Temporomandibular joint disc perforation: long-term results after operative arthroscopy.

PURPOSE: Disc perforation (DP) is one of the most important pathologic signs of intracapsular temporomandibular joint (TMJ) disease; however, few clinical studies have focused on the arthroscopic management of this feature. The purpose of the present study was to assess whether operative arthroscopy with abrasion of the perforation borders is effective for the treatment of this alteration of the internal derangement of the TMJ. PATIENTS AND METHODS: Thirty-six patients (39 joints) who underwent TMJ arthroscopy under general anesthesia and presented with DP (Wilkes stages IV and V) from 1994 through 2006 were included in this study. The age range at the time of surgery was 14 to 59 years. DPs were classified into 3 groups according to size: small (SMA), medium (MED), or large (LAR). Pain (visual analog scale, scores 0 to 100), maximal interincisal opening, and lateral and protrusive excursions were assessed at 1, 3, 6, 12, 24 and 48 months after surgery. Preoperative and postoperative scores were compared and tested for statistically significant differences by the Student t test for paired data. The level of statistical significance was set at .05. Differences in the global, SMA, MED, and LAR groups were evaluated. RESULTS: In the global group, the mean score of preoperative pain according to the visual analog scale was 53.97 mm, which decreased to 14.33 mm at 4-year follow-up. The maximal interincisal opening improved from a mean of 28.56 mm before surgery to 34.88 mm after the final follow-up. SMA perforations were found in 11 cases (28.20%), MED in 19 cases (48.71%), and LAR in 9 cases (23.07%). A significant decrease in pain (P < .01) was observed from the first postoperative month to the end of the follow-up period in the global and SMA groups. A statistically significant increase in mouth opening was observed in the global group from 6 months postoperatively; however, no significant differences were observed in the MED and LAR groups from before surgery to the different times of follow-up. After the final follow-up, 2 patients underwent open TMJ surgery owing to unfavorable results. CONCLUSIONS: Operative arthroscopy of the TMJ is a reliable and effective procedure for the articular dysfunction associated with DP because this procedure alleviates pain and improves mouth opening. Patients with SMA perforations are better candidates for this surgical treatment.

Lateral pterygoid muscle dystonia. A new technique for treatment with botulinum toxin guided by electromyography and arthroscopy.

Lateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoid muscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy.

Preprosthetic and implantological surgery in patients with severe maxillary atrophy.

AIMS: To evaluate the success of the osseointegration of dental implants in patients with severe maxillary atrophy after sinus lift augmentation and onlay graft surgery with autologous bone grafts. DESIGN: A descriptive and analytic study of 27 patients with severe maxillary atrophy and partial or total edentulism, after 4 years follow-up. All cases underwent to autologous bone graft sinus lift augmentation with or without onlay grafts in the anterior maxillae. After this, reconstruction with osseointegrated implants was performed. RESULTS: After the follow-up period, 89.1% of implants were osseointegrated and loaded. Anterior iliac crest bone graft provides good results with respect to implant osseointegration. The achievement of two surgical procedures for bone grafts surgery and implants surgery, separated 2 or more months, provides better results for osseointegration in comparison to a sole surgical procedure (p<0.01). CONCLUSIONS: Implants survival predictability is greater when a second surgical procedure is performed, once bone grafts have experimented an appropriate consolidation. The use of onlay graft and sinus lift augmentation techniques is useful in the resolution of complex problems such as the severe maxillary atrophy.