An exchange technique in temporomandibular joint (TMJ) arthroscopy to insert a larger operative cannula to facilitate advanced procedures.

The paper describes a modification of the surgical technique for temporomandibular joint arthroscopy, using an exchange guide to replace the 2.2 mm cannula with one of 2.9 mm to better facilitate osteoplasty of the medial wall. The procedure is a simple and safe manoeuvre that reduces complications such as fluid extravasation into soft tissues, damage to the articular eminence, and bleeding into the superior joint space. Every oral and maxillofacial surgeon could benefit from this novel method, which reduces the chances of failure when exchanging the working cannulas, the potential morbidity of re-entry, and the duration of surgery.

Arthroscopic osteoplasty of the medial and anteromedial wall of temporomandibular joint: surgical technique and anatomical considerations.

The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications.

Role of Arthroscopic Eminoplasty in the Management of the Habitual Dislocation of Temporomandibular Joint.

AIM: To evaluated the effectiveness of arthroscopic eminoplasty in the management of habitual dislocation of the temporomandibular joint (TMJ). PATIENTS AND METHODS: The study is based on a retrospective evaluation of 11 patients (20 joints) with chronic habitual dislocations of TMJ treated with arthroscopic eminoplasty. Maximal postoperative mouth opening, complications related to surgery, duration of postoperative hospital stay, and recurrence rate (at 2 years follow up) were analyzed. RESULTS: Six patients presented complete dislocation (non self-reducible), while 5 patients reported a history of repetitive subluxations that altered their quality of life. Arthroscopic eminoplasty showed great outcomes in terms of recurrence rate, complications related to surgery and hospital stay. DISCUSSION: Arthroscopic eminoplasty represents a safe and effective technique to treat habitual dislocation of the TMJ. Moreover, the integrity of the TMJ capsule-ligament system is respected with this approach and this is extremely important in terms of joint stability.

Arthroscopic Eminoplasty of Temporomandibular Joint: Surgical Technique.

Temporomandibular joint (TMJ) is one of the most used joint of the body. Moreover, it is common knowledge that TMJ may show degenerative changes 10 years earlier than other joints. Recently, the use of arthroscopic surgery is revolutionizing the classic management of TMJ pathologies. In fact, the minimal invasiveness of this procedure allows faster results and fewer complications than other procedures. In this article, we present our arthroscopic technique. In this line, we would like to emphasize that we used this approach in different temporomandibular disorders such as anchored disk syndrome, habitual dislocation of TMJ, and internal derangement. Furthermore, we wish to underline that our efforts have been rewarded with great results.

Nodular Tenosynovitis of the Temporomandibular Joint: An Entity Not Yet Described.

Nodular tenosynovitis usually affects the hands and it represents a benign pathology with locally aggressive behavior. Its etiology could be related to chronic inflammatory processes such as trauma, metabolic disturbance, and joint diseases. Histopathological analysis is required for a diagnosis of certainty and surgery represents the treatment of choice. There are no cases in the literature that describe a nodular tenosynovitis affecting the temporomandibular joint (TMJ) The main aim of the present report therefore, is to describe this unusual case and to show the utility of arthroscopic procedures in managing intra-articular tumors of the TMJ.

Arthroscopic approach for treating a pigmented villonodular sinovitis of TMJ. A case report.

The present report describes the case of a 29-year-old man referred to our service for TMJ pain and progressive reduction of the mouth opening. Differential diagnostics included rheumatologic diseases, monoarthritis and intraarticular lumps. In this line, a face CT scan and a MRI of TMJ were carried out in order to ensure a proper diagnosis. These tests showed a solid lesion into the joint cavity. In view of that, we decided to perform a diagnostic and therapeutic arthroscopy of TMJ. Histopathological studies confirmed the diagnosis of pigmented villonodular synovitis. The main aim of this report is to describe this rare syndrome with the goal of proposing suitable treatments. Moreover, we highlight the benefits of using arthroscopic procedures in the cases which the tumor is still confined to the joint. As far as we are aware, scientific literature documents only a single case of pigmented villonodular synovitis of TMJ treated with arthroscopic approach. Key words:Arthroscopic approach, pigmented villonodular synovitis, TMJ, mouth opening.

