Arthroscopic assisted release of lateral pterygoid versus scarification of retrodiscal tissue in management of internal derangement of temporomandibular joint-A randomized clinical trial.

The purpose of this study was to compare the effectiveness of arthroscopic-assisted lateral pterygoid muscle release versus scarification of retrodiscal tissues in the treatment of temporomandibular joint internal derangement. A prospective, comparative, randomized clinical trial involved 16 patients with TMJ internal derangement. Arthroscopic assisted release of lateral pterygoid muscle was assigned to one group of patients (Group I). Group II patients received arthroscopic assisted scarification of retrodiscal tissues. Data collected through functional examination including visual analogue scale (VAS), maximum mouth opening, lateral excursion, and clicking sound immediately and after 3, 6, and 12 months. Pre- and post-operative MRI was used to assess disc position. The VAS scores decreased in both groups at the end of the follow-up period (0.45 vs 6.75, and 1.13 vs 6.50 in group I and II respectively; P<0.001). The maximum mouth opening improved to 32.9.50 ± 1.69 mm in group I, and 30.49 ± 0.93 in group II (P<0.001). Lateral excursion improved in both groups (P<0.001). Clicking sounds disappeared in all patients. Within the limitations of the study, it seems that arthroscopic assisted release of lateral pterygoid and scarification of retrodiscal tissues may be beneficial in management of anteriorly displaced discs that don't respond to conservative treatments.

A comparative evaluation of retromandibular versus Modified Risdon approach in surgical treatment of condylar fracture.

The purpose of this study was aimed to compare the efficiency and safety of retromandibular versus modified Risdon approach using periangular incision for open reduction and internal fixation of low subcondylar mandibular fracture. Open reduction and internal fixation with different plating systems were utilized via retromandibular approach (group I) and via modified Risdon approach with periangular incision (group II). Twenty four (n= 24) condylar fractures in 21 adult patients were divided randomly into two equal groups (12 each) according to the cutaneous incision (approach) utilized. The evaluation score for scarring in group I it was excellent in 9 patients, good in 2 patients and acceptable in only one patient (Mean 2.4 ± SD 3.38). While in group II was excellent in 10 patients and good in 2 patients (Mean 2.4 ± SD 3.87) and the p value was 0.591. Symptoms of transient facial nerve weakness were noted in only 3 patients in group I with slight to moderate dysfunction (Mean 2 ± SD 3.21), while only one patient had facial nerve weakness in group II with House - Brackman score of 2 immediate postoperatively and this got resolved in 6 weeks (Mean 2 ± SD 4.04) and the p value was 0.00022. Within the limitations of the study it seems that a modified Risdon approach using periangular incision for reduction and fixation of low subcondylar fracture should be preferred whenever possible because it yields better outcomes.

A modified surgical approach for the treatment of mandibular unicystic ameloblastoma in young patients.

BACKGROUND: Unicystic ameloblastoma is a distinct clinicopathological entity with its cyst-like radiographic appearance and occurrence in the mandible of young patients. Surgical resection of the mandible leads to jaw deformity and challenging reconstruction burden, especially among young patients. Conservative treatment, however, results in less serious function and esthetic impairment. PURPOSE: We aimed at evaluating dredging method as an alternative conservative surgical approach in young patient with large unicystic ameloblastoma. PATIENTS AND METHODS: Twenty patients (n=20) with histologically-diagnosed unicystic ameloblastoma were recruited for this prospective study. The surgical treatment protocol comprised an initial deflation (marsupialization) step, followed by later enucleation and subsequent repeated separate dredging procedures. RESULTS: The study population comprised 16 males and 4 females. The average age at the time of diagnosis was 18.5 years. At the last follow-up period, achievement of normal mandibular bone contour with no radiographic signs of recurrence was evident. CONCLUSION: The dredging method as a modified surgical technique may represent a reliable approach for management of unicystic ameloblastoma in young patients.