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Corrêa-Silva M, de Carvalho TMI, Zambon CE, Peres MPSDM, Machado GG. Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:244-254. [PMID: 38749875 DOI: 10.1016/j.oooo.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.
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Affiliation(s)
- Matheus Corrêa-Silva
- Oral and Maxillofacial Surgery Service, Clinics Hospital, University of São Paulo, São Paulo, Brazil.
| | | | - Camila Eduarda Zambon
- Oral and Maxillofacial Surgery Service, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | | | - Gustavo Grothe Machado
- Oral and Maxillofacial Surgery Service, Clinics Hospital, University of São Paulo, São Paulo, Brazil
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Martin-Granizo R, González LV, López JP, de la Sen O. Needle Therapy: A Minimally Invasive Therapeutic Concept as Part of Temporomandibular Single-Portal Arthroscopy. J Oral Maxillofac Surg 2024; 82:519-524. [PMID: 38387855 DOI: 10.1016/j.joms.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
The transition from a single portal to a double portal can be complex, necessitating time and training to minimize complications that rely on the operator's skill. Needle therapy is a simple method for treating symptoms that has several benefits. Consequently, this innovative strategy aims to introduce an intermediate technique that enables surgeons to perform therapeutic procedures during single-port arthroscopy.
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Affiliation(s)
- Rafael Martin-Granizo
- Professor, Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Vicente González
- Professor, Oral and Maxillofacial Service, Hospital Universitario La Samaritana, Bogotá, Colombia; Professor, Department of Oral Research, School of Dentistry, Institución Universitaria de Colegios de Colombia UNICOC, Bogotá DC, Colombia
| | - Juan Pablo López
- Professor, Oral and Maxillofacial Surgery Service, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia; Professor, Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia.
| | - Oscar de la Sen
- Professor, Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Gaete C, Droguett C, Sáez F, Astorga P. Clinical and demographic factors associated with the effectiveness of temporomandibular joint arthroscopy. Oral Maxillofac Surg 2024; 28:405-411. [PMID: 37222837 DOI: 10.1007/s10006-023-01158-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE High success rates and minimal complications have consolidated arthroscopy as the therapeutic alternative of choice for minimally invasive treatment of internal disorders (ID) of the temporomandibular joint (TMJ). However, there is no certainty regarding the demographic and clinical factors associated with the technique's success or failure. This study was performed to analyze the effectiveness of arthroscopy regarding pain and the mandibular dynamics and also to determine whether variables such as age, sex, and preoperative Wilkes stage influence the results. METHODS A retrospective study was conducted involving 92 patients with ID of the TMJ between September 2017 and February 2020. In all cases, a first stage of intra-articular lysis and lavage was executed. As needed, a phase of operative arthroscopy or arthroscopic discopexy was implemented. RESULTS A total of 152 arthroscopies were performed. Both the variation in pain and mouth opening in patients with ID of the TMJ treated were statistically significant for the follow-up periods studied. Better results were observed for patients with lower Wilkes stages. No association with age was found. CONCLUSION Based on the results, we recommend early intervention as soon as an ID in the TMJ is detected.
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Affiliation(s)
- Carlos Gaete
- Department of Maxillofacial Surgery, Hospital del Trabajador, ACHS, Santiago, Chile
- Private Practice, Oral and Maxillofacial Surgery at Clinica Santa Maria and Clinica Universidad de los Andes, Santiago, Chile
| | - Christian Droguett
- Department of Maxillofacial Surgery, Hospital del Trabajador, ACHS, Santiago, Chile
- Private Practice, Oral and Maxillofacial Surgery at Clinica Dávila and MEDS, Santiago, Chile
| | - Felipe Sáez
- Department of Maxillofacial Surgery, Hospital del Trabajador, ACHS, Santiago, Chile.
