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A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012
ARTICLE IN PRESS
YBJOM-4018; No. of Pages 4
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Review
A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012 A.S. Tahim a,∗ , A.M.C. Goodson a , K.F.B. Payne a , P.A. Brennan b a b
Department of Oral and Maxillofacial Surgery, King’s College Hospital, London SE5 9RS, UK Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Accepted 11 April 2013
Abstract This review summarises the articles relating to the temporomandibular joint (TMJ) that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. In total 24 papers were published. Of these, 16 (67%) were full-length articles, which included prospective, retrospective, and laboratory-based studies as well as reviews. The remaining 8 papers were short communications, technical notes, and letters to the editor, which report on, amongst other things, unusual cases, rare complications, and novel surgical techniques. © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Temporomandibular joint; Pathology; Surgery; Review
Introduction This article reviews papers related to temporomandibular joint (TMJ) surgery that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2011 to December 2012. Of the 24 papers published, 16 were full-length articles and 8 were shorter papers. Six (25%) were published online only. There were considerably fewer articles published on the TMJ than on oncology (n = 127)1 and trauma (n = 45),2 although the number is comparable with the number of papers relating to the salivary glands, and orthognathic papers (18 and 42, respectively).3,4 A breakdown of these publications is shown in Table 1. There has been a slight increase in the number of articles compared with a previous TMJ review5 when 22 related articles had been published. The 16 full-length articles covered a broad range of topics including disease pathogenesis, diagnosis, imaging, and clinical management (Table 2). We
∗
Corresponding author. Tel.: +44 07779 081197. E-mail address: [email protected] (A.S. Tahim).
will discuss them according to the clinical categories shown in Table 1 before briefly summarising the short communications, technical notes, and letters to the editor.
Disease aetiology, pathogenesis, and development Four articles addressed the causes and development of TMJ disorders including ankylosis, acute closed lock, and osteoarthritis. Bello et al. retrospectively investigated the aetiology of TMJ ankylosis in an African population.6 In their review of 23 patients that presented to their unit over a 5-year period, they found that the commonest aetiological factor was trauma (48%) either secondary to falls or because of previously untreated facial fractures. Infection, including childhood cancrum oris, was the second most common cause (39%). The age of the patient at the time of the original injury to the TMJ was an important factor in the severity of the disease, and they found that all patients with severe facial deformities in the study had sustained their injury before the age of 5 years. The study had an emphasis on poverty as a
0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2013.04.008
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
ARTICLE IN PRESS
YBJOM-4018; No. of Pages 4
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A.S. Tahim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Table 1 Breakdown of type of article published. Type of publication
No. (%)
Full-length articles Disease pathogenesis, aetiology and development Imaging and diagnosis Clinical management Technical notes Short communications Letters to the editor
16 (67) 4 1 11 2 (8) 2 (8) 4 (17)
Total
24
Clinical management
Table 2 Type of full-length article published. Design of study Retrospective Prospective Randomised/randomised controlled trial Review/survey Laboratory Total
resonance imaging (MRI) to assist in the diagnosis of perforations of the articular disc,10 and added to the evidence base for the use of imaging in the diagnosis of disease in the TMJ. The authors suggested that an area of high signal intensity in the middle of the articular disc might indicate perforation. They studied 50 joints in patients with closed lock. Patients had MRI and subsequent arthroscopy and the findings correlated fully. The authors proposed that MRI could reduce the need for solely diagnostic arthroscopy.
