The temporomandibular joint (TMJ) is a dynamic living tissue that connects the jaw joint with the lower jaw with the skull. The jaw joint is a special joint 1 -1.5 cm in front of the ear hole, connecting the lower jaw and the skull, opening and closing the jaw, the joint head of the lower jaw bone in the joint capsule, with a unique cartilage disc, filled with a joint fluid such as oil. It is the structure that allows the lower jaw bone, which is the only movable bone in the face bones, to connect to the head base and move. It plays a very important role in the relationship of the lower and upper jaw bones and in the dental closing system.

What are jaw joint diseases?

• Intra-capsular dysfunction in the jaw joint (painful chewing, restricted and sliding opening, difficulty biting and tearing)
• Jaw locking
• Jaw release
• Head fractures due to trauma
• Birth diseases of the jaw (genetic) aplasia, hypoplasia, hyperplasia
• Tumoral diseases of the jaw
• Cystic diseases of the jaw
• Rheumatic diseases affecting the jaw joint
• Infectious diseases affecting the jaw joint
• Infectious diseases affecting the jaw joint
• Bone ankylosis that develops in the jaw joint
• Jaw joint disc slipping
• Asymmetry at the jaw joints

How is the jaw joint examined?

• Patient anemia
• Inspection of the teeth and closing system
• Inspection of chewing muscles
• Inspection of jaw joint
• Radiological examination

What is a jaw joint disorder?

It is a syndrome characterized by severe pain that holds the chewing muscles with dysfunction in the jaw joint system.

What is Orthognathic Surgery?

Orthognathic surgery is a general term that describes surgeries related to the correction of skeletal and dental disorders in facial bones. Orthognathic surgery is a surgical procedure performed in people who have reached adult age, in cases where the lower jaw and upper jaw are not positioned in the normal position or where the teeth are not ideally seated with each other when the mouth is closed, to bring the jaw and tooth positions to the position where they should be.

Who performs orthogathic surgery?

Orthognathic surgery operations are performed by dentists who are ORAL dental and JAW SURGERY specialists.

How do patients orthognathic surgical processes begin and continue?

Orthognathic surgery requires teamwork. Firstly, the patient should have an orthodonthic and surgical clinical and radiological examination. Oral hygiene is ensured before the operation, if the tooth closure is broken, wire treatment or transparent plaque treatment is performed to bring the teeth to the appropriate position. Then, surgical splints are made to guide during the operation by making a surgical plan. Piezo surgery is performed by applying general anesthesia. After bone healing is achieved, orthodontic treatment is continued and the final routines are performed.

Will I need x-rays and tomography before orthogathic surgery?

Full head graphs of the patient before starting treatment (panoramic, cephalometric, three-dimensional (3D) tomography, etc.) withdrawals are examined. Then a detailed consultation for radiological examination (by the jaw surgeon, orthodontist and dentist) is performed.

Before the treatment, it is necessary to share all the questions about the treatment of the patient with their physicians at this stage. The patient, who is informed in detail about the treatment, follows the treatment plan with the orthognathic surgical team.

To whom is orthognathic surgery performed?

• It is recommended in people whose teeth and jaws do not show proper closure, therefore, chewing and speech functions are insufficient, and facial aesthetics are impaired.
• When the lower jaw is in the front, back, right or left side,
• In cases where one or all of the lower jaw is underdeveloped,
• When the upper jaw is in the front, back, right or left side,
• In the lower part of the upper part,
• The teeth in the upper and lower jaw do not touch each other (open bite),
• If the jaw tip is forward or backward and is small or large,
• If the cheekbones are larger, smaller, front or back than they should be,
• The shape and structure of the jaws due to accident and tumor,

Biting disorder in cases where the relationship between the lower jaw and the upper jaw is not normal – malocclusion occurs. These problems in the teeth and skeletal structure also reflect on facial aesthetics to a different extent. So, the problem here is both functional and aesthetic.

What are the stages of orthognathic surgery?

• Planning (radiological, models, etc.)
• Correction of teeth with orthodontic treatment (1-2 years)
• Surgical planning and guide splint preparation
• Orthognathic piezo surgery (healing approximately 1-2 months)
• End with orthodontic treatment (6-12 months).

What should be considered in orthognathic  surgery planning?

• Problems in chewing, biting and swallowing functions,
• Problems with speech,
• Respiratory problems,
• The position of the jaws relative to each other when in the closed position,
• A hundred things,
• The patient’s wishes and wishes.