Arthroscopic eminoplasty: a new choice of treatment for TMJ internal derangement.

BACKGROUND: Temporomandibular joint (TMJ) internal derangement is a common disabling disorder that is often underestimated by society. The main goal of our study was to show the clinic improvement experienced by patients that underwent arthroscopic eminoplasty as a treatment for TMJ in our center. METHODS: Nineteen patients (1 male, 18 females) agreed to participate voluntarily in our study. These patients presented signs and symptoms of TMJ internal derangement and pathological MRI images, and underwent arthroscopic eminoplasty in our center. A patient database was created to record Wilkes stages, type of surgical intervention, complications, and preoperative and postoperative pain and mouth opening. RESULTS: Our data showed that TMJ pain (measured 6 months before surgery) was higher (M=7.44, SD=1.44; t(18)=8.37, P<0.01) than the pain registered eighteen months after surgery (M=3.10, SD=2.40). Moreover, postoperative mouth opening (M=33.6 SD=7.92) was greater than preoperative mouth opening. CONCLUSIONS: The results indicate that this technique is effective in reducing pain and increasing mouth opening with minimal postoperative morbidity. Specifically, this technique minimizes the stress suffered by the joint disc at the narrowest points of joint space and increases articular stability.

Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: A case series.

Necrotising fasciitis (NF) is an uncommon infection. Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site. Moreover, fulminant evolution and high mortality rate are typical of this pathology. In the present report we describes three cases of cervical necrotizing fasciitis complicated by acute mediastinitis. All patients were apparently immunocompetent adults. The main aim of the present report is to show the serious consequences that a dental infection might trigger. Furthermore, we highlight the importance of a multidisciplinary approach in these cases. The constant interaction between different medical specialties is essential for ensuring a proper management of each case. Key words:Cervical necrotizing fasciitis, acute mediastinitis, odontogenic origin , multidisciplinary approach.

Aneurysmal bone cyst of the mandible affecting the articular condyle: a case report.

Aneurysmal bone cyst (ABC) is a benign osteolytic lesion that is fast-growing, expansile, and locally destructive. The present case is of a young girl with facial asymmetry, which had become accentuated during the previous months. A conservative treatment was performed to reduce morbidity and affectation of the lower dental nerve.

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections.

Traumatic arteriovenous fistula as consequence of TMJ arthroscopic surgery. A case report.

UNLABELLED: The ocurrence of a traumatic arteriovenous fistula after arthroscopic surgery of TMJ represents an extremely rare event. Specifically, this uncommon complication has been described only in a few case reports. In this light, the most frequent symptoms showed by this disease are thrills, bruits, pulsatile tinnitus, and an expansible vascular mass. Importantly, the severity of these symptoms is also dependent on the vessels involved. With regard to the management, is important to note that the vessel ligation with surgery as well as vessel emolization with endovascular procedures have been shown to be effective in the treatment of these cases. In view of that, the present study describes a case of superficial temporal arteriovenous fistula that arose as a postoperative complication of a bilateral arthroscopic eminoplasty of TMJ. The aim of the present report is to characterize this rare syndrome with the goal of proposing suitable treatments. KEY WORDS: Arteriovenous fistula, arthroscopic surgery, eminoplasty of TMJ, temporal vessels.

Tapia's syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series.

BACKGROUND: Tapia's syndrome is an uncommon disease described in 1904 by Antonio Garcia Tapia, a Spanish otolaryngologist. It is characterized by concomitant paralysis of the hypoglossal (XIIth) and pneumogastric (Xth) nerves. Only 69 cases have been described in the literature. Typically, the reported patients presented with a history of orotracheal intubation. Common symptoms are dysphonia, tongue deviation toward the affected side, lingual motility disturbance, and swallowing difficulty. CASE PRESENTATION: In the report, we describe three cases of Tapia's syndrome in three Caucasian patients who underwent surgery with general anesthesia. Two of these patients underwent neck abscess drainage, and the third had an open reduction of a shoulder fracture. The clinical symptoms of Tapia's syndrome appeared after extubation. All three of our patients recovered their lost function at 3 months after diagnosis. CONCLUSIONS: We underline the importance of performing airway endoscopy and a specific program of swallowing rehabilitation for the proper management of Tapia's syndrome.

