Reconstruction of the Temporo-mandibular joint (TMJ) represent a challenge for all craniofacial and maxillofacial surgeons for the last 4 decades, many disease of the TMJ were not fully understood in the west (like TMJ ankylosis), since they do not see much of these cases as in the Middle east because the standard of health education to understand the basic roles for managements of traumatic injuries of the TMJ is absent.
In the south of Arab land as in Yemen, Somalia and Sudan, people daily habit of chewing Qat which is the main cause for destruction of the TMJ structures featuring, recurrent dislocation and subluxation of the TMJ.
Great advances carried out by pioneers in TMJ surgery to understand the pathogenesis of these destructive disease of the TMJ by advocating many surgical procedures and techniques for reconstruction of the TMJ by using either autogenously tissue or metals such as 2 part prosthesis or sialastic (Rubber Silicon) or temporalis muscle flap for treatment of ankylosis or by using different techniques for managements of subluxation and dislocation including seclerosing materials like STD or by reinforcement by placation of the capsule or by reconstruction of the capsule by finger like temporal fascia flap or making an obstacle by augmentation of the zygomatic root of temporal bone by bone graft from iliac crest. Using Botox A injection to the upper part of lateral petrygoid muscle to delay the action of the muscle connected to the disc, to stabilize the disc and to prevent further movement of the condyle forward behind the articular eminence to prevent clicking of the disc and to prevent unpleasant noises.
