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The natural course of nonreducing disk displacement of the temporomandibular joint — Relationship of the clinical findings at the initial visit with the outcome after 12 months without treatment
P21-3 Temporomandibularjoint P 2 1 - 3 T e m p o r o m a n d i b u l a r joint
1. Newly Developed Arthroscope with a Channel for TMJ Surgery and its Clinical Application
Kakudo, K. 1, Kurita, K. 2, Kim, K. S. ~, Yamada, K. 1, Shirasu, R. 1
1First Department of OMS, Osaka Dental Univ., Osaka, Japan, 2Second Department of OMS, School of Dentistry, Aichi-Gakuin Univ., Nagoya, Japan A new arthroscope, which has a channel for endoscopic surgery of the temporomandibular joint (TMJ), and the instruments needed for this surgery have been recently developed. In the past, two techniques (single puncture and double puncture techniques) were used for endoscopic surgery of TMJ. The single puncture technique can be subdivided into the blind technique and the direct visual technique. The blind technique has a disadvantage in that a precise surgery is not possible. The direct visual technique has a disadvantage in that because the arthroscopic lens systems used for this technique need a channel for surgery, and the diameter of this endoscope is thick (3.8• iron) which causes a relatively high amount of surgical damage. The double puncture technique has a disadvantage in that much skill is needed for maneuvering the surgical instruments (inserted through a separate cannula) into the visual field of the arthroscope inserted through another cannula. Following the recent development of a very small diameter fiberscope with a high pixel number (15,000 pixels), we have recently developed a new arthroscope, designed to resolve the previous problems. This arthroscope combines a fiberscope with a surgical channel (<1.1 mm). The length and diameter (<2.9 mm) of this fiberscope cannula are identical to those of the most frequently used Striker's arthroscope cannula. At the same time, we have developed the instruments for use in surgery that would fit through the surgical channel of this arthroscope (probe, forceps, knives, cautery knives, etc.). The use of this arthroscope causes less surgical damage and allows more reliable arthroscopic surgery, when compared with conventional techniques.
2. The Natural Course of Nonreducing Disk Displacement of the Temporomandibular Joint - Relationship of the clinical findings at the initial visit with the outcome after 12 months without treatment
Sato, S., Goto, S., Kawamura, H., Motegi, K.
Department of Oral and Maxillofacial Surgery L Tohoku University School of Dentistry, Sendai, Japan The natural course and the association between the outcome at 12 months and the age, range of motion for maximal mouth opening, intercuspal occlusal relationship, morphology of the mandibular fossa and the articular eminence at the initial visit, and the locking duration was evaluated in
159
52 patients with nonreducing disk displacement of the temporomandibular joint (TMJ) who were naturally observed without any treatment during 12 months. The patients mean age was 28.6 years (range 13 to 58 years). Patients were enrolled in this study if they met the following criteria: 1) constant or frequent pain of the TMJ or a range of motion of less than 35 mm at the initial visit; 2) no previous TMJ treatment; 3) agreement to conservative observation without any treatment; and 4) a follow-up observation after a 12 month period. Good resolution was seen in 59.6% of the patients according to the criteria presented in1995 by the American Association of Oral and Maxillofacial Surgeons. The patients with good resolution were significantly younger than that those with poor resolution (P<0.05, two tailed t-test). There were no differences in any other factors between the patients with good resolution and those with poor resolution. A possibility of spontaneous resolution of clinical signs and symptoms in natural course of the nonreducing disk displacement of the TMJ was suggested, and a younger age at the initial visit appears to be a positive factor in the prognosis.
3. A Simple Device to Allow Immediate Jaw Movement after Surgical Correction of Prolonged Mandibular Dislocation
Nishida, 3/1., Murakami, K., Moriya, Y, Lizuka T. Department of Oral and Maxillofacial Surgery, Kyoto University, Kyoto, Japan In prolonged dislocation of the mandibular condyle, closed reduction is often extremely difficult because of pathologic changes such as contraction of the joint capsule and obliteration of the joint space by granulation tissue. Thus surgical reduction is commonly employed. A number of surgical procedures such as arthrotomy and condylectomy have been reported. In most procedures, postoperative mandibular immobilization is recommended for several weeks to avoid recurrence. In elderly patients or in those who have dislocation associated with trauma, seizure, encephalitis, and/or mental disorders, the mandibular immobilization may induce a mental stress and worsen the systemic condition. In addition, postoperative immobilization for more than two weeks may increase the risk of secondary ankylosis. We successfully attempted the loose fixation of the condyle to the articular eminence without postoperative jaw immobilization. This procedure was performed on five patients in the last seven years. The method was considered more efficient and excellent as compared with conventional approaches because the patient was able to start earlier postoperative rehabilitation without any relapse or complication. Follow up study showed acceptable mouth opening and jaw function. The surgical technique is as follows. After the arthrectomy, consisting of removal of the disc and adherent soft tissues in the joint cavity, the mandibular condyle is reduced to the appropriate position. However, the condyle usually tends to be easily luxated again by the contraction of the surrounding soft tissue. A small hole is drilled through the articular eminence and the anterior aspect of the condyle. A stainless steel wire 0.5 mm in diameter is then passed through the holes,
