TMJ arthroscopy in patients with Ehlers Danlos syndrome: case series.

OBJECTIVE: The purpose of this report was to assess the outcome of temporomandibular joint (TMJ) arthroscopy in patients with temporomandibular disorders (TMDs) associated with Ehlers Danlos syndrome (EDS). STUDY DESIGN: This retrospective case series describes 18 patients with EDS who underwent arthroscopy for temporomandibular disorders. The patients' demographics were recorded, along with preoperative TMJ symptoms, Wilkes classification, mouth opening, and the presence of systemic involvement. The incidence of early and late postoperative complications and the final outcome were noted. RESULTS: All of the patients were females, with EDS Type III, and had a mean age of 34 years. A high proportion of the patients had joints other than the TMJ affected. Five patients were classified as stage II according to the Wilkes classification, 9 patients were stage III, 3 patients were stage IV, and only 1 patient was diagnosed with stage V Wilkes before intervention. Arthroscopy, followed by arthrocentesis and balloon dilatation of the affected TMJs was performed and intra-articular morphine injections were given to all patients. The main pre- and early postoperative complaint was pain, but this resolved in most cases. Improvement of mouth opening was noted from 23.4 +/- 4.2 to 27.8 +/- 5.1 mm after arthroscopy. Patients were followed for an average of 62 months and all were asymptomatic at their last review appointment. CONCLUSION: For patients where conservative measures of treating TMD are not effective, arthroscopy is a minimally invasive surgical procedure that has been shown to result in a satisfactory outcome, with no need to resort to open joint surgery. This case series is limited by its size and further research on surgical intervention on EDS patients with temporomandibular disorders is recommended.

Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited.

OBJECTIVE: Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study. STUDY DESIGN: This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced. RESULTS: At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons. CONCLUSION: One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown.

Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities.

This review explores the aetiology of temporomandibular disorders and discusses the controversies in variable treatment modalities.Pathologies of the temporomandibular joint (TMJ) and its' associated muscles of mastication are jointly termed temporomandibular disorders (TMDs).TMDs present with a variety of symptoms which include pain in the joint and its surrounding area, jaw clicking, limited jaw opening and headaches. It is mainly reported by middle aged females who tend to recognize the symptoms more readily than males and therefore more commonly seek professional help.Several aetiological factors have been acknowledged including local trauma, bruxism, malocclusion, stress and psychiatric illnesses. The Research Diagnostic Criteria of the Temporomandibular Disorders (RDC/TMD) is advanced to other criteria as it takes into consideration the socio-psychological status of the patient.Several treatment modalities have been recommended including homecare practices, splint therapy, occlusal adjustment, analgesics and the use of psychotropic medication; as well as surgery, supplementary therapy and cognitive behavioural therapy. Although splint therapy and occlusal adjustment have been extensively used, there is no evidence to suggest that they can be curative; a number of evidence-based trials have concluded that these appliances should not be suggested as part of the routine care.Surgery, except in very rare cases, is discouraged since it is the most invasive alternative; recent studies have shown healthier outcome with cognitive behavioural therapy.