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Monje Gil F, Martínez Artal P, Cuevas Queipo de Llano A, Muñoz Guerra M, González Ballester D, López Arcas JM, López Cedrún JL, Gutiérrez Pérez JL, Martín-Granizo R, del Castillo Pardo de Vera JL, García Medina B, González-García R, Moreno Sánchez M, Rodríguez EV, Fernández Sanromán J, López Martos R, Peral Cagigal B, Redondo Alamillos M, Morey Mas M, Salcedo Gil C, Ramos Medina B, Valls Ontañón A, Masià Gridilla J, Dean Ferrer A. Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint. J Clin Med 2024; 13:3319. [PMID: 38893029 PMCID: PMC11173044 DOI: 10.3390/jcm13113319] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.
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Affiliation(s)
- Florencio Monje Gil
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Patricia Martínez Artal
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Alberto Cuevas Queipo de Llano
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Mario Muñoz Guerra
- Oral and Maxillofacial Surgery Department, La Princesa University Hospital, 28006 Madrid, Spain; (M.M.G.); (R.G.-G.)
| | - David González Ballester
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | | | - José Luis López Cedrún
- Oral and Maxillofacial Surgery Department, University Hospital A Coruña, 15008 A Coruña, Spain;
| | - José Luis Gutiérrez Pérez
- Oral and Maxillofacial Surgery Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain; (J.L.G.P.); (R.L.M.)
| | - Rafael Martín-Granizo
- Oral and Maxillofacial Surgery Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | | | - Blas García Medina
- Oral and Maxillofacial Surgery Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | - Raúl González-García
- Oral and Maxillofacial Surgery Department, La Princesa University Hospital, 28006 Madrid, Spain; (M.M.G.); (R.G.-G.)
| | - Manuel Moreno Sánchez
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Ekaitz Valle Rodríguez
- Oral and Maxillofacial Surgery Department, University Hospital Reina Sofía, 30003 Murcia, Spain;
| | | | - Ricardo López Martos
- Oral and Maxillofacial Surgery Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain; (J.L.G.P.); (R.L.M.)
| | - Beatriz Peral Cagigal
- Oral and Maxillofacial Surgery Department, University Hospital Río Hortega, 47012 Valladolid, Spain;
| | - Marta Redondo Alamillos
- Oral and Maxillofacial Surgery Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Miguel Morey Mas
- GBCOM Dental and Maxillofacial Clinic, 07014 Palma de Mallorca, Spain;
| | - Carlos Salcedo Gil
- Oral and Maxillofacial Surgery Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Benito Ramos Medina
- Oral and Maxillofacial Surgery Department, University Hospital Santa Lucía, 30202 Cartagena, Spain;
| | - Adaia Valls Ontañón
- Oral and Maxillofacial Surgery Department, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Jorge Masià Gridilla
- Oral and Maxillofacial Surgery Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Alicia Dean Ferrer
- Oral and Maxillofacial Surgery Department, Hospital Reina Sofía, 14004 Córdoba, Spain;
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Fernández-Ferro M, Fernández-González V, Salgado-Barreira Á, Santos-Armentia E, Valdés-Sarmiento P, Fernández-García A, Gómez-Rey D, Fernández-Sanromán J. Correlation between the main clinical, imaging, and arthroscopy findings in patients with temporomandibular disorders. Int J Oral Maxillofac Surg 2023; 52:237-244. [PMID: 35985912 DOI: 10.1016/j.ijom.2022.08.007] [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: 01/07/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
The purpose of this work was to prospectively correlate the most characteristic clinical symptoms of temporomandibular disorders, such as pain and limitation of mouth opening, with the findings of magnetic resonance imaging (disc position, degenerative changes, and effusion) and arthroscopy findings (roofing, synovitis, chondromalacia, adhesions, and perforations). These examinations were performed in 298 patients diagnosed with internal derangement refractory to conservative treatment. The mean age of the patients was 38.59 years; 92.6% were female. The t-test and one-way analysis of variance (ANOVA) were used to correlate the findings. Significant relationships were found between pain and disc displacement without reduction (P = 0.033) and effusion (P = 0.003) on MRI, coinciding with correlations between pain and roofing of 0-25% (P = 0.016) and synovitis (P = 0.001) on arthroscopy. A significant relationship was also observed between mouth opening limitation and the presence of osteoarthrosis (P = 0.018) on MRI, and between mouth opening limitation and synovitis (P = 0.022), chondromalacia (P = 0.002), and adhesions (P < 0.001) on arthroscopy. All of these findings were observed in patients with a poor initial clinical situation, which highlights the considerable potential of correlating these data with imaging and arthroscopy findings.
