Temporomandibular disorders: clinical and laboratory analyses for risk assessment of criteria for surgical therapy, a pilot study.

Temporomandibular disorder (TMD) is a broad category involving dysfunction of the skeletomuscular structures of the head and neck, and the temporomandibular joint (TMJ). A total of 66 patients, 54 with TMD, participated in this study. Group 1 (G1) had 31 patients suffering from early to intermediate stage disease, and no prior surgeries. G1 patients had arthrotomy/meniscectomy performed on the diseased joint(s). Group 2 (G2) consisted of 23 patients with late stage disease. All G2 patients had previously had unsuccessful TMJ surgery and were treated with either a partial or total joint prosthesis. Group 3 (G3) consisted of 12 patients who were clinically and radiographically asymptomatic. Medical histories including inflammatory bowel disease, headaches, vertigo, tinnitus and anemia, as well as surgical tonsillectomies, appendectomies and cholecystectomies, were significantly greater in G1 and G2 when compared to G3. Serological testing included HLA subtype, positive (ANA) antinuclear antibody, erythrocyte sedimentation rate (ESR), anemia profile, hormonal levels of prolactin and estradiol, and rheumatoid factor (RF). HLA frequencies, as well as some serological analyses, were significantly different among the three groups. These findings suggest that surgical failure may be secondary to autoimmune dysfunction with a predisposition to multisystem disease. The utilization of genetic markers, serological testing, and thorough medical and surgical histories should allow the clinician to determine which patients are potentially better surgical risk candidates for treatment of TMD.

Alternative Total TMJ Arthroplasty: Metal-on-Metal for Longevity in Implant Survivorship and Patient Satisfaction.

Use of biomaterials as an implant device for TMJ joint reconstruction in oral maxillofacial surgery has been an ever-increasing dilemma for the oral maxillofacial surgeon. The decision to choose the best procedure and device/material in providing longevity wirh satisfaction to the patient has become a demanding factor. Maxillofacial surgeons are faced with a "young age" patient population and are in a continual struggle to find the proper device to maintain long-term survivorship without recurrent multiple operations. This multiple operation(s) factor can cause a further complication in itself, and also reduce the survivorship of implant devices. There has been a steady decrease in recent years in the number of TMJ surgical procedures performed by accredited OMS residency training programs; this may be due to the many short-term survivorship failures with certain alloplastic devices (Proplast/Teflon and Silastic) as well as the short-term survivorship of autologous tissue implants (Fascia and Grafts) and the added factor of enhanced complications with multiple surgeries. So the question asked by many oral maxillofacial surgeons is: what other procedure or biomaterial/device, if any, is available to avert the ever-present TMJ disease process and disorder?

The Christensen prosthesis. A retrospective clinical study.

The objective of this study was to determine if the Christensen temporomandibular joint prosthesis system in an effective alternative in treating patients with severe temporomandibular joint disorders. A total of 69 patients who were not responsive to either nonsurgical or prior surgical treatments were placed into one of three treatment groups depending on the following diagnoses: (1) placement of a glenoid fossa-eminence prosthesis with meniscus retention (22 patients, 40 joints); (2) placement of a glenoid fossa-eminence prosthesis without retention of the meniscus (26 patients, 49 joints); (3) total joint replacement (21 patients, 34 joints). Patients were evaluated immediately before surgery and at regular intervals after surgery for an average of 3.1 years. Success was measured as a significant improvement of function and decrease in pain as measured on a visual analogue scale, as well as improved incisor opening as measured with a Therabite Scale (Lorenz Surgical, Jacksonville, Fla.). Comparison of mean and average pre- and postsurgical values for all groups and criteria showed significant improvement. Results of this study indicate that the Christensen temporomandibular joint prosthesis system may offer a viable method for the treatment of severe temporomandibular joint disease with a high degree of success.

Eagle's syndrome: a comparison of intraoral versus extraoral surgical approaches.

Eagle first described vague orofacial pain associated with styloid elongation in 1937. Since that time, many authors have described the various clinical symptoms, radiographic features, and treatment regiments seen with Eagle's syndrome. Two cases of Eagle's syndrome treated surgically are presented in this article. Both extraoral and intraoral approaches were separately used. These two surgical approaches are critically discussed in depth. The extraoral approach is advocated. In addition, diagnostic procedures and nonsurgical treatment alternatives are discussed.

Malignant teratoma of the mandible.

A rare case of malignant teratoma of the mandible that resembled a dentigerous cyst radiographically is presented. Treatment by surgical resection and secondary reconstruction resulted in satisfactory function and esthetics.

Kinetics of cell proliferation and migration associated with orthodontically-induced osteogenesis.

Cell kinetics of rat molar periodontal ligament (PDL) during orthodontically-induced osteogenesis revealed: 1) primary growth fraction of 59%, 2) proliferating cells from throughout the PDL migrate toward the bone surface, 3) preosteoblasts, capable of forming osteoblasts without synthesizing DNA, are present in the PDL, 4) osteoblasts are derived from local PDL cells, and 5) cell death is a characteristic feature of the osteogenic response.

Recurrent melanotic neuroectodermal tumor of infancy: report of case and tumor heterotransplantation studies.

A fifth case of rapidly recurring melanotic neuroectodermal tumor of infancy is reported. The possibility of recurrence and subsequent encroachment on vital facial structures is emphasized. Vigorous bony curettage at initial excision of this benign lesion may aid in the preventing recurrence. Heterotransplantation studies disclosed the benign nature of the MNTI cells.

Heterotransplantation of human neoplasms.

The heterotransplantation of 39 solid human neoplasms into athymic and asplenic-athymic mice resulted in the successful growth of 28 of the transplants. However, only 17 of the tumors could be maintained in serial passage. Metastasis or local infiltration by the transplanted tumors was not observed. Melanomas and colorectal carcinomas grew well whereas other types grew poorly or not at all. Possible factors responsible for the poor growth or lack of growth are discussed. The rapid growth of a melanoma in newborn mice in contrast with the slow growth of the same tumor in adult mice suggests a new experimental approach for transplantation of malignancies which previously have been difficult to establish.

Arthrography in the evaluation of the temporomandibular joint.

Temporomandibular joint arthrography has been helpful in selecting patients for reconstructive surgery who have severe temporomandibular joint dysfunction. Structural abnormalities of the soft tissues can be demonstrated where only minimal osseous changes are seen on tomography. The normal arthrographic anatomy of the joint is reviewed and normal and pathological joints are illustrated.

Utilization review: P.S.R.O. and the oral surgeon.

The P.S.R.O. program is being implemented to improve the quality of care through effective peer review. Effective peer review requires that the oral surgeon must not only detect problems, but analyze causes and develop, implement, and evaluate corrective programs. To actively participate in development of P.S.R.O. criteria for admission, the Department of Oral Surgery at the University of Tennessee Memorial Hospital, Knoxville, conducted a restrospective survey of oral surgery admissions. Utilization review of the oral surgery admissions was conducted to determine the average length of stay and the utilization of the operating room and the ambulatory surgery clinic for patients admitted to the hospital.

Evaluation and refinement of the intraoral vertical subcondylar osteotomy.

Data were collected from the use of intraoral vertical subcondylar osteotomy in 42 patients. The results of treatment compare favorably with those attained with sagittal split osteotomy and extraoral vertical subcondylar osteotomy. Modification in instrumentation and techniques has further improved the intraoral vertical subcondylar osteotomy. The primary advantage of this technique compared to the sagittal split osteotomy is the much less frequent and less severe damage to the mandicular nerve. This intraoral technique deserves serious consideration as the method for reduction of the prognathic mandible.