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key pre-disposing factor. The authors suggested that healthcare providers should increase efforts to prevent infection and provide early access for the treatment of facial injuries. Ankylosis was studied further in a comprehensive review by Arakeri et al.7 who discussed the factors that influence its pathogenesis after trauma and its recurrence after treatment. The authors reviewed the role of intra-articular haematoma, the TMJ meniscus and healing after condylar fractures. They highlighted the need for further research to understand ankylosis of the TMJ more fully. To explore the natural history of the disorder, Yura evaluated a case series of 40 patients with unilateral acute closed lock of the TMJ.8 The study showed that patients with acute closed lock are younger than those with the chronic counterpart and it does not share the same female preponderance. Symptoms such as reduced mouth opening and joint pain resolved within 2 weeks of instigating conservative management in 63% of patients, and by 12 weeks 95% were symptom-free. Amir et al. reported their preliminary results of the vascular mechanism of osteoarthritis in the TMJ.9 It has previously been postulated that subchondral sclerosis associated with disintegration of articular cartilage may be caused by vascular compromise. Using 2-butoxyethanol (an ethylene glycol ether) they created a model of vascular occlusion in the TMJ in rats, which subsequently showed histological and radiological features consistent with osteoarthritis. Their study supports the need to explore the vascular mechanism of osteoarthritis further.
Diagnosis and imaging single study published in this field during 2011–2012 described the use of fat-saturated T2-weighted magnetic
Publications on the clinical management of disorders of the TMJ included non-surgical treatments, arthroscopic procedures, and joint replacement surgery. 2 papers evaluated adjunctive treatments. In a prospective randomised trial, Yoshida et al. found evidence that movement exercises for the mandibular condyle were useful in the treatment of TMJ closed lock.11 They found that mouth opening, lateral movements, and protrusive movements improved in test cases after a 10 min exercise regimen compared with controls who did not have physiotherapy. Sidebottom et al. proposed cryoanalgesia as a useful adjunct in the management of intractable pain in a retrospective review of all patients who had treatment over a 5-year period.12 In their study, all 17 patients had failed to respond to conventional treatment such as arthroscopy and arthrocentesis, but were not deemed suitable candidates for open procedures. They found significant improvements in pain scores, with a mean duration of 7 months, and a small but not significant improvement in mouth opening. Their suggested management protocol includes initial conservative treatment, which is followed by arthroscopy and arthrocentesis, and then by cryoanalgesia in patients who respond to intra-articular bupivacaine. Four articles focused on arthroscopy and arthrocentesis. In a review of current TMJ arthroscopy practice in the UK, Thomas and Matthews surveyed 346 oral and maxillofacial (OMFS) consultants.13 Of the 215 that responded roughly 20% used arthroscopy, and most that did used it for diagnostic and therapeutic purposes. Reasons for not doing TMJ arthroscopy included lack of interest, limited need, and lack of training. The authors emphasised its benefits as a minimally invasive tool to manage patients with inflammatory and degenerative disorders of the joint, and advocated appropriate training for trainees in the specialty. Tozoglu et al. reviewed all articles published over a 19year period regarding techniques for lysis and lavage of the TMJ.14 They summarised the advantages of different arthroscopic approaches along with evidence for the therapeutic effects of drugs used in intra-articular injection. Two further studies reported successful outcomes after arthroscopic intervention.15,16 Zhu et al. evaluated the success of an arthroscopic procedure in patients with anterior displacement of the disc without reduction of the TMJ.15 The procedure included
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
YBJOM-4018; No. of Pages 4
ARTICLE IN PRESS A.S. Tahim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
