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Ângelo DF, Sanz D, Cardoso HJ. Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention-a prospective study. Clin Oral Investig 2023; 27:6167-6176. [PMID: 37632580 DOI: 10.1007/s00784-023-05233-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Evaluate the efficacy of bilateral temporomandibular joint (TMJ) arthroscopy in patients with different categories of severity based on Dimitroulis classification (categories 2-4) and the role of a second TMJ intervention in primary failure. METHODS A 3-year prospective study was designed, including patients submitted to bilateral TMJ arthroscopy. The primary outcome was TMJ pain (VAS, 0-10) and the secondary outcomes were the maximum mouth opening (MMO) and masticatory myalgia degree (0-3). In cases of symptomatic relapse, a second TMJ intervention was performed (TMJ arthrocentesis or TMJ open surgery). RESULTS Eighty patients (93.4% women) were enrolled, with a mean age of 32.40 ± 11.41 years. With an average follow-up of 523.7 days (34-1606), a statistically significant improvement in TMJ pain, MMO, and myalgia degree was observed (P < 0.0001). The overall successful outcome of one-single bilateral arthroscopy was ~ 69%. Twenty-two patients relapsed: (1) arthralgia (n = 15, 68.18%); (2) arthralgia + myalgia (n = 4, 18.18%); (3) dislocated disc without reduction (DDwoR) (n = 2, 9.09%); (4) DDwoR + osteoarthrosis (OA) (n = 1, 4.55%). Arthralgia was re-managed with TMJ arthrocentesis with local anesthesia (n = 19, 86.36%). New DDwoR with or without OA was re-treated with TMJ open surgery (n = 3, 13.64%). After the second intervention, the success rate increased to 85%. CONCLUSIONS Bilateral TMJ arthroscopy presented overall benefit in all parameters evaluated. CLINICAL RELEVANCE This study highlights the importance of TMJ arthroscopy as the first line of treatment for moderate-severe temporomandibular disorders cases contributing to the reduction of TMJ open surgeries. In cases of arthroscopy unsuccess, TMJ arthrocentesis under local anesthesia was an effective and safe intervention for patients with recurrent TMJ arthralgia.
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Affiliation(s)
- David Faustino Ângelo
- Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal.
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028, Marinha Grande, Portugal.
- Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - David Sanz
- Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal
| | - Henrique José Cardoso
- Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal
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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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3
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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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4
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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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5
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González LV, López JP, Díaz-Báez D, Orjuela MP, Chavez M. Clinical outcomes of operative arthroscopy and temporomandibular medical infiltration with platelet-rich fibrin in upper and lower articular space. J Craniomaxillofac Surg 2021; 49:1162-1168. [PMID: 34384651 DOI: 10.1016/j.jcms.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
This study aims to describe the short-term therapeutic results of patients treated with operative arthroscopy and medical infiltration with platelet-rich fibrin in upper and lower articular space. The study design is descriptive observational with retrospective case series of patients with Wilkes II and III. These patients were managed with operative arthroscopy viscosupplementation with platelet-rich fibrin (PRF) and were followed up for up to 8 months to evaluate their response to treatment. 17 patients were included in the study. In the pre-surgical assessment (T1) mean VAS was 7.1 and MID was 22.2 mm. Eight months later (T4) a relevant improvement in both mentioned variables MID 38.2 ± 4.1 and VAS 1.1 ± 0.2 was observed. Regarding the reduction of pain, a significant improvement in symptoms were found, this being 84.6% ± 3.5% and in mandibular mobility satisfactory results were also obtained, improving in 41.7% ± 20.9%. Within the limitations of the study temporomandibular joint arthroscopy and medical infiltration platelet-rich fibrin viscosupplementation is a procedure of limited invasiveness that shows promising results.
