Disc Repositioning Research Articles

Clinical guidance based on MRI for the management of temporomandibular joint synovial chondromatosis: One institution's experience

The aim of this retrospective observational study was to introduce a comprehensive MRI evaluation criterion for the clinical management of synovial chondromatosis of the temporomandibular joint (TMJ-SC). Patients received different treatments according to the MRI evaluation system: bone erosion, extent, articular disc condition, location, maturity, and size of loose body. At least a 2-year follow-up was completed to assess tumor recurrence, visual analogue scale score for pain (VAS) and maximum interincisal opening (MIO). Of the 195 patients included for TMJ-SC, 34 received arthroscopy and 161 received open surgery. Among the patients with significant extent of SC, 32 received temporary resection of the condylar neck or zygomatic arch and 2 received treatment combined with ear, nose and throat(ENT). 28 received articular disc reconstruction and 56 received disc repositioning. Patients showed good recovery of joint function with only two cases of tumor recurrence at an average follow-up of 75.1 months after surgery. The MIO had improved from 30.2 mm to 40.0 mm(P < 0.0001) and VAS had decreased from 5.1 to 0.78(P < 0.0001).The preoperative MRI evaluation principles has been effective in selecting appropriate surgical options.

Comparison of disc position stability and condylar bone remodelling between two open disc repositioning surgeries: a retrospective single-centre cohort study.

Open suturing (OSu) and mini-screw anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodelling (CBR) between these two surgical procedures in a single centre. A retrospective cohort study using MRI scans (pre-operation, 1 week and 12months post-operation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one centre through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting five factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression. Three hundred eighty-five patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% CI, 1.27-6.85) and better CBR (RR=1.58; 95% CI, 1.02-2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95% CI, 1.11-6.26) and overcorrected or posteriorly repositioned discs were more stable than normally repositioned discs (RR=5.84; 95% CI, 2.58-13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95% CI, 0.89-0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95% CI, 1.76-3.83). OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.

Stability of skeletal class III surgical treatment. Affect of high condylectomy

Purpose: To evaluate the role of high condylectomy on surgical treatment stability of Class III patients with condylar hyperplasia. Materials and Methods: Twenty-four patients (9 females and 15 males) were paired according to gender, age, skeletal and dental characteristics in three groups. Group 1 (no condylar hyperplasia) underwent orthognathic surgery only, Group 2 (with unilateral or bilateral condylar hyperplasia) underwent high condylectomy, articular disc repositioning and orthognathic surgery in the same procedure and Group 3 (with unilateral or bilateral condylar hyperplasia) underwent orthognathic surgery only. Lateral cephalometric radiographs were selected at the immediately before surgery (T1), immediate after surgery (T2) and longest follow-up (T3). Results: Cephalometric comparison between the 3 groups showed no significant differences among the variables at the initial observation period (T1). During the observational period (T3-T2), patients in Group 3 showed significant relapse at SNB (mean = 2.18, sd = 1.39 degrees), ANB (mean = -2.68, sd = 2.24 degrees), SN.Pog (mean = -1.48, sd = 1.66 degrees), OJ (mean = -2.99, sd = 1.64 mm), OB (mean = 1.45, sd = 1.16 mm), Ar-Go (mean = 2.23, sd = 2.66 mm), Ar-Gn (mean = 3.76, sd = 1.48 mm), S-Gn (mean = 2.3, sd = 2.34 mm) and ANS-Me (mean = 2.06, sd = 2.2 mm) demonstrating that treatment adopted was insufficient for stable results within this Group. Groups 1 and 2 remained stable one year after surgery. Conclusions: Orthognathic surgery for correction of skeletal class III malocclusion is a stable procedure for patients without condylar growth abnormalities and for patients undergoing simultaneous high condylectomies and articular disc repositioning. Those patients with preoperative condylar hyperplasia who underwent double-jaw surgery and no TMJ intervention experienced significant relapse.

Studying positional changes of the disc-condyle-fossa complex in ADDWoR patients after TMJ disc repositioning surgery.