lavage, lysis of adhesions in the superior compartment, making an incision parallel to the disc-synovial crease of the upper joint compartment, then pulling back the anteriorly located disc. They showed improvements in mouth opening, pain scores and position of the disc after arthroscopic surgery in 23 patients who had not previously responded to 6 months of non-surgical treatment. Ahmed et al.16 studied 244 patients who had arthroscopy or arthrocentesis over a 5-year period and reported significant improvements in mouth opening, lateral excursion, and protrusion. All patients were reviewed 6 weeks postoperatively, and showed significant improvements in mouth opening (29.8 mm preoperatively to 36.4 mm postoperatively) and pain scores. They also reported repeatedly low morbidity. All procedures but one were done as day cases, and 2 patients had temporary weakness of the temporal branch of the facial nerve. Five articles discussed various aspects of TMJ joint replacement surgery. Mehrotra et al. published the results of a pilot study that investigated the use of a hydroxyapatite and collagen scaffold impregnated with platelet-rich plasma to treat ankylosis.17 Nineteen patients aged 4–16 years had reconstruction with the graft, which was fixed to the ramus using an L-shaped miniplate, after which temporal fascia was interposed between the two articular surfaces. In all cases mouth opening and range of mandibular movement improved significantly. Grafted material was assessed radiographically, and there were significant improvements in opacity scores by 18 months postoperatively, which indicated successful osteogenesis, and formation of a new condyle. The authors suggested that an appropriate randomised trial was needed to compare this technique with current treatments. Yang et al. conducted a randomised controlled trial of patients treated by bilateral osteoarthrectomy with condylar reconstruction using autologous coronoid process with and without the use of preoperative planning using three-dimensional simulation software.18 Mouth opening improved in both groups, and there were fewer postoperative malocclusions when threedimensional planning was used. They suggested that such techniques make the procedure easier and more accurate. In a prospective analysis of 46 patients after partial and complete TMJ replacements, Kanatas et al. showed that pain and mouth opening improved significantly within one month of operation.19 Another article reported short-term outcomes after total joint replacement using the Christensen patient-specific system.20 Thirty-one patients were assessed for changes in pain and mouth opening before and after total TMJ replacement, and significant improvements in pain scores and mouth opening were found one year postoperatively. Finally, Dhanda et al. highlighted the difficulties that the TMJ surgeon faces in establishing and maintaining an occlusal relation in joint replacement surgery in edentulous patients.21 They presented 4 cases to demonstrate methods of delineating patients’ occlusal relations including adaptations of current dentures or the preoperative construction of Gunning splints.
3
Technical notes Two technical notes were published, describing novel techniques to assist the TMJ surgeon. One reported the preoperative construction of splints to establish and maintain an ideal occlusion, and enable appropriate postoperative physiotherapy.22 The other described use of an intraoral high condylotomy in the treatment of a chronic mandibular dislocation.23
Short communications Two short communications were published, both of which were case reports. The first related to the management of a tracheostomy-dependent child with severe micrognathia and ankylosis of the TMJ.24 The second outlined an unusual case of tuberculosis of the TMJ that presented with severe trismus and left-sided facial pain. Treatment with antituberculous drugs was followed by a joint replacement.25
Letters to the editor Of the 4 letters that were published during the 2011–2012 period, 2 discussed tuberculosis that affected the TMJ.26,27 Another reported adverse symptoms after accidental use of alcohol during TMJ arthrocentesis,28 and the fourth called for larger scale trials to research the management of posttraumatic ankylosis of the TMJ.29
Conclusion In summary, BJOMS continues to publish papers across the whole remit of our specialty including TMJ surgery. The number of publications in this subspecialty is smaller than in other areas such as oncology and salivary gland disease, and probably reflects its specialised nature, but it is encouraging to find that continued research is expanding the evidence base for practice in TMJ surgery.
References 1. Gulati A, Herd MK, Blythe J, et al. A synopsis of head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery in 2009/10. Br J Oral Maxillofac Surg 2011;49:368–75. 2. Payne KF, Tahim A, Goodson AM, et al. A review of trauma and traumarelated papers published in the British Journal of Oral and Maxillofacial Surgery in 2010-2011. Br J Oral Maxillofac Surg 2012;50:769–73. 3. Gulati A, Scott J, Blythe JN, et al. Review of salivary papers published in the British Journal of Oral and Maxillofacial Surgery during 2009-2010. Br J Oral Maxillofac Surg 2011;49:627–9. 4. Sadiq Z, Coombes DM, Cascarini L, et al. Orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2008-2009. Br J Oral Maxillofac Surg 2010;48:364–8.