Jaw osteonecrosis management around a dental implant inserted 2 years before starting treatment with zoledronic acid.

Bisphosphonates (BP) are a type of drug known to inhibit bone resorption through complex interventions. Their primary mechanism of action is aimed at the cellular level, inhibiting osteoclast activity and so bone resorption. BPs are widely used, with many patients receiving continuous treatment for years. But it is well known that these drugs can produce osteonecrosis of the jaw (ONJ). Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication. ZA is the most potent BP in clinical development. This report describes the case of a 62-year-old woman with breast cancer antecedents which relapsed, who had received a maxillary dental implant two years before the start of therapy with zoledronic acid. She later developed osteonecrosis of the jaw (ONJ), which began in the peri-implant area, and was treated for stage 3 ONJ by sub-total maxillectomy. Key words:Bisphosphonates, zoledronic acid, osteonecrosis of the jaw, peri-implantitis, maxillectomy.

Cambios en la dimensión de la vía aérea en pacientes con secuencia de Pierre-Robin asociada a síndromes malformativos tras distracción mandibular. Planificación del vector de distracción / Changes in airway dimensions after mandibular distraction in patients with Pierre-Robin sequence associated with malformation syndromes

Introducción: La secuencia de Pierre Robin es una tríada caracterizada por micrognatia, glosoptosis y obstrucción respiratoria alta con o sin paladar hendido. La mayoría de los pacientes responden al tratamiento postural, aunque en ocasiones extremas hay que realizar traqueotomía. En la actualidad la distracción mandibular es la alternativa eficaz de tratamiento que elonga la mandíbula y resuelve la obstrucción respiratoria. La elección del vector de distracción es importante en los cambios de dimensión de la vía aérea. Pacientes y métodos: El objetivo del estudio es evaluar los cambios producidos en las dimensiones de la vía aérea superior en 8 niños, con secuencia de Pierre Robin, tratados con distracción mandibular dependiendo del vector de distracción planificado. Para ello realizamos una radiografía lateral de cráneo pre y posdistracción, trazamos una línea que une el plano mandibular con la base de la lengua hasta la pared posterior de la faringe y medimos los milímetros de separación entre ambas estructuras. Resultados y conclusiones: Analizando los resultados obtenidos, el vector de distracción horizontal en primer lugar y en segundo lugar el oblicuo son de elección por su repercusión positiva en la vía aérea (AU)

Introduction: The Pierre Robin syndrome, or sequence, is a triad characterized by micrognathia, glossoptosis and upper respiratory obstruction, with or without cleft palate. Most patients respond to postural treatment, although tracheotomy is necessary on extreme occasions. Mandibular distraction is currently an effective therapeutic alternative that elongates the jaw and resolves the respiratory obstruction. The choice of vector for distraction is essential for modifying the dimensions of the airways. Patients and methods: The objective of this study is to evaluate the changes produced in the dimensions of the upper airways in eight children with Pierre Robin sequence, treated with mandibular distraction, depending on the vector of distraction planned. To this end, a lateral cranial X-ray was performed pre- and post-distraction, tracing a line from the mandibular plane to the base of the tongue and as far as the posterior pharyngeal wall, measuring the milimeters of separation between the two structures. Results and conclusions: The results showed that the horizontal distraction vector, in the first place, and the oblique vector in the second place, would be the procedures of choice in view of their positive effects on the airways (AU)

Oral and general health-related quality of life in patients treated for oral cancer compared to control group.

