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Effectiveness of disk repositioning and suturing comparing open-joint versus arthroscopic techniques: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:506-513. [PMID: 34034997 DOI: 10.1016/j.oooo.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/03/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to present a systematic review of the effectiveness of discopexy in managing internal derangement of the temporomandibular joint (TMJ). STUDY DESIGN We searched MEDLINE through PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials and grey literature accessed through Google Scholar, Openthesis, and hand-searching from inception to July 2020. The search strategy yielded 363 potentially relevant studies. After screening titles and abstracts, 41 full-text articles were assessed for eligibility and 7 studies were included in the meta-analysis. RESULTS There was an overall decrease in visual analog scale (VAS) pain score of 4.59 cm (95% confidence interval [CI], 2.03-7.16; P < .001) during the follow-up time and an overall increase of 10 mm (95% CI, 6.93-13.01; P < .001) in mouth opening after TMJ surgeries with discopexy. CONCLUSIONS The available evidence showed an overall decrease in VAS pain score and an improvement in mouth opening after TMJ surgeries with discopexy. Changes in maximal interincisal opening were greater after arthroscopic disk repositioning compared to open-joint procedure.
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Liu X, Zhou Z, Mao Y, Chen X, Zheng J, Yang C, Zhang S, Huo L. Temporomandibular joint anchorage surgery: a 5-year follow-up study. Sci Rep 2019; 9:19106. [PMID: 31836752 PMCID: PMC6911021 DOI: 10.1038/s41598-019-54592-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to confirm the 5-year efficiency of temporomandibular joint (TMJ) anchorage, using clinical evaluation and magnetic resonance imaging (MRI). We also studied the influence of disc length and position on efficiency and postoperative condylar height. Sixty-one patients (76 joints) undergoing TMJ disc anchorage were followed up for >5 years. Visual analogue scale (VAS) score and maximum mouth-opening pre-and postsurgery were analysed and patient satisfaction recorded. Disc length, condyle height and disc position pre- and postsurgery were measured using MRI. Patients were ranked as A, B or C degree according to postoperative disc condyle position. Mean follow-up time was 71.34 months. Maximum mouth-opening improved by 14.34 ± 5.87 mm, and VAS score decreased by 33.44 ± 20.56 (P < 0.05). Clinical evaluation efficiency was 84.21%; patient satisfaction rate was 85.53%. On follow-up MRI, 68 joints were judged A or B degree (89.67%). Disc length was 7.96 ± 1.38 mm, 7.10 ± 1.41 mm and 5.75 ± 1.16 mm in A, B and C groups, respectively. In patients evaluated as C, condylar height decreased by 0.43 ± 1.36 mm, while increasing by 0.67 ± 1.88 mm and 0.51 ± 1.09 mm in A and B groups, respectively (all P < 0.05). We concluded that anchorage surgery improves mouth-opening and eliminates pain, longer disc length is related to better postoperative disc position, and significant condylar reconstruction occurs after disc repositioning. MRI confirmed that TMJ disc anchorage is reliable 5 years postsurgery.
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Affiliation(s)
- Xiuming Liu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Zhihang Zhou
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Yi Mao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Xuzhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Jisi Zheng
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| | - Shanyong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Liang Huo
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
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A New Method To Reposition the Displaced Articular Disc For a Patient With Comminuted Condylar Fracture. J Craniofac Surg 2019; 30:e373-e376. [PMID: 30839468 DOI: 10.1097/scs.0000000000005384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Repositioning the displaced articular disc is the key procedure that prevents ankylosis of the temporomandibular mandibular joint (TMJ) in the treatment of patients with comminuted condylar fractures. The conventional procedure performed clinically is to use two anchors and sutures to reposition the displaced articular disc. Therefore, this paper introduces a new and economical method to reposition the articular disc without metallic implantation materials. CLINICAL PRESENTATION A 60-year-old male patient who had fainted suddenly 3 days before came to our hospital to complain of pain of the bilateral TMJ areas and limited mouth opening. Clinical examination revealed severe restriction of mouth opening and the disappearance of bilateral condylar movements. Preoperational 3-dimensional computed tomography (3-DCT) indicated bilateral intracapsular comminuted fractures of the mandibular condyles. The patient was operated in a bilateral preauricular approach for repositioning of the bilateral articular discs and removal of the fracture fragments. Instead of repositioning the displaced disc with anchors, we designed a method to use sutures to stabilize the TMJ disc and to assess the disc's position using a magnetic resonance imaging (MRI) scan when following up. There were no severe complications during the operation. Results of an MRI scan 1 month after operation showed that post-operation articular discs kept their normal position, the mouth opening and the lateral and protrusive movements of the mandible recovered when followed up for 3 months. CONCLUSION The method of using sutures to reposition and stabilize the articular disc for a patient with comminuted fractures is effective. There is great significance not only for patients with comminuted condylar fractures but for treatment of TMJ dysfunction especially for patients with high psychological pressure who persist in requiring the removal of metallic anchors although there are no clinical symptoms.