What is piezo surgery?

Piezo surgery is the process of performing orthognathic surgery using a special saw (piezoelectric surgical device) that makes bone incisions, ultrasonic vibrations.

What are the benefits of Piezo Surgery?

Due to its micrometric and selective cutting, the piezoelectric surgical device allows for safe and precise osteotomies without causing any osteonecrotic damage to the bone. The device only works effectively on mineralized tissues (bone, cartilage) and does not damage soft tissues such as mucosa, nerve, veins. It positively affects wound healing.

What is a SINGLE mouth operation?

According to the planning result, it is a correction procedure performed by applying piezo orthognathic surgery to only the patient’s jaw (lower or upper jaw).

What does DOUBLE mouth surgery mean?

According to the planning result, it is the correction procedure performed by applying piezo orthognathic surgery to the double jaw (both lower and upper jaw) of the patient. It is applied in patients with extreme skeletal closing disorder.

Should patients be afraid of orthognathic surgery?

Since the surgical application is performed under general anesthesia, the patient is completely unaware of the procedures performed. Of course, as with any surgical procedure, there are complications in orthognathic surgery. Post-operative complications such as pain, percent swelling, bruising, numbness in tissues may disturb the patient in a short period of time. Some complications related to healing can also be permanent. Thanks to the drugs applied after the operation, patient complaints are minimized.

What does orthognathic surgery bring to the patient?

• And a better face,
• An ideal image in jaw and tooth closures,
• Improvement in speech, breathing and chewing functions,
• Positive reflections in patient psychology, depending on these,
• Improved oral health due to tooth closure,
• Better fit for social life.

When will I be discharged from the hospital after orthognathic surgery?

Patients should be monitored for 3-4 days in the hospital environment after surgery. Complications that may occur after surgery will ensure that bleeding, pain control and medication are well controlled. During this time, patients are not allowed to feed by mouth. It will be easier to feed and use drugs through the vein.

Genioplasty; what is jaw tip aesthetics?

A jaw tip aesthetic is called an intervention in the tip of the chin. It is also called genioplasty. Genioplasty surgeries are operations aimed at changing the aesthetic appearance of the jaw tip. With these aesthetic surgeries, the size and length of the jaw tip can be increased or decreased. That is, the jaw tip can be reshaped in accordance with aesthetic norms.

Why is the jaw tip prosthesis applied?

It is used to extend the jaw tip or to provide symmetry. These prosthetics are made from materials such as silicone, titanium or medpor.

What is a jaw tip aesthetic implant?

Inanimate substances placed in or on living tissues within the body are called implants. Jaw prostheses are used to change the aesthetic appearance, support weak structures and fill the deformations that occur from birth or after in the mouth jaw area. Deformations and obsolescence can affect vital functions such as swallowing, eating, chewing and speaking, as well as the psychological structure of individuals in terms of appearance.

The fact that the tip of the nose and the jaw end are in the same plane and compatible with the face makes the face look proportionate and beautiful and contributes to the formation of symmetry. The most common condition related to jaw structure disorders that disrupt symmetry and appearance; the jaw is small and behind. Without any abnormalities in the position of the teeth or lower jaw, it is called micrognati that only the lower jaw tip is small. The most appropriate solution methods for the micrognati problem are jaw tip filler and jaw tip prosthesis. But it is a temporary and repeated application, and no permanent result is achieved.

How to make a chin tip prosthesis?

Jaw tip prosthesis; it is a painless intervention with general anesthesia or local anesthesia that can be applied to people who have completed bone development and do not have problems with tooth structure. Taking into account the complaints and demands of the patient, using two-dimensional or three-dimensional simulations, the intervention is planned and the possible image to be formed after the operation is evaluated. The prostheses used are produced from many different materials that are safe and flexible, in a different size and form. Mostly silicone and medpor prostheses are used.

Is it easy to place the jaw tip prostheses?

Silicone prostheses can be easily placed and removed in small incisions due to their slippery structure. They can only play with the same slippery place, sometimes causing melting in the bone.

Medpor prostheses are biodegradable plastic derivatives with small pores. It is more difficult to place and remove small incisions due to their porous structure. However, it is unlikely to move due to the same rough structure. In addition, due to its biocompatibility, tissue growth is faster and the risk of allergic reactions and infections is not so small.

Are there any risks of breast replacement?

