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Treating Malocclusion After TMJ Surgery for Internal Derangement
Oral Abstract Session 5
Treating Malocclusion After TMJ Surgery for Internal Derangement D. Perez, M. Pham: U. of Texas HSC San Antonio Statement of the Problem: TMJ internal derangement includes an aberrant relationship between the articular disc and the condyle that when symptomatic and unresponsive to conservative therapy can be corrected surgically. Arthrocentesis, arthoscopy or disc repositioning open procedures are some of the surgical techniques advocated to treat this condition; however, one of the disadvantages of TMJ disc repositioning is postoperative malocclusion. The aim of this study is to utilize class III guiding elastic postoperatively to treat malocclusion seen after disc repositioning surgery and to discuss the different options and rationale for success. Materials and Methods: This study included 42 patients (72 joints) who presented with a Wilkes class III or IV internal derangement that had failed conservative therapy and were proposed surgical correction. All patients underwent the same surgical technique for repositioning of the TMJ disc using a Mitek mini anchor. All surgeries were performed by the same surgeon. Thirtyfive patients were placed in class III guiding elastic immediately postoperatively for 2 weeks. Seven patients did not receive class III guiding elastics. The patient’s occlusion was recorded before and after surgery. All patients completed a pre- and post-operative visual analogue scale assessing their symptoms and occlusion. Postoperative MRIs in a small subset of these patients were also obtained to corroborate surgical success and disc position. Results of Investigation: All 35 patients who received class III guiding elastic did not experience any malocclusion postoperatively. All 7 patients that did not receive guiding elastics experienced malocclusion. Four of those patients’ malocclusion did not resolve over time and are currently awaiting corrective jaw surgery. Three of the seven patients who did not receive the guiding elastic had malocclusion that resolved after 3 to 4 months of heavy physical therapy. All patients had improvement of their pain and resolution of their chief TMJ complaint at longest follow up. Conclusion: The use of class III guiding elastic is a simple and noninvasive technique to treat malocclusion after TMJ disc repositioning surgery. References: Mehra P, Wolford L. The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int. J. Oral Maxillofac. Surg. 2001: 30: 497-503. Wang BL, Yang C, Cai XY, Chen MJ, Zhang SY, Fang B, Yun B. Malocclusion as a Common Occurrence in Temporomandibular Joint Arthroscopic Disc Repositioning: Outcomes at 49 Days After Surgery. J Oral Maxillofacial Surg. 2011 Jan 27 [Epub ahead of print].
AAOMS • 2011
Etiologic Factors and Clinical Symptoms in Patients With Disc-Related Disorders of the Temporomandibular Joint B. Lund: Institution of Odontology, M. Ögren, C. Kärnfalk, A. Holmlund Statement of the Problem: Disc-related disorders of the temporomandibular joint (TMJ) approximately affects 20% of the population, with a strong, as yet unexplained female predominance. The 2 major clinical features of disc-related disorders are termed reciprocal clicking (RC), with or without pain, and acute or chronic closed lock (CL). RC is clinically evident by its clicking sound caused by a hypermobile disc, thickened by callus formation, reciprocally reduced and displaced during translation, while CL is characterized by a reduced translation. The structural features of these 2 conditions are distinct where CL commonly displays altered morphology of anatomical components of the joint and signs of inflammation while the structural appearance of PC solely is disc displacement and a thickening of the disc. When PC or CCL has developed and eventual non-surgical treatment has failed, surgical treatment may be performed. Despite the common occurrence of CL and RC, the etiology of these conditions is not completely understood. The difference in the structural feature between these 2 conditions has raised the question of different etiology. Prior trauma or generalized joint hypermobility have previously been suggested as risk factors. The aim of the study was to investigate whether there is a difference between patients with painful RC or chronic CL and control individuals with regard to pain, functional impairment, hypermobility and prior trauma. Materials and Methods: Patients diagnosed with either chronic CL (n⫽21) or painful reciprocal clicking (n⫽21) and matched healthy controls (n⫽20), were included in the study. Trauma and generalized, or local, (TMJ) hypermobility was registered. Patients’ perception of TMJ pain and TMJ dysfunction was recorded using visual analogue scale (VAS) and mandibular function impairment questionnaire (MFIQ). The study was approved by the local ethical committee. Patients’ and controls’ informed consent was obtained before inclusion. Methods of Data Analysis: Chi-squared test. Results of Investigation: The distribution of prior trauma between the groups was 5/21 (24%) for CL patients, 7/21 (33%) for RC and 9/20 (45%) for controls. Generalized hypermobility was significantly more common among patients with CL (15/21; 71%) and RC (16/ 21; 76%), compared to controls (5/20; 25%). The rate of individuals with local TMJ hypermobility was 33% (7/21) in the CL group, 67% (14/21) for RC and 5% (1/20) among controls. The mean MFIQ was higher for patients with CL (11.4) or RC (10.0) than for controls (0.45). e-45