1. Newly Developed Arthroscope with a Channel for TMJ Surgery and its Clinical Application
Kakudo, K. 1, Kurita, K. 2, Kim, K. S. ~, Yamada, K. 1, Shirasu, R. 1
1First Department of OMS, Osaka Dental Univ., Osaka, Japan, 2Second Department of OMS, School of Dentistry, Aichi-Gakuin Univ., Nagoya, Japan A new arthroscope, which has a channel for endoscopic surgery of the temporomandibular joint (TMJ), and the instruments needed for this surgery have been recently developed. In the past, two techniques (single puncture and double puncture techniques) were used for endoscopic surgery of TMJ. The single puncture technique can be subdivided into the blind technique and the direct visual technique. The blind technique has a disadvantage in that a precise surgery is not possible. The direct visual technique has a disadvantage in that because the arthroscopic lens systems used for this technique need a channel for surgery, and the diameter of this endoscope is thick (3.8• iron) which causes a relatively high amount of surgical damage. The double puncture technique has a disadvantage in that much skill is needed for maneuvering the surgical instruments (inserted through a separate cannula) into the visual field of the arthroscope inserted through another cannula. Following the recent development of a very small diameter fiberscope with a high pixel number (15,000 pixels), we have recently developed a new arthroscope, designed to resolve the previous problems. This arthroscope combines a fiberscope with a surgical channel (<1.1 mm). The length and diameter (<2.9 mm) of this fiberscope cannula are identical to those of the most frequently used Striker's arthroscope cannula. At the same time, we have developed the instruments for use in surgery that would fit through the surgical channel of this arthroscope (probe, forceps, knives, cautery knives, etc.). The use of this arthroscope causes less surgical damage and allows more reliable arthroscopic surgery, when compared with conventional techniques.
2. The Natural Course of Nonreducing Disk Displacement of the Temporomandibular Joint - Relationship of the clinical findings at the initial visit with the outcome after 12 months without treatment
Sato, S., Goto, S., Kawamura, H., Motegi, K.
Department of Oral and Maxillofacial Surgery L Tohoku University School of Dentistry, Sendai, Japan The natural course and the association between the outcome at 12 months and the age, range of motion for maximal mouth opening, intercuspal occlusal relationship, morphology of the mandibular fossa and the articular eminence at the initial visit, and the locking duration was evaluated in
159
52 patients with nonreducing disk displacement of the temporomandibular joint (TMJ) who were naturally observed without any treatment during 12 months. The patients mean age was 28.6 years (range 13 to 58 years). Patients were enrolled in this study if they met the following criteria: 1) constant or frequent pain of the TMJ or a range of motion of less than 35 mm at the initial visit; 2) no previous TMJ treatment; 3) agreement to conservative observation without any treatment; and 4) a follow-up observation after a 12 month period. Good resolution was seen in 59.6% of the patients according to the criteria presented in1995 by the American Association of Oral and Maxillofacial Surgeons. The patients with good resolution were significantly younger than that those with poor resolution (P<0.05, two tailed t-test). There were no differences in any other factors between the patients with good resolution and those with poor resolution. A possibility of spontaneous resolution of clinical signs and symptoms in natural course of the nonreducing disk displacement of the TMJ was suggested, and a younger age at the initial visit appears to be a positive factor in the prognosis.
3. A Simple Device to Allow Immediate Jaw Movement after Surgical Correction of Prolonged Mandibular Dislocation
Nishida, 3/1., Murakami, K., Moriya, Y, Lizuka T. Department of Oral and Maxillofacial Surgery, Kyoto University, Kyoto, Japan In prolonged dislocation of the mandibular condyle, closed reduction is often extremely difficult because of pathologic changes such as contraction of the joint capsule and obliteration of the joint space by granulation tissue. Thus surgical reduction is commonly employed. A number of surgical procedures such as arthrotomy and condylectomy have been reported. In most procedures, postoperative mandibular immobilization is recommended for several weeks to avoid recurrence. In elderly patients or in those who have dislocation associated with trauma, seizure, encephalitis, and/or mental disorders, the mandibular immobilization may induce a mental stress and worsen the systemic condition. In addition, postoperative immobilization for more than two weeks may increase the risk of secondary ankylosis. We successfully attempted the loose fixation of the condyle to the articular eminence without postoperative jaw immobilization. This procedure was performed on five patients in the last seven years. The method was considered more efficient and excellent as compared with conventional approaches because the patient was able to start earlier postoperative rehabilitation without any relapse or complication. Follow up study showed acceptable mouth opening and jaw function. The surgical technique is as follows. After the arthrectomy, consisting of removal of the disc and adherent soft tissues in the joint cavity, the mandibular condyle is reduced to the appropriate position. However, the condyle usually tends to be easily luxated again by the contraction of the surrounding soft tissue. A small hole is drilled through the articular eminence and the anterior aspect of the condyle. A stainless steel wire 0.5 mm in diameter is then passed through the holes,