Longitudinal electromyographic changes in masseter and anterior temporalis muscle before and after temporomandibular joint arthroplasty in ankylosis patients.

PURPOSE: The literature lacks evidence about activity of masseter and anterior temporalis muscles in temporomandibular joint ankylosis (TMJA) patients. The purpose of this study was to evaluate longitudinal electromyography (EMG) changes in masseter and anterior temporalis muscle before and after gap arthroplasty in unilateral TMJA patients. Specific aim was to investigate the EMG activity restoration to the level of non-ankylosed side after arthroplasty. METHODS: The investigator implemented a prospective longitudinal study amongst TMJA patients treated with gap arthroplasty. EMG of masseter and anterior temporalis were recorded bilaterally on ankylosed and non-ankylosed side. EMG signals of masseter and anterior temporalis were recorded preoperatively and 1 week, 3 month and 6 month postoperatively at rest and at maximum voluntary clench (MVC). RESULTS: The study sample was composed of 16 (male:female = 1:1.28) unilateral TMJA patients. The mean duration of ankylosis was 3.25 ± 1.18 years. The difference in EMG root-mean-square (RMS) values of ankylosed side when compared to the preoperative values of non-ankylosed side was found to be statistically significant (p < 0.001) preoperatively, 1 week and 3 month postoperatively, while it was statistically not significant (p > 0.99) at 6-month postoperatively. CONCLUSION: The present study concludes that the TMJA patients have hyperactivity of masseter and anterior temporalis muscle. Restoring the function causes the muscle activity to progress to the values of normal side. EMG activity as measured on follow-up may be one of the predicting factor for re-ankylosis.

Ultrasound-guided autologous blood injection in patients with chronic recurrent temporomandibular joint dislocation.

OBJECTIVE: To evaluate the accuracy and effectiveness of ultrasound (US) guided autologous blood injection (ABI) for the treatment of chronic recurrent TMJ dislocation. DESIGN: Prospective cohort study. SETTING: Centre for medical education and research. PARTICIPANTS OR ANIMALS SPECIMENS CADAVERS: Ninteen patients with chronic recurrent TMJ dislocation (Fifteen bilateral and fourteen unilateral). INTERVENTIONS: Autologous blood injected, 2ml in superior joint space (SJS) and 1 ml in peri-capsular tissue (PT) under ultra sound guidance. MAIN OUTCOME MEASURES: Reduction in number of dislocation episodes, maximal mouth opening, pain (visual analogue scale) and TMJ sounds (present or absent) at the end of 2 weeks, 3 months, 6 months and 1 year. RESULTS: At 2 weeks post operatively 18 patients (95%) were asymptomatic only one patient (5%) complained of Recurrence of dislocation and was treated successfully by a 2nd injection. At subsequent follow up visits none reported dislocation. CONCLUSIONS: US guided ABI for patients with chronic recurrent TMJ dislocations serves as an alternative, minimally invasive, highly effective and accurate modality of treatment since it includes exposure without radiation, real-time visualization of soft tissues, visualization of the needle tip advancement, local anesthetic spread relevant to the surrounding structures which can be performed on an outpatient basis.

Piezoelectric harvest of osteo-odonto-lamina in modified osteo-odonto keratoprosthesis: A maxillofacial perspective.

PURPOSE: We describe the piezo-osteotomy feasibility in rehabilitation and harvesting of osteo-odonto lamina in modified osteo-odonto keratoprosthesis (MOOKP) surgery. Surgery was evaluated regarding operative technique and success of the keratoprosthesis (KPros) in terms of perception to light (+ve) to finger counting (+ve). MATERIALS AND METHODS: This retrospective cohort study included 12 patients undergone MOOKP surgery procedures. Harvesting of osteo-odonto-lamina was performed using piezosurgical osteotomy during 2007-2012. RESULTS: The mean follow up was 34 months (range 24-48 months). Of the 12 patients six patients had vision ≥6/12, four patients had vision <6/12, but >6/60 and one patients had vision ≤6/60. KPros was retained and functional in all the eyes after a minimum follow up of 24 months. There was mucosal overgrowth over the optical cylinder occurred in two cases over 4 years follow up which was corrected with trimming. Postoperative complication at donor site was seen in three cases, two cases with exposure of root of adjacent teeth and oro antral fistula in one. CONCLUSIONS: This study suggests that piezoelectric harvest of osteo-odonto-lamina is a valuable surgical option in patients undergoing MOOKP surgery, resulting in high success rate with less complication.