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P101 Complications of temporomandibular joint arthroscopy: a prospective study of 183 cases
S50
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
Material and Methods: This prospective study involved 23 patients with TMJ ankylosis treated with interpositional arthroplasty with cartilage grafting from the pinna between 2001 and 2008. Pre- and postoperative assessment included age, gender, etiology, ankylosis type/classification, existing facial asymmetry, maximal pre- and postoperative mouth opening, complications, and recurrence of ankylosis. Results and Statistics: The results were cross tabulated and the Chi-squared statistic was used to test for differences in the casemix. Fisher’s exact test was used for the analysis of contingency tables and therefore to measure the p-value. The mean maximal incisal opening in the preoperative period was 8.34±4.3 mm and in the postoperative period was 29.15±6.35 mm. All patients experienced significant reduction of pain during function and resumed eating a normal diet. There was no facial nerve paralysis. There was recurrence in 4 cases and one patient developed postoperative infection and had to undergo debridement and cartilage removal. Conclusions and Clinical relevance: Joint reconstruction with interpositional arthroplasty proved to be effective regarding the prevention of recurrence and restoration of joint function and patient quality of life. Early postoperative jaw exercises and appropriate physiotherapy may play an important role in the prevention of recurrence. P101 Complications of temporomandibular joint arthroscopy: a prospective study of 183 cases W. Jerjes, T. Upile, Z. Hamdoon, M. Morcos, S. Akram, P. Hoonjan, C. Hopper. UCLH Head and Neck Centre, London, United Kingdom, UK Introduction and Aims: Temporomandibular joint (TMJ) arthroscopy has been considered a safe surgical procedure in the treatment of TMJ derangement. This prospective study evaluates the complications of arthroscopy in patients with temporomandibular disorders. Material and Methods: One hundred and eighty three consecutive patients (326 joints) with TMJ derangement underwent arthroscopy between 2003 and 2008. All the patients were classified as II to V in the Wilkes classification. Pre- and postoperative assessment included age, gender, aetiology, existing facial asymmetry, maximal pre- and postoperative mouth opening and complications. Results: Complications were recognized during or immediately after the surgery. A 0.9% complication rate was found in the whole series. Pain was reported by 17% of the patients which lasted up to 2 weeks. Bleeding or fluid collection within the TMJ space was observed in 4.5% of the cases. No otologic or infective complications were reported. Paraesthesia of the mandibular branch of the trigeminal nerve was seen in 2 patients; temporary weakness of the temporal branch of the facial nerve was seen in 3 patients. One patient suffered temporary weakness of the oculomotor/ trochlear nerves. Conclusions and Clinical relevance: When compared to other surgical interventions, TMJ arthroscopy and arthrocentesis is considered to be safe with the least complications. Reported complications in the literature included pain, vascular problems, swelling, infection, otologic, neurologic, perforation of the middle cranial fossa and broken instruments.
P102 TMJ arthroscopy in patients with Ehlers Danlos Syndrome: case series W. Jerjes, T. Upile, P. Shah, S. Abbas, A. Vincent, C. Hopper. UCLH Head and Neck Centre, UK Introduction: The purpose of this case series was to assess the outcome of temporomandibular joint (TMJ) arthroscopy in patients with temporomandibular disorders (TMDs), associated with Ehlers Danlos syndrome (EDS). Materials and Methods: This retrospective case series describes 18 patients with EDS who underwent arthoscopy for temporomandibular disorders. The patients’ demographics were recorded, along with preoperative TMJ symptoms, Wilkes classification, mouth opening and the presence of systemic involvement. The incidence of early and late postoperative complications and the final outcome were noted. Results: All of the patients were females, with EDS Type III and had a mean age of 34 years. A high proportion of the patients had joints other than the TMJ affected. Five patients were classified as stage II according to the Wilkes classification, 9 patients were stage III, 3 patients were stage IV. Arthroscopy, followed by arthrocentesis and balloon dilatation of the affected TMJs was performed and intra-articular morphine injections were given to all patients. The main pre- and early postoperative complaint was pain. Improvement of mouth opening was noted from 23.4±4.2 to 27.8±5.1 after arthroscopy. Patients were followed up for an average of 62 months and all were asymptomatic at their review appointment. Conclusion: For patients where conservative measures of treating TMD are not effective, arthroscopy is a minimally invasive surgical procedure that has been shown to result in a satisfactory outcome. This case series is limited by its size and further research on surgical intervention on EDS patients with temporomandibular disorders is recommended. P103 Temporomandibular joint dysfunction following third molar surgery under general anaesthesia – retrospective audit V. Jasani, C. Avery. Leicester Royal Infirmary, University Hospitals of Leicester, UK Background: Temporomandibular joint dysfunction (TMJD) following third molar surgery is a well-recognised complication. The incidence of it occurring after third molar removal exclusively under general anaesthesia (GA) is not well documented. TMJD may be a life long phenomenon and can lead to changes in life style of the patient. Obtaining informed consent and quoting the incidence regarding this complication, particularly for GA can prevent complaints and medico-legal litigations. Aim: To investigate the incidence of TMJD after third molar surgery under GA and assess the quality of consent regarding information about TMJD given to patient. Methods: A cohort of randomly selected 30 patients, who underwent third molar surgery under GA and did not have TMJD prior to procedure, were telephonically interviewed. A questionnaire was created which asked patients about various jaw joint symptoms after they had their procedure at interval of 1 week, 1 month and 3 months. Consent forms and notes of these patients were also analysed regarding inclusion of this complication. Result: There is increased incidence of TMJD following third molar surgery under GA particularly at 1 week and 1 month interval that subsequently settled. But the quality of information given to patients about this complication was barely adequate.
