Evaluation of Intermaxillary Fixation (IMF) Screw Therapy with Craniomandibular Index Analysis for Chronic Recurrent Dislocation in the Temporomandibular Joint.

BACKGROUND: Temporomandibular joint (TMJ) hypermobility is classified as a subluxation, complete (luxation), unilateral, or bilateral, acute, chronic protracted, or chronic recurrent dislocation. AIMS: This controlled randomized clinical study aims to evaluate the effectiveness of intermaxillary fixation (IMF) screw application and autologous blood injections in the treatment of chronic recurrent dislocation of TMJ in comparison with the placebo group. PATIENTS AND METHODS: The patients who were admitted to the Faculty of Dentistry of the Atatürk University between October 2018 and January 2020 were evaluated. Three hundred patients diagnosed with bilateral chronic recurrent dislocation of TMJ based on clinical findings and radiographs were included in the study. The patients were randomly divided into three groups according to the evaluation criteria. Group 1 received IMF, group 2 received autologous blood injection, and group 3 (placebo group) received an intraarticular saline injection. RESULTS: The results of the patients who received IMF, autologous blood injection, and saline injection were evaluated by the craniomandibular index. The IMF group showed significant improvement after 1 month and 6 months (P < 0.001), while the patients who received autologous blood injection and saline injection showed no significant improvement (P > 0.05). The data were analyzed with IBM SPSS V23. The significance level was P < 0.05. CONCLUSION: In our study, the IMF gave the best results among all the study groups. The IMF technique can be used in patients with protracted chronic recurrent dislocation in whom autologous blood injection has failed.

Laser therapy reduces gelatinolytic activity in the rat trigeminal ganglion during temporomandibular joint inflammation.

OBJECTIVES: To investigate whether low-level laser therapy (LLLT) alters the expression and activity of MMP-2 and MMP-9 in the trigeminal ganglion (TG) during different stages of temporomandibular joint (TMJ) inflammation in rats. It also evaluated whether LLLT modifies mechanical allodynia and orofacial hyperalgesia. MATERIALS AND METHODS: Wistar rats (±250 g) were divided into groups that received saline (SAL) or complete Freund's adjuvant (CFA, 50 µl) in the TMJ, and that later underwent LLLT (20 J cm(-2) ) at their TMJ or not (groups SAL, SAL + LLLT, CFA, and CFA + LLLT). LLLT was applied on days 3, 5, 7, and 9 after SAL or CFA. Mechanical allodynia was evaluated on days 1, 3, 5, 7, and 10; orofacial hyperalgesia was assessed on day 10. Gelatin zymography and in situ zymography aided quantification of MMPs in the TG. RESULTS: Low-level laser therapy abolished the reduction in the mechanical orofacial threshold and the increase in orofacial rubbing during the orofacial formalin test induced by CFA. LLLT also decreased the CFA-induced rise in the levels of MMP-9 and MMP-2 as well as the gelatinolytic activity in the TG. CONCLUSION: Low-level laser therapy could constitute an adjuvant therapy to treat temporomandibular disorders and prevent inflammation-induced alterations in the levels of MMP-2 and MMP-9 and in the gelatinolytic activity in TGs.

