Temporomandibular joint disc repositioning by modified anchorage surgery

The appropriate position and morphologic preservation of the disc are critical to prevent excess remodeling and degenerative changes within the temporomandibular joint. The paper reviews the history of surgical approaches to disc displacement and presents a modified technique of temporomandibular joint disc reposition developed by the authors. Seven key points are highlighted that are essential for the success of the proposed arthroscopic intervention. The anterior release should be complete, with avoidance of any damage to the masseteric nerve and vessels. Expansion of the upper joint space to ensure appropriate placement of the incision should be performed with the straight ramus retractor used to distract the mandible and injecting saline, which helps prevent cutting of the disc or cartilage when entering the fossa. The disc should be repositioned without any tension. Two mattress sutures (one medial and one lateral) should be placed at the border of the disc and the posterior band. The disc is fixed with one bone anchor which is sufficient for its further stability. The position of the disc should be overcorrected to avoid relapse. Autogenous fat grafting in the anterior release region is vital to lessen scarring and thus to improve long term outcomes. All steps of the proposed technique are discussed with comparison with previous approaches. Factors influencing a relapse and measures to prevent it are reviewed in detail.