The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints

Ultrasonographic evaluation of masseter muscle thickness in patients with disk displacement with reduction

OBJECTIVES

This study was performed to ultrasonographically assess the masseter muscle thicknesses of individuals with disk displacement with reduction.

METHODS

The thickness of the masseter muscle in 100 patients (28 male, 72 female; average age 34 years) who presented with one-sided temporomandibular joint pain and a clicking sound and were diagnosed with disk displacement with reduction was measured in relaxation and at maximum contraction using ultrasonography.

RESULTS

In the contracted position, the difference in the masseter muscle thickness between the healthy side and the side with disk displacement with reduction was statistically significant (p < 0.05). However, no statistically significant difference was found between the two sides in the relaxed position.

CONCLUSIONS

Obvious ultrasonographic changes of the masseter muscle were found in patients with temporomandibular disk displacement with reduction, and these changes might be related to unilateral chewing. Individuals with anterior disc displacement probably chew unilaterally because of pain and clicking.

Rearthroscopy of the temporomandibular joint: A retrospective study of 600 arthroscopies

PURPOSE

Arthroscopic surgery is an effective treatment for patients with temporomandibular disorders, releasing symptoms and restoring the mandibular function. In patients with poor arthroscopic outcomes, several options of treatment can be considered such as conservative nonsurgical therapy, open surgery, or a second arthroscopy. The purpose of this study was to evaluate our results after 619 arthroscopies.

MATERIALS AND METHODS

The clinical data of 619 arthroscopies performed between 1996 and 2015 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale (VAS), and improvement in maximal interincisal opening (MIO). The minimum follow-up period was 24 months.

RESULTS

The incidence of TMJ reoperation in the 371 patients who underwent arthroscopic surgery was 5.9%, with a mean time between surgeries of 66.73 months. Significant improvement between presurgical and postsurgical pain and presurgical and postsurgical MIO at months 6 and 12 were evident. The mean of preoperative MIO was 30.84 mm, which increased to 35.92 mm 1-year postsurgery, these results being statistically significant (p < 0.05).

CONCLUSIONS

In most of the cases the result of a new arthroscopy is satisfactory. Rearthroscopy of the TMJ is a valid and effective method for patients with a first unsuccessful arthroscopy.

A prospective study of 138 arthroscopies of the temporomandibular joint

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.

The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: a retrospective study

Objectives: The main purpose of this study was to determine the prognosis and outcomes of the patients with bilateral temporomandibular disorder which underwent bilateral temporomandibular joint surgery in a consecutive number of patients in a retrospective study. Study Design: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. Results: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. Conclusions: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients’ groups waspresent.

Key words:Temporomandibular joint, prognosis, retrospective studies.

Reoperative temporomandibular joint surgery

TMJ surgeries are not always successful. Many potential pitfalls can occur during any phase of the treatment and can lead to complications, less than desirable results, and short- or long-term failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.

Temporomandibular joint arthritis in juvenile idiopathic arthritis: the forgotten joint

PURPOSE OF REVIEW

This review explores the prevalence, clinical and radiographic signs, and treatment of temporomandibular joint arthritis in children with juvenile idiopathic arthritis.

RECENT FINDINGS

Temporomandibular joint arthritis seems to be a more frequent manifestation in patients with juvenile idiopathic arthritis than previously believed, in part due to the paucity of clinical symptoms and poor sensitivity of conventional radiographs used for diagnosis. Antinuclear antibody positivity, early onset of disease, and presence of systemic or polyarticular disease are all risk factors for temporomandibular joint arthritis but may underpredict temporomandibular joint involvement in juvenile idiopathic arthritis. Magnetic resonance imaging enhanced with gadolinium is currently the gold standard in detection of temporomandibular joint arthritis, and treatment with intra-articular corticosteroids has been shown to be effective and safe, with minimal side effects.

SUMMARY

Given the paucity of clinical symptoms in temporomandibular joint arthritis, detection of temporomandibular joint inflammation using contrast-enhanced magnetic resonance imaging is essential for instituting appropriate therapy in a timely fashion. The use of intra-articular corticosteroids holds promise for control of temporomandibular joint inflammation and prevention of associated morbidities.

One-year clinical course following visually guided irrigation for chronic closed lock of the temporomandibular joint

OBJECTIVE

This study aimed to explore the clinical course following visually guided irrigation (VGIR) for chronic closed lock (CCL) of the temporomandibular joint (TMJ) as well as the factors of importance for clinical outcome. Evaluation emphasis was placed on the period needed for the patients to reach the success criteria.

STUDY DESIGN

Sixty-one patients with unilateral CCL comprised the study group. The cumulative success rate of VGIR and the additional surgical treatments following VGIR were studied. The 61 patients were divided into either the good outcome (g) group or poor outcome (p) group on the basis of whether they reached the success criteria within 3 months postoperatively, and clinical and arthroscopic factors were correlated with the clinical outcome of VGIR.

RESULTS

The cumulative success rate of VGIR increased up to the 6-month follow-up (success rate of 72.1%) but did not change after that point in time. A repeated VGIR (success rate of 87.5%) was performed in 8 patients. Open TMJ surgery (success rate of 87.5%) was performed in 8 patients, 7 of whom had an interfering condylar osteophyte. A pronounced reduction of preoperative painless range of mandibular motion (P-ROM) and advanced osteoarthritis (OA) were more frequently found in the p-group than in the g-group. The multivariate adjusted odds ratio showed that a decreased preoperative P-ROM was significantly predictive for a poor outcome of VGIR.

CONCLUSIONS

The efficacy of VGIR is clinically acceptable as an initial surgical treatment for TMJ CCL. A 6-month follow-up period ought to be sufficient for outcome assessment of VGIR. A pronounced reduction of preoperative P-ROM should be considered as a risk factor for delay of the postoperative improvement, and OA changes may sometimes affect the clinical outcome of VGIR.