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Surgery of the temporomandibular joint
Book Reviews
patients: perhaps those who are overweight might doubly benefit from lowering calorie intake at the same time. W. M. Edgar
Surgery of the Temporomandibular David Alexander Keith (ed.). Pp. 299. Blackwell. Hardback, f 59.50.
Joint. 1988. Oxford,
Edited by David Keith with support from 1 1 others, this book begins by reminding us ‘it is less important to invent new operations and new techniques of operating than to find ways and means to avoid surgery’; and later, while reviewing the history of temporomandibular joint surgery, that: ‘the procedures used today being, by and large, modifications and improvements of techniques developed in the late 1800s and early 1900s. contemporary surgeons would do well to observe the lessons of history’. With this in mind the reader is then taken through the history, diagnosis and examination of the temporomandibular joint. Congenital and growth abnormalities, infections, ankylosis, trauma, dislocations, internal derangements and degenerative disease are all covered in some detail. The remaining four chapters cover tumours, the relationship between pain, pathology and surgery in treatment, postoperative physical therapy and, finally, the success, failure and complications of surgery. Overall, the book is well presented. The illustrations and photographs are by and large useful additions to the text, although there are some which seem redundant. Those showing the intra-operative findings in internal derangements, some of which are in colour, are particularly interesting. There is a bibliography at the end of each chapter, but that dealing with internal derangements is too limited. Closed condylotomy is described for degenerative diseases, whereas some surgeons would prefer an open procedure. Inevitably, one’s attention is drawn to the last paragraph where David Keith defines his criteria for success under assessment of mandibular motion, elimination of pain and the incidence of complications including failures related to implant prosthesis. This is a useful publication for the practising oral surgeon and for the postgraduate student seeking a clear explanatory text which is also well supported by diagrams and additional references. I am sure it will find a place on many of our bookshelves. G. R. Barker
Occlusal Correction. Principles and Practice. A. Solnick and D. C. Curratte. Pp. 413. 1988. New Malden, Quintessence. Hardback, f96.00. This is a definitive textbook that teaches occlusal correction by occlusal grinding and restorative dentistry. It is conveniently divided into three sections, Theory, Diagnosis and Treatment so that the authors can develop a sound scientific basis for the treatment of dysfunctions of the stomatognathic system that result from occlusal disharmonies and parafunctional activity. By applying a gnathological concept they show selective grinding to be a rational approach to occlusal correction if the clinician fully understands the principles of occlusion as related to jaw function. The book is presented in an atlas style, is well written and extremely well illustrated to help considerably in the understanding of what can be a most difficult subject Those illustrations showing the palpation
311
of the various muscles of mastication are particularly good. Although the authors draw the reader’s attention to the multifactorial problems from the occlusion and mandibular joint, they emphasize more than once the importance of a conservative approach whereby reversible rather than irreversible treatments are carried out first. No occlusal adjustments should be carried out when there are any signs of a myofascial pain dysfunction syndrome or other joint disease. These conditions should be treated first and only when there is a normal functional state, free from pain, should occlusal treatment be carried out. There are very few exceptions accepted by the authors where there should be any deviation from this rule. Several useful points emerge but two of the more interesting ones were first, the importance of taking lower impressions with the mouth not fully open due to a distortion of 1 mm or more in the width of the mandible, and, second, the use of looped dental floss to locate premature contacts where these cannot be found easily with articulating paper. Also helpful are the numerous excellent references as well as an appendix whose summaries can be quickly referred to in clinical practice. I have one criticism: the chapter on occlusal correction by restorative procedures could have been more than 33 pages out of 400. Otherwise, this book is highly recommended for undergraduates and postgraduates. It will repay careful and detailed reading. W. G. Jenkins
Diagnosis and Treatment of Muscle Pain. Hans Kraus. Pp. 166. 1988. New Malden, Quintessence. Softback, f 25.00. This small book sets out to inform medical and dental practitioners about muscle pain, a subject which the editor points out has been neglected by writers, medical schools and practitioners. It has eight contributors, with the main coming from Hans Kraus, a psychiatrist. In the first four chapters, he attempts to describe the four types of muscle pain: spasm, tension, deficiency and triggerpoints. The first three are described briefly, progressing rapidly to the author’s conception of treatment with the emphasis on activity rather than rest. That on triggerpoints is, in effect an introduction to what follows from other medical/dental specialists who refer to them liberally. It appears that trigger-points are tender areas, readily identified in relaxed muscles, which develop after prolonged spasm or tension. While no satisfactory explanation has been provided for their occurrence, it is thought that they represent necrotic or ischaemic areas which are electrically silent. According to Kraus, they are areas of degenerated muscle fibres, without signs of inflammation, which respond to injections of saline, lignocaine or even dry-needling. The understanding of this concept is not helped by such vague comments as ‘electrolyte imbalance may produce generalized muscle pain and trigger-points’ (chapter 4) and that they may be perpetuated by ‘suboptimal thyroid function, hyperuricaemia and hypoglycaemia’ (chapter 7). Dental practitioners will be interested in the chapter by Harold Gelb on ‘Craniocervical mandibular disorders’. It is his view that an unsatisfactory occlusion can lead to abnormal posture of the mandible, which in turn influences that of the cervical vertebrae. This may lead to abnormal strain in the upper torso and ultimately effects the posture of the head, neck, shoulder and back. His argument is not easy to follow, as it is poorly
patients: perhaps those who are overweight might doubly benefit from lowering calorie intake at the same time. W. M. Edgar
Surgery of the Temporomandibular David Alexander Keith (ed.). Pp. 299. Blackwell. Hardback, f 59.50.