To investigate the positional changes in the temporomandibular joint (TMJ) disc-condyle-fossa complex of patients with anterior disc displacement without reduction (ADDWoR) and to evaluate the effect of disc repositioning (DR) surgery. Fifteen patients with unilateral ADDWoR (30 joints) were included. MRI of the TMJ was performed at T0 (1week before surgery), T1 (1month after surgery), and T2 (9-12months after surgery). The glenoid fossa, disc, and condyle were reconstructed and analyzed using Mimics software. In the patients with unilateral ADDWoR, the disc on the ADD side showed a tendency to downward shift in the coronal direction and forward shift in the sagittal direction; the condyle of ADD side showed a tendency to backward shift in the sagittal direction and upward shift in the coronal direction. When comparing the same ADDwoR TMJ at T0, T1, and T2, the disc was found to move upward and backward after DR surgery at T1 and T2, and the condyle was found to move upward and backward after DR surgery at T1 but returned to the original position at T2. ADDWoR leads to forward and downward displacement of the disc relative to the condyle and upward displacement of the condyle relative to the tuberosity. DR surgery improved upon the structural abnormalities of the TMJ complex, for which stability was maintained as determined in the 9 to 12 month postoperative follow-up. DR surgery effectively and constantly improves the positional abnormalities of the TMJ complex.

Divergent chondro/osteogenic transduction laws of fibrocartilage stem cell drive temporomandibular joint osteoarthritis in growing mice

The anterior disc displacement (ADD) leads to temporomandibular joint osteoarthritis (TMJOA) and mandibular growth retardation in adolescents. To investigate the potential functional role of fibrocartilage stem cells (FCSCs) during the process, a surgical ADD-TMJOA mouse model was established. From 1 week after model generation, ADD mice exhibited aggravated mandibular growth retardation with osteoarthritis (OA)-like joint cartilage degeneration, manifesting with impaired chondrogenic differentiation and loss of subchondral bone homeostasis. Lineage tracing using Gli1-CreER+;Tmfl/-mice and Sox9-CreER+;Tmfl/-mice showed that ADD interfered with the chondrogenic capacity of Gli1+ FCSCs as well as osteogenic differentiation of Sox9+ lineage, mainly in the middle zone of TMJ cartilage. Then, a surgically induced disc reposition (DR) mouse model was generated. The inhibited FCSCs capacity was significantly alleviated by DR treatment in ADD mice. And both the ADD mice and adolescent ADD patients had significantly relieved OA phenotype and improved condylar growth after DR treatment. In conclusion, ADD-TMJOA leads to impaired chondrogenic progenitor capacity and osteogenesis differentiation of FCSCs lineage, resulting in cartilage degeneration and loss of subchondral bone homeostasis, finally causing TMJ growth retardation. DR at an early stage could significantly alleviate cartilage degeneration and restore TMJ cartilage growth potential.

TMJ anterior disc displacement anchorage surgery: a retrospective study based on a suture-free titanium screw strategy.

To evaluate the feasibility and effectiveness of using a suture-free titanium screw in repositioning anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ). A consecutive sample of twelve patients (fifteen joints) was included in this study. All patients were diagnosed with ADDwoR and showed limited mouth opening or temporomandibular joint pain symptoms. Suture-free titanium screw was placed in the condyle directly following the disc repositioning. Pre- and postoperative evaluation parameters include operation time, the visual analogue scale for pain (VAS), lateral excursion movements (LEM), maximum interincisal opening (MIO), and disc length and position on MRI. In addition, the mandibular condyle height was also measured. Statistical significance was considered when p < 0.05. The unilateral operation time was 58.54 ± 5.43min; during the 6-month period after the operation, the VAS values decreased from 87 ± 6.34 to 14.08 ± 6.65. The MIO increased from 30.07 ± 4.73 to 39.89 ± 1.69mm (p = 0.01). The TMJ disc length was prolonged from 8.23 ± 1.12 to 11.51 ± 1.29mm. The condyles showed significant remodeling, and the height of the condyle increased from 18.24 ± 4.12 increase to 19.6 ± 4.31mm. The LEM was increased from 5.27 ± 0.51 to 6.36 ± 0.62mm. The MRI images showed the stability of the disc in position during the opening and closing of the mouth. The TMJ disc position was stable during the follow-up period. Anteriorly displaced articular disc can be repositioned by a suture-free titanium screw strategy. This technique is an alternative method to address ADDwoR.

