[Retrospective study of two years of surgery for temporomandibular joint pain dysfunction syndrome]. / Etude rétrospective de deux années de chirurgie du Sadam.

BACKGROUND: Assessment of temporomandibular joint (TMJ) surgery is a controversial topic. We analyzed our long-term surgical results in a set of patients who underwent TMJ surgery in our unit from January 1995 through December 1996. We used a simple methodology based on 4 criteria: pain, mouth opening, type of feeding and patient satisfaction. MATERIAL AND METHODS: We reviewed 21 operated patients who had been managed by an orthodontist after surgery. The post-surgical follow-up was 4 years. Patient age at surgery ranged from 14 to 51 years; the sex ratio was 1/9 M/F. Seventeen patients suffered a closed-lock, 2 had fibrous ankylosis of the disc. Fifteen patients underwent bilateral TMJ arthrotomy with joint fixation and, very often, mandibulo-condylar-plasty to counteract the bony compression inside the joint. We rated outcome as "very good" if four factors were found: resolution or improvement of pain, more than 40 mm post-surgery mouth opening or at least 10 mm improvement for patients with less than 40 mm post-surgical mouth opening, normal feeding, subjective satisfaction rated as very or quite good. Outcome was thus rated as very good (4 factors), quite good (3 factors), good (2 factors), poor (1 factor), failure (0 factors). RESULTS: Resolution of pain was achieved in 55% of the patients with an improvement in the others. All patients recovered normal feeding. Mouth opening remained limited for two patients. Subjective patient satisfaction was very or quite good in 80% of the cases. Outcome was rated very good in 9 patients, quite good in 7, and good in 5. There were no patients with poor outcome or failure. Analysis of the good outcome group showed that 3 had experience a post-surgery trauma, one had not complied with rehabilitation therapy, and one suffered from undiagnosed rheumatoid polyarthritis. CONCLUSION: According to the literature, TMJ surgery is an effective means of treating pain and reducing dysfunction. We obtained good and stable outcome in patients who participated in our postoperative follow-up. The TMJ is a fragile joint particularly susceptible to trauma.

[MRI of the semicircular canals in cranio-facial asymmetries and craniomandibular syndrome]. / IRM des canaux semi-circulaires dans les asymétries crânio-faciales et le syndrome crânio-mandibulaire.

The cranio-mandibular syndrome (CMS) is often secondary to an cranio-facial asymmetry (CFA); it associate a painful masticatory dysfunction syndrome with functional and aching clinical signs in relation with a functional torticollis required for oculo-labyrinthal equilibration maintenance. Our anatomical and functional MRI protocol uses tridimensional study of semi-circular canals (SCC) up relation to the medial cerebral axis (MCA), and permit to measure precisely these CFA and propose, with a multispecialist approach, an adapted treatment of the SCM. Application of MRI to SCC asymmetry looks to its future use for spatial intracranial referencial of cerebral structures.

[Indications and role of surgery in painful dysfunction syndromes of the masticatory apparatus]. / Indications et place de la chirurgie dans les syndromes algo-dysfonctionnels de l'appareil manducateur.

Among the numerous causes of facial neuralgias, the painful dysfunction syndrome of the manducatory apparatus corresponds to a frequent etiology whose thorough study carried out by a multidisciplinary team over about 500 cases allowed their splitting into several evolutive clinical forms. At present, a number of these forms which are particularly painful, require a disk surgery (dislocation reduction, perforation suture, etc.) and if necessary an articular facet surgery (modelling condylectomy, surfacing, etc.). This study specifies the indications and prognosis for these surgical operations.

[Arthrography of the temporomandibular joint]. / L'arthrographie de l'articulation temporo-mandibulaire (ATM).

In 1989, opaque contrast arthrography of temporomandibular joint is still seldom used. A brief historical review of the procedure is presented here, and the technique of puncturing the menisco-condylar and menisco-temporal compartments is discussed. The value of injecting opaque contrast material into the lower compartment and carrying out kinetic and tomographic studies as well as bilateral examinations is stressed. Normal aspects are described with their variants, as well as pathological ones (reducible and non-reducible luxations, perforations, distension of the bilaminar zone, adhesions, etc.). Both the place of arthrography in relation to other investigations (TDM, IRM) and its indications for visualization of menisco-condylar problems are discussed.

[Contrast arthrography of the temporomandibular joint]. / L'arthrographie opaque de l'articulation temporo-mandibulaire.

Seventy-four temporomandibular arthrographic examinations, mostly involving paracentesis of the menisco-condylar compartment, provided the means for visualizing normal and pathologic aspects of both reducible and non-reducible meniscal dislocations, and of perforations. Findings included distension of the bilaminar zone and adhesions. Post modeling condyloplasty status was noted. At present, arthrography seems to be the most reliable test, as well as being the easiest to perform and the least expensive one for visualizing menisco-condylar abnormalities.