Keynote - "Destructed TMJ, how do we correct the form and function? "

Destruction of the TMJ has many reasons. Trauma, inflammatory disease, and tumors are the main reasons for the often painful but also functional debilitation process that may have a profound psychological influence on a patient, mostly due to chronic pain, limiting the joy of eating, and the prolonged process before functional rehabilitation can take place. The reason for the destructive process, as well as the functional disturbance, dictates the process of conservative management, minimally invasive surgery, as well as more invasive reconstructive interventions. Conservative management, where possible, should be the first line of treatment in cases where ablative surgery is not indicated. Too early an intervention and too many surgical interventions may be detrimental to the healing process and may accelerate the destructive process with an increase in chronic pain. When this line of treatment has been exhausted, depending on the functional and structural deficit, reconstructive procedures can be considered. When the condyle could be stabilised, rather than use it as a base to correct the occlusion by orthognathic surgery procedures, or even utilize osseodistraction. When ablative surgery is indicated or if the measures mentioned before have failed, consideration should be given to more definitive reconstructive options like free bone transplants, free vascular tissue transfer, or, as a last option, total joint replacement. It is imperative to consider all treatment options, based on the underlying pathology, structures that may still be utilized, and the influence of previous and future treatment that may influence your reconstructive efforts. This presentation will walk you through the minefield of the destructed TMJ, giving guidelines based on the literature and a wide base of experience and case presentations.