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Disc repositioning plus temporal eminectomy for temporomandibular joint internal derangement: A pilot study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:16-18. [DOI: 10.1016/j.jormas.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/05/2017] [Accepted: 10/02/2017] [Indexed: 11/23/2022]
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McCain JP, Hossameldin RH, Srouji S, Maher A. Arthroscopic discopexy is effective in managing temporomandibular joint internal derangement in patients with Wilkes stage II and III. J Oral Maxillofac Surg 2014; 73:391-401. [PMID: 25530277 DOI: 10.1016/j.joms.2014.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE Disc repositioning for temporomandibular joint (TMJ) internal derangement (ID) is a well-established surgical technique with variable success. The purpose of the present study was to assess the outcomes after arthroscopic disc repositioning (discopexy) for TMJ ID. PATIENTS AND METHODS This was a prospective, cohort, single-institutional clinical study. The study included patients with TMJ ID in whom diagnostic arthroscopy had failed. These patients were presented and treated at Miami Oral and Maxillofacial Surgery, Baptist Hospital (Miami FL). The predictive variable was the Wilkes diagnostic categories, presented in 2 groups: II and III versus IV and V. The primary outcome variable was the absence of joint pain at 12 months postoperatively. The secondary outcome variables included joint function, maximum interincisal opening, medication use, joint loading sign, and muscle pain. The patients were followed for 1 year postoperatively. The statistical analyses included paired and independent sample Student's t test, χ(2) test, and logistic regression analysis. RESULTS A total of 32 subjects (42 joints), with a mean age of 31 years, were included in the present study; 28 (87.5%) were women. Of the 42 joints, 71.4% were classified as Wilkes stage II and III. A successful outcome was seen in 69% of the studied subjects and in 86.7% of the Wilkes II and III group versus 25% of the Wilkes IV and V group (P = .001). CONCLUSION The results of the present study have shown that TMJ arthroscopic discopexy is an effective and predictable treatment of patients with TMJ ID in whom primary TMJ arthroscopy failed. Our results have also shown that patients with Wilkes II or III TMD will have the most successful outcome.
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Affiliation(s)
- Joseph P McCain
- Oral & Maxillofacial Surgeon, Private Practice, Oral and Maxillofacial Surgery, Miami, FL; Chief, Department of Oral and Maxillofacial Surgery, Baptist Health Systems, Jacksonville, FL; Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Nova Southeastern School of Dental Medicine, Fort Lauderdale, FL
| | - Reem H Hossameldin
- Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Cairo University School of Dental Medicine, Cairo, Egypt; Research Scholar, Department of Oral and Maxillofacial Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL.
| | - Samer Srouji
- Surgeon, Department of Oral and Maxillofacial Surgery, Carmel Medical Center, Haifa, Israel; Department of Anatomy and Cell Biology, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Amr Maher
- Anesthesia Consultant, Cairo University School of Dental Medicine, Cairo, Egypt; Biostatistician, Cairo University, Cairo, Egypt
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Abstract
TMJ surgeries are not always successful. Many potential pitfalls can occur during any phase of the treatment and can lead to complications, less than desirable results, and short- or long-term failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.
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Zhang S, Liu X, Yang X, Yang C, Chen M, Haddad MS, Chen Z. Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by magnetic resonance imaging. BMC Musculoskelet Disord 2010; 11:262. [PMID: 21073724 PMCID: PMC2992481 DOI: 10.1186/1471-2474-11-262] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/12/2010] [Indexed: 11/18/2022] Open
Abstract
Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.
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Affiliation(s)
- Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, People's Republic of China
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Lumpkins SB, Pierre N, McFetridge PS. A mechanical evaluation of three decellularization methods in the design of a xenogeneic scaffold for tissue engineering the temporomandibular joint disc. Acta Biomater 2008; 4:808-16. [PMID: 18314000 DOI: 10.1016/j.actbio.2008.01.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 01/11/2008] [Accepted: 01/15/2008] [Indexed: 11/19/2022]
Abstract
Tissue-engineered temporomandibular joint (TMJ) discs offer a viable treatment option for patients with severe joint internal derangement. To date, only a handful of TMJ tissue engineering studies have been carried out and all have incorporated the use of synthetic scaffold materials. These current scaffolds have shown limited success in recapitulating morphological and functional aspects of the native disc tissue. The present study is the first to investigate the potential of a xenogeneic scaffold for use in tissue engineering the TMJ disc. The effects of decellularization agents on the disc's mechanical properties were assessed using three common decellularization protocols: Triton X-100, sodium dodecyl sulfate (SDS) and an acetone/ethanol solution. Decellularized scaffolds were subsequently characterized through cyclic mechanical testing at physiologically relevant frequencies to determine which chemical agent most accurately preserved the native tissue properties. Results have shown that porcine discs treated with SDS most closely matched the energy dissipation capabilities and resistance to deformation of the native tissue. Treatments using Triton X-100 caused the resultant tissue to become relatively softer with inferior energy dissipation capabilities, while treatment using acetone/ethanol led to a significantly stiffer and dehydrated material. These findings support the potential of a porcine-derived scaffold decellularized by SDS as a xenograft for TMJ disc reconstruction.
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Affiliation(s)
- Sarah B Lumpkins
- Engineering Physics and the School of Chemical, Biological and Materials Engineering, University of Oklahoma, Norman, OK 73019-1004, USA
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