TMJ 'dysfunction' - Health implications

This procedure uses a transpalatal distractor (TPD) inserted onto the palate at the region of the first molar. Using a nasal endoscope for visualization, midpalatal osteotomy is performed with a piezo-electric blade. The midpalatal osteotomy is carried out from the posterior nasal spine (PNS) at the junction between the nasal septum and nasal floor with the blade angling towards the midline. The entire osteotomy is performed with the piezoelectric blade cutting through the nasal mucosa and bone while taking care to avoid injuring palatal mucosa.

Furthermore, in the posterior tuberosity the pterygomaxillary suture is separated with a piezoelectric blade avoiding injury to the intraoral mucosa. The ANS and bone in between the roots of the central incisors is not disturbed. The TPD is activated for 1.5 mm at the completion of the osteotomy to facilitate separation of the mid palatal suture.

The TPD is activated between five and seven days after surgery by 0.3 mm per day. The expansion process is deemed complete when no further clinical improvement with continual expansion is observed or when there has been 7 mm of expansion. Once expansion is completed, the TPD is locked and removed under local anesthesia two months later.

The reported advantages of TPD are that it has numerous advantages compared to that of other surgical widening techniques:
• It is dramatically less invasive.
• It minimises patient trauma, pain and swelling.
• It is a single-stage operation in which the distractor is placed at the same time as the bone operation.
• It does not require an incision at the front part of the mouth.
• It results in a smaller gap between the front teeth (usually 2-3 mm) that can be eliminated easily using orthodontics.
• It achieves opening of the entire nasal airway, especially the back of the nose and palate.

It is mainly used for the treatment of sleep apnoea but has the potential of a much wider application orthodontically.

If any practitioner of this technique wishes to supply any pre and post-op photographs and contact info for referrals it is most welcome.