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Affiliation(s)
| | - Juan Pablo López
- Universidad El Bosque, Bogotá, Colombia; Hospital Universitario Santa Fe de Bogotá, Bogotá, Colombia.
| | - David Díaz-Báez
- Universidad El Bosque, Bogotá, Colombia; Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá, Colombia
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6
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Arthroscopic outcomes in TMJ internal derangement and surgical progression in a single centre in New Zealand. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Ulmner M, Weiner CK, Lund B. Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study. Int J Oral Maxillofac Surg 2019; 49:614-620. [PMID: 31564479 DOI: 10.1016/j.ijom.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/23/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n=49), good (25%, n=23), intermediate (20%, n=19), or deteriorated (2%, n=2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P=0.048). Low age (OR 1.03, P=0.05) and bilateral joint surgery/operated side (OR 0.24, P=0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.
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Affiliation(s)
- M Ulmner
- P.F. Craniofacial Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - C Kruger Weiner
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Oral and Maxillofacial Surgery, Folktandvården Stockholm, Eastmaninstitutet, Stockholm, Sweden
| | - B Lund
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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9
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Sato F, Lima C, Tralli G, da Silva R. Is there a correlation between arthroscopic findings and the clinical signs and symptoms of patients with internal derangement of the temporomandibular joint? A prospective study. Int J Oral Maxillofac Surg 2019; 48:233-238. [DOI: 10.1016/j.ijom.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
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10
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Abouelhuda AM, Khalifa AK, Kim YK, Hegazy SA. Non-invasive different modalities of treatment for temporomandibular disorders: review of literature. J Korean Assoc Oral Maxillofac Surg 2018; 44:43-51. [PMID: 29732308 PMCID: PMC5932270 DOI: 10.5125/jkaoms.2018.44.2.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 02/05/2023] Open
Abstract
Temporomandibular disorders (TMDs) are diseases that affect the temporomandibular joint and supporting structures. The goal of treatment for TMDs is elimination or reduction of pain and return to normal temporomandibular joint function. Initial treatment for TMDs is non-invasive and conservative, not surgical. Oral and maxillofacial surgeons should fully understand and actively care about non-invasive treatments for TMDs. The purpose of this study is to review the validity and outcomes of non-invasive and surgical treatment modalities for TMDs.
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Affiliation(s)
- Amira Mokhtar Abouelhuda
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Prosthodontics, Mansoura University Hospital, College of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ahmad Khalifa Khalifa
- Department of Prosthodontics, Mansoura University Hospital, College of Dentistry, Mansoura University, Mansoura, Egypt
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Salah Abdelftah Hegazy
- Department of Prosthodontics, Mansoura University Hospital, College of Dentistry, Mansoura University, Mansoura, Egypt
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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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12
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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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Long-Term Outcome of Arthrocentesis Plus Hyaluronic Acid Injection in Patients With Wilkes Stage II and III Temporomandibular Joint Internal Derangement. J Craniofac Surg 2016; 26:2104-8. [PMID: 26468791 DOI: 10.1097/scs.0000000000002078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Arthrocentesis is a minimally invasive procedure used to manage temporomandibular joint (TMJ) internal derangement (ID). This study evaluated the outcome of arthrocentesis in patients with Wilkes stage II and III TMJ ID. PATIENTS AND METHODS This retrospective study enrolled 50 patients who underwent arthrocentesis in 2011 and 2012 at the Karadeniz Technical University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey. In total, 43 patients underwent unilateral arthrocentesis, whereas 7 patients had bilateral arthrocentesis. The clinical parameters recorded were pain (visual analogue scale [VAS] 0-100 mm during movement), chewing function efficacy (VAS 0-100), clicking sounds, and mandibular movements, including maximum interincisal opening (MIO), lateral excursion, and protrusion. All the parameters were recorded preoperatively, and 1, 3, 6, and 24 months after treatment. RESULTS The MIO, lateral excursion, and protrusion were significantly greater than preoperatively in all the patients. Pain declined significantly postoperatively. The patients in Wilkes III group had greater improvement in mandibular movement and pain than the patients in Wilkes II group. CONCLUSION Arthrocentesis was reliable for treating both Wilkes II and III TMJ ID, and the treatment results were better in Wilkes III patients.
