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Cui ZK, Chen Y, Guo YJ, Wei XT, Yan W, Qi MC. The influence of open disc repositioning surgery on the internal derangement of the contralateral temporomandibular joint: a prospective study of 96 patients. Clin Oral Investig 2024; 28:487. [PMID: 39145865 DOI: 10.1007/s00784-024-05864-3] [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: 05/22/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To assess the influence of unilateral open disc repositioning surgery (ODRS) of the temporomandibular joint (TMJ) on the internal derangement (ID) of the contralateral joint. METHODS Patients with bilateral ID of TMJ who underwent unilateral ODRS were enrolled and followed-up for one year. They were divided into two groups based on the contralateral disease: the anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Postoperative evaluation included clinical and MRI evaluation. Indices measured were unilateral intermaxillary distance (UID), visual analogue scale (VAS), disc length (DL), condylar height (CH), and disc-condyle angle (DCA). Paired t tests were used to compare the clinical and MRI indices between different time points. RESULTS Ninety-six patients were enrolled, including 47 in the ADDWR group and 49 in the ADDWoR group. One-year post-surgery, ODRS led to significant increases in MMO, DL, and CH, and decrease in VAS and DCA on the operated side (P < 0.05). In ADDWR group, UID, DL, and CH increased significantly, and VAS decreased (P < 0.05), with no significant change in DCA (P > 0.05). In ADDWoR group, clinical and MRI variables worsened slightly, except for UID, which remained unchanged (P > 0.05). CONCLUSIONS ODRS is a promising method for correcting TMJ ID and may improve condition of ADDWR and decrease progress of ADDWoR at the contralateral joint. Preoperative bilateral TMJ evaluation is essential for better outcomes. CLINICAL RELEVANCE ODRS can effectively treat TMJ ID and produce adaptive changes in the contralateral ID, for which continuous monitoring of the contralateral joint is essential.
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Affiliation(s)
- Ze-Kun Cui
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, Tangshan City, Hebei Province, PR China
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yong Chen
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Yan-Jun Guo
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Xiao-Tong Wei
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Wei Yan
- Department of Oral & Maxillofacial Surgery, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China
| | - Meng-Chun Qi
- Department of Oral & Maxillofacial Surgery, College of Stomatology, North China University of Science and Technology, Tangshan City, Hebei Province, PR China.
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Lu C, Zhao J, Zhang X, Fan X, Nie X, Yu C, Yang C, He D. Comparison of disc position stability and condylar bone remodeling between two open disc repositioning surgeries: a retrospective single-center cohort study. Int J Surg 2024; 110:01279778-990000000-01003. [PMID: 38241415 PMCID: PMC11020046 DOI: 10.1097/js9.0000000000001129] [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: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Open suturing (OSu) and Mini-screw Anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodeling (CBR) between these two surgical procedures in a single center. METHODS A retrospective cohort study using magnetic resonance imaging (MRI) scans (preoperation, 1 week and 12 mo postoperation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one center through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting 5 factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression. RESULTS 385 patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% confidence interval [CI], 1.27 to 6.85) and better CBR (RR=1.58; 95%CI, 1.02 to 2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95%CI, 1.11 to 6.26) and overcorrected or posteriorly repositioned discs were more stable than normally-repositioned discs (RR=5.84; 95%CI, 2.58 to 13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95%CI, 0.89 to 0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95%CI, 1.76 to 3.83). CONCLUSION OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
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Affiliation(s)
- Chuan Lu
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Jieyun Zhao
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Xiaoyu Zhang
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Xingda Fan
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Xin Nie
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine. Shanghai, China
| | - Chuangqi Yu
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Chi Yang
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
| | - Dongmei He
- Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology
