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1.
J Coll Physicians Surg Pak ; 34(6): 717-722, 2024 Jun.
Article En | MEDLINE | ID: mdl-38840358

OBJECTIVE: To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of cannula, and the occurrence of complications. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ankara Yildirim Beyazit University, Ankara, Turkiye, between September 2021 and May 2022. METHODOLOGY: Forty patients with Wilkes III temporomandibular joints (TMJ) internal derangement were identified and 13 patients who met the inclusion criteria were reviewed. The main outcomes regarding the clinical applicability of modified CCT included the duration of arthrocentesis, the number of reposition of cannula, and the occurrence of complications. RESULTS: The values of maximum mouth opening (MMO) without pain and MMO without assistance measured in the immediate postoperative period and at the 4th and 8th postoperative weeks were found to be significantly higher than the pre-arthrocentesis values. The values of MMO with assistance measured in the immediate postoperative period and at the 8th postoperative week were also significantly higher than the baseline values. Compared with preoperative values, notable decreases in pain scores were observed at the 4th (p = 0.003) and 8th (p = 0.002) postoperative weeks. The assessment of the jaw dysfunction also revealed significantly lower scores at the 4th (p = 0.024) and 8th (p <0.001) postoperative weeks. CONCLUSION: Modified CCT of arthrocentesis substantially decreased pain and improved mandibular functions in patients with internal derangement of TMJ. Additionally, this technique could be performed with a reduced number of cannula relocations and required a shorter operative time even with the use of a higher irrigation volume during the lavage procedure. KEY WORDS: Arthrocentesis, Temporomandibular joint disorder, Temporomandibular joint.


Arthrocentesis , Temporomandibular Joint Disorders , Humans , Arthrocentesis/methods , Male , Female , Temporomandibular Joint Disorders/surgery , Adult , Middle Aged , Punctures/methods , Needles , Treatment Outcome , Young Adult , Temporomandibular Joint/surgery , Range of Motion, Articular , Cannula
2.
J Contemp Dent Pract ; 25(3): 197-198, 2024 Mar 19.
Article En | MEDLINE | ID: mdl-38690689

How to cite this article: Mosaddad SA. Arthroscopy for the Treatment of Temporomandibular Disorders. J Contemp Dent Pract 2024;25(3):197-198. Keywords: Arthroscopy, Facial pain, Temporomandibular joint, Temporomandibular joint disorders.


Arthroscopy , Temporomandibular Joint Disorders , Arthroscopy/methods , Humans , Temporomandibular Joint Disorders/surgery , Facial Pain/surgery , Facial Pain/etiology
3.
Acta Odontol Scand ; 83: 273-280, 2024 May 07.
Article En | MEDLINE | ID: mdl-38712696

OBJECTIVE: Temporomandibular joint (TMJ) pathologies are prevalent, affecting approximately 40% of the worldwide population, with nearly 80% involving intracapsular disorders. Despite this, standardized treatment protocols are lacking. This study aimed to compare the efficacy of conservative and surgical approaches in managing intracapsular TMJ disorders. METHODS: Eighty-six patients diagnosed with intracapsular TMJ disorders were included in the study, with 40 males and 46 females, averaging 52.4 ± 4.7 years. Patients were recruited from polyclinics in Beijing, China (n = 36), and Kyiv, Ukraine (n = 50). A comprehensive examination protocol was conducted, including assessment of patient complaints, medical history, jaw mobility measurements, TMJ palpation, and magnetic resonance imaging (MRI) screening. RESULTS: The main outcomes of our study revealed significant improvements in patients undergoing surgical intervention for intracapsular TMJ disorders, particularly in cases of disc displacement. Conservative mouth guard/occlusal splint treatment showed limited effectiveness, primarily improving joint effusion and disc displacement. Surgical intervention led to notable enhancements in various TMJ parameters, with significant improvements observed in joint function and pain reduction. Based on these findings, orthodontic rehabilitation was recommended to ensure long-term efficacy, focusing on optimizing occlusion and restoring TMJ function. These results highlight the importance of tailored treatment approaches for managing intracapsular TMJ disorders, emphasizing the role of surgical intervention coupled with comprehensive rehabilitation strategies. CONCLUSIONS: Future research should consider demographic factors and explore innovative examination methods, such as optical systems, to enhance understanding and management of intracapsular TMJ disorders.