- Department of Oral and Maxillofacial Surgery, Universidad de los Andes, Santiago, Chile.
| | - Paula Astorga
- Department of Oral and Maxillofacial Surgery, Universidad de los Andes, Santiago, Chile
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Liu Y, Wang P, Telha W, Jiang N, Bi R, Zhu S. Arthroscopic reduction and rigid fixation of the anteriorly displaced temporomandibular joint disc without reduction using titanium screw: a case series. Clin Oral Investig 2024; 28:156. [PMID: 38376600 DOI: 10.1007/s00784-024-05552-2] [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: 09/06/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of arthroscopic reduction and rigid fixation (ARRF) using a suture-free titanium screw as a treatment approach to temporomandibular joint's (TMJ) anterior disc displacement without reduction (ADDwoR) and assess its impact on clinical outcomes, including improvements in symptoms related to TMJ disorders. MATERIALS AND METHODS A series of twenty patients presented to the Department of Orthognathic and Temporomandibular Surgery at West China Hospital of Stomatology between September 2022 and January 2023, complaining of symptoms such as pain, clicking, and limited mouth opening. Standard magnetic resonance image (MRI) imaging T1 and T2 sequences in both sagittal and coronal views study with closed and maximal open mouth positions were taken preoperatively to assess the disc's position, integrity, and shape. Also, cone-beam computed tomography (CBCT) scans images to find any degenerative changes and evaluate the condylar bone's features and volume. Additionally, the clinical examination assesses limited oral opening, mechanical pain, and the presence of any noises such as clicking and crepitus. All cases were treated under general anesthesia using the arthroscopic release, reduction, and rigid fixation of the TMJ's ADDwoR to establish a normal disc-condyle relationship and to restore the functional position. RESULTS Patients' symptoms, such as pain and mouth opening, improved significantly following the arthroscopic treatment. Postoperative MRI and CBCT imaging follow-up conducted at 6 months demonstrated the stable position of the reduced TMJ disc and the fixation screw. Notably, none of the patients exhibited signs of relapse during this follow-up period. CONCLUSION Overall, the ARRF of TMJ's ADDwoR using a suture-free titanium screw proved to be safe and provides satisfactory results, in addition to the several advantages of using suture-free titanium screws, such as biocompatibility, strong fixation, and durability. However, it is a technically demanding procedure requiring extensive, long-term training. CLINICAL RELEVANCE ARRF using a cost-effective fixation titanium screw to treat ADDwoR emerges as a clinically effective minimally invasive approach.
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Affiliation(s)
- Yao Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Peng Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Wael Telha
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.
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Henein P, Ziccardi VB. Temporomandibular Disorders: Surgical Implications and Management. Dent Clin North Am 2023; 67:349-365. [PMID: 36965936 DOI: 10.1016/j.cden.2022.12.002] [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: 03/27/2023]
Abstract
Temporomandibular disorders are a group of conditions that interfere with the daily lives of patients. Pain and limited function are primary concerns, and general dentists are usually the primary clinicians to be made aware of this issue. Evaluation and diagnosis is the key to determining a management plan. Minimally invasive surgical treatment includes arthrocentesis and arthroscopy, which can reduce inflammatory mediators, thereby reducing pain and increasing joint function. Open joint surgery for internal derangements focuses on instrumentation to remove and reshape the diseased condyle and disc as arthroplasty. Patients with severely limited function are candidates for total joint replacement.
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Affiliation(s)
- Peter Henein
- Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, 110 Bergen Street, Room B854, Newark, NJ 07103-2400, USA.