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Affiliation(s)
- M Fernández-Ferro
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain.
| | - V Fernández-González
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - Á Salgado-Barreira
- Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
| | - E Santos-Armentia
- Department of Radiology, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - P Valdés-Sarmiento
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - A Fernández-García
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - D Gómez-Rey
- Department of Family Medicine and Community Health, Santiago de Compostela University Clinical Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Fernández-Sanromán
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
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Ferrillo M, Nucci L, Giudice A, Calafiore D, Marotta N, Minervini G, d'Apuzzo F, Ammendolia A, Perillo L, de Sire A. Efficacy of conservative approaches on pain relief in patients with temporomandibular joint disorders: a systematic review with network meta-analysis. Cranio 2022:1-17. [PMID: 36148997 DOI: 10.1080/08869634.2022.2126079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the efficacy of conservative interventions in pain relief in patients with intracapsular temporomandibular disorders (TMD). METHODS PubMed, Scopus, and Web of Science were systematically searched until January 1st, 2022 to identify randomized controlled trials (RCTs) presenting patients with diagnosis of intracapsular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), conservative approaches as interventions, and pain intensity as outcome. RESULTS Out of 3372 papers, 13 RCTs were included, with 844 study participants. Most of them (n = 7) investigated the efficacy of splint appliance. Meta-analysis revealed that rehabilitative interventions had a significant overall effect size of 0.75 [0.17, 1.34], reporting splint appliance and laser therapy as significantly effective treatments. CONCLUSION Findings of this systematic review with network meta-analysis suggested that conservative approaches might be effective in pain relief of intracapsular TMD patients.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Ludovica Nucci
- Dentistry Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuseppe Minervini
- Dentistry Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabrizia d'Apuzzo
- Dentistry Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Letizia Perillo
- Dentistry Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial-Hernández V, Sanz-García A, Brabyn PJ, Fernández-Domínguez M. Temporomandibular joint arthroscopy in advanced stages of internal derangement: a retrospective cohort study on the influence of age. Int J Oral Maxillofac Surg 2022; 51:1579-1586. [PMID: 35654642 DOI: 10.1016/j.ijom.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/07/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ2 test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.
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Affiliation(s)
- M F Muñoz-Guerra
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, Universidad CEU San Pablo, Madrid, Spain.
| | - F J Rodríguez-Campo
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - V Escorial-Hernández
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Sanz-García
- Data Analysis Unit, Health Research Institute, University Hospital La Princesa, Madrid, Spain
| | - P J Brabyn
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Fernández-Domínguez
- Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, Universidad CEU San Pablo, Madrid, Spain
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Celotti C, Martín-Granizo R, De La Sen Ó. Correlation of arthroscopic findings with clinical-radiological signs and symptoms of temporomandibular joint dysfunction: retrospective study of 829 joints. Int J Oral Maxillofac Surg 2022; 51:1069-1073. [PMID: 35115221 DOI: 10.1016/j.ijom.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Temporomandibular joint (TMJ) arthroscopic findings are difficult to predict based on clinical criteria. Few studies have attempted to correlate signs, symptoms, and characteristics of patients with the final arthroscopic findings. The aim of this study was to assess the correlation between clinical-radiological signs and symptoms and arthroscopic findings in patients with TMJ dysfunction undergoing arthroscopy. A retrospective study was performed involving 487 patients (829 joints) with TMJ dysfunction who underwent TMJ arthroscopy between 2000 and 2019. The clinical-radiological variables recorded were pain, maximum mouth opening, joint noises, Wilkes classification, and disc displacement. The arthroscopic findings evaluated were synovitis, chondromalacia, adhesions, disc perforation, disc displacement, and roofing. Pain symptoms were significantly associated with the intensity of synovitis (P = 0.005) and disc displacement evaluated arthroscopically (P < 0.001). A statistically significant relationship was observed between Wilkes stage and the level of synovitis (P < 0.001) and chondromalacia (P < 0.001). Mouth opening was negatively correlated with adhesions (P < 0.001). Based on this study, pain symptomatology was associated with the intensity of synovitis and disc displacement evaluated arthroscopically, the Wilkes stage was a good predictor of the severity of synovitis and chondromalacia, and mouth opening was negatively correlated with adhesions.