Treating Malocclusion After TMJ Surgery for Internal Derangement D. Perez, M. Pham: U. of Texas HSC San Antonio Statement of the Problem: TMJ internal derangement includes an aberrant relationship between the articular disc and the condyle that when symptomatic and unresponsive to conservative therapy can be corrected surgically. Arthrocentesis, arthoscopy or disc repositioning open procedures are some of the surgical techniques advocated to treat this condition; however, one of the disadvantages of TMJ disc repositioning is postoperative malocclusion. The aim of this study is to utilize class III guiding elastic postoperatively to treat malocclusion seen after disc repositioning surgery and to discuss the different options and rationale for success. Materials and Methods: This study included 42 patients (72 joints) who presented with a Wilkes class III or IV internal derangement that had failed conservative therapy and were proposed surgical correction. All patients underwent the same surgical technique for repositioning of the TMJ disc using a Mitek mini anchor. All surgeries were performed by the same surgeon. Thirtyfive patients were placed in class III guiding elastic immediately postoperatively for 2 weeks. Seven patients did not receive class III guiding elastics. The patient’s occlusion was recorded before and after surgery. All patients completed a pre- and post-operative visual analogue scale assessing their symptoms and occlusion. Postoperative MRIs in a small subset of these patients were also obtained to corroborate surgical success and disc position. Results of Investigation: All 35 patients who received class III guiding elastic did not experience any malocclusion postoperatively. All 7 patients that did not receive guiding elastics experienced malocclusion. Four of those patients’ malocclusion did not resolve over time and are currently awaiting corrective jaw surgery. Three of the seven patients who did not receive the guiding elastic had malocclusion that resolved after 3 to 4 months of heavy physical therapy. All patients had improvement of their pain and resolution of their chief TMJ complaint at longest follow up. Conclusion: The use of class III guiding elastic is a simple and noninvasive technique to treat malocclusion after TMJ disc repositioning surgery. References: Mehra P, Wolford L. The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int. J. Oral Maxillofac. Surg. 2001: 30: 497-503. Wang BL, Yang C, Cai XY, Chen MJ, Zhang SY, Fang B, Yun B. Malocclusion as a Common Occurrence in Temporomandibular Joint Arthroscopic Disc Repositioning: Outcomes at 49 Days After Surgery. J Oral Maxillofacial Surg. 2011 Jan 27 [Epub ahead of print].
AAOMS • 2011
Etiologic Factors and Clinical Symptoms in Patients With Disc-Related Disorders of the Temporomandibular Joint B. Lund: Institution of Odontology, M. Ögren, C. Kärnfalk, A. Holmlund Statement of the Problem: Disc-related disorders of the temporomandibular joint (TMJ) approximately affects 20% of the population, with a strong, as yet unexplained female predominance. The 2 major clinical features of disc-related disorders are termed reciprocal clicking (RC), with or without pain, and acute or chronic closed lock (CL). RC is clinically evident by its clicking sound caused by a hypermobile disc, thickened by callus formation, reciprocally reduced and displaced during translation, while CL is characterized by a reduced translation. The structural features of these 2 conditions are distinct where CL commonly displays altered morphology of anatomical components of the joint and signs of inflammation while the structural appearance of PC solely is disc displacement and a thickening of the disc. When PC or CCL has developed and eventual non-surgical treatment has failed, surgical treatment may be performed. Despite the common occurrence of CL and RC, the etiology of these conditions is not completely understood. The difference in the structural feature between these 2 conditions has raised the question of different etiology. Prior trauma or generalized joint hypermobility have previously been suggested as risk factors. The aim of the study was to investigate whether there is a difference between patients with painful RC or chronic CL and control individuals with regard to pain, functional impairment, hypermobility and prior trauma. Materials and Methods: Patients diagnosed with either chronic CL (n⫽21) or painful reciprocal clicking (n⫽21) and matched healthy controls (n⫽20), were included in the study. Trauma and generalized, or local, (TMJ) hypermobility was registered. Patients’ perception of TMJ pain and TMJ dysfunction was recorded using visual analogue scale (VAS) and mandibular function impairment questionnaire (MFIQ). The study was approved by the local ethical committee. Patients’ and controls’ informed consent was obtained before inclusion. Methods of Data Analysis: Chi-squared test. Results of Investigation: The distribution of prior trauma between the groups was 5/21 (24%) for CL patients, 7/21 (33%) for RC and 9/20 (45%) for controls. Generalized hypermobility was significantly more common among patients with CL (15/21; 71%) and RC (16/ 21; 76%), compared to controls (5/20; 25%). The rate of individuals with local TMJ hypermobility was 33% (7/21) in the CL group, 67% (14/21) for RC and 5% (1/20) among controls. The mean MFIQ was higher for patients with CL (11.4) or RC (10.0) than for controls (0.45). e-45