After the jaw tip prosthesis is inserted, it can be seen that the implant has recently shifted and shifted. Although rare, temporary or permanent loss of sensation in the jaw area can be observed. Although low, as with all medical interventions, there is a risk of anesthesia side effects, internal bleeding, infection, pain and swelling. A corrective operation can be performed in a possible negativity.

Is the price of the mouth prosthesis high?

It is not possible to give general information about the price of jaw tip prosthesis. Because each application has its own special conditions. The size and material of the prosthesis to be made according to the demand and need of the patient will change, which will affect the price. According to the good results obtained, the wages are reasonable.

Who does the mouth prosthesis?

It is performed by oral dental and jaw surgery specialists.

What is jaw tip torching?

The jaw tip scrubbing surgery is the procedure for proper shaping of the bone in the jaw tip and side area. The most commonly used technique in jaw aesthetics is the jaw tip torching process; the front of the jaw end is eliminated by torching the excess of the jaw tip, down or sideways. Piezo surgery is performed.

How to reduce the jaw tip?

Jaw torching surgery removes excess protrusions from the jaw, allowing the jaw to adapt to the face. It is possible to reduce the size of the jaw with this surgery, which lasts about 1-2 hours.

Is the mouth tip aesthetic permanent?

The results of surgical methods applied in jaw aesthetics are largely permanent.

Do men want a jaws aesthetic?

Male jaw aesthetics practices differ according to women. Facial features and jaw folds are planned in such a way that they do not eliminate masculine features.

Can the upper and lower jaw be messed up?

The jaws are made up of bones and tissues that make up the lower part of the face. Asymmetrical parts can be removed.

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Is the cost of the jaw pricey?

The prices for the torching procedure for these bones are determined according to a number of factors from the hospital where the surgery will take place to the physician’s experience in this regard. You can find out the price information from your doctor during the examination.

Is it possible to do non-surgical jaw tip styling?

Dermal fillers are usually used in order to eliminate disorders and irregularities in the jaw tip without surgery.

With hyaluronic acid filler injection applications, the jaw tip can be reshaped in about 15-20 minutes.

It is also possible to reshape the jaw tip by injecting the fat tissue supplied from the patient’s body into the jaw tip.

The aforementioned non-surgical applications applied to the jaw end are often preferred because they give quick results, have a fast healing process and offer fast return. However, this method should be repeated on average every 1 -1.5 years.

What is maxillary corticotomy?

The upper jaw is an enlargement surgery. Since media fuses into the sutura palate after reaching adult age, the process of unilateral or bilateral fracture of the upper jaw bone is called maxillary corticotomy in order to be effective with the apparatus to be installed to expand the upper jaw.

Is a maxillary corticotomy a difficult surgery?

There is no difference from other mouth surgeries. General anesthesia is applied.

In which cases is maxillary corticotomy performed?

• Where the upper jaw is not fully developed and is narrow in relation to the lower jaw
• In cases where the rear teeth have a one-sided cross-closing
• In the case of double-sided cross-closing teeth
• In cases where the dome is too deep
• In the case of a front tine close
• It can be applied in patients who have problems breathing through the nose in the upper jaw narrowness.

The wisdom teeth are the molars at the end of the tooth sequence that try to erupt after the second molars in the lower and upper jaw have erupted. These teeth are usually between the ages of 14 and 20 years old and they try to drive compulsively on both sides of the jaw. But most of them are buried in the jawbone because they cannot find a place to drive properly. All teeth in the jaw are likely to remain buried, but the most commonly buried teeth are the lower third molars. They are wisdom  teeth. They are usually called wisdom teeth because they are the teeth that hurt our heads in the twenties. Although the natural time of riding comes; teeth that remain in the jawbone and cannot take their normal position are called buried teeth. A buried tooth operation is an operation that should not be feared. It is usually recommended to withdraw.

Why are wisdom teeth buried?

There are many theories about the fact that the teeth of wisdom teeth remain buried.

• Genetic,
• External inconsistencies,
• Eating habits,
• Early loss of milk teeth,
• Infections in the mouth,
• The presence of pathological formations such as cysts,
• Again, do not eat with refined and soft foods

These are thought to be a reason why wisdom teeth remain buried.

Can wisdom teeth be damaged?