Temporomandibular Joint Disorders , Humans , Temporomandibular Joint Disorders/surgery , Male , Female , Middle Aged , Adult , China , Ukraine , Magnetic Resonance Imaging , Treatment Outcome
4.
Clin Oral Investig ; 28(6): 317, 2024 May 16.
Article En | MEDLINE | ID: mdl-38750335

OBJECTIVES: To evaluate the effects of costochondral grafting (CCG) used for temporomandibular joint ankylosis (TMJA) in growing patients. MATERIALS AND METHODS: Pediatric patients with TMJA treated by CCG from 2010.5 to 2021.7 were included in the study. CT scans were performed before and after operations with at least 1 year follow-up. The height of the mandibular ramus, menton deviation or retraction, osteotomy gap, etc. were measured by ProPlan CMF1.4 software. CCG growth, resorption, and relapse were evaluated and analyzed with influencing factors such as age, ostectomy gap, etc. by generalized estimating equation. RESULTS: There were 24 patients (29 joints) with an average age of 6.30 ± 3.13 years in the study. After operation, the mandibular ramus was elongated by 5.97 ± 3.53 mm. Mandibular deviation or retrusion was corrected by 4.82 ± 2.84 mm and 3.76 ± 2.97 mm respectively. After a mean follow-up of 38.91 ± 29.20 months, 58.62% CCG grew (4.18 ± 7.70 mm), 20.69% absorbed (2.23 ± 1.16 mm), and 20.69% re-ankylosed. The re-ankylosis was negatively correlated with the osteotomy gap (OR:0.348,0.172-0.702 95%CI, critical value = 6.10 mm). CCG resorption was positively correlated with the distance of CCG ramus elongation (OR:3.353,1.173-9.586 95%CI, critical value = 7.40 mm). CONCLUSIONS: An adequate osteotomy gap and CCG ramus elongation distance are the key factors for successful treatment of TMJA with jaw deformities in growing patients. CLINICAL RELEVANCE: TMJA affects mouth opening and jaw development in pediatric patients. The most common autogenous bone graft for pediatric patients is CCG due to its growth potential, convenient access and easy contouring. Also, it can simultaneously reconstruct the TMJ and improve jaw deformity by lengthening the mandibular ramus. But the growth of CCG is unpredictable. In this study, we explored several factors that may affect the absorption and re-ankylosis of CCG, expecting to provide several suggestions to improve future CCG treatment.


Ankylosis , Temporomandibular Joint Disorders , Tomography, X-Ray Computed , Humans , Child , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/diagnostic imaging , Female , Ankylosis/surgery , Male , Treatment Outcome , Ribs/transplantation , Bone Transplantation/methods , Child, Preschool , Retrospective Studies , Cartilage/transplantation
5.
Ned Tijdschr Tandheelkd ; 131(5): 223-230, 2024 May.
Article Nl | MEDLINE | ID: mdl-38715535

The initial treatment of symptomatic disorders of the temporomandibular joint typically consists of a conservative approach, in which medication (painkillers and muscle relaxants), orofacial physiotherapy and splints are most important. In most cases, minimally invasive treatment options, such as arthrocentesis, arthroscopy or joint injections, are only considered when conservative methods provide insufficient symptom reduction. There is, however, an ongoing debate about the optimal treatment strategy due to an increasing body of evidence concerning the superior effectiveness in symptom reduction of minimally invasive treatment options with regard to conservative treatments. If these minimally invasive treatment options are also ineffective, open joint surgery may be considered as a last option for a select group of patients.


Arthroscopy , Minimally Invasive Surgical Procedures , Temporomandibular Joint Disorders , Humans , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/therapy , Arthroscopy/methods , Treatment Outcome , Temporomandibular Joint/surgery , Arthrocentesis/methods
6.
J Craniofac Surg ; 35(4): 1236-1240, 2024 Jun 01.
Article En | MEDLINE | ID: mdl-38727210

Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.


Arthrocentesis , Duloxetine Hydrochloride , Pain Measurement , Temporomandibular Joint Disorders , Humans , Duloxetine Hydrochloride/therapeutic use , Female , Male , Adult , Temporomandibular Joint Disorders/drug therapy , Temporomandibular Joint Disorders/surgery , Arthrocentesis/methods , Treatment Outcome , Combined Modality Therapy , Middle Aged , Anxiety , Depression , Chronic Pain/drug therapy , Serotonin and Noradrenaline Reuptake Inhibitors/therapeutic use , Serotonin and Noradrenaline Reuptake Inhibitors/administration & dosage
7.
J Craniomaxillofac Surg ; 52(5): 558-564, 2024 May.
Article En | MEDLINE | ID: mdl-38631972

This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.