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
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5. Spencer HR, Morrison A, Braga A, et al. Review article: oral surgery and TMJ-related papers published in BJOMS in 2008 and 2009. Br J Oral Maxillofac Surg 2010;48:544–8. 6. Bello SA, Aluko-Olokun B, Olaitan AA, et al. Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria. Br J Oral Maxillofac Surg 2012;50:80–4. 7. Arakeri G, Kusanale A, Zaki GA, et al. Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review. Br J Oral Maxillofac Surg 2012;50:8–12. 8. Yura S. Natural course of acute closed lock of the temporomandibular joint. Br J Oral Maxillofac Surg 2012;50:646–9. 9. Amir G, Goldfarb AW, Nyska M, et al. 2-Butoxyethanol model of haemolysis and disseminated thrombosis in female rats: a preliminary study of the vascular mechanism of osteoarthritis in the temporomandibular joint. Br J Oral Maxillofac Surg 2011;49:21–5. 10. Yura S, Nobata K, Shima T. Diagnostic accuracy of fat-saturated T2weighted magnetic resonance imaging in the diagnosis of perforation of the articular disc of the temporomandibular joint. Br J Oral Maxillofac Surg 2012;50:365–8. 11. Yoshida H, Sakata T, Hayashi T, et al. Evaluation of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation. Br J Oral Maxillofac Surg 2011;49:310–3. 12. Sidebottom AJ, Carey EC, Madahar AK. Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review. Br J Oral Maxillofac Surg 2011;49:653–6. 13. Thomas SM, Matthews NS. Current status of temporomandibular joint arthroscopy in the United Kingdom. Br J Oral Maxillofac Surg 2012;50:642–5. 14. Tozoglu S, Al-Belasy FA, Dolwick MF. A review of techniques of lysis and lavage of the TMJ. Br J Oral Maxillofac Surg 2011;49: 302–9. 15. Zhu Y, Zheng C, Deng Y, et al. Arthroscopic surgery for treatment of anterior displacement of the disc without reduction of the temporomandibular joint. Br J Oral Maxillofac Surg 2012;50:144–8. 16. Ahmed N, Sidebottom A, O’Connor M, et al. Prospective outcome assessment of the therapeutic benefits of arthroscopy and arthrocentesis of the temporomandibular joint. Br J Oral Maxillofac Surg 2012;50:745–8.
17. Mehrotra D, Kumar S, Dhasmana S. Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents. Br J Oral Maxillofac Surg 2012;50:774–8. 18. Yang X, Hu J, Yin G, et al. Computer-assisted condylar reconstruction in bilateral ankylosis of the temporomandibular joint using autogenous coronoid process. Br J Oral Maxillofac Surg 2011;49:612–7. 19. Kanatas AN, Jenkins GW, Smith AB, et al. Changes in pain and mouth opening at 1 year following temporomandibular joint replacement—a prospective study. Br J Oral Maxillofac Surg 2011;49:455–8. 20. Kanatas AN, Needs C, Smith AB, et al. Short-term outcomes using the Christensen patient-specific temporomandibular joint implant system: a prospective study. Br J Oral Maxillofac Surg 2012;50:149–53. 21. Dhanda J, Cooper C, Ellis D, et al. Technique of temporomandibular joint replacement using a patient-specific reconstruction system in the edentulous patient. Br J Oral Maxillofac Surg 2011;49:618–22. 22. Kakuguchi W, Yamaguchi HO, Inoue N, et al. Postoperative management of arthroplasty by using unique splints in almost edentulous patient. Br J Oral Maxillofac Surg 2012;50:270–1. 23. Pappachan B, Alexander M, Snehal B. Intraoral high condylotomy for a case of chronic mandibular dislocation. Br J Oral Maxillofac Surg 2012;50:e38–40. 24. de Castro e Silva LM, Pereira Filho VA, Vieira EH, et al. Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: case report. Br J Oral Maxillofac Surg 2011;49:e47–9. 25. Patel M, Scott N, Newlands C. Case of tuberculosis of the temporomandibular joint. Br J Oral Maxillofac Surg 2012;50:e1–3. 26. Kirti C, Dutt N, Awana M. Tuberculosis of the temporomandibular joint: part of a bigger picture. Br J Oral Maxillofac Surg 2012;50:e64. 27. Patel M, Scott N, Newlands C. Response to “Tuberculosis of the temporomandibular joint: part of a bigger picture”. Br J Oral Maxillofac Surg 2012;50:e63. 28. Etoz O, Er N, Alkan A. Accidental use of alcohol during arthrocentesis of the temporomandibular joint. Br J Oral Maxillofac Surg 2011;49:e1–2. 29. Kanatas AN, Worrall SF. Re: Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review. Br J Oral Maxillofac Surg 2012;50:90–1.