When buried teeth do not find enough room to drive through the jawbone into the mouth, they cause various disturbances in the jawbone and surrounding tissues. The most common of these are tooth and jaw pain in the area concerned. Although the second large molars just in front of wisdom teeth  are not bruised, head-related pain can be observed. If the buried  wisdom teeth are not extracted, due to the continuation of this head, the second large molars may have bruises, tooth roots melting and serious abscess formation. In neglected cases, cysts can form inside the jawbone, causing the loss of permanent teeth and bone melting in the jawbone. When mouth care is not good, they cause bad breath. They can cause cheek bites when they are not fully removed.

Is it necessary to have wisdom teeth removed?

Is it necessary to have wisdom teeth removed?

Jaw cysts are spaces that are structurally balloon-like, considered pathological, surrounded by membranes or capsules, filled with liquid or semi-liquid material. They will grow wherever they are growing.

Cysts can occur all over the human body, but they are most common in our jaws. They can develop inside the jawbone, at the root end of our teeth or in the gums.

How to treat jaw cysts?

In the treatment of jaw cysts, two methods called enucleation and marsupyalization are used.

Enuleasion is the complete removal of the cyst in one piece surgically. Depending on the size of the cyst, it can be applied with local or general anesthesia.

Marsupalization; complete surgical removal of large-sized jaw cysts associated with tissues such as the sinus cavity, nerve numbing our lower lip, may result in irreversible damage to these anatomical structures. Therefore, we do not prefer to have the cysts in this situation removed completely surgically in the first stage.

With an apparatus placed in the cyst in the marsupalization method, a striking reduction in cyst sizes is achieved in a few months. The shrinking cyst moves away from the anatomical structures that are important to us, making it very easy to completely remove. After the surgical procedure, the healing process is greatly shortened and facilitated, the healing is completed with zero damage to the tissues.

Jaw tumors are lesions that develop in soft tissues in the mouth and face or in the jawbone.

How many tumors are there?

Benign tumors are non-cancerous tumors. It is an abnormal growth of tissue within the jaw bone. It can be caused by cells that play a role in the formation of teeth. Some benign tumors may consist of cells that make up bones, cartilage, or other tissues. Although most tumors in the mouth and jaw are benign, they can damage the jaw structure if not treated properly.

Malignant tumors are tumors from irregularly shaped cells that multiply uncontrollably, spread to other parts of the body. It is an abnormal growth that spreads from the jawbone to neighboring tissues. Cancer, usually from the gums or mucosa of the mouth, occurs when it spreads to the jawbone. Odontogenic tumors are quite rare lesions.

Where do tumors usually form in the mouth?

Most of these malignant tumors grow in the back of the mouth, near the molars in the lower jaw. Some also affect the upper jaw.

Jaw fractures are fractures caused by heavy impact. The surgeon should be consulted without losing any time. In order for the patient to return to their pre-fracture state, the broken parts are reinstated, aligned and fixed in the correct position using wires, plaque, screws, dentures or special splints to fuse.

A jaw fracture may require different treatments and interventions depending on the extent of the damage. In cases of tooth loss, completion of missing teeth or stitched treatment may sometimes be needed for injuries to the skin. In some cases, aesthetic application may be required to prevent marks on the face of the patient.

Many teeth can be buried in the jaws. Most often, the drawing is recommended. Sometimes milk teeth can also be buried. It is taken by jaw surgery specialists. It can be difficult in risky situations.

In the case of bone deficiency, the materials applied to the area where the bone is wanted to form are called bone grafts. These bone grafts can be taken from one’s own body (usually from jawbone and hip bone), sometimes from human or animal origin (bovine-derived bone grafts), or produced synthetically.

In what cases is bone powder used?

Bone powders can usually be used in cases where there is not enough bone to place an implant, in cases where the extraction site is desired to heal without loss after tooth extraction, to fill that area after cyst or tumor is removed.

What are the different types of bone grafts?

• Autograft: The process of transplanting grafts from any part of a person’s body to a different part of the body. In dentistry, it is usually taken from the jaw and hip bone for bone making in the jawbone. Bone grafts taken from the jaw are taken from the front or back area of the jaw, which is particularly intact.
• Allograft: Grafts from genetically different individuals of the same species. The other name is homogeneity. The bones taken from cadavers are easy to obtain because they are stored in tissue banks. When these grafts are taken, they undergo various special procedures to prevent the transfer of diseases.
• Allografts can be mineralized, demineralized, chips (chips), powder or whole bone.
• Xenogreft: Graft taken from different types is again the process of transplanting to different types.
• Synthetic bone grafts: Bone grafts can be produced artificially as they can be taken from one’s own body or animal. These grafts are produced from hydroxyapatite or tricalcium phosphate materials.