| | - Vincent B Ziccardi
- Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, 110 Bergen Street, Room B854, Newark, NJ 07103-2400, USA
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Bhagat B, Bhagat S, Sachdev M, Pandey ND. Desideratum of corroboration-based management for temporomandibular joint disorders: pressing priority in oral surgery. J Korean Assoc Oral Maxillofac Surg 2023; 49:53-54. [PMID: 36859376 PMCID: PMC9986000 DOI: 10.5125/jkaoms.2023.49.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- Bhushan Bhagat
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, India
| | - Shubhangi Bhagat
- Department of Pharmacutics, Dr. D. Y. Patil College of Pharmacy, Akurdi, India
| | - Muskaan Sachdev
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, India
| | - Narayan Dutt Pandey
- Department of Oral and Maxillofacial Surgery, Sinhgad Dental College & Hospital, Pune, India
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Regulski PA, Szopinski KT, Levičnik-Höfferle Š. Photobiomodulation Therapy for the Symptoms Related to Temporomandibular Joint Disk Displacement. Case Rep Dent 2023; 2023:5947168. [PMID: 37089525 PMCID: PMC10118889 DOI: 10.1155/2023/5947168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
Pain related to temporomandibular disorders (TMD) is a common problem that can significantly influence a patient's quality of life. Laser photobiomodulation (PBM) has been reported as a promising method in medicine for wound and bone healing, pain relief, and treatment of the temporomandibular joint (TMJ). Our clinical case aimed to demonstrate the effectivity of PBM using 1064 nm Nd:YAG laser for the treatment of pain and restricted mandible movement in a patient with anterior disk displacement of the left TMJ, using subjective (pain on visual analogue scale - VAS) and objective outcome measures [dynamic magnetic resonance imaging (MRI)]. PBM was performed on the left condyle in four sessions using a 1064 nm Nd:YAG laser with a flat-top handpiece. Results after 10 weeks showed an increase in mouth opening and a painless joint on palpation, with no reported adverse effects. An MRI of the TMJ confirmed the left disk displacement, however, with no signs of inflammation or effusion and with less pronounced disk deformity as compared with the first MRI examination. Use of PBM with Nd:YAG laser may be an efficient method for the management of orofacial pain in patients with acute and chronic TMJ disk displacements and may reduce the recovery time.
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Affiliation(s)
- Piotr A. Regulski
- Department of Dental and Maxillofacial Radiology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Binieckiego 6 St, Warsaw, Poland
- Piotr Regulski Dental Office, Grochowska 278 Street, Warsaw, Poland
| | - Kazimierz T. Szopinski
- Department of Dental and Maxillofacial Radiology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Binieckiego 6 St, Warsaw, Poland
- Gamma Medical Center, Broniewskiego 3, Warsaw, Poland
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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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Al-Ani Z. Temporomandibular Joint Osteoarthrosis: A Review of Clinical Aspects and Management. Prim Dent J 2021; 10:132-140. [PMID: 33722124 DOI: 10.1177/2050168420980977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The symptoms of TMJ Osteoarthrosis/Osteoarthritis(TMJ OA) are characteristic and in most cases specific to the disorder. There is, however, an overlap of symptoms with other TMDs.Treatment of TMJ OA is generally directed towards management of the symptoms as the temporomandibular joint does retain the capacity throughout life to repair and remodel. Non-conservative and invasive treatment is only rarely necessary.It should be remembered that the mandibular condyle retains the capacity to repair and remodel throughout life and patients should be encouraged to bear this in mind. Conservative measures are usually sufficient to treat symptoms and a period of time should be allowed to elapse before undertaking a more aggressive treatment plan, which, in the overwhelming majority of patients, will not be necessary. This disorder should be approached on the terms of 'a quality of life issue' and treatment should be directed towards patient needs.
