Page 367 - Demo

Summary in English and Dutch36514This thesis aimed to develop and research a patient-specific total temporomandibular joint prosthesis, which would not only meet the orthopedic standards set for both wear properties and adverse tissue reactions but would also provide improved functionality through the reattachment of the lateral pterygoid muscle. In addition, we hypothesized that the experience and knowledge gained through this research would also lead to the development of new, improved, per- and post-operative protocols.The 1st chapter discussed the complex anatomy of the TMJ with attention to the peri-articular surgical and anatomical landmarks. The indications for a total joint replacement were highlighted and the surgical approaches used to access the joint were elaborated upon. The TMJ is a highly complex diarthrosis, that is comprised of the head of the mandibular condyle and the temporal glenoid fossa, which are enveloped by a fibrous capsule with a synovial lining. The joint is divided into a superior and inferior compartment by a fibrocartilaginous disc, allow rotational movement in the inferior compartment and translational movement in the upper compartment. Four muscles insert directly onto the joint, three of which are responsible for closing of the mouth, whereas the lateral pterygoid muscle allows for laterotrusive and protrusive movement. These movements are limited by both the capsular tissue and the articular ligaments.When the indications for a surgical replacement are met, an extraoral approach is considered as the preferred approach. Whilst a retro- or endaural approach can be considered, the preauricular approach is usually opted for. Several modifications to this approach have been described, all aiming for better exposure of the joint. During this procedure, one must not neglect the presence of the facial nerve and its temporofacial branch, nor the auriculotemporal nerve, when gaining access to the joint. In addition, when performing the condylectomy, the surgeon must be mindful of the medial meningeal artery. In addition to the auricular approach, a submandibular approach is used for proper exposure of the mandibular angle and ramus. Attention to the cervical facial branch must be given when performing this dissection.Nikolas de Meurechy NW.indd 365 05-06-2024 10:15