Needle Therapy: A Minimally Invasive Therapeutic Concept as Part of Temporomandibular Single-Portal Arthroscopy.

The transition from a single portal to a double portal can be complex, necessitating time and training to minimize complications that rely on the operator's skill. Needle therapy is a simple method for treating symptoms that has several benefits. Consequently, this innovative strategy aims to introduce an intermediate technique that enables surgeons to perform therapeutic procedures during single-port arthroscopy.

Could titanium screws be an appropriate disc stabilization technique in temporomandibular joint arthroscopy?

Multiple techniques for disc fixation through temporomandibular joint arthroscopy have been described. They can be classified as non-rigid, semi-rigid, and rigid. They all offer different advantages and disadvantages, and some have greater difficulties than others. Currently, multiple modifications to the basic techniques have been described in order to facilitate the technique since disc fixation corresponds to one of the procedures that most require skill. However, each technique requires extensive evaluation and monitoring in order to avoid complications and find the benefits of each technique. For this reason, the objective of this letter to the editor is to discuss two situations observed in the previously described fixation technique with osteosynthesis screws. The first issue is the fixation mechanism, and the second is the fixation time. This is in order to continue searching for the truth among all to achieve the best results and the benefit of patients.

External Jugular Thrombosis: A Previously Unreported Complication of Temporomandibular Joint Arthroscopy.

Temporomandibular joint intra-articular disorders are commonly managed using arthroscopic-assisted procedures. Arthroscopic procedures are minimally invasive, generally successful, and report a low frequency of complications. Vascular complications are particularly uncommon. This case report summarizes the diagnosis and management of jugular vein thrombosis following temporomandibular joint arthroscopy.

Reliability of magnetic resonance for temporomandibular joint disc perforation: A 12 years retrospective study.

The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.

Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial.

OBJECTIVE: To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. METHODS: The device was tested on a sample of patients with xerostomia due to Sjögren's syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. RESULTS: A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P<0.002), xerostomia frequency (P<0.05), quality of life impairment (P<0.01), and swallowing difficulty (P<0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P<0.0001), xerostomia frequency (P<0.0001), oral discomfort (P<0.001), speech difficulty (P<0.02), sleeping difficulty (P<0.001), and resting salivary flow rate (P<0.01). CONCLUSION: Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

Arthroscopic Disc Repositioning Techniques of the Temporomandibular Joint Part 2: Resorbable Pins.

Arthroscopic rigid fixation (ARF) of the temporomandibular joint (TMJ) with resorbable pins and other advanced arthroscopic disc repositioning (ADR) techniques by sutures has provided a renewed interest in the role played by the disc in the treatment of the most severe cases of TMJ ID with anterior disc displacement with severe limitation of mouth opening. These techniques may be the last step prior to open TMJ surgery, if other less complex operative arthroscopic techniques (OAT) have previously failed, or for those cases in which no predictable results are expected with simpler OAT due to the presence of a severe displaced disc or closed lock. In this article, ARF with resorbable pins is being approached, with a special focus on describing the technique while reporting its advantages and disadvantages. Also, potential complications and postoperative management and recovery, together with some advice in terms of pearls and pitfalls will be exposed.

Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualificationin oral surgery and maxillofacial surgeons in a Spanish subpopulation

Background: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. Material and Methods: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Nonparametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. Results: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11 ±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. Conclusions: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty. (AU)

Neuro-reflexotherapy for the management of myofascial temporomandibular joint pain: a double-blind, placebo-controlled, randomized clinical trial.

