CC BY-NC-ND 4.0 · Indian J Plast Surg 2008; 41(02): 175-182
DOI: 10.1055/s-0039-1699262
Original Article
Association of Plastic Surgeons of India

Surgery of temporomandibular joint under local anaesthesia

Gajiwala J. Kalpesh
Holy Family Hospital, Bandra; Ramkrishna Mission Hospital, Khar; Saifee Hospital, Charni Road; AYJNIHH, Bandra, Mumbai, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)

ABSTRACT

Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction.

 
  • 1 Dasgupta D.. Endotracheal intubation in bilateral temporomandibular joint ankylosis. Indian J Anesth 1987; 35: 367-73
  • 2 Latto IP, Vaughan RS. editors Difficulties in tracheal intubation. 2. nd ed Philadelphia: WB Saunders; 1997
  • 3 Colmenero C, Esteban R, Albarino AR, Colmenero B. Sleep apnoea syndrome associated with maxillofacial abnormalities. J Laryngol Otol 1991; 105: 94-100
  • 4 Ugboko VI, Aod A, Ho O, Ndukwe KC. Temporomandibular joint ankylosis: A multicenter nigerian study.J Dent Oral Med. 2002 4.
  • 5 Vartak A.. (Plastic surgeon, Mumbai, India) suggested this in a national conference of Association of Plastic Surgeons of India in 1986,in a floor discussion.
  • 6 El-Sheikh E, Medra AM. Management of unilateral temporomandibular ankylosis associated with facial asymmetry. J Craniomaxillofac Surg 1997; 25: 109-15
  • 7 Shah FR, Sharma KR, Hilloowalla RN, Karandikar AD. Anaesthetic considerations of temporomandibular joint ankylosis with obstructive sleep apnoea: A case report. J Indian Soc Pedod Prev Dent 2002; 20: 16-20
  • 8 Naveed M, Syed A. Facilitated blind nasotracheal intubation in paralysed patients with temporomandibular joint ankylosis. J Coll Physicians Surg Pak 2005; 15: 4-6
  • 9 Kulkarni DK, Prasad AD, Rao SM. Experience in fibreoptic nasal intubation for temporomandibular joint ankylosis. Indian J Anaesth 1999; 43: 26-9
  • 10 Gopinath R, Rajender Y, Kumar D, Rao SM. Anaesthesia for temporomandibular joint surgery: A revived technique. Indian J Anaesth 1991; 39: 105-8
  • 11 Weisman H, Wes TW, Elam JO. Use of double nasopharyngeal airways in anaesthesia. Anaesth Analg 1969; 48: 356-8
  • 12 Biswas BK, Bhattacharyya P, Joshi S, Tuladhar UR, Baniwal S. Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening. Br J Anaesth 2005; 94: 128-31
  • 13 Arya VK, Dutta A, Chari P, Sharma RK. Difficult retrograde endotracheal intubation: The utility of a pharyngeal loop. Anesth Analg 2002; 94: 470-3
  • 14 Vas L, Sawant P. A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis. Paediatr Anaesth 2001; 11: 237-44
  • 15 Lesile RB. From something old something new. Anesthesiology 2000; 92: 913
  • 16 Mohamed R, Mark S. Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy. Pediatr Anesth 1997; 7: 349-51
  • 17 Waters DJ. Guided blind endotracheal intubation. Anaesthesia 1963; 18: 158-62
  • 18 Poon YK. Case history number 89: A life-threatening complication of cricothyroid membrane puncture. Anesth Analg 1976; 55: 298-301
  • 19 Schillaci RF, Iacovoni VE, Conti RS. Transtracheal aspiration complicated by fatal endotracheal hemorrhage. N Engl J Med 1976; 295: 488-90
  • 20 Stauffer JL. Complications of endotracheal intubation and trachcostomy. Respir Care 1999; 44: 828
  • 21 Feinberg SE, Larsen PE. The use of pedicled temporalis muscle-pericranial flap for replacement of the temporomandibular joint disc: Preliminary report. J Oral Maxillofac Surg 1989; 47: 142-5
  • 22 Pogrel MA, Kaban LB. The role of a temporalis fascia and muscle flap in temporomandibular joint surgery. J Oral Maxillofac Surg 1989; 48: 142-4
  • 23 Umeda H, Kaban LB, Pogrel MA, Stern M. Long-term viability of the temporalis muscle/fascia flap used for Temporomandibular joint reconstruction. J Oral Maxillofac Surg 1993; 51: 530-3
  • 24 Keams GJ, Perrott DH, Kaban LB. A protocol for the management of failed alloplastic temporomandibular joint disc implants. J Oral Maxillofac Surg 1995; 53: 1240-7
  • 25 Lopez EN, Dogliotti PL. Treatment of temporomandibular joint ankylosis in children:Is it necessary to perform mandibular distraction simultaneously?. J Craniofac Surg 2004; 15: 879-84
  • 26 Chossegros C, Guyot L, Cheynet F, Blanc JL, Gola R, Bourezak Z. etal Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: Long-term follow-up. Br J Oral Maxillofac Surg 1997; 35: 157-60
  • 27 Erden E, Alkan A. The use of acrylic marbles for interposition arthroplasty in the treatment of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2001; 30: 32-6
  • 28 Karaca C, Barutcu A, Menderes A. Inverted T- shaped silicone implant for the treatment of temporomandibular joint ankylosis. J Craniofac Surg 1998; 9: 539-42
  • 29 Markowitz NR, Patterson T, Caputa L. A two-stage procedure for temporomandibular joint disc re placement using free pericranial grafts: Apreliminary report. J Oral Maxillofac Surg 1991; 44: 476-80
  • 30 Matukas VJ, Lachner J. The use of autologous auricular cartilage for temporomandibular joint disc replacement: A preliminary report. J Oral Maxillofac Surg 1990; 48: 348-50
  • 31 Popescu V, Vasiliu D. Treatment of temporomandibular joint ankylosis with particular p to the interposition of full-thickness skin auto transplants. J Oral Maxillofac Surg 1977; 5: 3-14
  • 32 Sawhney CP. Bony ankylosis of temporomandibular joint: Follow-up of 70 patients treated with acrylic spacer interposition. Plast Reconstr Surg 1986; 1: 29-38
  • 33 Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: A report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 166-9
  • 34 Gray′s Anatomy. 38. th ed London: Churchill Livingstone; 2000: 580