Arthroscopy for temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMDs) are considered a collection of disorders involving many organic, psychological and psychosocial factors. They can involve the masticatory muscles or the temporomandibular joint (TMJ) and associated structures, or both. It is estimated that 40% to 75% of the population displays at least one sign of the disease and 33% of the population reports at least one symptom. Arthroscopy has been used to reduce signs and symptoms of patients with TMD but the effectiveness has still not been totally explained. OBJECTIVES: To assess the effectiveness of arthroscopy for the management of signs and symptoms in patients with TMDs. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register (to 23 December 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2010), MEDLINE via OVID (1950 to 23 December 2010), EMBASE via OVID (1980 to 23 December 2010), LILACS via BIREME Virtual Health Library (1982 to 23 December 2010), Allied and Complementary Medicine Database (AMED) via OVID (1985 to 23 December 2010), CINAHL via EBSCO (1980 to 23 December 2010). There were no restrictions regarding the language or date of publication. SELECTION CRITERIA: Randomized controlled clinical trials of arthroscopy for treating TMDs were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The authors of the selected articles were contacted for additional information. MAIN RESULTS: Seven randomized controlled trials (n = 349) met the inclusion criteria. All studies were either at high or unclear risk of bias. The outcome pain was evaluated after 6 months in two studies. No statistically significant differences were found between the arthroscopy versus nonsurgical groups (standardized mean difference (SMD) = 0.004; 95% confidence interval (CI) -0.46 to 0.55, P = 0.81). Two studies, analyzed pain 12 months after surgery (arthroscopy and arthrocentesis) in 81 patients. No statistically significant differences were found (mean difference (MD) = 0.10; 95% CI -1.46 to 1.66, P = 0.90). Three studies analyzed the same outcome in patients who had been submitted to arthroscopic surgery or to open surgery and a statistically significant difference was found after 12 months (SMD = 0.45; 95% CI 0.01 to 0.89, P = 0.05) in favor of open surgery. The two studies compared the maximum interincisal opening in six different clinical outcomes (interincisal opening over 35 mm; maximum protrusion over 5 mm; click; crepitation; tenderness on palpation in the TMJ and the jaw muscles 12 months after arthroscopy and open surgery). The outcome measures did not present statistically significant differences (odds ratio (OR) = 1.00; 95% CI 0.45 to 2.21, P = 1.00). Two studies compared the maximum interincisal opening after 12 months of postsurgical follow-up. A statistically significant difference in favor of the arthroscopy group was observed (MD = 5.28; 95% CI 3.46 to 7.10, P < 0.0001). The two studies compared the mandibular function after 12 months of follow-up with 40 patients evaluated. The outcome measure was mandibular functionality (MFIQ). This difference was not statistically significant (MD = 1.58; 95% CI -0.78 to 3.94, P = 0.19).   AUTHORS' CONCLUSIONS: Both arthroscopy and nonsurgical treatments reduced pain after 6 months. When compared with arthroscopy, open surgery was more effective at reducing pain after 12 months. Nevertheless, there were no differences in mandibular functionality or in other outcomes in clinical evaluations. Arthroscopy led to greater improvement in maximum interincisal opening after 12 months than arthrocentesis; however, there was no difference in pain.

Functional surgery of the temporomandibular joint with conscious sedation for "closed lock" using eminectomy as a treatment: a case series.

PURPOSE: The purpose of this case series study was to evaluate the advantages and disadvantages of using local anesthesia and conscious sedation (CS) rather than general anesthesia (GA) for performing functional surgery on patients suffering from temporomandibular joint (TMJ) closed lock, using the eminectomy procedure. Performing this procedure using CS allows functional assessment of the TMJ meniscus at the time of surgery. The objectives of this study were to determine if this surgery is possible under CS, to determine the benefits of being able to see the meniscus in action, and to investigate the patients' acceptability for this form of anesthesia. PATIENTS AND METHODS: Twenty-two patients who underwent this eminectomy procedure under either CS or GA on a day-case basis participated in this retrospective case series study. All the recruited patients had this procedure carried out after a course of nonsurgical conservative treatment that had failed to relieve the symptoms associated with their TMJ disorder--"closed lock." RESULTS: Objective results obtained were as follows: preoperative and postoperative mouth opening; preoperative investigations; preoperative treatments. Subjective results obtained were as follows: preoperative and postoperative pain; noises; clicks; hearing and deviation on opening; patient rating of operation success. Paired t testing showed a significant change in mouth opening for both groups. The mean mouth opening change in the CS group (n = 9) was 10.6 mm (P = .014) and in the GA group (n = 13) was 13.7 mm (P < .001). An unpaired t test showed there is no statistical difference between these groups (P = .467). The subjective data recorded showed comparable outcomes and acceptance for the 2 techniques in terms of pain and operation success. CONCLUSIONS: The use of local anesthesia and CS is an alternative to GA for performing TMJ procedures in appropriately selected patients. The advantage of direct visualization of the meniscus and its movements in the nonasleep patient requires further evaluation.

Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy.

Various surgical procedures have been used to reduce prolonged bilateral dislocation of the temporomandibular joint, but with some complications. A prolonged bilateral dislocation of the mandibular condyle was simply reduced by a midline mandibulotomy without any complications. One year postoperatively, joint function was unimpeded and there was no recurrence of condylar dislocation.

