TMJ and systemic affects associated with Chlamydia psittaci

Oral Abstract Session 4: Maxillofacial Reconstruction/Nerve Repair/TMJ/Facial Cosmetic Surgery which were then compiled for a comparative statistical analysis. Success was defined as the absence of joint pain and MIO greater than 35 mm, and the mean success rate (MSR) was calculated for each implant type. Method of Data Analysis: Confidence interval (CI) was used to formulate a risk ratio (RR) on changes in joint pain and MIO. A 95% CI above 1 was considered to be statistically significant (P ⬍ .05). Results: Seventeen studies met the criteria. Other studies were excluded because of duplicate/inadequate clinical data, or insufficient number of subjects. Discectomy without implants (4 studies; n ⫽ 432; mean follow-up, 5.7 years): MSR was 86.5%. CI for pain and MIO improvement following surgery were statistically significant (RR ⬎ 3.39 and 2.78, respectively). Silastic implants (3 studies; n ⫽ 159; mean follow-up, 5.2 years): MSR was 81.1% (75.4% for temporary/83% for permanent implants). CI for pain improvement was statistically significant (RR ⬎ 1.5), but the improvement in MIO was not (RR ⬍ 0.38). Proplast-Teflon (6 studies; n ⫽ 934; mean follow-up, 5.1 years): MSR was 58.9%. This figure would be lower than what is reported in the literature, because of the radiographic evidence of bony destruction with PTFE implants. If the implant failure is defined by the number of implants removed solely due to a radiographic bony destruction in the absence of clinical symptoms, the failure rate of PTFE implants would be greater than 85%. CI for pain and MIO improvement following PTFE implant placement were not statistically significant (RR ⬍ 0.8). Temporalis flap (2 studies; n ⫽ 35; mean follow-up, 2.2 years): MSR was 91.4%. CI for pain improvement was not statistically significant (RR ⬍ 0.28). Auricular cartilage (1 study; n ⫽ 17; mean follow-up, 3 years): MSR was 82.4%. CI for pain improvement was statistically significant (RR ⬎ 1.2). Dermal graft (1 study; n ⫽ 17; mean follow-up, 5.5 years): MSR was 87.9⬎. CI for pain improvement was statistically significant (RR ⬎ 4.1). There were insufficient data to extrapolate CI for MIO improvement in all of the studies involving the autogenous grafts, although the t test based on the mean change in MIO did show a statistical significance for all autogenous grafts. Conclusion: TMJ discectomy without interpositional graft resulted in a more favorable clinical outcome compared to the alloplasts, in terms of improving joint pain and MIO. It is difficult to draw a definitive conclusion on the autogenous grafts such as temporalis flap, auricular cartilage and dermal grafts, given the insufficient number of human clinical trials with adequate clinical data, but they seem to have comparable mean success rates to other types of disc replacement technique. References Eriksson L, Westesson P: Discectomy as an effective treatment for painful temporomandibular joint internal derangement: A 5-year clinical and radiographic follow-up. J Oral Maxillofac Surg 59:750, 2001 Kent JN, Block MS, Halpern J, et al: Update on the Vitek partial and

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total temporomandibular joint systems. J Oral Maxillofac Surg 51:408, 1993

TMJ and Systemic Affects Associated With Chlamydia psittaci Larry M. Wolford, DMD, 3409 Worth Street, Suite 400, Dallas, TX 75246 (Henry CH; Goncalves JR) Statement of the Problem: Our previous studies involving PCR assays targeting specific DNA sequences have identified Chlamydia trachomatis and/or Mycoplasma genitalium and/or fermentans bacterium present in the bilaminar tissues of 73% of patients with TMJ internal derangements. A separate study identified the presence of Chlamydia psittaci DNA in 34 of 55 patients (62%) with significant exposure to pet or domestic birds. C. psittaci (carried by birds) can affect any human body system and can cause very serious and sometimes life threatening illness. This study was undertaken to determine the involvement of other body systems in patients exposed to birds as compared to controls (TMJ patients with no bird exposure). Materials and Methods: A standardized questionnaire was administered to TMJ patients by a single clinician to determine the presence of problems in other body systems including other joints, urinary tract, reproductive system, ocular system, sinuses, respiratory system, GI, and other areas (brain, heart, endocrine). Method of Data Analysis: Data from 100 TMJ patients (89 females, 11 males), ages 14 to 65 years were analyzed. There were 60 patients exposed to birds and 40 control patients (no bird exposure). The percentage of occurrence was determined on the two patient populations for problems in other body systems. Results: In all body systems evaluated, patients with exposure to birds had significantly elevated rates of occurrence of other body system problems (from 14% to 40%) as compared to patients with no bird exposure. Table 1. PERCENTAGE OF PATIENTS WITH PROBLEMS IN OTHER BODY SYSTEMS Patient Exposure Joints Bird (n ⫽ 60) Non-bird (n ⫽ 40)

