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Cayón-Somacarrera S, Gutiérrez-Rodríguez R, Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial-Hernández V, Ocón-Alonso EM. Unlocking the Temporomandibular Joint: CT, MRI, and Arthroscopic Correlation. Radiographics 2024; 44:e240025. [PMID: 39325658 DOI: 10.1148/rg.240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
The temporomandibular joint constitutes a synovial connection between the mandible and the skull base and plays a pivotal role in functions such as jaw movement, chewing, and verbal and emotional expression. Temporomandibular joint dysfunction is observed in about 30% of the population, with a higher prevalence in young to middle-aged women. Interestingly, a majority of individuals affected do not report pain, and only 5%-10% of symptomatic cases necessitate therapeutic intervention. The most common temporomandibular joint disorder manifests as pain in the masticatory muscles and is referred to as myofascial syndrome. However, articular disorders are also very common, usually due to disk displacement and degenerative or inflammatory arthropathies. Less frequently, the temporomandibular joint may be affected by a range of congenital and acquired conditions such as trauma and neoplasms. Imaging becomes necessary for the small percentage of patients who do not respond to conservative management or when there is uncertainty in the diagnosis. A comprehensive understanding of the normal imaging appearance of the temporomandibular joint as well as the wide range of potential pathologic conditions is essential for conducting an accurate radiologic assessment. Moreover, collaboration among multidisciplinary teams and the correlation of imaging findings with arthroscopic observations are crucial to advancing the diagnosis and treatment of temporomandibular joint dysfunction. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Silvia Cayón-Somacarrera
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Rocío Gutiérrez-Rodríguez
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Mario F Muñoz-Guerra
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Francisco J Rodríguez-Campo
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Verónica Escorial-Hernández
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Elena M Ocón-Alonso
- From the Department of Radiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain (S.C.S.); and Departments of Radiology (R.G.R., E.M.O.A.) and Oral and Maxillofacial Surgery (M.F.M.G., F.J.R.C., V.E.H.), Hospital Universitario de La Princesa, Madrid, Spain
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Cui ZK, Chen Y, Guo YJ, Wei XT, Yan W, Qi MC. The influence of open disc repositioning surgery on the internal derangement of the contralateral temporomandibular joint: a prospective study of 96 patients. Clin Oral Investig 2024; 28:487. [PMID: 39145865 DOI: 10.1007/s00784-024-05864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To assess the influence of unilateral open disc repositioning surgery (ODRS) of the temporomandibular joint (TMJ) on the internal derangement (ID) of the contralateral joint. METHODS Patients with bilateral ID of TMJ who underwent unilateral ODRS were enrolled and followed-up for one year. They were divided into two groups based on the contralateral disease: the anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Postoperative evaluation included clinical and MRI evaluation. Indices measured were unilateral intermaxillary distance (UID), visual analogue scale (VAS), disc length (DL), condylar height (CH), and disc-condyle angle (DCA). Paired t tests were used to compare the clinical and MRI indices between different time points. RESULTS Ninety-six patients were enrolled, including 47 in the ADDWR group and 49 in the ADDWoR group. One-year post-surgery, ODRS led to significant increases in MMO, DL, and CH, and decrease in VAS and DCA on the operated side (P < 0.05). In ADDWR group, UID, DL, and CH increased significantly, and VAS decreased (P < 0.05), with no significant change in DCA (P > 0.05). In ADDWoR group, clinical and MRI variables worsened slightly, except for UID, which remained unchanged (P > 0.05). CONCLUSIONS ODRS is a promising method for correcting TMJ ID and may improve condition of ADDWR and decrease progress of ADDWoR at the contralateral joint. Preoperative bilateral TMJ evaluation is essential for better outcomes. CLINICAL RELEVANCE ODRS can effectively treat TMJ ID and produce adaptive changes in the contralateral ID, for which continuous monitoring of the contralateral joint is essential.
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Affiliation(s)
- Ze-Kun Cui
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, Tangshan City, Hebei Province, PR China
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yong Chen
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yan-Jun Guo
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Xiao-Tong Wei
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Wei Yan
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Meng-Chun Qi
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, Tangshan City, Hebei Province, PR China.
