Systemic Disease Control

As with the implantation of any device into medically compromised patients, it is essential that any risk-related systemic pathology be under control before surgery. Conditions affecting the immune system including diabetes should be optimized prior to any surgery. Any dosage and/or medication modifications should be made in consultation with the patient’s physician.

Smoking

Cigarette smoking is associated with inhibited wound healing and decreased circulation to the skin due to microvascular obstruction from platelet aggregation and increased nonfunctioning hemoglobin. In addition, smoking has been found to compromise the immune system and the respiratory system [20]. Smoking should be discontinued 6-8 weeks before surgery. In a randomized study, participation in a preoperative smoking cessation program was found to reduce postoperative complication rates. No wound-related complications occurred in the patients who stopped smoking before surgery [21, 22]. Furthermore, in an experimental study, the use of transdermal nicotine patches during smoking cessation did not impair wound healing [23].

Preexisting Remote Site Infections

Infections at a site remote from the TJR have been linked to a three- to fivefold increase in surgical site infection rates [24]. The most common sources of blood- borne infection are the skin, urinary, and respiratory tracts. Therefore, any remote infections should be identified and managed before TMJ TJR. It is not uncommon for multiple dental extractions to be required in order for oral infections to be eliminated preoperatively. Although the underlying evidence is weak, it is advisable to perform dental extractions before TMJ TJR [25].

There are several operative variables that are thought to influence the risk of TJR infection that are amenable to intervention by the surgeon and operative team.