

This is her scar postoperatively, before and after. Again, it is nearly imperceptible.

Regardless of the indication for exposure to the condyle, temporomandibular joint, eminence, or coronoid, this exposure is effective. Thank you.