Joint. 1988. Oxford,
Edited by David Keith with support from 1 1 others, this book begins by reminding us ‘it is less important to invent new operations and new techniques of operating than to find ways and means to avoid surgery’; and later, while reviewing the history of temporomandibular joint surgery, that: ‘the procedures used today being, by and large, modifications and improvements of techniques developed in the late 1800s and early 1900s. contemporary surgeons would do well to observe the lessons of history’. With this in mind the reader is then taken through the history, diagnosis and examination of the temporomandibular joint. Congenital and growth abnormalities, infections, ankylosis, trauma, dislocations, internal derangements and degenerative disease are all covered in some detail. The remaining four chapters cover tumours, the relationship between pain, pathology and surgery in treatment, postoperative physical therapy and, finally, the success, failure and complications of surgery. Overall, the book is well presented. The illustrations and photographs are by and large useful additions to the text, although there are some which seem redundant. Those showing the intra-operative findings in internal derangements, some of which are in colour, are particularly interesting. There is a bibliography at the end of each chapter, but that dealing with internal derangements is too limited. Closed condylotomy is described for degenerative diseases, whereas some surgeons would prefer an open procedure. Inevitably, one’s attention is drawn to the last paragraph where David Keith defines his criteria for success under assessment of mandibular motion, elimination of pain and the incidence of complications including failures related to implant prosthesis. This is a useful publication for the practising oral surgeon and for the postgraduate student seeking a clear explanatory text which is also well supported by diagrams and additional references. I am sure it will find a place on many of our bookshelves. G. R. Barker
Occlusal Correction. Principles and Practice. A. Solnick and D. C. Curratte. Pp. 413. 1988. New Malden, Quintessence. Hardback, f96.00. This is a definitive textbook that teaches occlusal correction by occlusal grinding and restorative dentistry. It is conveniently divided into three sections, Theory, Diagnosis and Treatment so that the authors can develop a sound scientific basis for the treatment of dysfunctions of the stomatognathic system that result from occlusal disharmonies and parafunctional activity. By applying a gnathological concept they show selective grinding to be a rational approach to occlusal correction if the clinician fully understands the principles of occlusion as related to jaw function. The book is presented in an atlas style, is well written and extremely well illustrated to help considerably in the understanding of what can be a most difficult subject Those illustrations showing the palpation
311
of the various muscles of mastication are particularly good. Although the authors draw the reader’s attention to the multifactorial problems from the occlusion and mandibular joint, they emphasize more than once the importance of a conservative approach whereby reversible rather than irreversible treatments are carried out first. No occlusal adjustments should be carried out when there are any signs of a myofascial pain dysfunction syndrome or other joint disease. These conditions should be treated first and only when there is a normal functional state, free from pain, should occlusal treatment be carried out. There are very few exceptions accepted by the authors where there should be any deviation from this rule. Several useful points emerge but two of the more interesting ones were first, the importance of taking lower impressions with the mouth not fully open due to a distortion of 1 mm or more in the width of the mandible, and, second, the use of looped dental floss to locate premature contacts where these cannot be found easily with articulating paper. Also helpful are the numerous excellent references as well as an appendix whose summaries can be quickly referred to in clinical practice. I have one criticism: the chapter on occlusal correction by restorative procedures could have been more than 33 pages out of 400. Otherwise, this book is highly recommended for undergraduates and postgraduates. It will repay careful and detailed reading. W. G. Jenkins
Diagnosis and Treatment of Muscle Pain. Hans Kraus. Pp. 166. 1988. New Malden, Quintessence. Softback, f 25.00. This small book sets out to inform medical and dental practitioners about muscle pain, a subject which the editor points out has been neglected by writers, medical schools and practitioners. It has eight contributors, with the main coming from Hans Kraus, a psychiatrist. In the first four chapters, he attempts to describe the four types of muscle pain: spasm, tension, deficiency and triggerpoints. The first three are described briefly, progressing rapidly to the author’s conception of treatment with the emphasis on activity rather than rest. That on triggerpoints is, in effect an introduction to what follows from other medical/dental specialists who refer to them liberally. It appears that trigger-points are tender areas, readily identified in relaxed muscles, which develop after prolonged spasm or tension. While no satisfactory explanation has been provided for their occurrence, it is thought that they represent necrotic or ischaemic areas which are electrically silent. According to Kraus, they are areas of degenerated muscle fibres, without signs of inflammation, which respond to injections of saline, lignocaine or even dry-needling. The understanding of this concept is not helped by such vague comments as ‘electrolyte imbalance may produce generalized muscle pain and trigger-points’ (chapter 4) and that they may be perpetuated by ‘suboptimal thyroid function, hyperuricaemia and hypoglycaemia’ (chapter 7). Dental practitioners will be interested in the chapter by Harold Gelb on ‘Craniocervical mandibular disorders’. It is his view that an unsatisfactory occlusion can lead to abnormal posture of the mandible, which in turn influences that of the cervical vertebrae. This may lead to abnormal strain in the upper torso and ultimately effects the posture of the head, neck, shoulder and back. His argument is not easy to follow, as it is poorly