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
YBJOM-4018; No. of Pages 4
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Review
A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012 A.S. Tahim a,∗ , A.M.C. Goodson a , K.F.B. Payne a , P.A. Brennan b a b
Department of Oral and Maxillofacial Surgery, King’s College Hospital, London SE5 9RS, UK Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Accepted 11 April 2013
Abstract This review summarises the articles relating to the temporomandibular joint (TMJ) that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. In total 24 papers were published. Of these, 16 (67%) were full-length articles, which included prospective, retrospective, and laboratory-based studies as well as reviews. The remaining 8 papers were short communications, technical notes, and letters to the editor, which report on, amongst other things, unusual cases, rare complications, and novel surgical techniques. © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Temporomandibular joint; Pathology; Surgery; Review
Introduction This article reviews papers related to temporomandibular joint (TMJ) surgery that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2011 to December 2012. Of the 24 papers published, 16 were full-length articles and 8 were shorter papers. Six (25%) were published online only. There were considerably fewer articles published on the TMJ than on oncology (n = 127)1 and trauma (n = 45),2 although the number is comparable with the number of papers relating to the salivary glands, and orthognathic papers (18 and 42, respectively).3,4 A breakdown of these publications is shown in Table 1. There has been a slight increase in the number of articles compared with a previous TMJ review5 when 22 related articles had been published. The 16 full-length articles covered a broad range of topics including disease pathogenesis, diagnosis, imaging, and clinical management (Table 2). We
∗
Corresponding author. Tel.: +44 07779 081197. E-mail address: [email protected] (A.S. Tahim).
will discuss them according to the clinical categories shown in Table 1 before briefly summarising the short communications, technical notes, and letters to the editor.
Disease aetiology, pathogenesis, and development Four articles addressed the causes and development of TMJ disorders including ankylosis, acute closed lock, and osteoarthritis. Bello et al. retrospectively investigated the aetiology of TMJ ankylosis in an African population.6 In their review of 23 patients that presented to their unit over a 5-year period, they found that the commonest aetiological factor was trauma (48%) either secondary to falls or because of previously untreated facial fractures. Infection, including childhood cancrum oris, was the second most common cause (39%). The age of the patient at the time of the original injury to the TMJ was an important factor in the severity of the disease, and they found that all patients with severe facial deformities in the study had sustained their injury before the age of 5 years. The study had an emphasis on poverty as a
0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2013.04.008
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
ARTICLE IN PRESS
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A.S. Tahim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Table 1 Breakdown of type of article published. Type of publication
No. (%)
Full-length articles Disease pathogenesis, aetiology and development Imaging and diagnosis Clinical management Technical notes Short communications Letters to the editor
16 (67) 4 1 11 2 (8) 2 (8) 4 (17)
Total
24
Clinical management
Table 2 Type of full-length article published. Design of study Retrospective Prospective Randomised/randomised controlled trial Review/survey Laboratory Total
resonance imaging (MRI) to assist in the diagnosis of perforations of the articular disc,10 and added to the evidence base for the use of imaging in the diagnosis of disease in the TMJ. The authors suggested that an area of high signal intensity in the middle of the articular disc might indicate perforation. They studied 50 joints in patients with closed lock. Patients had MRI and subsequent arthroscopy and the findings correlated fully. The authors proposed that MRI could reduce the need for solely diagnostic arthroscopy.