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Affiliation(s)
- C Celotti
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - R Martín-Granizo
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Ó De La Sen
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Vervaeke K, Verhelst PJ, Orhan K, Lund B, Benchimol D, Van der Cruyssen F, De Laat A, Jacobs R, Politis C. Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study. Head Face Med 2022; 18:2. [PMID: 34996509 PMCID: PMC8739711 DOI: 10.1186/s13005-021-00305-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/13/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage. METHODS This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy. RESULTS A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474). CONCLUSION To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.
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Affiliation(s)
- Kobbe Vervaeke
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Pieter-Jan Verhelst
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Kaan Orhan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Bodil Lund
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Benchimol
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fréderic Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Antoon De Laat
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven, Leuven, Belgium.,Department of Dentistry, University Hospitals, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium. .,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium. .,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Frenkel B, Abu Shqara F, Rachmiel A. Proinflammatory cytokines levels in patients with temporomandibular joint disorder undergoing arthroscopy. Oral Maxillofac Surg 2021; 26:575-580. [PMID: 34716857 DOI: 10.1007/s10006-021-01014-1] [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: 01/25/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Biomarkers represent objective indicators of normal processes, pathology, or responses to therapeutic intervention. The purpose of this study is to evaluate the levels of proinflammatory cytokines in synovial fluid of the temporomandibular joint (TMJ) and to investigate whether there is a correlation between elevated levels and disease progression. MATERIALS AND METHODS This is a prospective study that included patients who were diagnosed with internal derangement according to magnetic resonance imaging and were classified according to Wilkes's classifications. After failing to improve with conservative treatment, they were referred for TMJ arthroscopy. During arthroscopy, synovial fluid was collected for biomarker analyses that included the investigation of levels of proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF). The Mann-Whitney U test was used for differences between subgroups for TNF-α, IL-6, and VEGF. RESULTS During the study period, 22 patients presented with a TMJ disorder and met the criteria of the study. There was a statistically significant correlation between the levels of VEGF, TNF-a, and osteoarthritis (P < 0.05). There was also a statistically significant correlation between TNF-a levels and a higher degree of chondromalacia (P = 0.019). CONCLUSION An increase in inflammatory cytokines coupled with chondromalacia propose a more aggressive degenerative disease.
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Affiliation(s)
- Boaz Frenkel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel
| | - Fadi Abu Shqara
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel.
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel
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Bengtsson M, Fransson P. Do patient-reported outcome measures correlate with clinical follow-up after arthroscopic treatment of internal derangement of the temporomandibular joint? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e21-e26. [PMID: 33845189 DOI: 10.1016/j.jormas.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Arthroscopic treatment of the temporomandibular joint (TMJ) has traditionally been evaluated with clinical measurements. Additional recordings of patient reported outcome measures (PROM) is expected to make the evaluation more complete. The aim of the study was to evaluate if PROM correlates with clinical follow-up measures after arthroscopic treatment of internal derangement of the TMJ. MATERIAL AND METHODS Patients with temporomandibular dysfunction (TMD), treated with arthroscopic lysis and lavage of the TMJ, were followed with a PROM questionnaire; Jaw Functional Limitation Scale 20 (JFLS-20) and a review of patient medical records. Out of 239 patients treated, 134 were eligible for inclusion to the study. RESULTS 91 subjects, 21 males and 70 females, with mean age 42.6 years completed the follow-up. The JFLS-20 mean score was 25.43 (range: 0-148). A correlation was found between JFLS and mouth opening. The JFLS-20 score was decreased by 1.48 (p = 0.0001) for ever millimeter larger mouth opening and with 1.16 (p = 0.001) for every gained millimeter of mouth opening after arthroscopic treatment of the TMJ. The mean maximal mouth opening was 38.43 mm preoperatively (15 to 75 mm) compared to 42.19 mm postoperatively (range: 21-75 mm). A total of 80 subjects with TMD associated pain preoperatively was reduced to 25 postoperatively (p = 0.0001). DISCUSSION Advantageous treatment effect with arthroscopic lysis and lavage was presented. The outcome of the JFLS-20 questionnaire indicates a correlation with the clinical findings. Future studies will focus on larger cohorts and using PROM with a case-control setting.
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Affiliation(s)
- Martin Bengtsson
- Consultant Oral and Maxillofacial Surgeon, Department of Oral & Maxillofacial Surgery, The University Hospital of Skåne, 22185 Lund, Sweden.
| | - Philip Fransson
- Department of Oral & Maxillofacial Surgery, The University Hospital of Skåne, 22185 Lund, Sweden.
