
Down Fracture- A Podcast for Talkin' Jaws
Rewriting the TMJ Treatment Algorithm With Dr. Gary Bouloux | Down Fracture Podcast
In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Gary Bouloux, chair of oral and maxillofacial surgery at Emory University. Dr. Bouloux chaired the AAOMS special committee that produced the 2024 TMJ management guidelines, and he represented the specialty at the FDA and National Academies meetings on temporomandibular disorders that preceded them. He performs roughly 300 arthroscopies a year and is currently on the committee revising those guidelines. The discussion covers where the treatment algorithm has moved, why the guidelines skew toward total joint replacement after failed minimally invasive surgery, and the manufacturing bottleneck that has left Australia and New Zealand without a viable custom device. Topics covered in this episode: - The FDA meeting with patient advocacy groups and why it was a difficult starting point - How the National Academies report and its recommendations led to the AAOMS guidelines - What is being updated in the current revision, and what has not changed - Biologics: why steroids underperform, and the case for hyaluronic acid combined with injectable PRF - The practical side of making IPRF in an office, and the reimbursement problem - Why the guidelines move from arthrocentesis or arthroscopy toward total joint rather than open arthroplasty - New data suggesting a single prior arthroplasty is the covariable most associated with worse total joint outcomes - Arthroscopy at roughly 70 percent success, and what to do with the 30 percent who fail - The pediatric exception, and how weak the disc plication literature actually is - Where the term IPD came from and why disc position moved out of the center of the diagnosis - Unilateral versus bilateral surgery, and whether the contralateral joint should be replaced at the same time - Coronoidectomy, fat grafts, and heterotopic bone in joint replacement - Two manufacturers, a 23-week turnaround, and what happened to the Australian market - Whether KLS Martin and 3D printed devices can bring real competition - How many joints a year it takes to stay competent, and what the orthopedic literature says Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests. #DownFracturePodcast #TalkingJaws #JawSurgery #OMFS #OralSurgery #TMJ #TMJSurgery #TMJReplacement #Arthroscopy #Arthrocentesis #TMD #OrofacialPain #MaxillofacialSurgery #PRF #TotalJointReplacement

