Abstract
BackgroundThe purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ).MethodsA total of 15 joints from 11 elderly patients (71–78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated.ResultsNo patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period.ConclusionAlthough nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.
Highlights
The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ)
Nonsurgical therapy could be the first treatment choice for ADD without TMJ reduction, surgical interventions may be the first option in select cases, including elderly patients with an erosive condylar surface
There is some controversy about the treatment of ADD without reduction of the TMJ; a few of the conservative approaches achieve definitely satisfactory curative effects [5,6,7]
Summary
The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). TMJ disorders are characterized by pain, noise within the joint, limited range of motion, impaired jaw function, and closed or open jaw locking. Nonsurgical therapy could be the first treatment choice for ADD without TMJ reduction, surgical interventions may be the first option in select cases, including elderly patients with an erosive condylar surface. Magnetic resonance imaging (MRI) examinations of ADD without reduction of TMJ often show displacements of discs that are abnormally shaped and illremodeling or osteoarthritic changes on the condylar heads. In many cases, the condylar surface changes, such as osteophytes and erosion, tend to be associated with long-duration symptoms and advanced ADD [3, 8]
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