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Fang H, Wang R, Liu Y, Cao P, Wang P, Bi R, Zhu S. Studying positional changes of the disc-condyle-fossa complex in ADDWoR patients after TMJ disc repositioning surgery. Clin Oral Investig 2023; 27:7871-7880. [PMID: 37987822 DOI: 10.1007/s00784-023-05379-3] [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: 06/21/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJETIVES To investigate the positional changes in the temporomandibular joint (TMJ) disc-condyle-fossa complex of patients with anterior disc displacement without reduction (ADDWoR) and to evaluate the effect of disc repositioning (DR) surgery. MATERIAL AND METHODS Fifteen patients with unilateral ADDWoR (30 joints) were included. MRI of the TMJ was performed at T0 (1 week before surgery), T1 (1 month after surgery), and T2 (9-12 months after surgery). The glenoid fossa, disc, and condyle were reconstructed and analyzed using Mimics software. RESULTS In the patients with unilateral ADDWoR, the disc on the ADD side showed a tendency to downward shift in the coronal direction and forward shift in the sagittal direction; the condyle of ADD side showed a tendency to backward shift in the sagittal direction and upward shift in the coronal direction. When comparing the same ADDwoR TMJ at T0, T1, and T2, the disc was found to move upward and backward after DR surgery at T1 and T2, and the condyle was found to move upward and backward after DR surgery at T1 but returned to the original position at T2. CONCLUSIONS ADDWoR leads to forward and downward displacement of the disc relative to the condyle and upward displacement of the condyle relative to the tuberosity. DR surgery improved upon the structural abnormalities of the TMJ complex, for which stability was maintained as determined in the 9 to 12 month postoperative follow-up. CLINIC RELEVANCE DR surgery effectively and constantly improves the positional abnormalities of the TMJ complex.
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Affiliation(s)
- Han Fang
- State Key Laboratory of Oral Diseases; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, China
| | - Ruiyu Wang
- State Key Laboratory of Oral Diseases; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, China
| | - 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, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, China
| | - Pinyin Cao
- State Key Laboratory of Oral Diseases; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, 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, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, 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, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, 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, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Road, Chengdu, 610041, China.
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Sun J, Zhu H, Lu C, Zhao J, Nie X, Yang Z, He D. Temporomandibular joint disc repositioning and occlusal splint for adolescents with skeletal class II malocclusion: a single-center, randomized, open-label trial. BMC Oral Health 2023; 23:694. [PMID: 37759222 PMCID: PMC10537145 DOI: 10.1186/s12903-023-03402-3] [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: 01/29/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied. OBJECTIVE This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion. METHODS A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups. RESULTS After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001). CONCLUSION These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS. TRIAL REGISTRATION This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019.
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Affiliation(s)
- Jiali Sun
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Huimin Zhu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xin Nie
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zhi Yang
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Dongmei He
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Wang P, Liu Y, Bi R, Jiang N, Telha W, Cao P, Zhu S. TMJ anterior disc displacement anchorage surgery: a retrospective study based on a suture-free titanium screw strategy. Clin Oral Investig 2023; 27:4579-4584. [PMID: 37468599 DOI: 10.1007/s00784-023-05083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/21/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of using a suture-free titanium screw in repositioning anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ). METHODS A consecutive sample of twelve patients (fifteen joints) was included in this study. All patients were diagnosed with ADDwoR and showed limited mouth opening or temporomandibular joint pain symptoms. Suture-free titanium screw was placed in the condyle directly following the disc repositioning. Pre- and postoperative evaluation parameters include operation time, the visual analogue scale for pain (VAS), lateral excursion movements (LEM), maximum interincisal opening (MIO), and disc length and position on MRI. In addition, the mandibular condyle height was also measured. Statistical significance was considered when p < 0.05. RESULTS The unilateral operation time was 58.54 ± 5.43 min; during the 6-month period after the operation, the VAS values decreased from 87 ± 6.34 to 14.08 ± 6.65. The MIO increased from 30.07 ± 4.73 to 39.89 ± 1.69 mm (p = 0.01). The TMJ disc length was prolonged from 8.23 ± 1.12 to 11.51 ± 1.29 mm. The condyles showed significant remodeling, and the height of the condyle increased from 18.24 ± 4.12 increase to 19.6 ± 4.31 mm. The LEM was increased from 5.27 ± 0.51 to 6.36 ± 0.62 mm. The MRI images showed the stability of the disc in position during the opening and closing of the mouth. The TMJ disc position was stable during the follow-up period. CONCLUSION Anteriorly displaced articular disc can be repositioned by a suture-free titanium screw strategy. This technique is an alternative method to address ADDwoR.
