Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

Purpose: The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. Material and Methods: This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. Results: The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. Conclusion: This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Unusual Cause for Maxillofacial Injury.

Penetrating facial injuries are potentially dangerous and may require emergency management because of the presence of vital structures in the face, and it may be life-threatening especially when the injury involves airway, major blood vessels, spinal cord, and cervical spines. Penetrating injuries of the facial region can occur due to missile injuries, blast injuries, motor vehicle accidents, and accidental fall on sharp objects. However, injury to face caused by the shattering of a protective helmet itself is extremely rare. Primary management is targeted to deal with life-threatening conditions and stabilize the patient followed by subsequent care in a well-equipped setting. We present a case of a 30-year-old male, who suffered extensive soft and hard tissue injury of the maxillofacial region due to shattering of a protective helmet causing a ballistic effect.

Custom-made mouth prop for TMJ arthrocentesis: a technical note.

INTRODUCTION: TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space. METHOD: The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis. FINDINGS: The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.

Access Osteotomy in the Maxillofacial Skeleton.

Surgical accesses for the facial skeleton are based on the concept of modular osteotomies. Various techniques and combination of osteotomies facilitate access to the most inaccessible tumors of craniomaxillofacial region. Most appropriate surgical access is determined by considering size, location, extension of the tumor, and experience of the surgical team. These are primarily used for tumors in the nasopharynx or the skull base. The aim of this paper is to review surgical accesses that aid in removal of inaccessible tumors of craniomaxillofacial region with series of cases operated in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune, India, between July 2008 and June 2010. The surgical approaches constituted of transfacial, transoral, lip-split mandibulotomy and modified osteotomy of the orbital rim in cases of juvenile nasoangiofibroma, squamous cell carcinoma of the base of the tongue, orbital floor tumour respectively. Only 3 cases (33.33%) reported with postoperative paresthesia of the infraorbital region and mandibular symphysis region which resolved in 6 months. None of the patients presented with occlusal discrepancy, neuromotor deficit or sign of recurrence in the follow up period of one year.