Prevention of the Complication
Open TMJ Surgery
During open TMJ surgery careful surgical dissection is essential to minimize the potential risk of violating the middle cranial fossa. Certain complex surgical cases that involve the joint space, joint ankylosis, or traumatic injury of the fossa can increase the risk of iatrogenic perforation. Careful presurgical workup with a preoperative CT or MRI scan has become standard and can help in identifying areas that would be of concern in patients with erosive changes, joint ankylosis, or tumors. The use of virtual surgical planning or navigation surgery along with surgical precision can help to minimize the risk of violating the middle cranial fossa during dissection and bone removal in and around the glenoid fossa.
Arthroscopic TMJ Surgery
During arthroscopic surgery, it is important to be aware of angulation as well as depth of the instruments at all times. Directing the instruments toward the articular eminence and not toward the glenoid fossa can prevent complications associated with perforation of the roof of the glenoid fossa. As discussed in the earlier part of the chapter, close attention needs to be directed to puncture site, direction, depth, and force.