In the sinus region, the maxillary located just above the upper jaw are called anatomical cavities located near our molars. As a result of the sinus cavities sagging downwards, a number of bone losses occur in the bone volume. Although these losses are seen as a natural process, they pose a problem when it comes to implant treatment. Sinus grafting process is used to apply implant treatment to the tooth-free areas as a result of filling the sinus cavities that are sagging down. Thanks to this process, it allows to create enough volume for the length and width of the implant, which must be fully inserted into the bone. During sinus lifting, local anesthesia and general anesthesia are applied.

How is sinus lift surgery performed?

Sinus lifting surgery can usually be performed under local anesthesia or under general anesthesia depending on the case.the sinus area is removed at the desired level and made accessible by a small window opened from inside the mouth in that area. After ensuring the desired elevation in the sinus membrane covering the inside of the sinus, bone dust and grafting process is performed in the created space, sewing is done and the region is closed.

What should be considered after sinus lifting operation?

After the sinus lifting operation, care should be taken to eat with the other side for 24 hours to protect the wound area. After the procedure, nothing should be eaten and drunk for two hours. After sinus removal, pressure should not be applied when cleaning the nose and the mouth should be kept open when sneezing.

With local anesthesia used in dentistry applications, anesthesia of nerve branches that provide innervation of a specific region is aimed. Local anesthetics act in conjunction with neural networks to inhibit the flow of sodium here. They help to prevent the occurrence of pain during the procedures, to create a sense of trust between the patient and the dentist, and to alleviate negative emotions such as fear and anxiety.

General anesthesia is also known as narcosis in folk language. General anesthesia is a temporary destruction of the senses throughout the body so that the brain does not feel pain before surgery or a surgical operation. With general anesthesia, the nervous system is suppressed for a certain period of time, and the pain is not felt by the brain during the operation. Patients who need general anesthesia are put to sleep and awakened at the end of the procedure. It is similar to a deep sleep state, eliminating consciousness and the sense of pain.

What is an anesthesia and reanimation specialist?

The anesthesiologist is the specialist physician who decides and applies anesthesia to the patient in order to prevent the patient from experiencing any pain or sensation during the operation.

General anesthesia must be performed by a specialist anesthesiologist. The patient should be monitored with the monitor during the application. During the general anesthesia stage, the patient is not conscious and does not remember what happened during the operation.

How is general anesthesia applied?

General anesthesia is provided by giving medicine through the vein, inhaling gas from the lungs or applying both together. The patient does not remember these actions. After the patient is put to sleep, the operation is allowed to begin. After the operation is finished, the application of drugs other than oxygen is terminated. Medications are given that eliminate the effects of some. The tube in the patient’s throat is removed. It is taken to the wake-up room for monitoring the patient status. After the patient is fully awake and treatments to control pain are applied, they are sent to the room where they lie.

What is conscious sedation?

Conscious sedation; by applying medication to the patient to be operated, the patient is relieved by creating a light sleep state. The patient is conscious. He can understand and execute the commands given. He can breathe on his own. Anesthesia is a method used to eliminate pain, anxiety and fears. The patient is conscious when sedation is applied. However, during the operation, there is temporary relief and memory loss. It is a short sleep.

Is there a difference between General anesthesia and conscious sedation?

The patient can respond to verbal commands or repetitive stimuli according to the level of sedation and can breathe on his own, while in general anesthesia the patient cannot breathe on his own and is unconscious because he is connected to the machine. It is a very comfortable and comfortable method for patients.

To whom is general anesthesia or conscious sedation applied?

• People who are afraid of dentists
• In the case of people with advanced
• In operations that may be long-term or traumatic for the patient
• Patients who have difficulty opening their mouth for a long time
• In a single session
• The heartache, in individuals with vomiting and gauging reflexes
• In children who are not adapted to treatments
• In the treatment of mentally disabled patients

Which patients are not given general anesthesia?

The number of patients whose general anesthesia is not suitable is quite small. Especially in patients with advanced respiratory problems, general anesthesia in advanced heart and lung diseases may bring some risks. In such cases, short-term treatments should be preferred by applying local anesthesia unless it is compulsory.

Is general anesthesia or conscious sedation harmful/risky for children?

General anesthesia and conscious sedation applications can be safely applied in patients with good general health. There may be a possibility of developing an allergic reaction to the drugs used in patients with an allergic nature. It may be necessary to conduct an allergic evaluation for patients with such a history.