PURPOSE: To assess the efficacy of neuro-reflexotherapy intervention (NRT) for treating temporomandibular joint dysfunction attributed to myofascial pain. Neuro-reflexotherapy intervention consists of the temporary implantation of epidermal devices in trigger points in the back and ear. It has shown efficacy, effectiveness, and cost-effectiveness in treating subacute and chronic common back pain. No study, however, has explored its efficacy in treating myofascial temporomandibular joint pain (MF/TMJP). PATIENTS AND METHODS: This was a randomized, double-blind, placebo-controlled trial. Patients with MF/TMJP for more than 3 months in spite of conservative treatment, and with no evidence of major structural damage in the joint, were recruited at the Maxillofacial Department of the Hospital Clínico Universitario, a teaching hospital in Madrid, Spain. Patients were randomly assigned to an intervention group and to a control group. Patients in the treated group underwent 2 NRTs, immediately after baseline assessment and 45 days later. Sham interventions in the control group consisted of placement of the same number of epidermal devices within a 5-cm radius of the target zones. In both groups, conservative treatment during follow-up was allowed and recorded. Patients underwent clinical evaluations on 4 occasions: 5 minutes before intervention, 5 minutes after intervention, and 45 and 90 days later. The preintervention assessment was performed by the physician at the hospital service who included the patient in the study. The 3 follow-up assessments were performed independently by 1 of 2 physicians who had no connection with the research team, and who were blinded to patients' assignments. The primary outcome variable was level of pain severity during jaw movements at the last assessment (90 days), and the key comparison of interest was change in pain over time (pain levels at baseline and at 90 days). Level of pain was measured using a visual analog scale (VAS). RESULTS: Fifty-one patients with MF/TMJP were recruited into the study. Random assignment allocated 27 patients to the intervention group, and 24 to the control group. Differences in pain severity in favor of the intervention group appeared immediately after the intervention, persisted for 45 days, and increased after the second intervention. Differences at last follow-up were highly clinically and statistically significant (4 to 5 points on the VAS, P = .000), allowing for patients in the intervention group to cease drug treatment (P = .005). There were no differences in the evolution of crepitus or clicking in the joint. There were no clinically relevant side effects associated with the intervention. CONCLUSIONS: For patients in whom conservative treatment has failed, NRT improves the chronic pain associated with MF/TMJP syndrome.

Chondromalacia as pathological finding in arthroscopy of the temporomandibular joint: A retrospective study.

OBJECTIVE: The objective of this study was to describe the arthroscopic findings of chondromalacia and its relation with the internal derangement of the temporomandibular joint (TMJ). PATIENTS AND METHODS: A total of 161 patients (299 TMJs) who underwent arthroscopy were included in the study. The TMJs were evaluated objectively under arthroscopic vision, and 4 groups of patients were established according to the degree of involvement, degree I, II, III and IV. Statistical analyses were conducted using logistic regression models (P < 0.05). RESULTS: It was observed that 95 patients (59%) had no sign of chondromalacia and 66 (41%) in 88 joints exhibited some degree of chondromalacia (44 patients unilaterally and 22 bilaterally). Of the 88 joints with chondromalacia, 14 (15.9%) had chondromalacia degree I, 12 (13.6%) chondromalacia degree II, 20 (22.7%) chondromalacia degree III and 42 (47.7%) chondromalacia degree IV. The chondromalacia was more significantly found in patients with ADDwR and discal perforation (P < 0.05), even as a common finding in patients without any internal deragement. Chondromalacia degree IV was a significant finding in cases of ADDwoR (P = 0.000619). CONCLUSIONS: Chondromalacia of the TMJ is a common finding in patients with internal derangement even at the early stages.

Co-crystal of Tramadol-Celecoxib in Patients with Moderate to Severe Acute Post-surgical Oral Pain: A Dose-Finding, Randomised, Double-Blind, Placebo- and Active-Controlled, Multicentre, Phase II Trial.

BACKGROUND: Co-crystal of tramadol-celecoxib (CTC), containing equimolar quantities of the active pharmaceutical ingredients (APIs) tramadol and celecoxib (100 mg CTC = 44 mg rac-tramadol hydrochloride and 56 mg celecoxib), is a novel API-API co-crystal for the treatment of pain. We aimed to establish the effective dose of CTC for treating acute pain following oral surgery. METHODS: A dose-finding, double-blind, randomised, placebo- and active-controlled, multicentre (nine Spanish hospitals), phase II study (EudraCT number: 2011-002778-21) was performed in male and female patients aged ≥ 18 years experiencing moderate to severe pain following extraction of two or more impacted third molars requiring bone removal. Eligible patients were randomised via a computer-generated list to receive one of six single-dose treatments (CTC 50, 100, 150, 200 mg; tramadol 100 mg; and placebo). The primary efficacy endpoint was the sum of pain intensity difference (SPID) over 8 h assessed in the per-protocol population. RESULTS: Between 10 February 2012 and 13 February 2013, 334 patients were randomised and received study treatment: 50 mg (n = 55), 100 mg (n = 53), 150 mg (n = 57), or 200 mg (n = 57) of CTC, 100 mg tramadol (n = 58), or placebo (n = 54). CTC 100, 150, and 200 mg showed significantly higher efficacy compared with placebo and/or tramadol in all measures: SPID (0-8 h) (mean [standard deviation]): - 90 (234), - 139 (227), - 173 (224), 71 (213), and 22 (228), respectively. The proportion of patients experiencing treatment-emergent adverse events was lower in the 50 (12.7% [n = 7]), 100 (11.3% [n = 6]), and 150 (15.8% [n = 9]) mg CTC groups, and similar in the 200 mg (29.8% [n = 17]) CTC group, compared with the tramadol group (29.3% [n = 17]), with nausea, dizziness, and vomiting the most frequent events. CONCLUSION: Significant improvement in the benefit-risk ratio was observed for CTC (doses ≥ 100 mg) over tramadol and placebo in the treatment of acute pain following oral surgery. FUNDING: Laboratorios del Dr. Esteve, S.A.U.