Urinary

Reproductive Ocular

93%

87%

82%

65%

70%

55%

68%

25%

Patient Exposure Sinuses Respiratory Gastrointestinal Others Bird (n ⫽ 60) Non-bird (n ⫽ 40)

77%

83%

75%

75%

48%

50%

40%

48%

Conclusion: This study indicates that TMJ patients with significant exposure to birds have a significantly increased occurrence of problems in other body systems as compared to patients without exposure to birds. This may indicate a condition of systemic psittacosis in the AAOMS • 2004

Oral Abstract Session 4: Maxillofacial Reconstruction/Nerve Repair/TMJ/Facial Cosmetic Surgery TMJ patient population with significant exposure to birds. References Henry CH, Hughes CV, Gerard HC, et al: Reactive arthritis: Preliminary microbiologic analysis of the human temporomandibular joint. J Oral Maxillofac Surg. 58:1137, 2000 Wolford LM, Gerard HC, Henry CH, et al: Chlamydia psittaci infection may be involved in development of temporomandibular joint dysfunction. J Oral Maxillofac Surg 59:30, 2001 (suppl 1) Henry CH, Pitta MC, Wolford LM: Frequency of chlamydial antibodies in patients with internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:287, 2001

VIP Facelift: Tension-Free Rhytidectomy After Releasing the Retaining Osseocutaneous Ligaments Carlos A. Morales-Ryan, DDS, MSD, 4151 Bob Bullock Loop, Suite 212, Laredo TX 78043 (Watson SW; Sinn DP) Statement of the Problem: Tension in wound healing alters collagen deposition creating a noticeable scar. The purpose of this study was to objectively measure the outcome of releasing the retaining osseocutaneous ligaments (ROL) of the face and its relationship to flap tension. Materials and Methods: This prospective study included 30 female patients with an average age of 56 years (range, 54 to 61 years) that underwent the Vector in Planes (VIP) facelift. With reference landmarks estab-

AAOMS • 2004

lished, rhytidectomy is performed with our conventional approach. Tension forces were measured in grams using a Ohaus spring scale (Ohaus Corp, Pine Brook, NJ ) in two vectors: 1) superior and 2) inferior at two time intervals: T1 before releasing the ROL and T2 after releasing the ROL. Method of Data Analysis: Descriptive statistics and t tests were used for data evaluation. Results: Releasing the ROL significantly reduced flap tension in both vectors (P ⬍ .001). Flap tension for the superior vector was: T1 average 775 grams and 711 grams for the inferior vector. After detachment of ROL, flap tension average was 378 and 336 grams for the superior and inferior vector respectively. There was a significant flap tension reduction of 49% (range, 43% to 60%) for the superior vector and 47% (27% to 69%) for the inferior vector. Conclusion: The results of this study showed that the VIP facelift significantly reduced the flap tension contributing to improved wound healing and an enhanced natural and aesthetic result. References Stone TL, Watson SW, Throckmorton GS, et al: A comparative study of scalp tension with and without intraoral subperiosteal release of the midface in laser-assisted endoscopic browlift. Am J Cosmet Surg 17: 219, 2000 Ozdemir R, Kilinc H, Unlu RE, et al: Anatomicohistologic study of the retaining ligaments of the face and use in face lift: Retaining ligament correction and SMAS plication. Plast Reconstr Surg 110:1134, 2002; discussion 1148

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