Poster 252: Preliminary Study of Temporomandibular Joint MRI and CT View After Intraoral Modified Condylotomy for the Treatment of an Anterior Disc Dislocation of the TMJ

Abstract

The aim of this study was to evaluate the changes in the disc and condyle shape through a review of MRI and CT findings after an intraoral modified condylotomy (no formation of a butt joint, none or less stripping of the medial pterygoid muscle under 3mm) for treating a painful disc dislocation of the TMJ (Wiles Stage II and III). Thirteen sides in 7 consecutive patients with a painful anterior disc dislocation, who were operated on by a single surgeon at the Armed forces Capital Hospital in South Korea, were examined. Preoperatively, 6 patients complained of severe popping bilaterally or unilaterally. All the patients suffered from frequent pain, joint tenderness, intermittent locking, and masticatory muscle pain. A decision was made to perform this procedure after at least 6 months of conservative treatment (behavior, medication, splint therapy, and arthrocentesis). The positions of disc and condyle were inspected 3 times (pre op, post 1 week to 1 month, post 3 month to 6 month) with MRI. From the magnetic resonance imaging view, 11 sides had ADD with a reduction before surgery. In addition, the changes of condylar position and remodeling of the condylar surface were examined. n/a The symptoms of the TMJ showed significant improvement (by VAS) with the disappearance of the popping and intermittent locking. The MRI view showed that all discs had been reduced by the reciprocal movement of the condyle and disc. On the 3D CT view, the deposition of new bone at condylar surface was confirmed in 5 patients. However, one patient with ADD without a reduction (clinically no sounds with mouth opening limitation under 20mm) underwent surgery twice. He showed the relief of his TMJ symptoms but complained of an anterior open bite. The anterior open bite still remained even after the second operation. IVRO is useful of the treatment of TMJ disorder in selective case with severe popping refractory to conservative treatment.