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Abboud WA, Givol N, Yahalom R. Arthroscopic lysis and lavage for internal derangement of the temporomandibular joint. Ann Maxillofac Surg 2016; 5:158-62. [PMID: 26981463 PMCID: PMC4772553 DOI: 10.4103/2231-0746.175754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Arthroscopy of the temporomandibular joint (TMJ) is a valuable diagnostic and therapeutic tool for various intra-articular disorders, especially internal derangement (ID) of the TMJ. OBJECTIVES To evaluate the efficacy and safety of a standardized arthroscopic procedure for the treatment of two stages of ID; early/intermediate stage and intermediate/late stage. MATERIALS AND METHODS Retrospective analysis of medical records of 78 patients (99 joints) treated by arthroscopic lysis and lavage in the authors' department during a 5-year period. Patients were diagnosed preoperatively as suffering from ID of the TMJ. The results were stratified according to the stage of ID. Three outcome variables were used to assess efficacy of treatment: Maximal interincisal opening (MIO), level of pain on a visual analog scale (VAS), and frequency of intermittent locking episodes. In addition, complications were reported. RESULTS Mean MIO of the group of patients with intermediate/late stage ID increased from 27 ± 4.7 mm preoperatively to 38 ± 5.4 mm postoperatively (P < 0.0001). For the group of patients with early/intermediate stage ID, mean MIO did not change significantly after arthroscopy (39.1 ± 6.2 mm compared to 41.4 ± 5 mm, P = 0.06), however, subjective evaluation of pain on a VAS decreased from 7.2 ± 1.2 preoperatively to 3.4 ± 2.2 postoperatively (P < 0.0001), and 80% of the patients (25 of 31) denied experiencing intermittent locking episodes after treatment (P < 0.0001). CONCLUSION Arthroscopic lysis and lavage is a safe and effective therapeutic modality for the treatment of both mild and advanced stages of ID.
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Affiliation(s)
- Waseem A Abboud
- Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel-Aviv University, Israel
| | - Navot Givol
- Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ran Yahalom
- Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel-Aviv University, Israel
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Abstract
Biomaterials have played an increasingly prominent role in the success of biomedical devices and in the development of tissue engineering, which seeks to unlock the regenerative potential innate to human tissues/organs in a state of deterioration and to restore or reestablish normal bodily function. Advances in our understanding of regenerative biomaterials and their roles in new tissue formation can potentially open a new frontier in the fast-growing field of regenerative medicine. Taking inspiration from the role and multi-component construction of native extracellular matrices (ECMs) for cell accommodation, the synthetic biomaterials produced today routinely incorporate biologically active components to define an artificial in vivo milieu with complex and dynamic interactions that foster and regulate stem cells, similar to the events occurring in a natural cellular microenvironment. The range and degree of biomaterial sophistication have also dramatically increased as more knowledge has accumulated through materials science, matrix biology and tissue engineering. However, achieving clinical translation and commercial success requires regenerative biomaterials to be not only efficacious and safe but also cost-effective and convenient for use and production. Utilizing biomaterials of human origin as building blocks for therapeutic purposes has provided a facilitated approach that closely mimics the critical aspects of natural tissue with regard to its physical and chemical properties for the orchestration of wound healing and tissue regeneration. In addition to directly using tissue transfers and transplants for repair, new applications of human-derived biomaterials are now focusing on the use of naturally occurring biomacromolecules, decellularized ECM scaffolds and autologous preparations rich in growth factors/non-expanded stem cells to either target acceleration/magnification of the body's own repair capacity or use nature's paradigms to create new tissues for restoration. In particular, there is increasing interest in separating ECMs into simplified functional domains and/or biopolymeric assemblies so that these components/constituents can be discretely exploited and manipulated for the production of bioscaffolds and new biomimetic biomaterials. Here, following an overview of tissue auto-/allo-transplantation, we discuss the recent trends and advances as well as the challenges and future directions in the evolution and application of human-derived biomaterials for reconstructive surgery and tissue engineering. In particular, we focus on an exploration of the structural, mechanical, biochemical and biological information present in native human tissue for bioengineering applications and to provide inspiration for the design of future biomaterials.