Arthroscopy , Temporomandibular Joint Disorders , Humans , Arthroscopy/methods , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disorders/surgery
8.
Br J Oral Maxillofac Surg ; 62(3): 324-328, 2024 Apr.
Article En | MEDLINE | ID: mdl-38453560

Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a 'one size fits all' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an '80% chance of getting 80% better' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.


Arthroscopy , Temporomandibular Joint Disorders , Humans , Arthrocentesis/methods , Arthroplasty, Replacement/methods , Arthroscopy/methods , Temporomandibular Joint Disorders/surgery
9.
Br J Oral Maxillofac Surg ; 62(4): 340-348, 2024 May.
Article En | MEDLINE | ID: mdl-38521741

Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.


Mandibular Condyle , Orthognathic Surgical Procedures , Temporomandibular Joint Disc , Temporomandibular Joint Disorders , Humans , Mandibular Condyle/surgery , Mandibular Condyle/pathology , Orthognathic Surgical Procedures/methods , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disc/pathology , Osteoarthritis/surgery
10.
J Oral Maxillofac Surg ; 82(6): 632-640, 2024 Jun.
Article En | MEDLINE | ID: mdl-38442876

This technical innovation demonstrates the use of ImmersiveTouch Virtual Reality (VR) and Augmented Reality (AR)-guided total temporomandibular joint replacement (TJR) using Biomet stock prosthesis in 2 patients with condylar degeneration. TJR VR planning includes condylar resection, prosthesis selection and positioning, and interference identification. AR provides real-time guidance for osteotomies, placement of prostheses and fixation screws, occlusion verification, and flexibility to modify the surgical course. Radiographic analysis demonstrated high correspondence between the preoperative plan and postoperative result. The average differences in the positioning of the condylar and fossa prosthesis are 1.252 ± 0.269 mm and 1.393 ± 0.335 mm, respectively. The main challenges include a steep learning curve, intraoperative technical difficulties, added surgical time, and additional costs. In conclusion, the case report demonstrates the advantages of implementing AR and VR technology in TJR's using stock prostheses as a pilot study. Further clinical trials are needed prior to this innovation becoming a mainstream practice.


Arthroplasty, Replacement , Augmented Reality , Joint Prosthesis , Temporomandibular Joint Disorders , Virtual Reality , Humans , Arthroplasty, Replacement/methods , Arthroplasty, Replacement/instrumentation , Temporomandibular Joint Disorders/surgery , Mandibular Condyle/surgery , Mandibular Condyle/diagnostic imaging , Surgery, Computer-Assisted/methods , Female , Prosthesis Design , Middle Aged , Male , Temporomandibular Joint/surgery , Temporomandibular Joint/diagnostic imaging , Imaging, Three-Dimensional
11.
J Oral Maxillofac Surg ; 82(6): 641-647, 2024 Jun.
Article En | MEDLINE | ID: mdl-38547928

PURPOSE: Temporomandibular joint (TMJ) surgery is being increasingly performed globally with considerable success leading to improved quality of life for patients affected with disabling temporomandibular disorders. One of the most unusual phenomena noted during maxillofacial surgery due to stimulation of the trigeminal nerves is the Trigeminocardiac reflex (TCR), which causes sudden bradycardia and hypotension causing alarm and distress to the surgical and anesthetic team. The purpose of this systematic review is to identify the frequency and discuss the pathophysiology of the TCR especially during TMJ surgery. METHODS: The authors performed a systematic review by searching PubMed, Embase, Ovid, and Cochrane databases between 1946 and 2023 to identify studies that reported on the development of TCR during TMJ surgery. Non-English publications and those with inadequate details were excluded. RESULTS: Thirty-six papers reporting on the development of the TCR during oral and maxillofacial procedures were noted. Six papers reported specifically on TCR during TMJ surgery. A total of 25 subjects developed TCR during TMJ surgery. The mean age of the subjects was 31 (standard deviation 17.16) years. Twenty-three subjects (92%) developed bradycardia while 2 subjects (8%) developed asystole. All subjects recovered. The most common stimulant noted in these papers leading to TCR was manipulation and distraction of the TMJ. CONCLUSION: Although TCR is uncommon, it can occur during TMJ surgery, and it behooves the surgeon and anesthesia team to be aware of the potential for TCR to ensure adequate and timely treatment.


