High condylectomy and/or eminectomy under local anesthesia for medically compromised patients with habitual dislocation of the temporomandibular joint

摘要

Surgery for habitual dislocation of the temporomandibular joint (TMJ) is usually performed under general anesthesia. We modified the procedure to allow us to use local anesthesia on 49 TMJs in 27 medically compromised patients (mean age: 82.7 years). Under local anesthesia combined with intravenous sedatives, a vertical skin incision, 2 cm in length, was made directly above the articular eminence. Subcutaneous tissue was gently divided to expose the lateral joint capsule, followed by entry into the superior compartment and shaving of the eminence in a conventional manner. Additional high condylectomy was performed in 7 TMJs in 4 patients who were re-operated for recurrence (2 cases) or simultaneously applied for uncontrolled dislocation (2 cases) by eminectomy alone. These procedures were successfully accomplished without serious complications. The mean operation time was 41 min per joint. There was no distinct facial nerve palsy post-operatively.