Rearthroscopy of the temporomandibular joint: A retrospective study of 600 arthroscopies.

PURPOSE: Arthroscopic surgery is an effective treatment for patients with temporomandibular disorders, releasing symptoms and restoring the mandibular function. In patients with poor arthroscopic outcomes, several options of treatment can be considered such as conservative nonsurgical therapy, open surgery, or a second arthroscopy. The purpose of this study was to evaluate our results after 619 arthroscopies. MATERIALS AND METHODS: The clinical data of 619 arthroscopies performed between 1996 and 2015 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale (VAS), and improvement in maximal interincisal opening (MIO). The minimum follow-up period was 24 months. RESULTS: The incidence of TMJ reoperation in the 371 patients who underwent arthroscopic surgery was 5.9%, with a mean time between surgeries of 66.73 months. Significant improvement between presurgical and postsurgical pain and presurgical and postsurgical MIO at months 6 and 12 were evident. The mean of preoperative MIO was 30.84 mm, which increased to 35.92 mm 1-year postsurgery, these results being statistically significant (p < 0.05). CONCLUSIONS: In most of the cases the result of a new arthroscopy is satisfactory. Rearthroscopy of the TMJ is a valid and effective method for patients with a first unsuccessful arthroscopy.

Correlation between single photon emission computed tomography and histopathologic findings in condylar hyperplasia of the temporomandibular joint.

PURPOSE: To analyse the correlation between the level of activity measured in the single photon emission computed tomography (SPECT) and the pathological findings in patients with condylar hyperplasia (CH). MATERIALS AND METHODS: All patients evaluated in our department between 2007 and 2014 with a diagnosis of condylar hyperplasia who had undergone SPECT, evidenced signs of activity, and had undergone surgery were included. We included 28 patients, of whom 20 were women and 8 men. RESULTS: The male:female ratio was 2,5:1. The mean age of the subjects was 24.4 years at the time of diagnosis (with a range between 14 and 42 years). In 19 cases the affected condyle was the right, and in the remaining 9 it was the left (ratio R:L 2,1:1). On the SPECT, in 16 patients a high level of activity was identified (57.1%) and in the remaining 12 a low level (42.9%). Only 13 patients (6 in the low-activity group and 7 in the high-activity group) presented with islands of cartilage. When comparing the results between the two groups, the main differences were observed in the parameters related to the islands of cartilage. These were more frequent in the group with high activity compared with low activity (5.5 versus 0 per mm2 of median). Besides being more frequent, these islands were larger (more than double) in the high-activity group (385.1 µm versus 169.7 µm of median). This is the only statistically significant difference found, a fact that can be explained by the small sample size in the study. CONCLUSION: Radioisotope tests are the best indicator of the level of activity in condylar hyperplasia, which seems to be directly related to the intensity signal collection.

Discopexy using resorbable pins in temporomandibular joint arthroscopy: Clinical and magnetic resonance imaging medium-term results.

PURPOSE: To describe the use of resorbable pins for disc fixation in a series of patients and their medium-term outcomes. MATERIALS AND METHODS: A study was conducted in 26 patients who underwent operative arthroscopic surgery and discopexy using resorbable pins. All patients were refractory to conservative treatment and presented, in at least one joint, anterior disc displacement without reduction on magnetic resonance imaging (MRI). Pre- and postoperative evaluation parameters were disc position on MRI, maximal interincisal opening, lateral movements, joint pain, and articular locking and clicking. RESULTS: The technique was performed in 34 joints, and 47 pins were inserted. Mouth opening increased significantly, from a mean of 31.24 mm preoperatively to 39.57 mm 1 year postoperatively (p < 0.05). Patients reported a decrease in pain, obtaining values on a visual analogue scale (1-100) of less than 20 after 1 year postsurgery (mean improvement 47.9 points, p < 0.05). Analyzing 1-year MRI findings, in 65% of joints the discs were repositioned and in 20% of joints discs were in a more posterior position. CONCLUSIONS: The use of resorbable pins is a useful technique for disc fixation and shows medium-term improvement in clinical parameters and mandibular function. However, further studies are needed to evaluate a longer follow-up, joint morphologic changes, and disc stability on imaging.