Reflex, Trigeminocardiac , Temporomandibular Joint , Humans , Bradycardia/etiology , Intraoperative Complications , Oral Surgical Procedures/adverse effects , Reflex, Trigeminocardiac/physiology , Temporomandibular Joint/surgery , Temporomandibular Joint Disorders/surgery
12.
J Oral Maxillofac Surg ; 82(5): 519-524, 2024 May.
Article En | MEDLINE | ID: mdl-38387855

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.


Arthroscopy , Needles , Temporomandibular Joint Disorders , Humans , Arthroscopy/methods , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/therapy , Minimally Invasive Surgical Procedures
13.
Br J Oral Maxillofac Surg ; 62(3): 272-277, 2024 Apr.
Article En | MEDLINE | ID: mdl-38413292

This prospective cohort study examined the changes in airway area and soft tissue parameters following interpositional arthroplasty for temporomandibular joint (TMJ) ankylosis. Ten patients with TMJ ankylosis underwent surgery, and preoperative and postoperative skeletal and soft tissue measurements were obtained. A significant rise in soft tissue parameters was observed following surgery, although only minor changes in skeletal parameters were seen. The nasoropharyngeal area, oral area, soft palate area, and tongue area were examined. After the surgery, increases in values were observed in the nasoropharyngeal area (from 3482.4 mm2 to 3618.7 mm2), the oral area (from 2731.8 mm2 to 2840.8 mm2), the soft palate area (from 204.9 mm2 to 217.3 mm2), and the tongue area (from 2577.5 mm2 to 2600.8 mm2). These findings suggest that interpositional arthroplasty can improve airway area and soft tissue dimensions, affecting the stomatognathic system's aesthetic and functional aspects. Further research is needed to validate these results and assess long-term stability.


Ankylosis , Arthroplasty , Cephalometry , Temporomandibular Joint Disorders , Humans , Ankylosis/surgery , Temporomandibular Joint Disorders/surgery , Prospective Studies , Female , Male , Arthroplasty/methods , Adult , Young Adult , Adolescent , Middle Aged , Pharynx/anatomy & histology
14.
J Oral Rehabil ; 51(6): 1061-1080, 2024 Jun.
Article En | MEDLINE | ID: mdl-38400536

BACKGROUND: Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet. OBJECTIVE: The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD? METHODS: The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. RESULTS: The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence. CONCLUSION: Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.


Joint Dislocations , Minimally Invasive Surgical Procedures , Temporomandibular Joint Disc , Temporomandibular Joint Disorders , Humans , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/physiopathology , Temporomandibular Joint Disorders/therapy , Minimally Invasive Surgical Procedures/methods , Joint Dislocations/surgery , Temporomandibular Joint Disc/surgery , Treatment Outcome , Arthrocentesis/methods , Range of Motion, Articular/physiology , Hyaluronic Acid/therapeutic use , Hyaluronic Acid/administration & dosage , Injections, Intra-Articular
15.
J Craniomaxillofac Surg ; 52(5): 578-584, 2024 May.
Article En | MEDLINE | ID: mdl-38368213

The primary aim of this study was to investigate whether patients with end-stage temporomandibular joint (TMJ) disease treated with gap arthroplasty with temporalis interpositional flap (GAT) had improved maximal interincisal opening (MIO) and TMJ pain in a long-term perspective. All patients with severe osteoarthritis, or fibrous or bony ankyloses, and subjected to GAT between 2008 and 2015 were included. The criteria of treatment success were TMJ pain VAS score ≤4 and MIO ≥30 mm. Reoperation was considered as a failure. Forty-four patients (mean age 47 years) were included in this retrospective descriptive case series and followed up for up to 7 years (mean 4.5). Comorbidities were frequent (n = 34) and most commonly rheumatic disease (n = 17). The indications for surgery were ankylosis (n = 32) or severe osteoarthritis (n = 12). Of the 44 included patients, 84% (n = 37) had a history of earlier TMJ surgery. The preoperative mean values for TMJ pain and MIO (VAS 7 and 23 mm, respectively) changed significantly (p < 0.001) to postoperative means of VAS 3 and 34 mm, respecitvely. The success rate was 59% (n = 26). When compared with a previous 2-year follow-up, the success rate was found to have decreased over time (p = 0.0097). The rate of successful treatment outcome in terms of MIO alone was 82% (n = 36). The most common reason for treatment failure was residual pain. In conclusion, the success-rate after GAT did not show long-term stability and continued to drop over time in this patient cohort. TMJ pain seems to be the main reason for failure.