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Alhaj Kheder MB, Kandil NM, El-Ghareeb T, Abdel Aziz OM, Zeitoun R. Ultrasound-Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1401-1412. [PMID: 38581185 DOI: 10.1002/jum.16462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES This randomized clinical trial study aims to compare ultrasound-guided versus non-guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). MATERIAL AND METHODS The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non-guided and ultrasound (US)-guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre-injection, 1-, 2-, and 6-months postinjection. RESULTS Twenty-two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non-guided group and 24.3 ± 6.9 for the US-guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. CONCLUSION Intra-articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US-guided and non-guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture.
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Affiliation(s)
| | - Nour Mohamed Kandil
- Diagnostic and Interventional Radiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tarek El-Ghareeb
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | | | - Rania Zeitoun
- Diagnostic and Interventional Radiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Pandey AK, Sharma S, Gupta P, Kumar P, Chaudhry K. Medial Pterygoid Abscess Masquerading as a Temporomandibular Joint Disorder: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2828-2832. [PMID: 38883550 PMCID: PMC11169312 DOI: 10.1007/s12070-024-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/08/2024] [Indexed: 06/18/2024] Open
Abstract
A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient's well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.
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Affiliation(s)
- Akhilesh Kumar Pandey
- Oral and Maxillofacial Surgery (Department of Dentistry), All India Institute of Medical Sciences-Jodhpur, OPD block, 2A, 211, Jodhpur, Rajasthan 3420005 India
| | - Smily Sharma
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Palak Gupta
- Otorhinolaryngology, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery (Department of Dentistry), All India Institute of Medical Sciences-Jodhpur, OPD block, 2A, 211, Jodhpur, Rajasthan 3420005 India
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Sidebottom AJ. Current thinking in open temporomandibular joint surgery. Is this still indicated in the management of articular temporomandibular joint disorder? Br J Oral Maxillofac Surg 2024; 62:324-328. [PMID: 38453560 DOI: 10.1016/j.bjoms.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 03/09/2024]
Abstract
Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a 'one size fits all' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an '80% chance of getting 80% better' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.
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Affiliation(s)
- Andrew J Sidebottom
- Consultant Oral and Maxillofacial Surgeon Spire Nottingham Hospitals, NG12 4GA Nottingham, UK.
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Abdel-Gawwad EA, Atito E, Osman M, Emam ANM, Baraka Y, Abdullah AAB, Helal MA. Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study. J Int Soc Prev Community Dent 2024; 14:136-143. [PMID: 38827358 PMCID: PMC11141894 DOI: 10.4103/jispcd.jispcd_151_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 06/04/2024] Open
Abstract
Aim Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency. Materials and Methods One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively. Results Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P ˂ 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P ˂ 0.05). Conclusion The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.
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Affiliation(s)
| | - Ehap Atito
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Mohammed Osman
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Abdel-Naser M Emam
- Department of Prosthetic Dental Science, College of Dentistry, Najran University, , Saudi Arabia
| | - Yasser Baraka
- Department of Prosthodontics, Faculty of Dentistry, Deraya University, Al-Menia, Egypt
| | | | - Mohamed Ahmed Helal
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
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Navaneetham A, Vaibhav N, Navaneetham R, Balaraj BV, Roy NP, Madhusudan S. Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study. Indian J Otolaryngol Head Neck Surg 2023; 75:3116-3129. [PMID: 37974761 PMCID: PMC10645822 DOI: 10.1007/s12070-023-03890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 05/17/2023] [Indexed: 11/19/2023] Open
Abstract
The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years ± 10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.
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Affiliation(s)
- Anuradha Navaneetham
- Department of Oral and Maxillofacial Surgery, M R Ambedkar Dental College, 1/36, Cline Road, Cooke Town, Bangalore, 560005 India
| | - N. Vaibhav
- Department of Oral and Maxillofacial Surgery, M R Ambedkar Dental College, 1/36, Cline Road, Cooke Town, Bangalore, 560005 India
| | | | - B. V. Balaraj
- Department of Oral and Maxillofacial Surgery, M R Ambedkar Dental College, 1/36, Cline Road, Cooke Town, Bangalore, 560005 India
| | - Niti P. Roy
- Advanced Trauma and Implantology, HOSMAT Hospital, Bangalore, India
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El-Shaheed NH, Mostafa AZH, Aboelez MA. Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial. J Oral Rehabil 2023; 50:177-193. [PMID: 36564950 DOI: 10.1111/joor.13405] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stabilisation splint therapy (SST) and low-level laser therapy (LLLT) are effective-invasive treatment for temporo-mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo-mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown. OBJECTIVES The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR. METHODS This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software. RESULTS Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non-significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II. CONCLUSION All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement. CLINICAL TRIAL REGISTRATION NUMBER NCT05548894.
