Disease of the Temporomandibular Joint, Surgical Reconstruction, Clinical & Experimental Studies

Authors:
Professor Raja Kummoona, Fellow of the Royal College of Surgeons of England (FDSRCS),Emeritus professor of Maxillofacial Surgery of Iraqi Board for Medical Specializations, Fellow Royal Society of Medicine, Research Fellow Royal college of Surgeons of England for the years (1975-1977),President of Iraqi Dental Society for the years (1977-1985),Registrar Primary FDSRCS (Royal College of Surgeons of England) in Iraq for the years(1985-1990),the most distinguish professor of University of Baghdad for the years 1991-1992,one of 40 top scientist in Iraq awarded gold medal for 3 years 2000-2002 by presidential celebration ,he had many publication and contribution to science by advocating many surgical procedures and research in cancer surgery and flap reconstruction, TMJ surgery and Maxillofacial injuries, Orbit tumors& injuries ,missile war injuries of the face with advancing surgery of war injuries of the face worldwide. With contribution in research in cancer, The finder of post graduate studies in maxillofacial surgery in Iraq. Editor of book, Neck Dissection, Clinical Application and Recent Advances, Feb 2012, In Tech, Editor monograph of ,Surgical Reconstruction of the Temporo-mandibulr Joint,2013 ,Germany. Member of editorial Board of Annals of Oral&Mxillofacial Surgery, Journal of Pediatric Oncology(Open Access) and Journal of Surgery(Open Access).
Description:
Reconstruction of the Temporo-mandibular joint (TMJ) represent a challenge for all craniofacial and maxillofacial surgeons for the last 4 decades, many disease of the TMJ were not fully understood in the west (like TMJ ankylosis), since they do not see much of these cases as in the Middle east because the standard of health education to understand the basic roles for managements of traumatic injuries of the TMJ is absent.

In the south of Arab land as in Yemen, Somalia and Sudan, people daily habit of chewing Qat which is the main cause for destruction of the TMJ structures featuring, recurrent dislocation and subluxation of the TMJ.

Great advances carried out by pioneers in TMJ surgery to understand the pathogenesis of these destructive disease of the TMJ by advocating many surgical procedures and techniques for reconstruction of the TMJ by using either autogenously tissue or metals such as 2 part prosthesis or sialastic (Rubber Silicon) or temporalis muscle flap for treatment of ankylosis or by using different techniques for managements of subluxation and dislocation including seclerosing materials like STD or by reinforcement by placation of the capsule or by reconstruction of the capsule by finger like temporal fascia flap or making an obstacle by augmentation of the zygomatic root of temporal bone by bone graft from iliac crest. Using Botox A injection to the upper part of lateral petrygoid muscle to delay the action of the muscle connected to the disc, to stabilize the disc and to prevent further movement of the condyle forward behind the articular eminence to prevent clicking of the disc and to prevent unpleasant noises.

Other diseases of the TMJ that required reconstruction such as hemi facial microsomia or first arch dysplasia syndrome and hypoplasia of the condyle, these cases either the TMJ reconstructed by autogenous tissue like costo-chondral graft or by chondro-ossous graft, these two procedures were used for managements of ankylosis of the TMJ in children and for reconstruction of the TMJ in other congenital or inquired disease.

In cases of hemi facial microsomia which required a series of operations for correction of cleft of the angle of the mouth, reconstruction the atrophied masseter muscle by platysma muscle flap, removal or excision of tags in front of the ear as remnants of Meckels cartilage fallowed by reconstruction of the TMJ by Chondro-Ossous graft from iliac crest after reconstruction of the glenoid fossa by cartilage from the ear and reconstruction of zygomatic arch by bone graft from iliac crest.

Experimental studies on Iris Monkeys or Rabbit were of great value for application of these new surgical procedures on humans.

All these procedures and techniques did great progress to surgery of the TMJ and also we got the ability to understand the pathology of these diseases.

We hope to present to our colloquies worldwide the fruit of our long and valuable experience and to share with them this knowledge and experience and we hope we did contributions to science.
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