Arthroplasty , Surgical Flaps , Temporomandibular Joint Disorders , Humans , Middle Aged , Temporomandibular Joint Disorders/surgery , Retrospective Studies , Male , Female , Follow-Up Studies , Surgical Flaps/surgery , Adult , Arthroplasty/methods , Aged , Ankylosis/surgery , Osteoarthritis/surgery , Osteoarthritis/complications , Treatment Outcome , Pain Measurement , Temporal Muscle/surgery
16.
Medicina (Kaunas) ; 60(2)2024 Feb 19.
Article En | MEDLINE | ID: mdl-38399626

The temporomandibular joint (TMJ) is one of the most complex joints in the human anatomy. In advanced degenerative stages, conservative or minimally invasive surgical therapies have failed to restore joint function, and joint replacement with prostheses has been required. Stock prostheses, compared to custom-made prostheses, are much less expensive and require less pre-operative preparation time. Four patients followed for years for temporomandibular dysfunction and previously operated on by arthroscopy or open joint surgery that have been reconstructed with stock TMJ prostheses (STMJP) through virtual surgical planning (VSP) and an STL model with surgical and positioning guides were included. The median follow-up was 15 months; the median number of previous TMJ surgeries was 2. The mean preoperative MIO was 24.6 mm and at longest follow-up was 36.4 mm. The median preoperative TMJ pain score was 8, and the median postoperative TMJ pain was 3. All patients have improved their mandibular function with a clear improvement of their initial situation. In conclusion, we believe that stock TMJ prostheses with virtual surgical planning and surgical guides are a good alternative for TMJ reconstruction at the present time. Nonetheless, prospective and randomized trials are required with long-term follow up to assess their performance and safety.


Joint Prosthesis , Temporomandibular Joint Disorders , Humans , Pilot Projects , Temporomandibular Joint Disorders/surgery , Prospective Studies , Treatment Outcome , Temporomandibular Joint/surgery , Pain
17.
J Craniomaxillofac Surg ; 52(3): 347-354, 2024 Mar.
Article En | MEDLINE | ID: mdl-38368209

This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.


Jaw Abnormalities , Joint Dislocations , Orthognathic Surgery , Temporomandibular Joint Disorders , Humans , Retrospective Studies , Arthroscopy , Feasibility Studies , Temporomandibular Joint Disorders/diagnostic imaging , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint/surgery , Mandible/surgery , Magnetic Resonance Imaging/methods , Joint Dislocations/surgery
18.
Int J Surg ; 110(4): 2187-2195, 2024 Apr 01.
Article En | MEDLINE | ID: mdl-38241415

BACKGROUND AND OBJECTIVE: Open suturing (OSu) and mini-screw anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodelling (CBR) between these two surgical procedures in a single centre. METHODS: A retrospective cohort study using MRI scans (pre-operation, 1 week and 12 months post-operation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one centre through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting five factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression. RESULTS: Three hundred eighty-five patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% CI, 1.27-6.85) and better CBR (RR=1.58; 95% CI, 1.02-2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95% CI, 1.11-6.26) and overcorrected or posteriorly repositioned discs were more stable than normally repositioned discs (RR=5.84; 95% CI, 2.58-13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95% CI, 0.89-0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95% CI, 1.76-3.83). CONCLUSION: OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.


Bone Remodeling , Temporomandibular Joint Disc , Humans , Female , Retrospective Studies , Male , Adult , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disc/diagnostic imaging , Middle Aged , Bone Remodeling/physiology , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/diagnostic imaging , Magnetic Resonance Imaging , Mandibular Condyle/surgery , Mandibular Condyle/diagnostic imaging , Young Adult , Adolescent , Treatment Outcome , Joint Dislocations/surgery , Joint Dislocations/diagnostic imaging , Cohort Studies , Suture Anchors
19.
J Oral Maxillofac Surg ; 82(4): 402-411, 2024 Apr.
Article En | MEDLINE | ID: mdl-38244990

Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique utilizing two operative cannulas that completely remove nonfunctional cartilaginous tissue.


Joint Dislocations , Joint Prosthesis , Temporomandibular Joint Disorders , Humans , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disorders/surgery , Diskectomy , Cartilage , Joint Dislocations/surgery , Temporomandibular Joint/surgery , Arthroscopy , Range of Motion, Articular
20.
Int J Oral Maxillofac Surg ; 53(6): 503-520, 2024 Jun.
Article En | MEDLINE | ID: mdl-38286713

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.


Arthrocentesis , Arthroscopy , Conservative Treatment , Temporomandibular Joint Disorders , Humans , Arthroscopy/methods , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/therapy , Arthrocentesis/methods , Conservative Treatment/methods
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