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Affiliation(s)
- Peng Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yao Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wael Telha
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Pinyin Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Orthognathic and TMJ Surgery, No. 14, 3Rd Section of Ren Min Nan Rd, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Review of the studies on the relationship and treatment of anterior disc displacement and dentofacial deformity in adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:470-474. [PMID: 36229365 DOI: 10.1016/j.oooo.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/17/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Anterior disk displacement (ADD) is a common type of temporomandibular joint (TMJ) internal derangement. In adolescents, the relationship between ADD and dentofacial deformities are brought into focus. Whether treatment is needed, or what kind of treatment are effective are still without a consensus. From the literature review, the consequences of ADD without treatment and the effect on disk repositioning were summarized. The results showed that after ADD, condylar height was prone to reduce that may lead to or aggravate dentofacial deformities in adolescents. Disk repositioning could promote the regeneration of condylar bone, thus improving the development of dentofacial deformities.
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Lu C, Zhao J, Zhang C, Yu C, He D. Stability of the contralateral temporomandibular joint disk position after disk repositioning on one side. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:323-326. [PMID: 35428597 DOI: 10.1016/j.oooo.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the stability of the contralateral temporomandibular joint disk position after disk repositioning on 1 side. STUDY DESIGN Patients with unilateral anterior disk displacement (ADD) treated by disk repositioning from 2015 to 2019 were included in the study. The contralateral disk status was classified as follows: normal, ADD with reduction (ADDwR), and medial/lateral displacement. At 1-year follow-up, changes in the contralateral disk position were evaluated by MRI. RESULTS Two hundred thirty-four patients were included in the study. There were 84 disks with normal position, 51 with ADDwR, and 99 with medial/lateral displacement (M/LD) in the contralateral joint. At 1-year follow-up, all the repositioned disks were stable without relapse. In the contralateral joints, 75% of the disks with normal position were unchanged compared with 43.1% of the ADDwR and 54.5% of the M/LD. ADDwR had the highest rate of changing to ADDwoR compared with the disks in normal position (4.8%) and M/LD (7.1%, χ2 = 16.13, P < .001). There were 28.3% of M/LD disks and 3.9% of ADDwR that changed to normal position. CONCLUSIONS After unilateral disk repositioning, most of the contralateral disks with normal position were stable. M/LD disks tended to move to normal position, whereas ADDwR was largely changed to ADDwoR.
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Affiliation(s)
- Chuan Lu
- Attending, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. No. 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China
| | - Jieyun Zhao
- Resident and co-first author, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. No. 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China
| | - Changbin Zhang
- Attending, Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Kunming Medical University, Kunming 650000, China
| | - Chuangqi Yu
- Professor, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. No. 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China
| | - Dongmei He
- Professor, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. No. 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China.
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Martín IG, Cariati P, Rico AMS, Medina BG. Osteoplasty of Medial Temporomandibular Joint Wall. A New Strategy for Treating Disc Displacement. J Craniofac Surg 2021; 33:e322-e326. [DOI: 10.1097/scs.0000000000008217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mao Y, Chen X, Xie X, Xu W, Zhang S, Zhang S. Evaluation of an improved anchoring nail in temporomandibular joint disc repositioning surgery: A prospective study of 25 patients. J Craniomaxillofac Surg 2021; 49:929-934. [PMID: 34210564 DOI: 10.1016/j.jcms.2021.05.008] [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: 08/15/2020] [Revised: 05/06/2021] [Accepted: 05/30/2021] [Indexed: 11/15/2022] Open
Abstract
To confirm the effectiveness and stability of an improved anchoring nail through a prospective study using clinical evaluation and magnetic resonance imaging (MRI). Patients undergoing TMJ disc reduction and fixation were followed up for 1 year.Visual analog scale (VAS) pain scores and TMJ range of motion (maximum interincisal opening, protrusive excursion, lateral excursion) data were gathered pre- and postoperatively, and patient satisfaction was recorded. Four time points were investigated: before surgery (T0), 1 month post-surgery (T1), 6 months post-surgery (T2), and 1 year post-surgery (T3). Twenty-five patients (50 joints) participated in the study. The overall success rates of the improved and traditional anchoring nails were 88% and 92%, respectively. One year post-surgery, the patients' TMJ motion improved significantly (p < 0.001), and their pain was significantly alleviated (p < 0.001). Condyle height did not change significantly within 6 months (p = 0.801), but had increased by approximately 1.35 mm (p < 0.001) at 1 year post-surgery. The MRI scans also confirmed that new bone mass growth was present 1 year post-surgery. Compared with the traditional anchoring nail, the improved anchoring nail had a similar success rate and was associated with fewer foreign body sensations and less pain. Its clinical application should be further tested in studies with longer follow-up times and larger sample sizes.