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9
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Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial-Hernández V, Brabyn PJ, Fernández-Domínguez M, Naval-Gías L. Is There a Relationship Between Age, Personal Factors or Surgical Findings, and Outcome After Temporomandibular Joint Arthroscopy? J Oral Maxillofac Surg 2020; 79:1000-1008. [PMID: 33434521 DOI: 10.1016/j.joms.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The variables involved in prognosis after treatment of internal derangement (ID) of the temporomandibular joint (TMJ) are unclear. The purpose of this study was to estimate the frequency and identify which factors are associated with treatment success (or failure) among patients with ID managed with arthroscopy. MATERIAL AND METHODS A retrospective cohort study was carried out of patients undergoing TMJ arthroscopy over a 9-year-period. The predictor variable was composed of a set of demographic, clinical, and operative findings, including, as primary variable, the patient's age. The primary outcome variable was based on the American Association of Oral and Maxillofacial Surgery (AAOMS) criteria of pain (measured by visual analogue scale (VAS)) and maximal interincisal opening (MIO) defined as VAS ≤ 3 and MIO greater 35 mm and grouped as success or failure. The improvement in pain and functional values were compared with the age by using the Pearson correlation coefficient, whereas categorical variables were tested using chi-squared analysis, and mean values were compared with Student t-test or ANOVA. Subsequently, a logistic regression model was used, and the odds ratios (OR) of the evaluated comparisons were calculated. RESULTS A total of 212 patients were included in this study. In terms of arthroscopic findings, the presence of severe chondromalacia, adhesions or disc perforation (P < .001), was related with older patients. However, there was no statistically significant correlation between age and the postoperative improvement referred to pain or MIO. According to the AAOMS criteria, the procedure was successful in 54.24% of the cases. Two factors were related with a favorable outcome in the adjusted regression analysis: a higher presurgical MIO (OR 0.91, P < .001) and the presence of adhesions (OR 0.41, P = .003). CONCLUSION Age has no influence on the outcome after arthroscopy. A higher presurgical MIO and the presence of adhesions provide, in the long-term, a favorable prognosis.
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Affiliation(s)
- Mario Fernando Muñoz-Guerra
- Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain; Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital Montepríncipe, Madrid, Spain.
| | | | | | - Philip James Brabyn
- Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa-Madrid; Department of Oral & Maxillofacial, University Hospital Montepríncipe, Madrid, Spain
| | - Manuel Fernández-Domínguez
- Head, Department of Oral & Maxillofacial Surgery, University Hospital Montepríncipe (San Pablo CEU University), Madrid, Spain
| | - Luis Naval-Gías
- Head, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa (Autónoma University), Madrid, Spain
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Verhelst PJ, Vervaeke K, Orhan K, Lund B, Benchimol D, Coucke W, Van der Cruyssen F, De Laat A, Politis C, Jacobs R. The agreement between magnetic resonance imaging and arthroscopic findings in temporomandibular joint disorders. Int J Oral Maxillofac Surg 2020; 50:657-664. [PMID: 33248871 DOI: 10.1016/j.ijom.2020.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 01/15/2023]
Abstract
The aim of this retrospective observational study was to assess the potential agreement between independent magnetic resonance imaging (MRI) and arthroscopic findings and their respective contributions to a final diagnosis in patients with refractory temporomandibular joint disorders. Two dentomaxillofacial radiologists and two oral and maxillofacial surgeons scored 50 joints. All observers, who were blinded to additional clinical information, used a specific scoring form and selected one or more diagnostic labels. Agreement between MRI and arthroscopy and their contributions to the final diagnosis were assessed as primary outcomes using Fleiss' kappa. Intra-modality agreement and the correlation between signal intensity ratio (SIR) measurements on MRI and synovitis grading on arthroscopy were assessed as secondary outcomes. Agreement between MRI and arthroscopy was poor. A fair level of agreement was only reached for reduction capacity of the disc and disc perforation. Arthroscopic diagnostic labels matched better with the final diagnosis, suggesting a bigger contribution to that diagnosis. Higher SIR measurements correlated with higher synovitis grading scores for the retrodiscal tissue and the posterior band of the disc. Intra-modality agreement was better in arthroscopy. When blinded to clinical information, arthroscopy and MRI observations can lead to different conclusions. The diagnostic outcomes of both examinations should be considered and integrated into a final diagnosis.
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Affiliation(s)
- P-J Verhelst
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - K Vervaeke
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - K Orhan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - B Lund
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Benchimol
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - W Coucke
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - F Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - A De Laat
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals, Leuven, Belgium
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - R Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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