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
Material and Methods: This prospective study involved 23 patients with TMJ ankylosis treated with interpositional arthroplasty with cartilage grafting from the pinna between 2001 and 2008. Pre- and postoperative assessment included age, gender, etiology, ankylosis type/classification, existing facial asymmetry, maximal pre- and postoperative mouth opening, complications, and recurrence of ankylosis. Results and Statistics: The results were cross tabulated and the Chi-squared statistic was used to test for differences in the casemix. Fisher’s exact test was used for the analysis of contingency tables and therefore to measure the p-value. The mean maximal incisal opening in the preoperative period was 8.34±4.3 mm and in the postoperative period was 29.15±6.35 mm. All patients experienced significant reduction of pain during function and resumed eating a normal diet. There was no facial nerve paralysis. There was recurrence in 4 cases and one patient developed postoperative infection and had to undergo debridement and cartilage removal. Conclusions and Clinical relevance: Joint reconstruction with interpositional arthroplasty proved to be effective regarding the prevention of recurrence and restoration of joint function and patient quality of life. Early postoperative jaw exercises and appropriate physiotherapy may play an important role in the prevention of recurrence. P101 Complications of temporomandibular joint arthroscopy: a prospective study of 183 cases W. Jerjes, T. Upile, Z. Hamdoon, M. Morcos, S. Akram, P. Hoonjan, C. Hopper. UCLH Head and Neck Centre, London, United Kingdom, UK Introduction and Aims: Temporomandibular joint (TMJ) arthroscopy has been considered a safe surgical procedure in the treatment of TMJ derangement. This prospective study evaluates the complications of arthroscopy in patients with temporomandibular disorders. Material and Methods: One hundred and eighty three consecutive patients (326 joints) with TMJ derangement underwent arthroscopy between 2003 and 2008. All the patients were classified as II to V in the Wilkes classification. Pre- and postoperative assessment included age, gender, aetiology, existing facial asymmetry, maximal pre- and postoperative mouth opening and complications. Results: Complications were recognized during or immediately after the surgery. A 0.9% complication rate was found in the whole series. Pain was reported by 17% of the patients which lasted up to 2 weeks. Bleeding or fluid collection within the TMJ space was observed in 4.5% of the cases. No otologic or infective complications were reported. Paraesthesia of the mandibular branch of the trigeminal nerve was seen in 2 patients; temporary weakness of the temporal branch of the facial nerve was seen in 3 patients. One patient suffered temporary weakness of the oculomotor/ trochlear nerves. Conclusions and Clinical relevance: When compared to other surgical interventions, TMJ arthroscopy and arthrocentesis is considered to be safe with the least complications. Reported complications in the literature included pain, vascular problems, swelling, infection, otologic, neurologic, perforation of the middle cranial fossa and broken instruments.
P102 TMJ arthroscopy in patients with Ehlers Danlos Syndrome: case series W. Jerjes, T. Upile, P. Shah, S. Abbas, A. Vincent, C. Hopper. UCLH Head and Neck Centre, UK Introduction: The purpose of this case series was to assess the outcome of temporomandibular joint (TMJ) arthroscopy in patients with temporomandibular disorders (TMDs), associated with Ehlers Danlos syndrome (EDS). Materials and Methods: This retrospective case series describes 18 patients with EDS who underwent arthoscopy for temporomandibular disorders. The patients’ demographics were recorded, along with preoperative TMJ symptoms, Wilkes classification, mouth opening and the presence of systemic involvement. The incidence of early and late postoperative complications and the final outcome were noted. Results: All of the patients were females, with EDS Type III and had a mean age of 34 years. A high proportion of the patients had joints other than the TMJ affected. Five patients were classified as stage II according to the Wilkes classification, 9 patients were stage III, 3 patients were stage IV. Arthroscopy, followed by arthrocentesis and balloon dilatation of the affected TMJs was performed and intra-articular morphine injections were given to all patients. The main pre- and early postoperative complaint was pain. Improvement of mouth opening was noted from 23.4±4.2 to 27.8±5.1 after arthroscopy. Patients were followed up for an average of 62 months and all were asymptomatic at their review appointment. Conclusion: For patients where conservative measures of treating TMD are not effective, arthroscopy is a minimally invasive surgical procedure that has been shown to result in a satisfactory outcome. This case series is limited by its size and further research on surgical intervention on EDS patients with temporomandibular disorders is recommended. P103 Temporomandibular joint dysfunction following third molar surgery under general anaesthesia – retrospective audit V. Jasani, C. Avery. Leicester Royal Infirmary, University Hospitals of Leicester, UK Background: Temporomandibular joint dysfunction (TMJD) following third molar surgery is a well-recognised complication. The incidence of it occurring after third molar removal exclusively under general anaesthesia (GA) is not well documented. TMJD may be a life long phenomenon and can lead to changes in life style of the patient. Obtaining informed consent and quoting the incidence regarding this complication, particularly for GA can prevent complaints and medico-legal litigations. Aim: To investigate the incidence of TMJD after third molar surgery under GA and assess the quality of consent regarding information about TMJD given to patient. Methods: A cohort of randomly selected 30 patients, who underwent third molar surgery under GA and did not have TMJD prior to procedure, were telephonically interviewed. A questionnaire was created which asked patients about various jaw joint symptoms after they had their procedure at interval of 1 week, 1 month and 3 months. Consent forms and notes of these patients were also analysed regarding inclusion of this complication. Result: There is increased incidence of TMJD following third molar surgery under GA particularly at 1 week and 1 month interval that subsequently settled. But the quality of information given to patients about this complication was barely adequate.