Efficacy of Arthroscopic Diskopexy on Condylar Growth in Temporomandibular Joint Anterior Disk Displacement: A Randomized Clinical Trial

Current thinking in the management of temporomandibular disorders in children: A narrative review

The aim of this narrative review is to discuss current opinions on paediatric temporomandibular disorders (TMDs) due to their increasing incidence in routine secondary care maxillofacial clinics. A MEDLINE and EMBASE search was performed of the literature published in the past three years concerning paediatric TMD. Of 261 papers identified, 89 were selected for relevance, of which 52 full texts were eligible and 41 included. The narrative of this paper follows three domains: myogenous and arthogenous pain, juvenile idiopathic arthritis (JIA), and reconstruction. The principles of treating mild TMD in children are similar to those in adults, with even more emphasis on the management of psychosocial issues and self-care. The use of medication, however, needs to be more cautious. Symptomatic disc displacement should be treated to reduce inflammation, so early arthrocentesis or arthroscopy is relevant. Controversy exists on disc repositioning to reduce or even reverse condylar degeneration in the growing condyle. If undertaken it should ideally be performed arthroscopically by surgeons with significant experience. Arthritic disease is usually associated with JIA so a multidisciplinary approach is the focus of treatment. The role of arthroscopy in the management of symptoms is increasing but it does not prevent disease progression. Surgical correction may be required for secondary deformity. Reconstruction remains a challenge with no ideal autogenous method. Alloplastic joints are gaining popularity, but the long-term outcomes are unknown. Surgery can be undertaken with minimal morbidity, and the use of joint replacements, even as space maintainers, may therefore be more beneficial than repeated failed autogenous treatments.

Feasibility of simultaneous TMJ arthroscopy in ADDwoR patients undergoing orthognathic surgery for jaw deformity

This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.