Synovial chondromatosis of the temporomandibular joint: a clinical, radiological and histological study.

Synovial chondromatosis (SC) is a cartilaginous metaplasy of the mesenchymal remnants of the synovial tissue of the joints. It is characterized by the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). SC mainly affects to big synovial joints such as the knee and the elbow, being uncommon the onset within the TMJ, where 75 cases have been published. The main symptoms are pain, inflammation, limitation of the movements of the jaw and crepitation. Different methods of diagnosis include panoramic radiograph, CT, MR and arthroscopy of the TMJ. We report a new case of unilateral SC of the TMJ, including diagnostic images, treatment performed and histological analysis.

Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results.

OBJECTIVE: The objective of this study was to evaluate the relationship between intra-articular adhesions (IA) and disc position on magnetic resonance imaging (MRI) and direct arthroscopic vision, and to compare the presence of IA and clinical symptoms in patients diagnosed with internal derangements (ID) of temporomandibular joint (TMJ), along with their clinical outcomes. METHODS: A total of 67 patients (134 TMJs) were included in the study. All patients were refractory to previous conservative treatment, and MRI was performed before surgery in all cases. The incidence of IA was evaluated in relation to disc displacement, type of displacement (with or without reduction), and stage of ID according to the Wilkes-Bronstein classification. Patients were divided into an adhesion and non-adhesion group. The association between the two groups with respect to preoperative clinical parameters (maximal interincisal opening, locking duration, joint pain, patient age) and postoperative parameters at 6 and 12 months was evaluated. RESULTS: The incidence of IA was 44% and the most common location was the anterior recess of the joint. IA were found in 58.3% of the joints with disc displacement without reduction, and in 28.9% of those with disc displacement with reduction (p < 0.05). In joints with well-positioned discs, adhesions were found in 15% of the cases. Patient age and locking duration were significantly higher in the adhesions group (p < 0.05). In relation to clinical outcome, there was no clinically relevant difference between groups at 6 and 12 months. CONCLUSIONS: In TMJ with disc displacement without reduction, the presence of IA was significantly higher than in joints with well-positioned discs or displacement with reduction, which leads to the hypothesis that disc hypomobility is an important factor in the genesis of adhesions.

An unusual anomaly of the radial artery with potential significance to the forearm free flap. Case report.

INTRODUCTION: The radial forearm free flap has become the favourite transplant for microsurgical repair of small-to-medium sized soft tissue defects of the oral cavity. This flap derives its blood supply from perforators of the radial artery. As the radial forearm flap gains ever more popularity, it is likely that anomalous forearm vascular patterns will be encountered by more surgeons. PURPOSE: In this paper, a rare anomaly found in a patient during flap elevation is described. This 63-year-old male had a squamous cell carcinoma of the floor of the mouth and a radial forearm free flap was harvested to repair the defect. During this procedure an aberrant duplication of the radial artery was found which could have significance in harvesting such a flap in other patients. CONCLUSION: There are anomalies of the radial artery that may jeopardize the vascular supply to the radial forearm free flap. Surgeons performing this flap must be aware of the most common variants of the vascular anatomy of the forearm.

Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial.

OBJECTIVE: A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. STUDY DESIGN: The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. RESULTS: Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. CONCLUSIONS: The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Carcinoma mioepitelial de glándula submaxilar. Caso clínico y revisión de la literatura / Myoepithelial carcinoma of the submandibular gland. A case report and literature review

El carcinoma mioepitelial es de aparición rara en la glándula submaxilar. Presentamos un caso clínico y una revisión de la literatura que nos permiten establecer un diagnóstico diferencial y un tratamiento óptimo de este tumor. La histología y la inmunohistoquímica desempeñan un papel importante en el diagnóstico definitivo (AU)

Myoepithelial carcinomas or malignant myoepitheliomas are considered an uncommon salivary gland tumour with a predilection for the parotid gland. A case report is presented, along with a literature review in order to investigate the biological behaviour and proper management of myoepithelial carcinomas. Clinicopathological and immunohistochemical features are shown to achieve a better understanding this entity and to prevent their easy confusion with many other tumours (AU)