Arthroscopic Discectomy Technique: A Beneficial Approach for Managing Disk Perforations in the Temporomandibular Joint.

ABSTRACT: Disk perforation can result in degenerative changes within the joint structures. While discectomy has demonstrated enduring benefits, it has traditionally been described using an open approach, with the disadvantages inherent to this method. This study aims to present a series of patients who underwent arthroscopic discectomy technique and to report the outcomes. METHODS: Patients diagnosed with internal disorders of the temporomandibular joint underwent arthroscopic arthroscopic discectomy technique. Surgical outcomes were assessed by changes in pain using a visual analog scale and the maximum incisal opening. RESULTS: One hundred seventy-eight joints from 106 patients who underwent arthroscopic surgery were included. Discectomy was performed on 22 joints. Prior to surgery, patients reported an average visual analog scale pain score of 6.5, which decreased to an average of 0.5 at 6 months postsurgery (P<0.001). Before surgery, the average maximum incisal opening was 30 mm, which increased to 41 mm at 6 months postsurgery (P<0.001). CONCLUSIONS: The described technique represents an excellent alternative for managing patients with disk perforations.

A New Technique for Arthroscopic Discectomy of the Temporomandibular Joint Disc Perforation: A Technical Note.

Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique utilizing two operative cannulas that completely remove nonfunctional cartilaginous tissue.

Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies.

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.

Long-term clinical outcomes of arthroscopic discopexy with resorbable pins.

INTRODUCTION: Discopexy using resorbable pins is an arthroscopic technique to treat internal derangement of the TMJ, restoring the normal relationship between disc, condyle, and temporal bone. The objective of our study was to assess the 5-year clinical outcome of a series of patients treated with this technique. METHODS: A study was conducted on a series of patients who underwent arthroscopic discopexy using resorbable pins between January 2007 and February 2018. All the patients were refractory to conservative treatment and classified as Wilkes stage III. Clinical data were recorded at 1-year, 3-year, and 5-year visits. Pre- and postoperative evaluation parameters were: joint pain (VAS scale), mandibular movements (mm), and articular locking and clicking. RESULTS: The study included 33 patients and the technique was performed in 38 joints. Mouth opening increased significantly with each visit after surgery compared with preoperative scores (mean value of 10.65 mm, p < 0.001), with the mean value increasing significantly at the 5-year visit in relation to the mean value obtained at the 3-year visit. Patients reported significant decreases in pain after surgery, obtaining VAS values of under 10 at the 5-year visit (mean improvement of 56.95 points, p < 0.001). CONCLUSIONS: Discopexy using resorbable pins resulted in a good and stable clinical outcome at the long-term follow-up.

[Electrostimulation for the treatment of dry mouth].

Xerostomia is a very common condition, which not only involves dry mouth feeling, but can also lead to psychosocial distress, impaired quality of life, and complications, such as dental caries and oral candidiasis. It is generally induced by hypofunction of salivary glands, which has a wide variety of etiologies, such as Sjögren's syndrome, radiotherapy to the head and neck and side effects of medications. Current therapies rely on saliva substitutes and pharmacological stimulation of the parasympathetic system. These treatment modalities are somewhat limited by their short-term efficacy, high cost and drug interactions or other adverse effects. Local transcutaneous or permucosal electrostimulation in areas close to the nerves participating in the salivary autonomic reflex has been found to increase salivary secretion in animal and clinical experiments and to relieve symptoms of dry mouth in patients with salivary gland hypofunction. This concept is reviewed to update the readers on the current status and potential of intraoral miniature electrostimulating devices. They offer promise as an optional safe and non-chemical treatment of xerostomia.

Odontoameloblastoma: a case report and a review of the literature.

Odontoameloblastoma (OA) is an extremely rare mixed odontogenic tumor appearing within the maxillary bone, with both epithelial and mesenchymal components. The term odontoameloblastoma (OA) was included in the 1971 WHO classification. Only 23 well-documented cases have been reported in the medical literature. Because of their rarity, controversy exists in the treatment of this tumor. We present a new case of OA involving the mandible mimicking a compound odontoma and a brief review of the related literature.

Ameloblastic fibroma of the mandible. Report of two cases.

The ameloblastic fibroma (AF)-ameloblastic fibro-odontoma (AFO), is an uncommon benign mixed odontogenic tumor (epithelial and mesenchymal), that represents the 2% of all odontogenic tumors. It usually appears in the mandible and in the posterior segments of young patients without gender predilection, and sometimes is associated with an impacted tooth. The classification of the WHO includes it in the subtype of odontogenic tumors with a defined histologic features. The AF and the AFO are considered as an unique entity as they are variations of the same tumor, only distinct for the presence of an odontoma in the case of the AFO. Surgical conservative treatment with excision followed by curettage seems to be the most appropriate therapeutic option. The objective of this paper is to report two cases of this tumor, to make a brief review of the literature and its differential diagnosis, to analyse its clinical and histologic features and the therapeutic option.