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  Discussion on Treatment for Temporomandibular Joint (TMJ) Infection and Arthritis
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DrO

Posted on Friday, Oct 27, 2006 - 10:32 am:

Though rare, treatment for advanced disease of the TMJ joint has not been successful and leads to euthanasia. Here is a report where the joint is simply removed leaving the end of the mandible on the infected side just floating. One year after surgery the horse was doing well. For more on diagnosis and treatment see the article Disorders of the Mouth and Teeth accessible from the navigation bar above.
DrO

Vet Surg. 2006 Oct;35(7):663-668
Mandibular Condylectomy and Meniscectomy for the Treatment of Septic Temporomandibular Joint Arthritis in a Horse.

Nagy AD, Simhofer H.
From the Clinic for Surgery and Ophthalmology, Equine Department, University of Veterinary Medicine, Vienna, Austria.

Objective- To report use of mandibular condylectomy for treatment of advanced degenerative joint disease of the temporomandibular joint (TMJ) caused by sepsis. Design- Clinical case report. Animals- Two-year-old Noriker filly. Methods- Computed tomography (CT) was used to confirm advanced degenerative joint disease of the left TMJ and for follow-up after mandibular condylectomy and removal of necrotic meniscus. Results- Painful swelling (3 weeks duration) with drainage located just caudal to the left lateral canthus of the eye was associated with atrophy of the left masseter muscle, masticatory problems, and inappetence. There was incisor malocclusion with a 1.4 cm resting lateral mandibular deviation to the right and inability to open the mouth more than a few centimeters. Left mandibular condylectomy combined with meniscectomy and thorough debridement of the septic left TMJ resulted in resolution of clinical signs and complete return of function. Streptococcus zooepidemicus, intermediately resistant to penicillin and subsequently to enrofloxacin, was isolated from the wound. Regeneration of a mandibular "pseudocondyle" was evident on CT at 4 months. At 4 months and 1 year the filly had maximal mouth opening >10 cm and no malocclusion. Conclusion- Mandibular condylectomy can be used to facilitate management of septic TMJ arthritis. There was no radiologic or clinical evidence of TMJ ankylosis >1 year after meniscal removal. Clinical Relevance- Mandibular condylectomy, including meniscectomy, is an acceptable treatment option for advanced TMJ septic arthritis and allowed return of normal masticatory function.
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