1.       Communication

Temporomandibular Joint Dysfunctions (TMD) are group of disorders affecting the ginglymoarthrodial joint of the mandible and related structures. These disorders can be categorised as myofascial in origin, derangement of the intra-articular disc or related to systemic condition such as osteoarthritis [1]. Non- surgical and surgical modalities have been implemented for the management of TMD including arthroscopy [2] and arthroplasty [3]. In our OMS unit both TMJ arthroscopy and arthroplasty are performed at the operating room under general anesthetic. These two procedures involve preparing the preauricular skin with Betadine and drape in the usual standard sterile fashion. One of the technical challenges in performing such TMJ procedures is the assistant’s role in holding the mandible, via the mouth, for frequent jaw manipulation which deemed to be difficult while maintaining intact drape and sterile environment. To tackle this problem, some surgeons have modified a urology penile dressing and used it to keep the mouth flora isolated from the surgical sterile field, we found this more time consuming and may lead to saliva and secretion contamination during surgery. OptraDam^® plus (Ivoclar vivadent clinical) is a rubber dam device with a flexible rim, used by dentist, to accommodate the lip oral mucosa and provide dry field for dental restorative or root canal procedure. The efficacy of OptraDam^® in isolating the oral environment from the procedure field was tested and reported to be superior compared to other rubber dam modalities [4]. In our practice at University of Manitoba, Canada we have employed OptraDam^® in TMJ arthroscopy and arthroplasty procedures (Figure 1).

OptraDam was placed after patient intubation and just before prepping and draping the patient. The use of OptraDam provided easy access to jaw manipulation, protection of teeth, tongue and lips and prevented cross contamination with the oral flora. We have found it to be a handy flexible tool that is relatively cheaper and time efficient. We found two main limitations for its application: one is that OptraDam contains natural rubber and should not be used in patients with latex allergy; second, when arthroscopy or arthrocentesis procedures done under intravenous sedation and local anaesthetic as an office procedure, on a mouth breathing patient. 

Figure 1: Optradam was easily inserted in the labial and buccal vestibule just after nasal intubation, and ready for use after prepping and draping.

1.       Dworkin S (2010) Research diagnostic criteria for temporomandibular disorders: current status & future relevance. J Oral Rehab 37: 734-743.

2.       Ohnishi M (1980) Clinical application of arthroscopy in the temporomandibular joint diseases. The Bulletin of Tokyo Medical and Dental University 27: 141-150.

3.       Dimitroulis G (2002) A review of 56 cases of chronic closed lock treated with temporomandibular joint arthroscopy. J Oral Maxillofac Surg 60: 519-524.

4.       Kapitán M, Šustová Z, Ivančaková R, Suchánek J (2014) A comparison of different rubber dam systems on a dental simulator. Acta Medica 57: 15-20.