Retrospective study of facial nerve function following temporomandibular joint arthroplasty using the endaural approach.

The aim of this retrospective case-control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. A total of 39 approaches were performed through an endaural incision. Patients undergoing total joint replacement and/or with preexisting facial nerve dysfunction were excluded from the study. Five patients were lost to follow-up and were excluded from the study. Facial nerve function of all patients was clinically evaluated by resident physicians preoperatively, postoperatively, and at follow-up appointments. Facial nerve injury was determined to have occurred if the patient was unable to raise the eyebrow or wrinkle the forehead (temporalis branch), completely close the eyelids (zygomatic branch), or frown (marginal mandibular branch). Twenty-one of the 36 patients or 22 of the 39 approaches showed signs of facial nerve dysfunction following TMJ arthroplasty. This included 12 of the 21 patients who had undergone previous TMJ surgery. The most common facial nerve branch injured was the temporal branch, which was dysfunctional in all patients either as the only branch injured or in combination with other branches. By the 18th postoperative month, normal function had returned in 19 of the 22 TMJ approaches. Three of the 22 TMJ approaches resulted in persistent signs of facial nerve weakness 6 months after the surgery. This epidemiological study revealed a low incidence of permanent facial nerve dysfunction. A high incidence of temporary facial nerve dysfunction was seen with TMJ arthroplasty using the endaural approach. Current literature reveals that the incidence of facial nerve injury associated with open TMJ surgery ranges from 12.5 to 32%. The temporal branch of the facial nerve was most commonly affected, followed by 4 of the 22 approaches with temporary zygomatic branch weakness. Having undergone previous TMJ surgery did not increase the incidence of facial nerve injury using the endaural approach. This information is important for patients and surgeons in the postoperative period, as a majority of patients will experience recovery of nerve function.

Temporomandibular disorders: evaluation and management.

Temporomandibular disorders remain a common cause of visits to primary care physicians, internists, pediatricians, and emergency departments. Advances in the clinical diagnosis, radiographic imaging, and classification of these disorders have improved long-term management. There are several types of disorders of the masticatory muscles and the temporomandibular joint as well as associated structures and each may have a complex cause, clinical course, and response to therapy. Host susceptibility plays a role at several stages of these disorders. Future research offers greater possibility in defining this heterogeneous group of disorders and providing more focused and effective treatment strategies.

Use of bioresorbable plating systems in paediatric mandible fractures.

AIM: The aim of this study is to retrospectively evaluate the use of bioresorbable plating systems in the rigid fixation of paediatric mandible fractures. PATIENTS AND METHODS: Our series consists of fifteen paediatric patients (11 male, 4 female, average age 8.13 years) with mandible fractures of varying severity treated with bioresorbable plates over a 54-month period at our institution. Fractures of the ramus, body, parasymphysis, and symphysis were treated by one surgeon with open reduction and internal fixation with 1.5 mm and 2 mm resorbable plates and monocortical screws, using 3 different plating systems, each with differing polymer concentrations of polyglycolic and poly-L-lactic acid. The patients were followed with respect to the following clinical categories: fracture location, postoperative occlusion, maximum interincisal opening (MIO), segmental mobility at the fracture site, and any abnormal swelling at the operative site. RESULTS: Our data shows a stable occlusion and maximum interincisal opening of thirty millimetres or greater was achieved in 14 of 15 patients seen in follow up, with 8 patients having an MIO of 40 mm or greater. No segmental mobility noted at any of the fracture sites. Thirteen patients had no postoperative sequelae or implant related complications. Two patients developed a seroma-like collection at the operative site. Postoperative films starting at 1 year showed significant bony osseous fill where the previous screw sites were located. CONCLUSIONS: In our case series we found that the use of resorbable polyglycolic and poly-L-lactic acid plating systems when combined with a brief postoperative period of intermaxillary fixation is an effective method of internal fixation for mandibular fractures in the paediatric population.

Epidemiology, diagnosis, and treatment of temporomandibular disorders.

Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.