The hue of temporomandibular joint arthroscopy under local versus general anaesthesia.

BACKGROUND: Temporomandibular joint arthroscopy (TMJA) is often performed under general anaesthesia (GA) worldwide on an inpatient basis, whereas local anaesthesia (LA) is not equally considered as the standard procedure. OBJECTIVES: To compare the efficacy between LA and GA when performing TMJA. METHODS: This study retrospectively reviewed a total of 182 patients in LA group and 91 patients in GA group who underwent TMJA for the management of disc displacement. Patients were divided into two groups based on type of anaesthesia used for surgery; LA group and GA group. Comparisons were made based on operative time, intubation and extubation time (for GA only), hospital stay duration, total cost and post-operative clinical and radiological outcomes. RESULTS: The demographics and pre-operative clinical assessments were matched in both groups. No post-operative significant difference was found in outcomes when performing TMJA under LA compared to GA in terms of pain reduction (p = .016) and improvement in mouth opening (p = .866). The median operative time and hospital stay duration for LA group were significantly less compared to GA group (p < .001). GA group required an additional intubation and extubation time, whereas LA group patients were waived from it. TMJA for LA group was performed in the minor procedure setup, which reduced the costs for surgery (p < .001). Post-operative disc position was excellent and good with an overall success rate of 95%. CONCLUSION: The use of LA performing TMJA reduces operating time, costs, hospital stay and recovery room time than GA group. Furthermore, TMJA performed under LA shared similar post-operative clinical and radiological outcomes with those performed under GA.

Effect of Eruption Status of the Mandibular Third Molar on Distal Caries in the Adjacent Second Molar.

PURPOSE: To analyze the effect of the eruption status of the mandibular third molar (MTM) on distal caries in the mandibular second molar (MSM) by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Five hundred CBCT images of MTMs from 469 patients were evaluated. Presence of distal caries in MSMs, impaction depths and angulations of MTMs, cementoenamel junction (CEJ) distances between distal MSMs and mesial MTMs, presence of pericoronitis in MTMs, and patient characteristics (age and gender) were assessed. Data were analyzed by χ(2) test, univariate and multivariate logistic regression analyses, and Spearman correlation analysis. Descriptive and bivariate statistics were computed and the P value was set at .05. RESULTS: The overall prevalence of distal caries in the MSM was 52.0%. According to the classification of Pell and Gregory, position A was the impaction depth at which most distal caries in MSMs were present (P = .036). For angulation of the MTM, when mesial angulations were 43° to 73°, MSMs developed more distal caries (P < .0001). For the CEJ distance between the distal MSM and the mesial MTM, when distances ranged from 6 to 15 mm, distal caries in MSMs occurred more frequently (6 to 8 mm, P < .0001; 8 to 15 mm, P = .037). Furthermore, there was a linear correlation between angulation of the MTM and the CEJ distance between the distal MSM and the mesial MTM (P < .0001). CONCLUSIONS: Impaction depth and angulation of the MTM are associated with distal caries in the MSM. Angulation of the MTM is more stable and reliable than the CEJ distance between the distal MSM and the mesial MTM for the estimation of risk factors related to the MTM.

Prognostic indicators of arthroscopic discopexy for management of temporomandibular joint closed lock.

In order to optimize patient selection for temporomandibular joint (TMJ) arthroscopic discopexy to achieve favorable outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting surgical outcomes following arthroscopic discopexy for management of TMJ closed lock using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment was performed pre- and post-operatively. Multivariate analysis was used to evaluate various prognostic variables including gender, age, side, duration of illness, Wilkes staging, parafunctional habits, splint therapy and orthodontic treatment. A total of 147 patients (201 joints) were included. The outcome was categorized as excellent (n = 154/76.61%), good (n = 34/16.91%), or poor (n = 13/6.46%) with a success rate of 93.54%. Patients aged > 30 years old (p = 0.048), longer duration of illness (12-24 months: p = 0.034) and (> 24 months: p = 0.022), and patients with Wilkes stage IV (p = 0.002) were all significantly more likely to be in the poor outcome group. Finally, orthodontic treatment showed a significant association with excellent outcomes (p = 0.015). Age, duration of illness, Wilkes staging, and orthodontic treatment are considered significant prognostic factors that can predict the outcomes following the arthroscopic discopexy for management of TMJ closed lock.