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Affiliation(s)
- Ziad Al-Ani
- Senior Lecturer, Glasgow Dental Hospital and School
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Muñoz-Guerra M, Rodríguez-Campo F, Escorial-Hernández V, Brabyn P, Fernández-Domínguez M, Naval-Gías L. The minimally invasive arthroscopic anterior myotomy in the treatment of internal derangement of the temporomandibular joint. A detailed description of the surgical technique. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:50-55. [DOI: 10.1016/j.jormas.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
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Choi DD, Vandenberg K, Smith D, Davis C, McCain JP. Is Temporomandibular Joint Arthroscopy Effective in Managing Pediatric Temporomandibular Joint Disorders in the Short- and Long-Term? J Oral Maxillofac Surg 2019; 78:44-51. [PMID: 31454503 DOI: 10.1016/j.joms.2019.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Although temporomandibular joint (TMJ) arthroscopy outcomes have been well documented in the adult population, conclusive data are lacking for pediatric patients with TMJ disorders. The aim of the present study was to evaluate the early and late outcomes of TMJ arthroscopy in the pediatric population. PATIENTS AND METHODS We performed a retrospective analysis to evaluate the short- (1-month) and long-term (1-year) improvements in the visual analog scale (VAS) scores for pain after pediatric TMJ arthroscopy from 2008 to 2016. The arthroscopic interventions varied according to the diagnostic findings and Wilkes classification. The primary outcome variable was the magnitude of VAS score for pain (0, no pain; 100, worst pain) at 1 year postoperatively. The secondary outcome variables were the short-term for the VAS score for pain and the short- and long-term outcomes for perceived jaw dysfunction (0, normal jaw function; 100, complete jaw dysfunction), mouth opening, joint loading (contralateral joint pain when biting on the canine), joint noise, and muscle pain. Univariate, bivariate, and multivariate statistical analyses were performed with the significance level set at P < .05. RESULTS A total of 23 patients (37 joints), with a mean age of 14.1 years (range, 12.8 to 16.7 years) had undergone TMJ arthroscopic surgery with short- and long-term postoperative follow-up data available. The VAS scores for pain showed average improvements of 26% in the short-term (P < .0001) and 25% in the long-term (P < .0008). Perceived jaw dysfunction showed an average improvement of 23.8% in the short-term (P < .0001) and 19.2% in the long-term (P < .0008). The average mouth opening had improved by 5.4 mm in the short-term (P < .0016) and 8.2 mm in the long-term (P < .0001). Controlling for stage and diagnosis, the patients with Wilkes III showed the most benefit with statistically significant improvements in pain, jaw dysfunction, maximum interincisal opening, and joint loading pain. CONCLUSIONS TMJ arthroscopy could be an effective and minimally invasive form of surgical intervention for treating Wilkes II, III, and IV TMJ disorders in the pediatric population.
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Affiliation(s)
- Daniel D Choi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Katherine Vandenberg
- Resident, Division of Otolaryngology, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Drew Smith
- Medical Student, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Clayton Davis
- Associate Professor, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joseph P McCain
- Program Director, Endoscopic OMS Fellowship, and Director, TMJ Surgery, Massachusetts General Hospital, Boston, MA
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Efeoglu C, Calis AS, Koca H, Yuksel E. A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint. J Otolaryngol Head Neck Surg 2018; 47:33. [PMID: 29764480 PMCID: PMC5952503 DOI: 10.1186/s40463-018-0282-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/07/2018] [Indexed: 11/12/2022] Open
Abstract
Background Internal derangement is the clinical and pathological condition of disc displacement of the temporomandibular joint. Management of these cases involve conservative and surgical treatment options. Minimally invasive surgical procedures namely arthrocentesis and arthroscopy are promising techniques in the management of internal derangement. However patient selection algorithms, indications for minimally invasive procedures and details of the techniques should be further studied for safe and cost effective management of these cases. This manuscript aims to retrospectively analyze the significance of a stepped surgical treatment approach (arthrocentesis under local anaesthesia as the first line of treatment, followed by arthroscopic lysis and lavage under general anaesthesia in unresolving cases) of internal derangement with or without osteoarthritis. Methods This is a retrospective cohort study. Case notes of 1414 patients that were managed with a standard protocol were reviewed. Appropriate inclusion and exclusion criteria were set. Thirty-three patients were eligible for inclusion. Parameters recorded were pain-free inter-incisal opening, spontaneous pain, pain on function, difficulty on chewing, and perceived disability on jaw movements. Pre-operative and post-operative (at the end of the follow up period) pain free maximum interincisal opening values were compared with paired t test and the subjective parameters were evaluated with Chisquare analysis. Treatment outcome and success rate according to American Association of Oral and Maxillofacial Surgeons were descriptively shown. Results Interincisal opening values increased, and the number of patients with severe or medium rated subjective parameters were reduced at discharge. These improvements were found to be statistically significant. Clinical (Wilkes) staging of internal derangement pre-operatively and at discharge remained either unchanged or was lower. Treatment outcome and success according to American Association of Oral and Maxillofacial Surgeons criteria was 94%. Conclusion The stepped approach for the management of symptomatic internal derangement with or without osteoarthritis is a successful treatment strategy with favourable therapeutic outcomes.
