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Ultrasonography for temporomandibular joint disorders
TMJ study. Arthrocentesis being neither a surgical nor a non-surgical mode of treatment for the joint is cost-effective and simple chair side procedure that can be executed routinely to help in internal disc derangement of TMJ.
S.-Y. Zhang*, C. Yang, X. Cai, M. Chen, B. Yun, Y. Peng Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
doi:10.1016/j.ijom.2007.08.393
O16.19 Use of coblation in arthroscopic surgery of the temporomandibular joint C. Yang*, M. J. Chen, S. Y. Zhang, X. Y. Cai Department of Oral and Maxillofacial Surgery, School of Stomatology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, China Purpose: To introduce the technique of coblation used in TMJ arthroscopic surgeries and to preliminarily evaluate the clinical effects. Methods: Arthroscopic coblation, combined with disc suturing, was performed in 419 TMJs from July 2001 to March 2007. All the patients suffered from stage ? to ? of internal derangement (ID), according to Wilke’s classification. Besides disc suturing, the technique of coblation was used in procedures of adhesion ablation, anterior release, chondroplasty and discoplasty. All the patients were evaluated with immediate arthroscopic finding, clinical examination and MRI examination. Results: During the TMJ arthroscopic surgeries, the adhesion, unhealthy disc and cartilage were ablated completely. The surface of cartilage and disc were smooth without cautery damage and haemorrhage. In clinical follow-up period, 76.37% (320/419) TMJs were excellent, 16.47% (69/419) TMJs were good. The success rate was 92.84%. Masseter muscles atrophy occurred in 4 patients, and 30 TMJs needed second arthroscopic surgeries or opening surgeries. Conclusions: The technique of coblation proves to be an effective and less invasive option for the treatment of TMJ ID, with advantages such as high degree of precision and control, little or no thermal damage to surrounding tissue, leaving smooth anatomic surfaces, and achieving haemostasis of smaller blood vessels. doi:10.1016/j.ijom.2007.08.394
O16.20 Arthroscopic disc repositioning and suturing: an effective treatment to TMJ internal derangement
Purpose: To introduce an arthroscopic disc repositioning and suturing technique for stabilizing anteriorly displaced discs. Methods: 1037 patients (1252 joints) diagnosed as to V stages of ID based on clinical examination and MRI were undergone arthroscopic disc repositioning and suturing from May 2001 to December 2006. Two hundred and fifty-six males and 781 females with mean age of 39.73 years (range from 12 to 74 years old), and the mean duration is 10.08 months (range from 0.5 to 60 months). Postoperative MRIs were taken at varying intervals between 1 and 7 days. Results: Postoperative MRI confirmed that 92.25% (1155/1252) of all joints was excellent; 2.08% (26/1252) of all joints was partial improvement, and only 5.67% (71/1252) was poor, which were carried out in arthroscopic surgery once more or open surgery. Conclusion: This procedure has provided successful results in the treatment of internal derangements, although the evaluation is only short term. It was concluded that arthroscopic disc suturing technique was an effective treatment method for internal derangement refractory to non-surgical treatments. It has obvious advantages such as little trauma to TMJ, short operating time and rapidly recovery for the patients, but difficult to perform and widespread easily. doi:10.1016/j.ijom.2007.08.395
O16.21 Arthroscopic lysis and lavage are effective when arthrocentesis is not successful in TMJ ID and OA K. Kurita*, M. Ogita, K. Nakatuka, T. Yajima, M. Shimizu The First Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan Aims: This study aimed to analyse the effects of TMJ arthroscopic lysis and lavage for patients with internal derangement or osteoarthritis after conservative treatment and arthrocentesis had not been successful. Method: TMJ arthroscopic lysis and lavage were performed in 31 patients with unilateral disk displacement and/or osteoarthritis. Postoperative mouth-opening exercises were conducted
1067
together with intraoral administration of NSAIDs. Pre- and postoperative findings on maximal mouth opening and visual analogue scales (0–100) regarding pain at rest, pain with mandibular motion, pain on chewing and interference with daily life were compared before and after arthroscopic surgery. All cases were followed for more than 1 year after the operation. Results: Intracapsular fibrous adhesions were arthroscopically found and cut in all cases. Thirty cases (96.7%) improved between one and 9 months after the operation. The average maximal mouth opening increased from 20.3 mm pre-surgically to 38.6 mm postsurgically. The average decrease of visual analogue scales regarding pain at rest, pain with mandibular motion, pain on chewing and interference with daily life were 20.2, 30.3, 45.4 and 50.6, respectively, which were statistically significant between preoperative and postoperative evaluations. Conclusion: TMJ arthroscopic lysis and lavage was effective after conservative treatment and arthrocentesis were not successful. doi:10.1016/j.ijom.2007.08.396
