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A balloon pumping technique for treatment of internal derangement of the temporomandibular joint
DISCUSSION
952 joint: Treatment of internal derangement with persistent closed lock. Oral Surg 62:361, 1986 6. Kakudo K, Kotani J, Suzuki S, et al: Lateral pharyngeal edema following arthroscopic surgery: Report of a case. J Jpn Sot TMJ 7:304, 1995 7. Nitzan DW, Dolwick MF, Martinez GA: Temporomandibular
J Oral Maxillofac 55952, 1997
joint arthrocentesis: A simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg 49:1163, 1991 8. Hamada S, Hamaguchi M, Ogura T, et al: Effect of lavage manipulation technique on closed lock cases of temporomandibular joint internal derangement. Jpn J Oral Maxillofac Surg 39:284, 1993
Surg
Discussion A Balloon Pumping Technique for Treatment of Internal Derangement of the Temporomandibular Joint Thomas W. Braun, DMD, PhD University
of Pittsburgh
Medical
Center,
Pittsburgh,
Pennsylvania
The continuedinterestin developingnew methodsof therapy for management of adhesionsof the temporomandibular joint conceptually validates the concern that no available methodis foolproof and effective. The authorsproposean interestingconcept, ablation of adhesionsof the temporomandibularjoint throughthe useof volumetric expansionof the joint using a Swan-Ganz catheter-type balloon. It is hypothesizedthat a lesstraumatic method of adhesionremoval can be performedin this manner. However, severalshortcomings,are addressed by the authors and shouldbe apparentto the readersof this article. The rather smallnumberof proceduresincludedin this study hadonly a 64% success rate. The failureswere attributedto adhesions with a severity exceedingthe ability of balloonto
producelysis. Thesefailuresrequiredblunt trocar dissection as well. The authors also note that only a small area of ablationis possible,and that the recessesof the joint compartment are likely unaffected. A comparative study with arthrocentesiswould be helpful in determiningif this is truly a beneficialtherapeuticmodality or an additionalprocedure with little addedbenefit. Additional pointsnot mentionedby the authorsincludethe fact that entry into thejoint requiresusinga sharpinstrument; therefore, the risk is approximately the sameas with an arthroscopicprocedure.Although the authorsdo not report any ruptureof the balloons,that concernmustbe entertained, with the additionalpossibility of retainedforeign bodiesin thejoint if this shouldoccur. This would seemto be increasingly likely in caseswith more severeadhesionsin which rougheningof the bony joint surfacesexists. A more comprehensivestudy comparing this technique with other currently accepted and researchedmodalities shouldbe donebefore practitionersattemptto usethis new technique.However, the authors shouldbe complemented for their efforts, because it is through endeavors of this nature that improvedsurgicalandnonsurgicaltreatmentof the temporomandibularjoint have evolved.
952 joint: Treatment of internal derangement with persistent closed lock. Oral Surg 62:361, 1986 6. Kakudo K, Kotani J, Suzuki S, et al: Lateral pharyngeal edema following arthroscopic surgery: Report of a case. J Jpn Sot TMJ 7:304, 1995 7. Nitzan DW, Dolwick MF, Martinez GA: Temporomandibular
J Oral Maxillofac 55952, 1997
joint arthrocentesis: A simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg 49:1163, 1991 8. Hamada S, Hamaguchi M, Ogura T, et al: Effect of lavage manipulation technique on closed lock cases of temporomandibular joint internal derangement. Jpn J Oral Maxillofac Surg 39:284, 1993
Surg
Discussion A Balloon Pumping Technique for Treatment of Internal Derangement of the Temporomandibular Joint Thomas W. Braun, DMD, PhD University
of Pittsburgh
Medical
Center,
Pittsburgh,
Pennsylvania
The continuedinterestin developingnew methodsof therapy for management of adhesionsof the temporomandibular joint conceptually validates the concern that no available methodis foolproof and effective. The authorsproposean interestingconcept, ablation of adhesionsof the temporomandibularjoint throughthe useof volumetric expansionof the joint using a Swan-Ganz catheter-type balloon. It is hypothesizedthat a lesstraumatic method of adhesionremoval can be performedin this manner. However, severalshortcomings,are addressed by the authors and shouldbe apparentto the readersof this article. The rather smallnumberof proceduresincludedin this study hadonly a 64% success rate. The failureswere attributedto adhesions with a severity exceedingthe ability of balloonto
producelysis. Thesefailuresrequiredblunt trocar dissection as well. The authors also note that only a small area of ablationis possible,and that the recessesof the joint compartment are likely unaffected. A comparative study with arthrocentesiswould be helpful in determiningif this is truly a beneficialtherapeuticmodality or an additionalprocedure with little addedbenefit. Additional pointsnot mentionedby the authorsincludethe fact that entry into thejoint requiresusinga sharpinstrument; therefore, the risk is approximately the sameas with an arthroscopicprocedure.Although the authorsdo not report any ruptureof the balloons,that concernmustbe entertained, with the additionalpossibility of retainedforeign bodiesin thejoint if this shouldoccur. This would seemto be increasingly likely in caseswith more severeadhesionsin which rougheningof the bony joint surfacesexists. A more comprehensivestudy comparing this technique with other currently accepted and researchedmodalities shouldbe donebefore practitionersattemptto usethis new technique.However, the authors shouldbe complemented for their efforts, because it is through endeavors of this nature that improvedsurgicalandnonsurgicaltreatmentof the temporomandibularjoint have evolved.