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Affiliation(s)
- Candan Efeoglu
- Oral Surgery Department, Ege University School of Dentistry, 35100, Izmir, Turkey.
| | - Aylin Sipahi Calis
- Oral Surgery Department, Ege University School of Dentistry, 35100, Izmir, Turkey
| | - Huseyin Koca
- Oral Surgery Department, Ege University School of Dentistry, 35100, Izmir, Turkey
| | - Esra Yuksel
- Anesthesiology Department, Ege University School of Medicine, 35100, Izmir, Turkey
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Hossameldin R, McCain J. Outcomes of office-based temporomandibular joint arthroscopy: a 5-year retrospective study. Int J Oral Maxillofac Surg 2018; 47:90-97. [DOI: 10.1016/j.ijom.2017.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 05/08/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
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Miloro M, McKnight M, Han MD, Markiewicz MR. Discectomy without replacement improves function in patients with internal derangement of the temporomandibular joint. J Craniomaxillofac Surg 2017; 45:1425-1431. [DOI: 10.1016/j.jcms.2017.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022] Open
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Arthroscopy of the Inferior Compartment of the Temporomandibular Joint: A New Perspective. J Maxillofac Oral Surg 2017; 17:228-232. [PMID: 29618891 DOI: 10.1007/s12663-017-1023-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 05/26/2017] [Indexed: 10/19/2022] Open
Abstract
Objective Arthroscopy of the temporomandibular joint (TMJ) has become a well-standardized non-invasive procedure for the treatment of TMJ internal derangement (ID). Since the last 1980s, no clinical application for arthroscopy of the inferior compartment has been established because of the intrinsic difficulty of the technique and the believing of the absence of clinical relevance for treatment of ID. Methods We report on a particular case in which arthroscopy of the inferior joint compartment together with the examination of the upper joint space was performed in a patient with ID of the TMJ. A 1.9 mm scope was used, while the technique for entering the inferior compartment is presented. Results The presence of intense synovitis, fibrous adhesion, and pseudowall were observed in the inferior joint compartment, thus leading to the hypothesis of the more than likely influence of the status of the synovial lining within this space in the persistence of symptoms in recalcitrant patients with ID. Conclusion We believe that this new insight could lead surgeons to a more complete use of this non-invasive procedure for the treatment of this entity. Level of Evidence 4/5.
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Foletti JM, Cheynet F, Graillon N, Guyot L, Chossegros C. [TMJ arthroscopy. A review]. ACTA ACUST UNITED AC 2016; 117:273-9. [PMID: 27523442 DOI: 10.1016/j.revsto.2016.07.010] [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: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction. MATERIAL AND METHODS Using the keywords "TMJ" and "Arthroscopy", 1668 articles were found in the Sciencedirect database. We selected 17 papers published between September 2012 and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved? RESULTS AND DISCUSSION (1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned.
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Affiliation(s)
- J M Foletti
- Service de chirurgie maxillo-faciale, stomatologie et plastique, hôpital Nord, chemin des Bourrelys, 13015 Marseille, France
| | - F Cheynet
- Service de chirurgie maxillo-faciale et stomatologie, CHU conception, 147, boulevard Baille, 13005 Marseille, France
| | - N Graillon
- Service de chirurgie maxillo-faciale et stomatologie, CHU conception, 147, boulevard Baille, 13005 Marseille, France
| | - L Guyot
- Service de chirurgie maxillo-faciale, stomatologie et plastique, hôpital Nord, chemin des Bourrelys, 13015 Marseille, France
| | - C Chossegros
- Service de chirurgie maxillo-faciale et stomatologie, CHU conception, 147, boulevard Baille, 13005 Marseille, France.
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