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Affiliation(s)
- Yi Mao
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, And Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Xuzhuo Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, And Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Xinru Xie
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, And Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Weifeng Xu
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, And Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Shizhou Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, And Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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The Effect of Condylar Regeneration After Different Disc Repositioning Surgeries in Adolescents with Skeletal Class II Malocclusion. J Oral Maxillofac Surg 2021; 79:1851-1861. [PMID: 33901450 DOI: 10.1016/j.joms.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the effect of different temporomandibular joint (TMJ) disc repositioning surgeries for the treatment of anterior disc displacement (ADD) in juvenile patients with skeletal Class II malocclusion. PATIENTS AND METHODS Patients (< 20 years, cervical vertebral maturation stage, IV-V) who had bilateral TMJ ADD with skeletal Class II malocclusion were treated by disc repositioning surgery (mini-screw anchor, [MsA]; or opening suturing, [OSu]). Magnetic resonance imaging (MRI) and lateral cephalometric films before and more than 12 months after surgery were collected from all patients. Changes of SNA, SNB, ANB, incisor overjet, pogonion position (pg'-G'), and condylar height were measured before and after surgery in different disc reposition surgeries and compared by statistical analysis. RESULTS Eighty-four patients with an average age of 16.44 years and follow-up time of 14.60 months (12 to 33 months) were included in the study. Among them, 16 patients had a mean follow-up of 14.8 months without treatment before disc repositioning. Their condylar height was significantly decreased (P = .004) by MRI measurement. Six patients who had cephalometric films showed significantly decreased SNB (P = .042) and increased overjet (P = .037). After disc repositioning by either OSu (54 cases) or MsA (30 cases), condylar height, SNB were significantly increased and overjet, Pg'-G', ANB were decreased in both groups (P < 0.001). There was more new bone height in OSu than MsA (P = .004), but no significant differences in SNB, ANB, overjet and Pg'-G' between the 2 groups (P > .05). The new bone height was significantly correlated with the surgical method (P = .029), age (P = .015), SNB (P = .008), overjet (P = .048) and pg'-G' (P = .001). CONCLUSIONS Both types of disc repositioning method can effectively promote condylar regeneration and improve skeletal Class II malocclusion in adolescents with ADD. Disc repositioning by OSu obtained more new bone height than MsA.
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Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study. Int J Oral Maxillofac Surg 2021; 50:1351-1360. [PMID: 33750641 DOI: 10.1016/j.ijom.2021.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) arthroscopic and open disc repositioning procedures in the management of anterior disc displacement (ADD). All consecutive patients treated with arthroscopic (group I) or open (group II) disc repositioning between April 2014 and August 2018 were included prospectively. The patients were assessed clinically (1, 3, 6, 12, 24, and 36 months postoperative) and with magnetic resonance imaging (MRI). The statistical analysis was performed using IBM SPSS Statistics v.22.0; P < 0.05 was considered significant. A total of 177 patients (227 joints) were included: 104 patients (130 joints) in group I and 73 patients (97 joints) in group II. There were statistically significant improvements in pain score, clicking, quality of life, diet, and maximum inter-incisal opening when comparing pre- and postoperative clinical parameters within the two groups (P < 0.05 at all time-points for all clinical parameters); however, improvements occurred earlier in group I (at 1 month) than in group II (6 months). Postoperative MRI revealed an overall success rate of 98.1% in group I and 97.3% in group II. New bone formation was found in 70.2% in group I and 30.1% in group II. Arthroscopy may be a better choice for ADD patients, with the advantages of faster clinical improvement and recovery, minimal invasiveness, and better condylar remodelling.