Effect of occlusal stabilisation splint with or without arthroscopic disc repositioning on condylar bone remodelling in adolescent patients

The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12–20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13–20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.

Comparison between disc repositioning by open surgery versus occlusal splint in the treatment of temporomandibular joint anterior disc displacement without reduction: A retrospective cohort trial of short-term results

To compare the short-term clinical results between disc repositioning by open surgery (DROS) and stabilization splint (SS) for the treatment of temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR).Patients diagnosed with ADDwoR by magnetic resonance imaging (MRI) and treated by either DROS or SS from June 2020 to January 2022 were reviewed. They were selected to match the baseline data before each treatment and then to compare the clinical results including maximum interincisal opening (MIO), protrusion and lateral excursion distances, visual analogue scale (VAS) scores of pain, diet, and quality of life (QoL) and their effective rates, total satisfaction rate after 3 and 6 months of the treatment, and between the 2 treatment methods. SPSS software was used to analyze the statistical differences.A total of 175 patients were included in the study. There were 95 patients in the DROS group and 80 patients in the SS group. MIO and VAS scores were significantly improved after each treatment at 3 and 6 months (p < 0.05). DROS improved more at 6 months than 3 months (p < 0.001), whereas SS had no significant changes (p > 0.05). DROS had significantly better MIO, VAS score and effect rates than SS (p < 0.001). The total satisfaction rate was 94.73% in DROS and 86.25% in SS. The protrusion and lateral excursions decreased after DROS at 3 months (p < 0.001) but improved at 6 months to better than before the surgery (p = 0.03, p = 0.10). There were no significant changes in protrusion and lateral excursions after SS (p > 0.05, p > 0.05).DROS had better short-term clinical results than SS in the treatment of ADDwoR.

Proteome Analysis of Temporomandibular Joint with Disc Displacement

Disc displacement without reduction is a common disorder of the temporomandibular joint, causing clinical symptoms and sometimes condylar degeneration. In some cases, bone regeneration is detected following disc-repositioning procedures. Until now, however, systems-wide knowledge of the protein levels for condylar outcome with disc position is still lacking. Here, we performed comprehensive expression profiling of synovial fluid from 109 patients with disc displacement without reduction using high-resolution data-independent acquisition mass spectrometry and characterized differences in 1,714 proteins. Based on magnetic resonance imaging, samples were divided into groups with versus without condylar absorption and subgroups with versus without new bone. For the proteomic analysis, 32 proteins in groups presented with statistical significance (>2-fold, P < 0.05). Pathways such as response to inorganic substances, blood coagulation, and estrogen signaling were significantly expressed in the group with bone absorption as compared with pathways such as regulation of body fluid levels, vesicle-mediated transport, and focal adhesion, which were enriched in the group without bone absorption. In subgroup analysis, 45 proteins of significant importance (>2-fold, P < 0.05) were associated with pathways including would healing, glycolysis and gluconeogenesis, and amino acid metabolism. Combined with clinical examination, molecules such as acetyl-CoA carboxylase beta (ACACB) and transforming growth factor beta 1 (TGFB1) were related to features such as visual analog scale and maximum interincisal opening (P < 0.05). In addition, 7 proteins were examined by Western blotting, including progesterone immunomodulatory binding factor 1 (PIBF1), histidine-rich glycoprotein (HRG), and protein kinase C and casein kinase substrate in neurons 2 (PACSIN2). In conclusion, this study provides the first proteome analysis of condylar absorption at disc displacement without reduction and postoperative new bone formation after disc reposition. Integrated with clinical data, this analysis provides an important insight into the proteomics of condylar modification at disc position.

TMJ disc repositioning associated with orthognathic surgery for the treatment of severe retrognathism

Introduction: Orthognathic surgery associated with temporomandibular disc reposition is a modality of surgical treatment for dentofacial deformities associated with temporomandibular disorders that has been shown to be a stable and predictable alternative for such situations. However, there is still no consensus in the literature regarding the treatment modality in these cases. Several studies have been developed looking for more stable and predictable results in favor of the best patient treatment. Case Report: Patient with a class II facial pattern and temporomandibular dysfunction, submitted to bilateral repositioning of the articular disc and orthognathic surgery with counterclockwise rotation of the maxillomandibular complex, with improvement of the symptoms and of the functionality of the stomatognathic system, and satisfaction with facial aesthetics. Conclusion: Although there are controversies about the surgical repositioning of chronic articular disc displacements in retrognathism, this treatment modality has demonstrated long-term stability and reduction or resolution of joint symptoms.