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Dedeilia A, Papapanou M, Papadopoulos AN, Karela NR, Androutsou A, Mitsopoulou D, Nikolakea M, Konstantinidis C, Papageorgakopoulou M, Sideris M, Johnson EO, Fitzpatrick S, Cometto G, Campbell J, Sotiropoulos MG. Health worker education during the COVID-19 pandemic: global disruption, responses and lessons for the future-a systematic review and meta-analysis. HUMAN RESOURCES FOR HEALTH 2023; 21:13. [PMID: 36829158 PMCID: PMC9951171 DOI: 10.1186/s12960-023-00799-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes. METHODS Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE. RESULTS Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence. CONCLUSION The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.
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Affiliation(s)
- Aikaterini Dedeilia
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
| | - Michail Papapanou
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Society of Junior Doctors (SJD), Athens, Greece
| | - Andreas N Papadopoulos
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nina-Rafailia Karela
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Androutsou
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Mitsopoulou
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Nikolakea
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Konstantinidis
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manthia Papageorgakopoulou
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece
- School of Medicine, University of Patras, Patras, Greece
| | - Michail Sideris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | | | - Giorgio Cometto
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Jim Campbell
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Marinos G Sotiropoulos
- Harvard Medical School, Boston, MA, USA.
- HEALth Workforce Education (HEAL-Edu) Study Group, Athens, Greece.
- Department of Neurology, Brigham and Women's Hospital & Massachusetts General Hospital, 55 Fruit Street, WACC721, Boston, MA, 02114, USA.
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Khanna JN, Ramaswami R. Use of the Temporalis Myofascial Flap in Internal Derangement of the Temporomandibular Joint - An Evaluative Study. Ann Maxillofac Surg 2022; 12:133-138. [PMID: 36874790 PMCID: PMC9976858 DOI: 10.4103/ams.ams_116_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Internal derangement is an abnormal relationship between the articular disc and the mandibular condyle. The most common cause is trauma. Various classifications have been given for internal derangement. Initial management is done conservatively and if the disease is progressed, surgery is the option. Various surgical methods and interpositional materials following discectomy have been given in the literature. Materials and Methods Over the past 15 years, we selected a group of 30 patients, Wilkes Class IV and V where conservative therapy had failed and were candidates for surgery. The patients had their disc repositioned, the damaged part of the disc was excised and disc was reinforced using the temporalis myofascial flap (TMF). In cases where the disc was non-salvageable, discectomy was done and TMF was placed between condyle and glenoid fossa, sutured with Prolene. The follow-up period was 3 years. Results Of the 30 patients, there were 9 male and 21 female. Range of mouth opening was 3.3-3.8 cm with improvements in 1 year. The jaw relations gradually improved and were restored after 3 weeks. Patients were totally pain free in 6 months. Discussion For the cases where surgery is the line of treatment, we strongly suggest disc repositioning and reinforcement with TMF as the flap is bulky, locally available and easy to harvest and causes no deformity at the donor site.
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Affiliation(s)
| | - Radhika Ramaswami
- Department of Maxillofacial Surgery, Saifee Hospital, Mumbai, Maharashtra, India
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Chęciński M, Chęcińska K, Nowak Z, Sikora M, Chlubek D. Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used. J Clin Med 2022; 11:2305. [PMID: 35566431 PMCID: PMC9102811 DOI: 10.3390/jcm11092305] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains. MATERIAL AND METHODS The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis. RESULTS The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas. DISCUSSION Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis. CONCLUSIONS The most promising substances appear to be bone marrow and adipose tissue.
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Affiliation(s)
- Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland;
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland;
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta 2, 41-800 Zabrze, Poland;
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland;
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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