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Yibulayin F, Yu CX, Feng L, Wang M, Lu MM, Luo Y, Liu H, Yang ZC, Wushou A. Malignant tumours of temporomandibular joint. BMC Cancer 2020; 20:967. [PMID: 33023507 PMCID: PMC7539439 DOI: 10.1186/s12885-020-07425-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/16/2020] [Indexed: 01/27/2023] Open
Abstract
Background Malignant tumours of the temporomandibular joint (MTTMJ) are extremely rare. Studies describing its unique epidemiology, clinicopathological features, treatment and prognosis comprehensively are limited. To address these issues, current investigation was performed. Methods A retrospective research was carried out by using population-based data from the Surveillance, Epidemiology, and End Results database (1973–2016). Results Data for a total of 734 patients, including 376 men and 358 women, was found. The median age was 47 years. The 5-year and 10-year disease specific survival (DSS) rates were 69.2 and 63.6%, respectively. Significant differences in DSS were found according to age, race, tumour type, AJCC/TNM stage, surgery, radiotherapy, chemotherapy and different treatment modalities (P < 0.05). In the multivariate survival analysis, age > 44 years and AJCC stage III and IV were associated with poor DSS. Conclusion MTTMJ was mostly found in white people with a median age of 47 years without any sex predominance. Patient’s age and AJCC stage was independent predictor of DSS.
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Affiliation(s)
- Feiluore Yibulayin
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.,Department of Preventive Medicine, School of Public Health, Shanghai Medical College, Fudan University, Shanghai, 200001, People's Republic of China
| | - Chen-Xi Yu
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.,Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, 200001, People's Republic of China
| | - Lei Feng
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Meng Wang
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Meng-Meng Lu
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Yuan Luo
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Hui Liu
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Zhi-Cheng Yang
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.
| | - Alimujiang Wushou
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.
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Millón-Cruz A, Martín-Granizo López R. Long-term clinical outcomes of arthroscopic discopexy with resorbable pins. J Craniomaxillofac Surg 2020; 48:1074-1079. [PMID: 32998852 DOI: 10.1016/j.jcms.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Discopexy using resorbable pins is an arthroscopic technique to treat internal derangement of the TMJ, restoring the normal relationship between disc, condyle, and temporal bone. The objective of our study was to assess the 5-year clinical outcome of a series of patients treated with this technique. METHODS A study was conducted on a series of patients who underwent arthroscopic discopexy using resorbable pins between January 2007 and February 2018. All the patients were refractory to conservative treatment and classified as Wilkes stage III. Clinical data were recorded at 1-year, 3-year, and 5-year visits. Pre- and postoperative evaluation parameters were: joint pain (VAS scale), mandibular movements (mm), and articular locking and clicking. RESULTS The study included 33 patients and the technique was performed in 38 joints. Mouth opening increased significantly with each visit after surgery compared with preoperative scores (mean value of 10.65 mm, p < 0.001), with the mean value increasing significantly at the 5-year visit in relation to the mean value obtained at the 3-year visit. Patients reported significant decreases in pain after surgery, obtaining VAS values of under 10 at the 5-year visit (mean improvement of 56.95 points, p < 0.001). CONCLUSIONS Discopexy using resorbable pins resulted in a good and stable clinical outcome at the long-term follow-up.
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Affiliation(s)
- Alejandrina Millón-Cruz
- Department of Surgery, Medical School, Universidad Complutense de Madrid, Ramón y Cajal S/N, 28040, Madrid, Spain.
| | - Rafael Martín-Granizo López
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Profesor Martin Lago S/N, 28040, Madrid, Spain.
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