Rarely, during general anesthesia applications, serious complications such as myocardial debris, respiratory failure, kidney failure may occur. However, these conditions usually occur in patients at risk of protracted disease. In healthy patients, it is very rare.

When applied by specialist physicians, the risk is almost non-existent.

(TR)

Kapalı Çene Eklem Ameliyatı

Kapalı çene eklem ameliyatı, uzun süredir geçmeyen çene ağrısı, kulak çınlaması, baş ağrısı ve çene kilitlenmesi gibi şikayetlerin arkasında yer alan mekanik bozukluğu doğrudan hedef alan ileri düzey bir cerrahi yöntemdir ve literatürde kapalı çene eklem cerrahisi, kapalı çene eklem operasyonu, kapalı temporomandibular eklem ameliyatı veya kapalı TME ameliyatı gibi farklı şekillerde de adlandırılabilir; uluslararası literatürde ise bu yöntem en yaygın olarak artroskopik çene eklem ameliyatı olarak ifade edilir. Bu farklı adlandırmaların tamamı, çene ekleminin açılmadan, minimal girişlerle tedavi edilmesini ifade eder ve temelde aynı cerrahi yaklaşımı tanımlar.

Kapalı çene eklem cerrahisi, minimal invaziv yani dokuya en az müdahale edilen cerrahi yaklaşımlar arasında yer alır ve bu yönüyle yalnızca şikayetleri geçici olarak azaltmayı değil, doğrudan problemin kaynağına inerek çene ekleminin fonksiyonel dengesini yeniden kurmayı amaçlar. Buna karşılık açık çene eklem cerrahisi, daha geniş cerrahi alan gerektiren ve dokuya daha fazla müdahale içeren majör bir cerrahi yaklaşımdır ve bu nedenle iyileşme süreci daha uzun olabilir, hasta konforu farklılık gösterebilir ve komplikasyon riski daha dikkatli değerlendirilmelidir.

Kapalı çene eklem ameliyatı, tıbbi olarak Temporomandibular Eklem (TMJ) artroskopisi olarak adlandırılan ve eklem açılmadan milimetrik girişlerle gerçekleştirilen bir cerrahidir; bu işlem sırasında eklem diski, eklem yüzeyleri ve hareket mekanizması doğrudan görüntülenerek değerlendirilir ve gerekli durumlarda bu yapıların doğal konumu yeniden sağlanır. Artroskopik çene eklem ameliyatı olarak da bilinen bu yöntem, doğru teknikle uygulandığında eklemin doğal hareket düzeninin yeniden kazanılmasına imkan tanır.

Kapalı Çene Eklem Cerrahisinin Temel Yaklaşımı

Prof. Dr. Mustafa Tek’in Tek Clinic bünyesinde uyguladığı kapalı çene eklem cerrahisi yaklaşımı, yalnızca mevcut şikayetleri azaltmaya değil, doğrudan eklem diskinin anatomik konumunu yeniden düzenlemeye ve çene ekleminin biyomekaniğini yeniden kurmaya odaklanır. Bu yaklaşım, geçmişte kapalı çene eklem ameliyatı veya kapalı TME ameliyatı uygulamış ancak teknik zorluklar ve sınırlı başarı oranları nedeniyle bu yöntemden uzaklaşmış birçok cerrahi yaklaşımın ötesinde, sistematik bir tedavi modeli olarak ele alınır.

Prof. Dr. Mustafa Tek’in bu alandaki yaklaşımı yalnızca klinik deneyime değil aynı zamanda güçlü bir uluslararası eğitim sürecine dayanır; Amerika Birleşik Devletleri’nde Icahn School of Medicine at Mount Sinai, New York University ve Lenox Hill Hospital gibi merkezlerde çene eklemi cerrahisi üzerine çalışmış olması, kapalı çene eklem cerrahisinin yalnızca teknik bir işlem değil, ileri düzey bir değerlendirme ve planlama süreci gerektirdiğini ortaya koyar.

Bu nedenle Tek Clinic yaklaşımında primer hedef, mümkün olan her durumda kapalı çene eklem cerrahisi ile eklemin doğal yapısını koruyarak tedavi sağlamaktır.

