Parotid Gland

Parotid gland tissue is typically encountered during TMJ TJR surgery. Care should be observed during dissection, retraction, instrumentation, and use of power equipment to avoid injury to parotid tissue. Injury to this tissue can result in the contamination of the surrounding host bone, tissue, and device components with potentially bacteria laden saliva [30].

TMJTJR Components

Direct contamination of the devices before implantation from improper handling in the operating room environment or indirect contamination from the skin, ear flora, or saliva during multiple “try ins” of templates and/or device components can result in infection. Mercuri and Psutka state that it appears prudent to soak the components and then copiously irrigate the surgical access wounds with antibiotic or antibacterial solution before closure [12].

Hemostasis, Irrigation and Drains

Intraoperatively and before wound closure, the surgeon must ensure that adequate hemostasis has been achieved to prevent the formation of a hematoma. Hematomas have been implicated not only in the development of infections [32] but also in the need for revision surgery after TJR [33]. Copious irrigation with saline or antibiotic solution to remove any clotted blood, soft tissue, and bony fragments before wound closure is extremely important in decreasing the potential for a postoperative infection. The author considers the use of drains as a potential source of contamination and prefers meticulous attention to hemostasis to the use of either active or passive drains [30].