O16.22 Ultrasonography for temporomandibular joint disorders P. V. R. S. Prathigudu*, K. Kannadasan, K. K. Raja, Gnanam Department of Oral & Maxillofacial Surgery, S.R.M. Dental College, Bharathi Salai, Ramapuram, Chennai 89, Tamil Nadu, India Temporomandibular joint is prevalent among a majority of population in varying degrees. Being a painful and incapacitating condition, it requires early diagnosis and treatment because of its functional importance regarding speech and mastication. The primary simple yet reliable diagnostic aid seems to be ultrasonography according to our study. Materials and methods: Our study included two categories consisting of 10 patients each: (1) symptomatic with complains like pain, difficult in opening mouth and clicking; (2) asymptomatic: clinically normal patients. Specifications of ultrasonography: Sonograms were performed with a real time 12 MHz linear probe. Result: The consistent ultrasonography findings which were found related to symptomatic patients were an increase in the distance between the lateral aspect of the capsule and condyle both in longitudinal and
1068
TMJ
transverse scans. The findings of ultrasonography study were found to be consistent with magnetic resonance imaging study. Conclusion: Ultrasonography is a very affective, easy, economical and patient friendly diagnostic aid for patient with temporomandibular joint disorders with no adverse effects of radiation when compared to other diagnostic methods like computer tomography and magnetic resonance imaging.
considerable amounts of IL-1 beta were detected in the synovial fluid of the patients. Conclusion: Mandibular fractures can be a possible etiologic factor in cartilage destruction, biochemical and intra-articular pathology. Increased levels of IL-1 beta could be potential catabolic marker for cartilage degradation in the TMJ. Clinicians should recognize the aetiologic importance of TMJ macrotrauma and importance of long-term evaluation of TMJ.
doi:10.1016/j.ijom.2007.08.397 doi:10.1016/j.ijom.2007.08.398
O16.23 Mandibular fractures as a possible aetiology in temporomandibular joint disorders A. Kumar*, S. M. Kotrashetti, M. Umarani Kle’s Institute of Dental Sciences, Kle’s University Belgaum-10, Karnataka, India Background and objective: Mandibular fractures in specific is the main type of TMJ macrotrauma. Malocclusion, unilateral mastication as well as bad oral habits including bruxism and clenching are included in the category of TMJ microtrauma the articular disc in TMJ has a primary function of stress distribution. Trauma has been thought to alter the mechanical properties of the disc. TMJ macrotrauma may cause degeneration of articular cartilage and production of the inflammatory and pain mediators. A series of cytokines and chemical mediators are reported to play a major role in various arthropathies, for example, rheumatoid arthritis and osteoarthritis of TMJ. Among them, typically IL-1 beta appears to be of importance in pathogenesis of synovitis and in cartilage damage in these joint diseases. IL-1 beta acts to induce the production of metalloproteinases that induce matrix degradation. The inflammatory and degenerative changes of TMJ can develop after mandibular fractures. Method: Analysis of TMJ status of 15 mandibular fracture patients were done for histomorphic examination, blood cell examination. The procedure of arthrocentesis and synovial fluid biochemical analysis for IL-1 beta (IL-1 beta ELISA kit) was also performed on the selected patients. Exclusion criteria included high condylar and neck fractures and known cases of degenerative joint disorder. Results and observation: On histomorphic examination, bloody smear, degenerated cells, cartilage, inflammatory cells and crystals were observed. In biochemical analysis