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key pre-disposing factor. The authors suggested that healthcare providers should increase efforts to prevent infection and provide early access for the treatment of facial injuries. Ankylosis was studied further in a comprehensive review by Arakeri et al.7 who discussed the factors that influence its pathogenesis after trauma and its recurrence after treatment. The authors reviewed the role of intra-articular haematoma, the TMJ meniscus and healing after condylar fractures. They highlighted the need for further research to understand ankylosis of the TMJ more fully. To explore the natural history of the disorder, Yura evaluated a case series of 40 patients with unilateral acute closed lock of the TMJ.8 The study showed that patients with acute closed lock are younger than those with the chronic counterpart and it does not share the same female preponderance. Symptoms such as reduced mouth opening and joint pain resolved within 2 weeks of instigating conservative management in 63% of patients, and by 12 weeks 95% were symptom-free. Amir et al. reported their preliminary results of the vascular mechanism of osteoarthritis in the TMJ.9 It has previously been postulated that subchondral sclerosis associated with disintegration of articular cartilage may be caused by vascular compromise. Using 2-butoxyethanol (an ethylene glycol ether) they created a model of vascular occlusion in the TMJ in rats, which subsequently showed histological and radiological features consistent with osteoarthritis. Their study supports the need to explore the vascular mechanism of osteoarthritis further.
Diagnosis and imaging single study published in this field during 2011–2012 described the use of fat-saturated T2-weighted magnetic
Publications on the clinical management of disorders of the TMJ included non-surgical treatments, arthroscopic procedures, and joint replacement surgery. 2 papers evaluated adjunctive treatments. In a prospective randomised trial, Yoshida et al. found evidence that movement exercises for the mandibular condyle were useful in the treatment of TMJ closed lock.11 They found that mouth opening, lateral movements, and protrusive movements improved in test cases after a 10 min exercise regimen compared with controls who did not have physiotherapy. Sidebottom et al. proposed cryoanalgesia as a useful adjunct in the management of intractable pain in a retrospective review of all patients who had treatment over a 5-year period.12 In their study, all 17 patients had failed to respond to conventional treatment such as arthroscopy and arthrocentesis, but were not deemed suitable candidates for open procedures. They found significant improvements in pain scores, with a mean duration of 7 months, and a small but not significant improvement in mouth opening. Their suggested management protocol includes initial conservative treatment, which is followed by arthroscopy and arthrocentesis, and then by cryoanalgesia in patients who respond to intra-articular bupivacaine. Four articles focused on arthroscopy and arthrocentesis. In a review of current TMJ arthroscopy practice in the UK, Thomas and Matthews surveyed 346 oral and maxillofacial (OMFS) consultants.13 Of the 215 that responded roughly 20% used arthroscopy, and most that did used it for diagnostic and therapeutic purposes. Reasons for not doing TMJ arthroscopy included lack of interest, limited need, and lack of training. The authors emphasised its benefits as a minimally invasive tool to manage patients with inflammatory and degenerative disorders of the joint, and advocated appropriate training for trainees in the specialty. Tozoglu et al. reviewed all articles published over a 19year period regarding techniques for lysis and lavage of the TMJ.14 They summarised the advantages of different arthroscopic approaches along with evidence for the therapeutic effects of drugs used in intra-articular injection. Two further studies reported successful outcomes after arthroscopic intervention.15,16 Zhu et al. evaluated the success of an arthroscopic procedure in patients with anterior displacement of the disc without reduction of the TMJ.15 The procedure included
Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008
YBJOM-4018; No. of Pages 4
ARTICLE IN PRESS A.S. Tahim et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