Çene eklemi rahatsızlıklarının neden olduğu belirtiler

Çene eklemi, mandibula ile kafa tabanı arasında yer alan ve hem kas sistemi hem de sinir ağı ile doğrudan bağlantılı olan bir yapı olduğu için burada ortaya çıkan bir problem çoğu zaman yalnızca çene ile sınırlı kalmaz ve baş, boyun, kulak ve yüz bölgesine yayılan farklı şikayetlerle kendini gösterir; özellikle kronik baş ağrıları, boyun ve omuz gerginliği, kulak çınlaması, yüz bölgesinde basınç hissi ve çiğneme sırasında zorlanma gibi belirtiler çoğu zaman birbirinden bağımsız gibi değerlendirilse de, aslında çene eklemindeki mekanik dengesizlikten kaynaklanabilir ve bu durum çoğu zaman geç fark edilir.

Kapalı çene ameliyatının uygulama gerektirdiği durumlar

Kapalı çene eklem ameliyatı genellikle uzun süredir devam eden ve günlük yaşam kalitesini belirgin şekilde etkileyen durumlarda gündeme gelir çünkü başlangıçta hafif düzeyde hissedilen çene eklemi problemleri zamanla ilerleyerek daha kompleks bir tabloya dönüşebilir; ağız açma kısıtlılığı, çene kilitlenmesi, çiğneme sırasında ağrı, sabahları çenede sertlik hissi, diş sıkma alışkanlığı ve çeneden gelen sesler bu sürecin ilerlediğini gösteren önemli işaretlerdir ve bu noktada kapalı çene eklem cerrahisi önemli bir tedavi seçeneği haline gelir.

Tanı ve değerlendirme süreci

Çene eklemi problemlerinde kalıcı bir sonuç elde edilebilmesi için en kritik aşama doğru teşhistir çünkü her hasta için kapalı çene eklem ameliyatı gerekli değildir ve her çene ağrısı cerrahi gerektirmez; bu nedenle süreç detaylı bir klinik değerlendirme ile başlar ve çene hareketleri, kas dengesi, ağrı noktaları, ağız açıklığı, eklem sesleri ve fonksiyonel kısıtlılıklar ayrıntılı şekilde analiz edilir. Klinik muayene sırasında çene açma-kapama hareketinin seyri, eklemde deviasyon olup olmadığı, çiğneme kaslarının hassasiyeti, kilitlenme öyküsü ve ağrının günlük yaşama etkisi birlikte değerlendirilir.

Klinik muayenenin ardından radyolojik muayene aşaması devreye girer çünkü kapalı çene eklem operasyonu kararı yalnızca şikayetlere göre değil, eklem yapısının ayrıntılı biçimde görüntülenmesiyle verilmelidir. Bu noktada 3D volumetrik tomografi, çene eklemini oluşturan kemik yapıların detaylı olarak incelenmesini sağlar ve eklem başı, kemik yüzeyleri, yapısal düzensizlikler ya da dejeneratif değişiklikler hakkında önemli bilgiler verir. TME MR görüntüleme, özellikle eklem diskinin konumu, diskin yer değiştirme derecesi, eklem içi yumuşak dokular ve sıvı değişiklikleri gibi doğrudan cerrahi planlamayı etkileyen unsurların değerlendirilmesinde kritik rol oynar.

Bunlara ek olarak panoramik röntgen, genel çene yapısının, dişlerin, kemik ilişkilerinin ve eşlik eden başka problemlerin ön değerlendirilmesinde yararlı bir görüntüleme yöntemidir. TME röntgeni ise çene ekleminin temel yapısal görünümünü değerlendirmede ve bazı vakalarda ilk aşama görüntüleme desteği sağlamada kullanılabilir. Tüm bu klinik ve radyolojik veriler birlikte değerlendirildiğinde, kapalı çene eklem ameliyatının gerekli olup olmadığı çok daha net şekilde belirlenir ve her hasta için kişiye özel bir tedavi planı oluşturulur.

Kapalı çene ameliyatının cerrahi uygulama süreci

Kapalı çene eklem ameliyatı sırasında eklem içine küçük girişlerle ulaşılır ve artroskopik sistemler sayesinde eklem doğrudan görüntülenir; bu sayede eklem diskinin konumu, yüzeylerin uyumu ve hareket sırasında oluşan problemler detaylı şekilde değerlendirilir. Artroskopik çene eklem ameliyatı kapsamında gerekli durumlarda disk doğru pozisyonuna alınır, eklem içi yapışıklıklar giderilir ve hareketi kısıtlayan mekanik engeller ortadan kaldırılır ve bu süreçte amaç çene ekleminin doğal hareket düzenini yeniden sağlamaktır.

