Temporomandibular Joint Dysfunction: Evaluation and Treatment

Early treatment of unilateral temporomandibular joint ankylosis: a multidisciplinary approach

Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

Treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint dislocation is defined as the movement of condyle out of the fossa and the advancement of the posterior surface of the condyle in front of the articular eminence. If this condition becomes chronic, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. In this study, a retrospective analysis is presented examining 73 patients and 83 joints that were treated with hook-shaped miniplates and miniscrews fixed to otolog bone grafts. Records were obtained from archives of the Uludag University Medical Faculty, Plastic, Reconstructive and Aesthetic Surgery Department. The duration of postoperative follow-up was 3-30 months. In one case, the miniplate was fractured, and in two cases, abscesses existed. This study aims to emphasize that using miniplates and otolog bone grafts is more cost effective.

Reconstruction of the temporomandibular joint using a temporalis graft with or without simultaneous orthognathic surgery

PURPOSE

This article reports the outcome of free temporalis fascia and muscle graft (TFG) reconstruction of the temporomandibular joint (TMJ) with and without simultaneous orthognathic surgery (SOS).

MATERIALS AND METHODS

Twenty-nine patients (45 joints) were evaluated retrospectively. Group 1 consisted of 17 patients (16 women 1 man) and 30 joints. Fifteen (88%) patients had sagittal split ramus osteotomies (SSRO); 8 (53%) of these patients also had Le Fort I osteotomies, and 2 patients (12%) had only Le Fort I osteotomies with TFG. Group 2 consisted of 12 patients (15 joints) who received only TFG and no SOS.

RESULTS

Group 1 had 9 patients (53%) with an incisal opening greater than 35 mm, 11 joints (37%) with greater than 6 mm lateral excursive movement, and 11 patients (65%) were asymptomatic postoperatively. Average follow-up was 57.4 months (range, 23 to 69 months). Group 2 had eight patients (67%) with an incisal opening greater than 35 mm, six joints (40%) with greater than 6 mm lateral excursive movement, and seven patients (58%) were asymptomatic postoperatively. Average follow-up was 55.1 months (range, 48 to 64 months).

CONCLUSION

TFG with and without SOS produced similar treatment outcomes in comparing groups 1 and 2. No significant differences were observed for the number of patients with an incisal opening > 35 mm (P = .703), lateral excursion > 6 mm (P = 1.00), and successful elimination of pain (P = 1.00), even though group 2 had a significantly greater number of patients (P < 0.01) that were operated on unilaterally. Combining treatment outcomes for both groups, the number of previous joint surgeries significantly affected success (P < .01). The presence of osteoarthritic changes did-not significantly affect treatment outcome (P = .187).

Treatment outcomes for temporomandibular joint reconstruction after Proplast-Teflon implant failure

A retrospective study of 107 patients (male, n = 13; female, n = 94) with 163 joints previously treated with Proplast-Teflon (PT; Vitek, Inc, Houston, TX) implants was performed. The average time in situ for the PT was 59.8 months (range, 2 to 126 months). Average length of follow-up was 84.6 months (range, 59 to 126 months). Only 12% of joints showed no significant osseous changes radiographically. Forty-five patients (42%) continue to have in situ PT implants and 36% of them experience pain that requires medication; 25% have developed an anterior open bite and malocclusion; 9% have limited vertical opening; and 40% are asymptomatic. Temporomandibular joint (TMJ) reconstruction after PT implant failure was performed with five different autologous tissues or a total joint prosthesis. Autologous tissues used to reconstruct the TMJ and the rates of success were as follows: 1) 31% free temporalis fascia and muscle graft with and 13% without sagittal split ramus osteotomy, 2) 8% dermis, 3) 25% conchal cartilage, 4) 12% costochondral grafts, and 5) 21% sternoclavicular grafts. The success rate decreased in all autologous tissue groups as the number of TMJ surgeries performed before reconstruction increased. Ankylosis was the most common cause of failure. Results of TMJ reconstruction with a total joint prosthesis were as follows: 1) 88% functional and occlusal stability of total joint prosthesis; 2) level of pain reduction was rated as 46% good, 38% fair, and 16% poor; and 3) an average interincisal opening of 27 mm at 24 months or less, and 33 mm at 25 months and beyond.(ABSTRACT TRUNCATED AT 250 WORDS)

Composite temporalis pedicle flap as an interpositional graft in temporomandibular joint arthroplasty: a preliminary report

Fifteen temporomandibular joint patients were evaluated preoperatively and postoperatively to evaluate the effectiveness of a composite (fascia, muscle and periosteum) temporalis pedicle flap as an interpositional disc replacement. A modified Craniomandibular Index (CMI) and Symptom Severity Index (SSI) were used to assess clinical and subjective symptoms. Eighteen months postoperatively there was a significant reduction in the CM and SS indices (P less than .001), with significant clinical improvement of the mandibular range of motion (P less than .05). However, a significant reduction of translation (P less than .01) was evident indicating that the increased mandibular opening was owing to a compensatory rotational movement. This study indicates that the composite temporalis pedicle flap is a good autogenous tissue for the reconstruction of the temporomandibular joint.