Radiologic outcomes of temporomandibular joint disk repositioning by suturing through an open incision in adolescent patients with anterior disk displacement

To investigate the efficacy and stability of temporomandibular joint disk repositioning by suturing through an open incision in adolescents with anterior disk displacement (ADD). Patients(aged 10-18 years) diagnosed with ADD and operated for disc repositioning between June 2019and January 2021were included in this study. Magnetic resonance imaging (MRI) and cephalometric films before and 1 year after surgery were collected from all patients. The surgical success rate was defined as the primary outcome variable. Changes of condylar height, mandibular asymmetry, and retrognathia were defined as the secondary outcome variables. One hundred and four patients (167 joints) with a mean age of 14.6 ± 1.81 years were included in this study. Postoperative MRIs showed that all disks had been repositioned with an overall success rate of 94%. Statistically significant differences were found in the improvement of condylar height (P < .001), mandibular asymmetry (P < .001), and retrognathia (P < .001) after 1 year of follow-up. The relapse rate in patients <15 years (8.57%) was higher than that of patients older than 15 years (4.12%), although this was not statistically significant (P=.387). For juvenile patients, disk repositioning by suturing through an open incision was an effective treatment. Early surgery can promote condylar regeneration and alleviate maxillofacial deformity in juvenile patients.

Arthroscopic Disk Repositioning After Failed Open Disk Repositioning.

Open disk repositioning has been long achieving excellent functional and stability outcomes. However, still remains some relapses for whom a second open surgery is often challenging. This study aimed to evaluate the effectiveness of arthroscopic disk reposition as an alternative surgery for unsuccessful cases of anterior disk displacement (ADD) after an initial open disk repositioning. This retrospective study included all patients who underwent secondary arthroscopy for disk repositioning of the relapsed ADD after an initial open surgery between January 2012 to June 2017. The redo arthroscopic disk repositioning and suturing procedure was the primary predictor input variable in this study. Outcome evaluation was based on both clinical (visual analog scale and maximal interincisal opening) and magnetic resonance imaging data. Twenty-seven joints fulfilling the inclusion criteria were included. A significant improvement was detected at 24-month postoperatively compared with the baseline visual analog scale. The maximal interincisal opening showed a statistical improvement from 25.07mm preoperatively to 38.44mm at 24-month postoperatively. Twenty-six joints maintained a stable disk position with only 1 joint relapsed to ADD without reduction. Arthroscopic disk reposition and suturing technique is a reliable and effective repeat surgery after failed initial open disk repositioning for management of ADD.

Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles

BackgroundDisc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery.MethodsPatients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes.ResultsSeventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group.ConclusionsDisc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.

Stability of the contralateral temporomandibular joint disk position after disk repositioning on one side

To evaluate the stability of the contralateral temporomandibular joint disk position after disk repositioning on 1 side. Patients with unilateral anterior disk displacement (ADD) treated by disk repositioning from 2015 to 2019 were included in the study. The contralateral disk status was classified as follows: normal, ADD with reduction (ADDwR), and medial/lateral displacement. At 1-year follow-up, changes in the contralateral disk position were evaluated by MRI. Two hundred thirty-four patients were included in the study. There were 84 disks with normal position, 51 with ADDwR, and 99 with medial/lateral displacement (M/LD) in the contralateral joint. At 1-year follow-up, all the repositioned disks were stable without relapse. In the contralateral joints, 75% of the disks with normal position were unchanged compared with 43.1% of the ADDwR and 54.5% of the M/LD. ADDwR had the highest rate of changing to ADDwoR compared with the disks in normal position (4.8%) and M/LD (7.1%, χ2=16.13, P < .001). There were 28.3% of M/LD disks and 3.9% of ADDwR that changed to normal position. After unilateral disk repositioning, most of the contralateral disks with normal position were stable. M/LD disks tended to move to normal position, whereas ADDwR was largely changed to ADDwoR.

Use of the Temporalis Myofascial Flap in Internal Derangement of the Temporomandibular Joint - An Evaluative Study.