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Chandrashekhar VK, Kenchappa U, Chinnannavar SN, Singh S. Arthrocentesis A Minimally Invasive Method for TMJ Disc Disorders - A Prospective Study. J Clin Diagn Res 2015; 9:ZC59-62. [PMID: 26557619 DOI: 10.7860/jcdr/2015/15045.6665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Temporomandibular joint (TMJ) disc disorders are one of the major concerns to the mankind and doctors in day to day life due to its complex nature and failure to treat these kinds of conditions successfully. OBJECTIVES The aim of the present study was to evaluate the efficacy of arthrocentesis in patients suffering from TMJ disc disorders. MATERIALS AND METHODS A total of 50 subjects suffering from TMJ disc disorders were selected and treated by arthrocentesis. The subjects were followed up for a period of one year. RESULTS The mean maximal mouth opening prior to arthro-centesis was 32.13mm and after the procedure the mean maximal mouth opening was 46.6mm. The mean right and left lateral movements before arthrocentesis were 7.15mm and 7.59mm respectively, and the mean right and left lateral movements of 9.49 and 9.31 respectively were present after the procedure. The mean degree of pain before arthrocentesis was 8.7, and after the procedure the mean degree of pain was 1.13 as per the visual analogue scale. CONCLUSION The findings of this study suggested potential utility of arthrocentesis in the management of TMJ disc disorders.
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Affiliation(s)
- Vidya Kodage Chandrashekhar
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences , Bhubaneswar, India
| | - Umesh Kenchappa
- Professor and Head, Department of Oral and Maxillofacial Surgery, Oxford College of Dental Sciences , Bangalore, India
| | | | - Sarabjeet Singh
- Professor and Head, Department of Oral Medicine and Radiology, Sehora, Jammu, India
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Treatment of Intermittent Locking of the Jaw in Wilkes Stage II Derangement by Arthroscopic Lysis and Lavage. J Oral Maxillofac Surg 2015; 73:1466-72. [DOI: 10.1016/j.joms.2015.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/06/2015] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
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Silva PAD, Lopes MTDFF, Freire FS. A prospective study of 138 arthroscopies of the temporomandibular joint. Braz J Otorhinolaryngol 2015; 81:352-7. [PMID: 26163228 PMCID: PMC9442712 DOI: 10.1016/j.bjorl.2014.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 08/31/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Internal derangements (ID) of the temporomandibular joint (TMJ) have a multifactorial etiology and are most often treated conservatively by splints, physical therapy and medications. Only in 2-5% of cases are the treatment surgical, either by arthroscopy or arthrotomy. OBJECTIVE To evaluate improvement of mouth opening, pain relief during function, position of the articular disk and complications following Arthroscopic Lyse and Lavage (ALL). METHODS A prospective study of 78 patients (138 TMJs) with TMJ ID, 5 males and 73 females, mean age 29.7 years, treated between January 2010 and April 2013, who were refractory to conservative treatment, had limited mouth opening and pain localized to the TMJ during function, and who were submitted to TMJ ALL and followed for a period of 12 months, with periodic reviews. RESULTS ALL was effective in 93.6% of cases, with 85.3% experiencing improvement in mouth opening and 91.2% in pain reduction during function, 63% improvement in disk position and a rate of complications of 6.2%. CONCLUSION In this study the ALL exhibited a high rate of success with low morbidity in internal derangements of the TMJ.
