Improvement of bone-erosive temporomandibular joint (TMJ) abnormalities in adolescents undergoing non-surgical treatment: a longitudinal study.

OBJECTIVES: To investigate the longitudinal changes of the imaging temporomandibular joint (TMJ) characteristics in young patients with TMJ-related symptoms and treated with non-surgical methods. The severity of self-reported symptoms at follow-up was also investigated. METHODS: A cone beam CT (CBCT)/CT follow-up examination [median follow-up 4.1 (1.3-6.4) years] was performed in 22 patients with erosive TMJ abnormalities [baseline median age 16 (12-18) years]. Imaging characteristics were analyzed and the changes between the examinations were categorized as (A) improvement, (B) no change, or (C) worsening. Severity of follow-up symptoms was evaluated using Jaw Functional Limitation Scale (JFLS-8) and Graded Chronic Pain Scale (Grade 0-IV). Analyses were performed separately for left and right TMJ. Findings at baseline and follow-up were compared using McNemar test to account for dependencies. Changes in proportions of hard tissue findings between examinations were assessed using Wilcoxon signed ranks test. RESULTS: A significant reduction in the proportion of patients with erosive abnormalities was found [59.1%, 95% CI (36.4-79.3) %]. Baseline erosions improved in 9/12 (75%) right and 14/15 (93%) left TMJs. About half repaired; developed an intact cortical outline. Number of joints with osteophytes increased (right: p < 0.04, left: p < 0.003). New osteophytes were mostly found in joints with erosive findings. Low or no limitation of jaw function (Jaw Functional Limitation Scale) was found in 12/22 (55%) and no or low intensity of pain (Graded Chronic Pain Scale Grade 0 or I) in 19/22 (86%) at follow-up. CONCLUSION: We found a high potential for repair of erosive TMJ abnormalities. However, the patient series was small. The majority of patients assessed their symptom severity at follow-up as low.

CBCT characteristics and interpretation challenges of temporomandibular joint osteoarthritis in a hand osteoarthritis cohort.

OBJECTIVES: To characterise osteoarthritis (OA) in the temporomandibular joints (TMJs) by means of cone beam CT in a hand OA population, and identify interpretation challenges. METHODS: The TMJs of 54 individuals (mean age 71.3) recruited from the "The Oslo hand OA cohort", independently of TMJ-related symptoms, were examined with cone beam CT (ProMax MidCBCT). Images were analysed for bone change characteristics and each joint was diagnosed with either OA, no OA or as indeterminate for OA. The image analysis criteria developed for the Research Diagnostic Criteria for Temporomandibular Disorders were used. Frequencies of bone changes, joint diagnoses and severity grades (1-2) were calculated, as well as κ values for observer agreement. RESULTS: In the OA joints, the most frequent bone changes occurred in the condyle: flattening (79%), osteophyte (72%) and subcortical sclerosis (70%). The most frequent changes in the fossa/eminence were flattening (57%), erosion (49%) and subcortical sclerosis (47%). 53 (49%) of the 108 joints were diagnosed with TMJ OA (68 % Grade 2), 29 joints (27%) with no OA, and 26 joints (24%) were indeterminate for OA. Inter- and intraobserver agreement showed mean κ values of 0.67 and 0.62, respectively. CONCLUSIONS: TMJ changes were common in elderly with hand OA and characterised by bone productive changes. The radiologic features indicated a late stage TMJ OA. Interpretation challenges related to subtle changes were identified and are reflected by the rather low observer agreement. The diagnosis of TMJ OA should be based on evident and clear abnormalities only.

Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence: a retrospective follow-up 11.5 years post-operatively.

INTRODUCTION AND HYPOTHESIS: The aim was to evaluate the long-term cure rates and the late complications of the tension-free vaginal tape (TVT). METHODS: One hundred and forty-seven women with stress incontinence underwent surgery at our clinic between 1994 and 1997. At the time of follow-up, 128 were alive, 104 attended an objective evaluation at the clinic, while 20 women were contacted by telephone for an extensive interview. Eighty-four percent were assessed in a retrospective study 10-13 (11.5) years post-operatively. The evaluation included a stress test and, if this test was positive, also a 24-h pad-weighing test, the same questionnaire about urinary symptoms as that used pre-operatively and a visual analogue scale. RESULTS: The objective cure rate was 84%. The subjective cure rate was 77%, while 18% had improved. Ninety-four percent of the patients were satisfied with the surgical result. No late adverse effects of the operation were found. CONCLUSIONS: The TVT procedure is effective and safe for more than 10 years.