BACKGROUND: Health-related quality of life (HRQoL) is gaining importance as a valuable outcome measure in oral cancer area. The aim of this study was to assess the general and oral HRQoL of oral and oropharyngeal cancer patients 6 or more months after treatment and compare them with a population free from this disease. METHODS: A cross-sectional study was carried out with patients treated for oral cancer at least 6 months post-treatment and a gender and age group matched control group. HRQoL was measured with the 12-Item Short Form Health Survey (SF-12); oral HRQoL (OHRQoL) was evaluated using the Oral Health Impact Profile (OHIP-14) and the Oral Impacts on Daily Performances (OIDP). Multivariable regression models assessed the association between the outcomes (SF-12, OHIP-14 and OIDP) and the exposure (patients versus controls), adjusting for sex, age, social class, functional tooth units and presence of illness. RESULTS: For patients (n = 142) and controls (n = 142), 64.1% were males. The mean age was 65.2 (standard deviation (sd): 12.9) years in patients and 67.5 (sd: 13.7) years in controls. Patients had worse SF-12 Physical Component Summary scores than controls even in fully the adjusted model [ß-coefficient = -0.11 (95% CI: -5.12-(-0.16)]. The differences in SF-12 Mental Component Summary were not statistically significant. Regarding OHRQoL patients had 11.63 (95% CI: 6.77-20.01) higher odds for the OHIP-14 and 21.26 (95% CI: 11.54-39.13) higher odds for OIDP of being in a worse category of OHRQoL compared to controls in the fully adjusted model. CONCLUSION: At least 6 months after treatment, oral cancer patients had worse OHRQoL, worse physical HRQoL and similar psychological HRQoL than the general population.

Oral health-related quality of life and malnutrition in patients treated for oral cancer.

PURPOSE: This study examined whether oral health-related quality of life (OHRQoL) is associated with nutritional status in patients treated for oral cancer. METHODS: A cross-sectional study was carried out on with patients treated for oral cancer at least 6 months after treatment. OHRQoL was measured using two questionnaires: Oral Impacts on Daily Performances (OIDP) and Oral Health Impact Profile (OHIP-14); malnutrition risk was assessed through the Mini Nutritional Assessment (MNA). Multivariable regression models assessed the association between the outcomes (OIDP and OHIP-14) and the exposure (MNA), adjusting for sex, age, clinical stage, social class, date of treatment completion, and functional tooth units. RESULTS: The final simple included 133 patients, 22.6 % of which were malnourished or at risk of malnutrition. More than 95 % of patients reported a negative impact on the OHRQoL for both measures used. Patients with malnutrition or risk of malnutrition had significantly worse OHRQoL than those with no malnutrition, even after adjusting for clinical and socioeconomic data (ß-coefficient = 8.37 (95 % confidence interval (CI) 1.42-15.32) with the OIDP and ß-coefficient = 2.08 (95 % CI 0.70-3.46) with the OHIP-14). CONCLUSION: Being malnourished or at risk of malnutrition is an important longer-term determinant of worse OHRQoL among patients treated for oral cancer.

Condromatosis sinovial de la articulación temporomandibular con extensión a la base de cráneo / Synovial chondromatosis of the temporomandibular joint. a rare case with subcranial extension

La condromatosis sinovial (CS) es una metaplasia cartilaginosa de los remanentes mesenquimales del tejido sinovial de las articulaciones. Es una enfermedad de etiología desconocida y poco frecuente. Puede definirse como un proceso benigno sinovial caracterizado por la formación de nódulos cartilaginosos (cuerpos libres). La CS afecta principalmente a grandes articulaciones sinoviales siendo poco común su aparición en la articulación temporomandibular. La sintomatología predominante es dolor, inflamación, limitación de los movimientos mandibulares, crepitación y laterodesviación mandibular. El diagnóstico se realiza mediante el estudio radiológico y artroscópico de la articulación. El tratamiento adecuado englobaría la extirpación completa de los cuerpos libres y de la sinovial afecta, bien mediante artroscopia o mediante cirugía abierta. Cuando está afectada la articulación temporomandibular las lesiones suelen estar localizadas en la cavidad articular, siendo rara su extensión extraarticular. En este artículo describimos un caso excepcional de condromatosis sinovial con extensión a la fosa craneal media(AU)