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Affiliation(s)
- Paulo Alexandre da Silva
- Department of Oral and Maxillofacial Surgery and Traumatology (OMFST), Medical Center, Hospital Vivalle São José dos Campos, São José dos Campos, SP, Brazil.
| | - Maria Teresa de Fatima Fernandes Lopes
- Departament of Oral and Maxillofacial Surgery and Traumatology, Instituto Educacional de Ciências da Saúde (IECS Facsete/Ciodonto), Sete Lagoas, MG, Brazil
| | - Fernando Silva Freire
- Departament of Oral and Maxillofacial Surgery and Traumatology, Instituto Educacional de Ciências da Saúde (IECS Facsete/Ciodonto), Sete Lagoas, MG, Brazil
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Ekberg E, Hansson LG, List T, Eriksson L, Sahlström LE, Petersson A. Can MRI Observations Predict Treatment Outcome of Lavage in Patients with Painful TMJ Disc Displacement without Reduction? J Oral Maxillofac Res 2015; 6:e5. [PMID: 25937876 PMCID: PMC4414236 DOI: 10.5037/jomr.2014.6105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/10/2015] [Indexed: 11/16/2022]
Abstract
Objectives The purpose of this study was to examine magnetic resonance imaging findings in patients with painful disc displacement without reduction of the temporomandibular joint to determine whether the findings were able to predict treatment outcome of lavage and a control group treated with local anaesthesia without lavage in a short-term: 3-month perspective. Material and Methods Bilateral magnetic resonance images were taken of 37 patients with the clinical diagnosis of painful disc displacement without reduction. Twenty-three patients received unilateral extra-articular local anaesthetics and 14 unilateral lavage and extra-articular local anaesthetics. The primary treatment outcome defining success was reduction in pain intensity of at least 30% during jaw movement at the 3-month follow-up. Results Bilateral disc displacement was found in 30 patients. In 31 patients the disc on the treated side was deformed, and bilaterally in 19 patients. Osteoarthritis was observed in 28 patients, and 13 patients had bilateral changes. Thirty patients responded to treatment and 7 did not, with no difference between the two treated groups. In neither the treated nor the contralateral temporomandibular joint did treatment outcome depend on disc diagnosis, disc shape, joint effusion, or osseous diagnoses. Magnetic resonance imaging findings of disc position, disc shape, joint effusion or osseous diagnosis on the treated or contralateral side did not give information of treatment outcome. Conclusions Magnetic resonance imaging findings could not predict treatment outcome in patients treated with either local anaesthetics or local anaesthetics and lavage.
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Affiliation(s)
- EwaCarin Ekberg
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University Sweden
| | - Lars-Göran Hansson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University Sweden
| | - Lars Eriksson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University Sweden
| | | | - Arne Petersson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University Sweden
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Mehra P, Arya V. Temporomandibular Joint Arthrocentesis: Outcomes Under Intravenous Sedation Versus General Anesthesia. J Oral Maxillofac Surg 2015; 73:834-42. [DOI: 10.1016/j.joms.2014.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 11/16/2022]
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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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Weedon S, Ahmed N, Sidebottom A. Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint. Br J Oral Maxillofac Surg 2013; 51:625-9. [DOI: 10.1016/j.bjoms.2013.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
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Abstract
Arthroscopic surgery has been widely used for treatment of temporomandibular joint (TMJ) internal derangements and diseases for the last 40 years. Although 626 articles have been hit by Pubmed search in terms of "TMJ arthroscopic surgery", this review article is described based on distinguished publishing works and on my experiences with TMJ arthroscopic surgery and related research with an aim to analyse the rationale of arthroscopic surgeries of the temporomandibular joint. With arthrocentesis emerging as an alternative, less invasive, treatment for internal derangement with closed lock, the primary indication of arthroscopic surgery seems to be somewhat limited. However, the value of endoscopic inspection and surgery has its position for both patient and physician with its long-term reliable results.