O16.24 ‘Pterygoid dysjunction’—a new minimally invasive technique for treatment of painful TMJ dysfunction S. V. Kannan*, A. Thangavelu Depatment of Dentistry, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 14, India Pain of the temporomandibular joint was a riddle for a long time and postulates, hypothesis and theories abound the literature and still remains a puzzle, yet to be solved conclusively. Conservative treatment methods were widely accepted as the first line of management, though medical treatment may help to alleviate the pain from inflammation and gives symptomatic relief to the patient, it does not reverse the dysfunction due to disc and muscle problems. Many surgical procedures have been advocated, dropped and still research is going on to find logical and least traumatic method for management of TMJ dysfunction with pain. Here we are proposing a new minimally invasive technique ‘pterygoid dysjunction’ as a surgical management of TMJ dysfunction which cannot be categorized under any pathological classification, especially in the patients who complain of pain confining to the lateral pterygoid muscle on palpation, were subjected in to this procedure and the outcome was evaluated using computed tomography. Postoperative follow-up was done for 1 year and all of our patients were free of pain. This is an intraoral and minimally invasive technique and can be done as a day care procedure. This does not involve invasion into the joint and is devoid of major complications. Moreover this technique aims not only at symptomatic management but also at the correction of TMJ dysfunction. doi:10.1016/j.ijom.2007.08.399
O16.25 Hemimandibular hyperplasia— management perspective in developing country J. I. Mahmud*, M. R. Molla, M. Ahmed, S. M. A. Sadat, M. M. Hasan, F. Hakim BSM Medical University, Dhaka Dental College and Hospital, Bangladesh Hemimandibular hyperplasia is a rare disease of unknown origin. Trauma, infection, intrauterine influences are thought to be responsible. Variety of clinical features like TMJ pain and clicking sound, facial asymmetry, trismus may present. We have managed five cases who were attended in the Department of Oral and Maxillofacial Surgery in BSM Medical University and Dhaka Dental College and Hospital from June 2003 to April 2007. They were treated by high condylectomy after cessation of growth with or without temporary IMF. Follow-up ranges from a period of 6 months to 4 years. doi:10.1016/j.ijom.2007.08.400
O16.26 Therapy of the osteoarthritis of the TMJ V. Machon12*, J. Paska12, D. Hirjak12 1Department of Head and Neck Surgery, Homolka Hospital, Prague, Czech Republic2Department of Maxillofacial Surgery, Bratislava-Ruzinov, Slovakia Authors present four therapeutic methods for therapy of the arthrocentesis of the TMJ (analgotherapy and soft diet, occlusal splint, arthrocentesis only, arthrocentesis and occlusal splint together). This study undertakes 100 patients. Authors valued pain (O–5) and mouth opening before and after therapy in long-term study (1, 2, 3 and 6 months after). Good result was identified as pain O–11 and mouth opening minimally 30 mm interincisively. The best method for the therapy of the osteoarthritis of the TMJ is arthrocentesis and occlusal splint (86% patients with good results 6 month after therapy). doi:10.1016/j.ijom.2007.08.401
O16.27 Patho-anatomic position of nerves and vessels in the infratemporal fossa—a guide to surgical approach to the temporomandibular region
S.-Y. Zhang*, C. Yang, X. Cai, M. Chen, B. Yun, Y. Peng Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
doi:10.1016/j.ijom.2007.08.393
O16.19 Use of coblation in arthroscopic surgery of the temporomandibular joint C. Yang*, M. J. Chen, S. Y. Zhang, X. Y. Cai Department of Oral and Maxillofacial Surgery, School of Stomatology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, China Purpose: To introduce the technique of coblation used in TMJ arthroscopic surgeries and to preliminarily evaluate the clinical effects. Methods: Arthroscopic coblation, combined with disc suturing, was performed in 419 TMJs from July 2001 to March 2007. All the patients suffered from stage ? to ? of internal derangement (ID), according to Wilke’s classification. Besides disc suturing, the technique of coblation was used in procedures of adhesion ablation, anterior release, chondroplasty and discoplasty. All the patients were evaluated with immediate arthroscopic finding, clinical examination and MRI examination. Results: During the TMJ arthroscopic surgeries, the adhesion, unhealthy disc and cartilage were ablated completely. The surface of cartilage and disc were smooth without cautery damage and haemorrhage. In clinical follow-up period, 76.37% (320/419) TMJs were excellent, 16.47% (69/419) TMJs were good. The success rate was 92.84%. Masseter muscles atrophy occurred in 4 patients, and 30 TMJs needed second arthroscopic surgeries or opening surgeries. Conclusions: The technique of coblation proves to be an effective and less invasive option for the treatment of TMJ ID, with advantages such as high degree of precision and control, little or no thermal damage to surrounding tissue, leaving smooth anatomic surfaces, and achieving haemostasis of smaller blood vessels. doi:10.1016/j.ijom.2007.08.394
O16.20 Arthroscopic disc repositioning and suturing: an effective treatment to TMJ internal derangement