Synovial chondromatosis (SC) is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of joints. It is an uncommon disease of unknown origin. This benign synovial process involves the formation of cartilaginous nodules (loose bodies) in the synovium and within the articular space. SC mainly affects large synovial joints, and only very rarely affects the temporomandibular joint (TMJ). The main symptoms are pain, swelling, mouth opening limitation, crepitation, and lateral mandibular deviation. Diagnosis can be made by panoramic radiograph, computed tomography scan, magnetic resonance imaging, and arthroscopy of the TMJ. The main treatment includes complete removal of the loose bodies in conjunction with excision of the affected synovium. It can be performed by arthroscopy or by open surgery. In cases with TMJ involvement, the lesion is usually confined to the joint cavity. In this report, a rare case of SC of the TMJ with subcranial extension is presented(AU)

Tratamiento ortopédico con moldeador nasoalveolar prequirúrgico en la fisura labiopalatina unilateral / Orthopaedic treatment with presurgical nasoalveolar moulding in unilateral cleft lip and palate

Se describen 2 casos de niños con fisura labiopalatina unilateral total con gran separación de procesos alveolares, remitidos a nuestra unidad. Tras valoración por el equipo multidisciplinar se procede a realizar tratamiento ortopédico mediante moldeamiento nasoalveolar prequirúrgico durante 3,5 meses en un caso y 2 meses en el otro. A los 9 meses se mantiene la coalescencia de ambos procesos alveolares y la simetría nasal en ambos pacientes, existiendo una buena proyección de la punta nasal y longitud de la columela(AU)

We present two cases of children with total unilateral cleft lip and palate with a marked separation of alveolar segments. After evaluation by a multidisciplinart team, he children were treated with a presurgical nasoalveolar moulding for 2 months in one of them and 3.5 months in the other. At 9 months after the presurgical nasoalveolar moulding treatment, there was improved dental arch form, the cleft edges moved closer to each other, and improved symmetry of the nose in width, height, and columella lengths in both patients(AU)

Distracción ósea: tratamiento de la apnea obstructiva en neonatos con micrognatia / Mandibular distraction: treatment of obstructive apnea in neonates with micrognathia

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher-Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular grave, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural, en decúbito prono, puede ser necesario controlar la saturación de oxígeno, insertar un tubo nasofaríngeo e incluso intratraqueal. En casos más graves con pausas prolongadas y frecuentes de apnea, la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y, ocasionalmente, mortalidad. En los últimos 2 años, en la Unidad Multidisciplinaria de Labio y Fisura Palatina del Hospital Virgen de las Nieves de Granada, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular grave mediante distracción mandibular osteogénica, y este procedimiento se ha mostrado eficaz en la resolución del problema. Ha evitado la traqueostomía y se ha elongado la mandíbula en el plazo de 3-4 semanas. En este tiempo han desaparecido los problemas respiratorios obstructivos, así como también de la deglución, y los resultados estéticos obtenidos han resultado excelentes y las complicaciones, por el momento, mínimas(AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently accompanied by severe mandibular hypoplasia, which can cause upper airway obstruction due to retroposition of the base of the tongue in the posterior pharyngeal space. The majority of patients respond to postural treatment in decubitus prono. It may be necessary to monitor oxygen saturation and insert a nasopharyngeal or even an endotracheal tube. Tracheostomy may be necessary in more serious cases with long and frequent apnea pauses, but it is associated with high morbidity and occasional mortality. In the last two years, four children with severe obstructive apnea secondary to mandibular hypoplasia were treated by means of "osteogenic mandibular distraction" in the multidisciplinary Cleft Palate Department of Virgin de las Nieves Hospital (Granada, Spain). This procedure effectively resolved the problem, making tracheostomy unnecessary and lengthening the jaw within 3-4 weeks; in this period, obstructive respiratory problems and swallowing difficulties disappeared. The aesthetic results were excellent and the complications so far have been minimal. Objective: To present the results of a patient series with several types of POP treated using the same approach and operation(AU)