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Dr. Barry Eppley

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Archive for the ‘temporomandibular joint’ Category

Clinic Snapshots – TMJ Arthroplasty Scar

Wednesday, March 15th, 2017


Dysfunction of the temporomandibular joint (TMJ) is one of the most common causes of head and neck pain. Inside the joint is a working relationship between the condylar head (ball) and the glenoid fossa (socket) which is separated by a meniscus or disc. This thick fibrous structure allows the ball of the joint to rotate within as well as move out of the bony socket. Disruption of smooth meniscal movement is what causes clicking or joint noise to occur which can cause pain and, in more severe cases, limitation of condylar movement affecting mouth opening.

Treatment of these internal menisco-condylar derangements of the TMJ is mainly conservative. Anti-inflammatory drugs, rest, physical therapy and oral splints eventually resolve most symptoms. But some few patients will not improve and will progress to more significant internal joint problems such as meniscal sticking or dislocation which can ultimately require surgery.

TMJ surgery for meniscal dysfunction is most popularly treated by arthroscopy. Arthroscopy, however, has significant limitations in a joint that is about the size of your thumbnail. Such a small space limits what can be done to mainly fluid infusion to hopefully create release of adhesions. (adhesiolysis) In my experience an open TMJ arthroplasty is more versatile and allows a greater number of technical manuevers to e done to both the meniscus and the bone.

Open TMJ Arthroplasty incision Dr Barry Eppley IndianapolisOpen TMJ arthroscopy is more invasive than arthroscopy but if done well and in experienced hands it has no greater risks. A well placed incision offers an aesthetic outcome that would make the surgery very hard to detect. Borrowing from the preauricular portion of facelift surgery, the incision is made in a retrotragal fashion. This keeps the central portion of the resultant scar hidden both during the healing phase as well as with the final healed scar. (three week incision line results using a dissolveable suture closure)

By good incision placement in the natural attachments of the ear to the face, TMJ arthroplasty surgery can be done with good aesthetic results.

OR Snapshots – TMJ Glenoid Fossa Implant Removal

Saturday, December 24th, 2016


The temporomandibular joint (TMJ) creates the articulation between the lower jaw and the skull. It allows the mandible to open and close and creates the capability for the only moveable bone in the entire craniofacial skeleton. The TMJ is about the size of one’s thumb and is composed of a ball (condyle of mandible) and socket. (glenoid fossa of the temporal bone) Hence the term, temporomandibular joint)

Like all joints in the body, the TMJ is equally prone to degenerative changes by age-related osteoarthritis and the more aggressive immunologic disorder of rheumatoid arthritis. When significant condylar erosion has occurred, the joint may need to be rebuilt. This can be done by either an autologous approach using costocbondral rib grafts or the prosthetic approach of a total TMJ joint replacement system.

The TMJ joint replacement system borrows from the orthopedic joint replacement world with a metal condylar prosthesis and a high density polyethylene-based glenoid fossa insert. This glenoid fossa implant is attached along the temporal bone in front of the ear and has a cup shape that sits in and replicates that natural bony glenoid fossa. The metallic condylar prosthesis then fits into the fossa implant, recreating the ball and socket of the TMJ.

This 73 year-old female had a total TMJ replacement done 15 years for her severe rheumatoid arthritis and jaw dysfunction. Over the past year she developed some intermittent pain and drainage from the left ear canal. Multiple ENT physicians examined her ear and could not find any source for her ear drainage and pain.

tmj-joint-replacement-removal-dr-barry-eppley-indianapolisKnowing that she had a prosthetic TMJ replacement right in front of her ear canal, a connection was suspected between it and the ear canal problems. The prosthetic glenoid fossa implant was removed and a fistulous tract was found between its posterior flange and the ear canal. A dermal-fat graft was placed into space left by the glenoid fossa implant.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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