Preoperative autologous blood donation for oral and maxillofacial surgery: an analysis of 913 patients.

PURPOSE: Autologous transfusions are frequently used with elective surgical procedures and are a mandated choice under California law. Because unused units cannot be transfused to other patients, it is important to assess utilization and minimize waste. METHODS: The transfusion needs of 913 consecutive patients scheduled for major oral and maxillofacial surgery at the University of California San Francisco were evaluated in 3 categories: oncologic and reconstructive surgery (563), orthognathic surgery (260), and temporomandibular joint surgery (90). RESULTS: 24.9% of patients chose to undergo preoperative autologous blood donation. 24.2%, 20.6%, and 11.4% of oncologic and reconstructive surgery, orthognathic surgery, and temporomandibular joint surgery patients, respectively, who made an autologous donation preoperatively, subsequently received a transfusion postoperatively. CONCLUSION: Transfusion needs for most oral surgery procedures are clearly overestimated; the relatively low risk of blood loss associated with these procedures today should be taken into account when asking patients to participate in preoperative autologous blood donation.

[Arthroscopic dorsal ligament plasty using a hydrojet knife in the TMJ]. / Arthroskopische dorsale Kiefergelenkbandstraffung mit Wasserstrahlskalpell Eine experimentelle Studie am Landschwein.

PURPOSE: The aim of the study was the development and proof testing of an arthroscopic dorsal ligament plasty using a hydrojet knife in the pig TMJ before using in man. MATERIAL AND METHODS: The dorsal TMJ ligament of ten pigs (country breed) was irradiated with a hydrojet (diameter 120 microm, working pressure 90 bar) under arthroscopic visualization. Postoperatively the pigs were controlled for 10 weeks before sacrifice. The isolated TMJs were examined by light microscope and the results compared with untreated pig TMJs. The flows over our arthroscopic instruments were measured to exclude the possibility of damaging surrounding structures by pressure. RESULTS: Clinically we found no complications after arthroscopic surgery. Food intake was normal and development of body weight according to the food offered. Histology revealed tissue reorganization connected with increased collagen fibre production. Our calculations showed no pressure higher than 1000 mm water column in the TMJ under our working conditions. CONCLUSIONS: The idea of arthroscopic dorsal ligament plasty using a hydrojet works in pig TMJs. Experience in TMJ arthroscopy is necessary. We found no danger of barotrauma under arthroscopy with the hydrojet. The results indicate dorsal ligament shortening by development of scar formations. In our opinion the method can be used for the therapy of dorsal ligament elongation and disk displacements in the TMJ of man.

Aspergillosis of the temporomandibular joint following irradiation of the parotid region: a case report.

We report a case of aspergillosis in the right temporomandibular joint (TMJ) with a history of parotid carcinoma and post-irradiation otitis. Previous treatment attempts with surgery and antibiotics were unsuccessful. Radical debridement of the glenoid fossae, supplemented with amphotericin B and adjunct hyperbaric oxygen (HBO) therapy, was provided to resolve the symptoms. This case report highlights the need to be aware of the possibility of invasive mycosis in immunocompromised patients.

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints.

PURPOSE: The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints). STUDY DESIGN: The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years. RESULTS: Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy. CONCLUSION: Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.

Surgical reconstruction of the temporomandibular joint for chronic subluxation and dislocation.

This paper describes the use of an inferiorly based pedicled flap from the temporal fascia sutured to the anterior-lateral wall of the capsule and augmentation of the zygomatic root of the temporal bone by a bone graft from the iliac crest to prevent forward movement of the condyle beyond the eminence. It may be used for treatment of patients with chronic subluxation and dislocation of the temporomandibular joint.