Purpose: To introduce an arthroscopic disc repositioning and suturing technique for stabilizing anteriorly displaced discs. Methods: 1037 patients (1252 joints) diagnosed as to V stages of ID based on clinical examination and MRI were undergone arthroscopic disc repositioning and suturing from May 2001 to December 2006. Two hundred and fifty-six males and 781 females with mean age of 39.73 years (range from 12 to 74 years old), and the mean duration is 10.08 months (range from 0.5 to 60 months). Postoperative MRIs were taken at varying intervals between 1 and 7 days. Results: Postoperative MRI confirmed that 92.25% (1155/1252) of all joints was excellent; 2.08% (26/1252) of all joints was partial improvement, and only 5.67% (71/1252) was poor, which were carried out in arthroscopic surgery once more or open surgery. Conclusion: This procedure has provided successful results in the treatment of internal derangements, although the evaluation is only short term. It was concluded that arthroscopic disc suturing technique was an effective treatment method for internal derangement refractory to non-surgical treatments. It has obvious advantages such as little trauma to TMJ, short operating time and rapidly recovery for the patients, but difficult to perform and widespread easily. doi:10.1016/j.ijom.2007.08.395
O16.21 Arthroscopic lysis and lavage are effective when arthrocentesis is not successful in TMJ ID and OA K. Kurita*, M. Ogita, K. Nakatuka, T. Yajima, M. Shimizu The First Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan Aims: This study aimed to analyse the effects of TMJ arthroscopic lysis and lavage for patients with internal derangement or osteoarthritis after conservative treatment and arthrocentesis had not been successful. Method: TMJ arthroscopic lysis and lavage were performed in 31 patients with unilateral disk displacement and/or osteoarthritis. Postoperative mouth-opening exercises were conducted
1067
together with intraoral administration of NSAIDs. Pre- and postoperative findings on maximal mouth opening and visual analogue scales (0–100) regarding pain at rest, pain with mandibular motion, pain on chewing and interference with daily life were compared before and after arthroscopic surgery. All cases were followed for more than 1 year after the operation. Results: Intracapsular fibrous adhesions were arthroscopically found and cut in all cases. Thirty cases (96.7%) improved between one and 9 months after the operation. The average maximal mouth opening increased from 20.3 mm pre-surgically to 38.6 mm postsurgically. The average decrease of visual analogue scales regarding pain at rest, pain with mandibular motion, pain on chewing and interference with daily life were 20.2, 30.3, 45.4 and 50.6, respectively, which were statistically significant between preoperative and postoperative evaluations. Conclusion: TMJ arthroscopic lysis and lavage was effective after conservative treatment and arthrocentesis were not successful. doi:10.1016/j.ijom.2007.08.396
O16.22 Ultrasonography for temporomandibular joint disorders P. V. R. S. Prathigudu*, K. Kannadasan, K. K. Raja, Gnanam Department of Oral & Maxillofacial Surgery, S.R.M. Dental College, Bharathi Salai, Ramapuram, Chennai 89, Tamil Nadu, India Temporomandibular joint is prevalent among a majority of population in varying degrees. Being a painful and incapacitating condition, it requires early diagnosis and treatment because of its functional importance regarding speech and mastication. The primary simple yet reliable diagnostic aid seems to be ultrasonography according to our study. Materials and methods: Our study included two categories consisting of 10 patients each: (1) symptomatic with complains like pain, difficult in opening mouth and clicking; (2) asymptomatic: clinically normal patients. Specifications of ultrasonography: Sonograms were performed with a real time 12 MHz linear probe. Result: The consistent ultrasonography findings which were found related to symptomatic patients were an increase in the distance between the lateral aspect of the capsule and condyle both in longitudinal and
1068
TMJ
transverse scans. The findings of ultrasonography study were found to be consistent with magnetic resonance imaging study. Conclusion: Ultrasonography is a very affective, easy, economical and patient friendly diagnostic aid for patient with temporomandibular joint disorders with no adverse effects of radiation when compared to other diagnostic methods like computer tomography and magnetic resonance imaging.
considerable amounts of IL-1 beta were detected in the synovial fluid of the patients. Conclusion: Mandibular fractures can be a possible etiologic factor in cartilage destruction, biochemical and intra-articular pathology. Increased levels of IL-1 beta could be potential catabolic marker for cartilage degradation in the TMJ. Clinicians should recognize the aetiologic importance of TMJ macrotrauma and importance of long-term evaluation of TMJ.