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Affiliation(s)
- KenIchiro Murakami
- Oral and Maxillofacial Surgery, Ako City Hospital, Hyogo 678-0232, Japan
- Visiting Professor, Kanagawa Dental College, Yokosuka, Japan
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González-García R, Rodríguez-Campo FJ. Arthroscopic Lysis and Lavage Versus Operative Arthroscopy in the Outcome of Temporomandibular Joint Internal Derangement: A Comparative Study Based on Wilkes Stages. J Oral Maxillofac Surg 2011; 69:2513-24. [DOI: 10.1016/j.joms.2011.05.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/23/2011] [Accepted: 05/25/2011] [Indexed: 11/29/2022]
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González-García R, Gil-Díez Usandizaga JL, Rodríguez-Campo FJ. Arthroscopic Anatomy and Lysis and Lavage of the Temporomandibular Joint. Atlas Oral Maxillofac Surg Clin North Am 2011; 19:131-44. [DOI: 10.1016/j.cxom.2011.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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Machoň V, Sedý J, Klíma K, Hirjak D, Foltán R. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction. Int J Oral Maxillofac Surg 2011; 41:109-13. [PMID: 21885248 DOI: 10.1016/j.ijom.2011.07.907] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 05/08/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
Abstract
The authors prospectively analysed 50 patients with chronic anterior disc displacement without reduction, who underwent arthroscopic lysis and lavage of the temporomandibular joint (TMJ). Patients with symptoms lasting less than 1 year were assigned to Group A (n=28) and patients with symptoms lasting more than 1 year to Group B (n=22). The most common problems were inflammatory changes of synovial and retrodiscal tissue (Group A, 71%; Group B, 82%). Fibrous adhesions were present in 14% of Group A patients and 45% of Group B patients. Degenerative changes of the disc and articular surface were present in 4% of Group A patients and 32% of Group B patients. Mouth opening increased 123% from baseline in Group A, and 112% in Group B (P<0.05). Pain decreased significantly in both groups (Group A, 2.5 points; Group B, 1.68 points; P<0.05). In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from arthroscopic lysis and lavage of the TMJ. Patients with a shorter duration of symptoms problems benefited more than those with a longer duration. Arthroscopic lysis and lavage of the TMJ is safe and beneficial in chronic anterior disc displacement without reduction.
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Affiliation(s)
- V Machoň
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Venetis G, Pilavaki M, Triantafyllidou K, Papachristodoulou A, Lazaridis N, Palladas P. The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations. Dentomaxillofac Radiol 2011; 40:84-90. [PMID: 21239570 DOI: 10.1259/dmfr/13255885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. METHODS A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. RESULTS MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. CONCLUSIONS TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.
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Affiliation(s)
- G Venetis
- University Clinic of Oral and Maxillofacial Surgery, Thessaloniki, Greece.
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Thorp JN, Ritzline PD. Fibromyalgia Is Not a Predictor Variable for a Successful Outcome Following Surgical Correction of Internal Derangement of the Temporomandibular Joint. J Oral Maxillofac Surg 2011; 69:19-27. [DOI: 10.1016/j.joms.2010.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/01/2010] [Accepted: 07/08/2010] [Indexed: 01/22/2023]
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Leibur E, Jagur O, Müürsepp P, Veede L, Voog-Oras Ü. Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders. J Craniomaxillofac Surg 2010; 38:615-20. [DOI: 10.1016/j.jcms.2010.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 01/29/2010] [Accepted: 02/05/2010] [Indexed: 11/15/2022] Open
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Morey-Mas MA, Caubet-Biayna J, Varela-Sende L, Iriarte-Ortabe JI. Sodium hyaluronate improves outcomes after arthroscopic lysis and lavage in patients with Wilkes stage III and IV disease. J Oral Maxillofac Surg 2010; 68:1069-74. [PMID: 20144496 DOI: 10.1016/j.joms.2009.09.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/15/2009] [Accepted: 09/15/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE Among patients with Wilkes stage III and IV disease undergoing arthroscopic lysis and lavage, does the use of an intra-articular injection of sodium hyaluronate (SH), when compared with Ringer lavage, result in better postoperative pain control and temporomandibular joint (TMJ) function? PATIENTS AND METHODS We designed and implemented a randomized, double-blind, pilot controlled clinical trial. The study sample was composed of patients with middle Wilkes stage (late stage III and early stage IV) disease. Subjects were randomized to 1 of 2 treatment limbs. The treatment group received Ringer lactate plus an injection of 1 mL of SH after arthroscopy, whereas the control group was given Ringer lactate during arthroscopy. The primary outcome variables were pain and TMJ function measured by use of visual analog scales. Appropriate descriptive and bivariate statistics were computed. A P value less than .05 was considered statistically significant. RESULTS The study sample was composed of 40 patients with 20 subjects enrolled in both treatment groups. There were no statistically significant differences between the 2 groups in terms of demographics and preoperative variables. Postoperative analgesia was statistically significant in the treatment group with respect to the control group on the visits on days 14 and 84. No statistically significant differences were observed between the 2 groups in the maximum interincisal opening and tolerance. CONCLUSIONS An intra-articular injection of SH after arthroscopic lysis and lavage is effective in reducing pain in patients with TMJ dysfunction, enhancing postsurgical recovery. The analgesic effect of treatment with SH is maintained in the long term.