Cerrahi sürecin başarısı yalnızca işlemin uygulanmasına değil, ameliyatın hangi biyomekanik probleme yönelik planlandığına da bağlıdır. Bu nedenle işlem öncesinde elde edilen klinik ve radyolojik veriler doğrultusunda eklem diskinin durumu, hareket kısıtlılığının nedeni, ağrının kaynağı ve eklem içi yapışıklıkların seviyesi değerlendirilir; ameliyat sırasında da bu planlamaya uygun şekilde eklem içi yapıların serbestleştirilmesi, diskin fonksiyonel konumunun desteklenmesi ve eklemin daha dengeli hareket etmesini sağlayacak müdahaleler yapılır. Böylece kapalı çene eklem cerrahisi yalnızca görüntüleme yapılan bir işlem olmaktan çıkar ve doğrudan tedavi edici bir cerrahi yaklaşım haline gelir.

Ameliyat sonrası iyileşme ve takip süreci

Kapalı çene eklem ameliyatı sonrasında iyileşme süreci genellikle konforlu ilerler çünkü minimal invaziv yaklaşım sayesinde doku hasarı sınırlıdır ve eklem çevresindeki yapılar korunur; hastalar çoğu zaman aynı gün taburcu edilir ve kısa sürede günlük yaşamlarına dönebilir. Ancak kalıcı başarı için kapalı çene eklem cerrahisi sonrası takip süreci büyük önem taşır ve Tek Clinic’te bu süreç kişiye özel egzersiz programları ve düzenli kontroller ile desteklenir.

Ameliyat sonrasında yalnızca cerrahi alanın iyileşmesi değil, çene ekleminin yeniden doğru hareket düzenine adapte olması da önemlidir; bu nedenle hastanın kontrollü çene egzersizleri, beslenme düzeni, eklem üzerine binen yükün azaltılması ve hekim kontrollerine uyumu tedavinin ayrılmaz bir parçasıdır. Özellikle uzun süredir eklem problemi yaşayan hastalarda iyileşme süreci bir rehabilitasyon mantığıyla ele alınır ve bu yaklaşım, ameliyat sonrası elde edilen fonksiyonel kazanımın korunmasına önemli katkı sağlar.

Kapalı çene eklem ameliyatında başarı oranı

Uygulanan cerrahi yaklaşım ve tedavi protokolü birlikte değerlendirildiğinde, uygun hasta grubunda kapalı çene eklem ameliyatı sonrası elde edilen klinik başarı oranlarının %90’ın üzerinde olduğu görülmektedir ve bu durum, kapalı temporomandibular eklem ameliyatı olarak da bilinen bu yöntemin doğru hasta seçimi ve doğru teknik ile uygulandığında etkili bir tedavi seçeneği olduğunu gösterir. Ancak burada belirleyici olan unsur yalnızca ameliyatın adı değil; hastanın doğru değerlendirilmesi, eklem diskinin durumunun doğru analiz edilmesi, cerrahi planlamanın deneyimli bir ekip tarafından yapılması ve ameliyat sonrası takip sürecinin dikkatle yürütülmesidir.

Bu nedenle başarı oranı, tek başına genel bir istatistik olarak değil, doğru tanı, doğru hasta seçimi ve doğru cerrahi uygulamanın doğal sonucu olarak değerlendirilmelidir. Tek Clinic yaklaşımında hedef, yalnızca kısa süreli rahatlama sağlamak değil; çene ekleminin fonksiyonel dengesini yeniden kurarak hastanın günlük yaşam kalitesini kalıcı biçimde artırmaktır.

Kapalı çene ameliyatı ile açık cerrahi yöntemlerin karşılaştırılması

Tedavi sonucunu etkileyen faktörler

Kapalı çene eklem ameliyatı teknik olarak tanımlanmış bir işlem olsa da elde edilen sonuçlar her hastada aynı şekilde ilerlemez çünkü çene eklemi problemlerinin şiddeti, eklem diskinin konumu, kas dengesi, hastalığın süresi ve hastanın tedavi sürecine uyumu gibi birçok faktör bu süreci doğrudan etkiler; bu nedenle kapalı çene eklem cerrahisi sürecinde doğru hasta seçimi, doğru cerrahi planlama ve ameliyat sonrası sürecin dikkatli şekilde yönetilmesi tedavinin başarısında belirleyici rol oynar.