doi:10.1016/j.ijom.2007.08.397 doi:10.1016/j.ijom.2007.08.398
O16.23 Mandibular fractures as a possible aetiology in temporomandibular joint disorders A. Kumar*, S. M. Kotrashetti, M. Umarani Kle’s Institute of Dental Sciences, Kle’s University Belgaum-10, Karnataka, India Background and objective: Mandibular fractures in specific is the main type of TMJ macrotrauma. Malocclusion, unilateral mastication as well as bad oral habits including bruxism and clenching are included in the category of TMJ microtrauma the articular disc in TMJ has a primary function of stress distribution. Trauma has been thought to alter the mechanical properties of the disc. TMJ macrotrauma may cause degeneration of articular cartilage and production of the inflammatory and pain mediators. A series of cytokines and chemical mediators are reported to play a major role in various arthropathies, for example, rheumatoid arthritis and osteoarthritis of TMJ. Among them, typically IL-1 beta appears to be of importance in pathogenesis of synovitis and in cartilage damage in these joint diseases. IL-1 beta acts to induce the production of metalloproteinases that induce matrix degradation. The inflammatory and degenerative changes of TMJ can develop after mandibular fractures. Method: Analysis of TMJ status of 15 mandibular fracture patients were done for histomorphic examination, blood cell examination. The procedure of arthrocentesis and synovial fluid biochemical analysis for IL-1 beta (IL-1 beta ELISA kit) was also performed on the selected patients. Exclusion criteria included high condylar and neck fractures and known cases of degenerative joint disorder. Results and observation: On histomorphic examination, bloody smear, degenerated cells, cartilage, inflammatory cells and crystals were observed. In biochemical analysis
O16.24 ‘Pterygoid dysjunction’—a new minimally invasive technique for treatment of painful TMJ dysfunction S. V. Kannan*, A. Thangavelu Depatment of Dentistry, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 14, India Pain of the temporomandibular joint was a riddle for a long time and postulates, hypothesis and theories abound the literature and still remains a puzzle, yet to be solved conclusively. Conservative treatment methods were widely accepted as the first line of management, though medical treatment may help to alleviate the pain from inflammation and gives symptomatic relief to the patient, it does not reverse the dysfunction due to disc and muscle problems. Many surgical procedures have been advocated, dropped and still research is going on to find logical and least traumatic method for management of TMJ dysfunction with pain. Here we are proposing a new minimally invasive technique ‘pterygoid dysjunction’ as a surgical management of TMJ dysfunction which cannot be categorized under any pathological classification, especially in the patients who complain of pain confining to the lateral pterygoid muscle on palpation, were subjected in to this procedure and the outcome was evaluated using computed tomography. Postoperative follow-up was done for 1 year and all of our patients were free of pain. This is an intraoral and minimally invasive technique and can be done as a day care procedure. This does not involve invasion into the joint and is devoid of major complications. Moreover this technique aims not only at symptomatic management but also at the correction of TMJ dysfunction. doi:10.1016/j.ijom.2007.08.399
O16.25 Hemimandibular hyperplasia— management perspective in developing country J. I. Mahmud*, M. R. Molla, M. Ahmed, S. M. A. Sadat, M. M. Hasan, F. Hakim BSM Medical University, Dhaka Dental College and Hospital, Bangladesh Hemimandibular hyperplasia is a rare disease of unknown origin. Trauma, infection, intrauterine influences are thought to be responsible. Variety of clinical features like TMJ pain and clicking sound, facial asymmetry, trismus may present. We have managed five cases who were attended in the Department of Oral and Maxillofacial Surgery in BSM Medical University and Dhaka Dental College and Hospital from June 2003 to April 2007. They were treated by high condylectomy after cessation of growth with or without temporary IMF. Follow-up ranges from a period of 6 months to 4 years. doi:10.1016/j.ijom.2007.08.400
O16.26 Therapy of the osteoarthritis of the TMJ V. Machon12*, J. Paska12, D. Hirjak12 1Department of Head and Neck Surgery, Homolka Hospital, Prague, Czech Republic2Department of Maxillofacial Surgery, Bratislava-Ruzinov, Slovakia Authors present four therapeutic methods for therapy of the arthrocentesis of the TMJ (analgotherapy and soft diet, occlusal splint, arthrocentesis only, arthrocentesis and occlusal splint together). This study undertakes 100 patients. Authors valued pain (O–5) and mouth opening before and after therapy in long-term study (1, 2, 3 and 6 months after). Good result was identified as pain O–11 and mouth opening minimally 30 mm interincisively. The best method for the therapy of the osteoarthritis of the TMJ is arthrocentesis and occlusal splint (86% patients with good results 6 month after therapy). doi:10.1016/j.ijom.2007.08.401
O16.27 Patho-anatomic position of nerves and vessels in the infratemporal fossa—a guide to surgical approach to the temporomandibular region