lavage, lysis of adhesions in the superior compartment, making an incision parallel to the disc-synovial crease of the upper joint compartment, then pulling back the anteriorly located disc. They showed improvements in mouth opening, pain scores and position of the disc after arthroscopic surgery in 23 patients who had not previously responded to 6 months of non-surgical treatment. Ahmed et al.16 studied 244 patients who had arthroscopy or arthrocentesis over a 5-year period and reported significant improvements in mouth opening, lateral excursion, and protrusion. All patients were reviewed 6 weeks postoperatively, and showed significant improvements in mouth opening (29.8 mm preoperatively to 36.4 mm postoperatively) and pain scores. They also reported repeatedly low morbidity. All procedures but one were done as day cases, and 2 patients had temporary weakness of the temporal branch of the facial nerve. Five articles discussed various aspects of TMJ joint replacement surgery. Mehrotra et al. published the results of a pilot study that investigated the use of a hydroxyapatite and collagen scaffold impregnated with platelet-rich plasma to treat ankylosis.17 Nineteen patients aged 4–16 years had reconstruction with the graft, which was fixed to the ramus using an L-shaped miniplate, after which temporal fascia was interposed between the two articular surfaces. In all cases mouth opening and range of mandibular movement improved significantly. Grafted material was assessed radiographically, and there were significant improvements in opacity scores by 18 months postoperatively, which indicated successful osteogenesis, and formation of a new condyle. The authors suggested that an appropriate randomised trial was needed to compare this technique with current treatments. Yang et al. conducted a randomised controlled trial of patients treated by bilateral osteoarthrectomy with condylar reconstruction using autologous coronoid process with and without the use of preoperative planning using three-dimensional simulation software.18 Mouth opening improved in both groups, and there were fewer postoperative malocclusions when threedimensional planning was used. They suggested that such techniques make the procedure easier and more accurate. In a prospective analysis of 46 patients after partial and complete TMJ replacements, Kanatas et al. showed that pain and mouth opening improved significantly within one month of operation.19 Another article reported short-term outcomes after total joint replacement using the Christensen patient-specific system.20 Thirty-one patients were assessed for changes in pain and mouth opening before and after total TMJ replacement, and significant improvements in pain scores and mouth opening were found one year postoperatively. Finally, Dhanda et al. highlighted the difficulties that the TMJ surgeon faces in establishing and maintaining an occlusal relation in joint replacement surgery in edentulous patients.21 They presented 4 cases to demonstrate methods of delineating patients’ occlusal relations including adaptations of current dentures or the preoperative construction of Gunning splints.
3
Technical notes Two technical notes were published, describing novel techniques to assist the TMJ surgeon. One reported the preoperative construction of splints to establish and maintain an ideal occlusion, and enable appropriate postoperative physiotherapy.22 The other described use of an intraoral high condylotomy in the treatment of a chronic mandibular dislocation.23
Short communications Two short communications were published, both of which were case reports. The first related to the management of a tracheostomy-dependent child with severe micrognathia and ankylosis of the TMJ.24 The second outlined an unusual case of tuberculosis of the TMJ that presented with severe trismus and left-sided facial pain. Treatment with antituberculous drugs was followed by a joint replacement.25
Letters to the editor Of the 4 letters that were published during the 2011–2012 period, 2 discussed tuberculosis that affected the TMJ.26,27 Another reported adverse symptoms after accidental use of alcohol during TMJ arthrocentesis,28 and the fourth called for larger scale trials to research the management of posttraumatic ankylosis of the TMJ.29
Conclusion In summary, BJOMS continues to publish papers across the whole remit of our specialty including TMJ surgery. The number of publications in this subspecialty is smaller than in other areas such as oncology and salivary gland disease, and probably reflects its specialised nature, but it is encouraging to find that continued research is expanding the evidence base for practice in TMJ surgery.
References 1. Gulati A, Herd MK, Blythe J, et al. A synopsis of head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery in 2009/10. Br J Oral Maxillofac Surg 2011;49:368–75. 2. Payne KF, Tahim A, Goodson AM, et al. A review of trauma and traumarelated papers published in the British Journal of Oral and Maxillofacial Surgery in 2010-2011. Br J Oral Maxillofac Surg 2012;50:769–73. 3. Gulati A, Scott J, Blythe JN, et al. Review of salivary papers published in the British Journal of Oral and Maxillofacial Surgery during 2009-2010. Br J Oral Maxillofac Surg 2011;49:627–9. 4. Sadiq Z, Coombes DM, Cascarini L, et al. Orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2008-2009. Br J Oral Maxillofac Surg 2010;48:364–8.
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Please cite this article in press as: Tahim AS, et al. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2013.04.008