Sistema de dos vías y punción única para la realización de artrocentesis de la articulación temporomandibular

La utilidad de la artrocentesis de la ATM para resolver el bloqueo articular agudo ha quedado de manifiesto en múltiples estudios. Describimos una modificación de la técnica original que resulta fácil de realizar incluso para cirujanos con experiencia limitada. Existen dispositivos que emplean la técnica de punción única pero la ventaja de nuestro sistema es que se realiliza con un material asequible, accesible y desechable, ya que las normas de antisepsia no recomiendan la reesterilización de agujas de calibre fino como las que aquí se emplean (AU)

Anquilosis de la articulación temporo-mandibular: hipnosis y bloqueo nervioso externo como coadyuvantes de la fisioterapia posoperatoria sin dolor: informe de un caso / Ankylosis of the temporomandibular joint: hypnosis and external nervous blockade as helping of the physiotherapy posoperatoria without pain. A case report

Se presenta el caso de un niño de 12 años con anquilosis de la articulación temporomandibular izquierda. A partir de su cuadro clínico, estudios radiográficos y valoración psicológica se diseñó un plan de tratamiento que incluyó la artroplastia. Además, se utilizó la hipnosis y el bloqueo del nervio mandibular como coadyuvantes de la fisioterapia postoperativa, con resultados altamente satisfactorios(AU)

The clinical use of aluminium oxide bioceramic implants for mandibular condyle replacement: a six year report.

In a 6-year period, six bilateral and five unilateral compact aluminium oxide ceramic condyle fixed with titanium screws were implanted. During the years following the operation, it was not necessary to remove any ceramic condyle. In only one case (rheumatic polyarthritis) was it necessary to reoperate on the patient because of bilateral reankylosis. Ceramics can be recommended in a wide field application because of the simplicity, uniformity, durability, and good tissue-enduring ability. The danger of postoperative ankylosis occurs only in patients suffering from rheumatoid arthritis.

A retrospective evaluation of 301 TMJ Proplast-Teflon implants.

A retrospective review of 301 meniscectomies with Proplast-Teflon implants was performed. Factors such as interincisal opening, occlusion, joint sounds, joint degeneration, and patient satisfaction were examined. The overall surgical success rate was 88.7%, with an average follow-up period of 33 months. Although many patients demonstrated significant condylar degeneration at 1-year follow-up, such change did not necessarily result in symptomatology or joint dysfunction. Only 10% of implants resulted in removal. Surgical and postoperative procedures are contrasted with those of other clinicians experiencing lower success rates.

Application of compact aluminum oxide ceramic implants in maxillofacial surgery.

In a 4-year period, 40 compact aluminum oxide ceramic implants fixed with titanium plates and screws were used: 24 for the correction of mandibular defects, 9 for temporomandibular joint replacement, and 7 for augmentation of facial contour. During the 1 to 4 years following the operations, it was not necessary to remove any aluminum oxide joint or implant used for contour correction. In 5 of the 24 cases of mandibular reconstruction, however, it was necessary to remove the ceramic. In 3 cases, this was due to recurrence of the tumor, and in 2 cases the cause was dermal necrosis.

Light and electron microscopic evaluation of Proplast II TMJ disc implants.

Proplast II disc implants (Vitek Inc, Houston) were used in nine patients (14 joints) who underwent discectomy of the temporomandibular joint (TMJ). These patients subsequently underwent removal of the implants from 10 to 28 months postplacement due to pain and occlusal changes or radiographic changes in the joints. Light and electron microscopic evaluations were performed on the retrieved implants and surrounding tissue. Evidence of gross deterioration manifested by fracture of the implant was present in 10 of the 14 implants, and microscopic evidence of deterioration was present in all implants. Foreign-body giant cell reaction in surrounding tissues and microfragmentation of the implant were evident in all joints.

Comparative study of alloplastic materials for temporomandibular joint disc replacement in rabbits.

Young adult, white New Zealand rabbits underwent either sham surgical procedures or discectomy. In the animals that underwent discectomy, either reinforced silicone or polytetrafluoroethylene-aluminum oxide (PTFE-Al2O3) implants were placed in the glenoid fossa. During gross sectioning, the silicone implants could be easily displaced from the specimen, while the PTFE-Al2O3 implants were firmly anchored. Histologically, fragmentation of the implants was seen in the silicone group; 21.4% of the implants placed were torn. Foreign body giant cell reactions reached a peak after eight weeks. Associated fibrosis and foreign body giant cell reactions were seen, resulting in a thickened capsule and resorption of the condyle and articular fossa. In the PTFE-Al2O3 group there was marked osteoclastic activity, with resorption and severe degenerative changes in both the condyle and glenoid fossa. The foreign body giant cell reaction was severe at all time intervals and increased with time. Tearing of the implant was observed in 46.2% of the joints. These results indicate a need for further evaluation of these materials as disc replacements in humans.