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Affiliation(s)
- Miguel-Angel Morey-Mas
- Department of Oral and Maxillofacial Surgery, Son Dureta University Hospital, Palma de Mallorca, Spain.
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Kirk WS, Kirk BS. A biomechanical basis for primary arthroplasty of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2009; 18:345-68, vi. [PMID: 18088837 DOI: 10.1016/j.coms.2006.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomechanical principles of temporomandibular joint (TMJ) loading are unique, particularly in an orthopedic system that exhibits curvilinear general plane motion. Certain type-specific derangements can be surgically challenging and may primarily require open arthrotomy techniques rather than arthroscopy. This article discusses the basic biomechanical principles in normal and pathologic function. Three-dimensional preoperative imaging of TMJs is necessary for appropriate assessment of all patients and when open techniques are necessary as the initial surgical procedure.
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Smolka W, Yanai C, Smolka K, Iizuka T. Efficiency of arthroscopic lysis and lavage for internal derangement of the temporomandibular joint correlated with Wilkes classification. ACTA ACUST UNITED AC 2008; 106:317-23. [DOI: 10.1016/j.tripleo.2007.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 11/22/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Varol A, Basa S, Topsakal A, Akpinar I. Assessment of synovial vascularization by power Doppler ultrasonography in TMJ internal derangements treated arthroscopically. Br J Oral Maxillofac Surg 2008; 46:625-30. [PMID: 18584928 DOI: 10.1016/j.bjoms.2008.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2008] [Indexed: 01/01/2023]
Abstract
Our aim was to evaluate the effect of arthroscopic lysis and lavage of the temporomandibular joint (TMJ) on synovial microvascularisation by comparing preoperative and postoperative grades measured by power Doppler ultrasonography (US). We studied 22 patients with hypomobility, clicking, and pain in the TMJ. Power Doppler US were obtained preoperatively to assess the presence of synovial microvascularisation, and arthroscopic lysis and lavage were done after conservative treatment had proved unsuccessful. The severity of synovitis was assessed arthroscopically. The postoperative power Doppler US scans were obtained 2 months later. Other arthroscopic variables were roofing, adhesions, chondromalacia, clicking, and pain. Arthroscopic synovitis with varying degrees of synovial vascularisation was detected in all patients. Pain scores decreased considerably during the postoperative period. We conclude that power Doppler US is a good technique for the assessment of synovial changes by microvascularisation. Arthroscopy of the TMJ reduces synovial vascularisation.
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Affiliation(s)
- Altan Varol
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
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de Leeuw R. Internal derangements of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2008; 20:159-68, v. [PMID: 18343322 DOI: 10.1016/j.coms.2007.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article discusses several types of internal derangements of the temporomandibular joint. It includes definitions, clinical characteristics, and management options. Nonsurgical and surgical treatment strategies are discussed taking into consideration the latest evidence-based literature.
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Affiliation(s)
- Reny de Leeuw
- Orofacial Pain Center, University of Kentucky, College of Dentistry, 800 Rose Street, Lexington, KY 40536-0297, USA.
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