Case Study 19-1: Arthroplasty of the Right TMJ S.A., a 38-year-old teacher, was admitted for surgery for degenerative joint disease (DJD) of her right temporomandibular joint (TMJ). She has experienced chronic pain in her right jaw, neck, and ear since her automobile accident the previous year. S.A.’s diagnosis was con fi rmed by CT scan and was followed up with conservative therapy, which included a bite plate, NSAIDs, and steroid injections. She had also tried hypnosis in an attempt to manage her pain but was not able to gain relief. Her doctor referred her to an oral surgeon who specializes in TMJ disorders. S.A. was scheduled for an arthroplasty of the right TMJ to remove diseased bone on the articular surface of the right mandibular condyle. On the following day, she was transported to the OR for surgery. She was given general endotracheal anesthesia, and a vertical incision was made from the superior aspect of the right ear down to the base of the attachment of the right earlobe. After appropriate dissection and retraction, the posterior-superior aspect of the right zygomatic arch was bluntly dissected anteroposteriorly. With a nerve stimulator, the zygomatic branch of the facial nerve was identi fi ed and retracted from the surgical fi eld with a vessel loop. The periosteum was then incised along the superior aspect of the arch. An inferior dissection was then made along the capsular ligament and retracted posteriorly. With a Freer elevator, the meniscus was freed, and a horizontal incision was made to the condyle. With a Hall drill and saline coolant, a high condylectomy of approximately 3 mm of bone was removed while conserving function of the external pterygoid muscle. The stump of the condyle was fi led smooth and irrigated copiously with NSS. The lateral capsule, periosteum, subcutaneous tissue, and skin were then closed with sutures. The facial nerve was tested before closing and con fi rmed to be intact. A pressure pack and Barton bandage were applied. The sponge, needle, and instrument counts were correct. Estimated blood loss (EBL) was approximately 50 mL. S.A. was discharged on the second postoperative day with instructions for soft diet; daily mouth opening exercises; an antibiotic (Ke fl ex 500 mg po q6h); Tylenol no. 3 po q4h prn for pain; and four weekly postoperative appointments. CASE STUDY QUESTIONS Select the best answer and write the letter of your choice to the left of each number.