Internal derangement is an abnormal relationship between the articular disc and the mandibular condyle. The most common cause is trauma. Various classifications have been given for internal derangement. Initial management is done conservatively and if the disease is progressed, surgery is the option. Various surgical methods and interpositional materials following discectomy have been given in the literature. Over the past 15 years, we selected a group of 30 patients, Wilkes Class IV and V where conservative therapy had failed and were candidates for surgery. The patients had their disc repositioned, the damaged part of the disc was excised and disc was reinforced using the temporalis myofascial flap (TMF). In cases where the disc was non-salvageable, discectomy was done and TMF was placed between condyle and glenoid fossa, sutured with Prolene. The follow-up period was 3 years. Of the 30 patients, there were 9 male and 21 female. Range of mouth opening was 3.3-3.8 cm with improvements in 1 year. The jaw relations gradually improved and were restored after 3 weeks. Patients were totally pain free in 6 months. For the cases where surgery is the line of treatment, we strongly suggest disc repositioning and reinforcement with TMF as the flap is bulky, locally available and easy to harvest and causes no deformity at the donor site.

Role of Orthodontic Tooth Movement on Temporomandibular Joint: An Original Research.

Introduction:Orthodontic treatment may bring about changes in the temporomandibular joint (TMJ) disc. Hence, we aim to assess the impact of the orthodontic tooth movement on the articular disc repositioning of TMJ.Materials and Methods:We conducted an observational prospective study among 50 class IIdiv-I subjects. The magnetic resonance images were used to evaluate TMJ during the orthodontic treatments. The phases were T1-start of treatment, T2-thru phase I, T3-at the end of phase I, and T4-at the end of phase II. The qualitative values were compared for the disc changes.Results:No significant changes in the disc position or the regression were seen with open or closed mouth between T1-T3, T3-T4, and T1-T4. Significant variation for the position of the disc was seen in the opened mouth between T3-T4. Significant variation for the form of the disc was seen when closed at T1-T2 and T2-T3.Conclusions:Disc of the TMJ maintained the form and position during the treatments.

Clinical Effects of the Combination of Rhytidectomy and Temporomandibular Joint Disc Repositioning Surgery.

This study aims to investigate the clinical effects of the combination of rhytidectomy and temporomandibular joint (TMJ) disc repositioning surgery in internal derangement (ID) stage IV-V and facial aging patients. Eighteen facial aging with bilateral ID IV-V patients were enrolled in this study. All of them had undergone temporomandibular disc repositioning surgery and rhytidectomy by the same surgeon (Yao Min Zhu). Pre-/post-surgical clinical manifestations, facial photography, radiographic data were recorded and analyzed, as well as doctor, patient, third-party evaluation of postsurgical facial appearance satisfaction. The average age of 18 female patients was 52.9. The average of presurgical visual analog pain scale score was 5.94, ranged from 4 to 8. After 6 months, the average of postsurgical visual analog pain scale score was 0.28, ranged from 0 to 1 ( P > 0.05). The average maximal mouth opening of presurgical and postsurgical was 2.19 and 3.29 cm, ranged from 1.2 to 2.8 cm and 3.0 to 3.5 cm, respectively ( P < 0.05). Postoperative magnetic resonance imaging showed the location of the bilateral TMJ discs directly above the mandibular condyle. The satisfaction rate of doctors, patients and third-party with facial appearance was 95% to 98%, 96% to 99% and 96% to 99%, respectively, with an average of 95.72%, 98.11%, and 97.50%. For patients with bilateral ID IV-V and facial aging, the combination of disc repositioning surgery and rhytidectomy is a very feasible procedure to treat TMJ disorders and improve patients' facial appearance and satisfaction.

The Effect of Condylar Regeneration After Different Disc Repositioning Surgeries in Adolescents with Skeletal Class II Malocclusion

To evaluate the effect of different temporomandibular joint (TMJ) disc repositioning surgeries for the treatment of anterior disc displacement (ADD) in juvenile patients with skeletal Class II malocclusion. Patients (< 20 years, cervical vertebral maturation stage, IV-V) who had bilateral TMJ ADD with skeletal Class II malocclusion were treated by disc repositioning surgery (mini-screw anchor, [MsA]; or opening suturing, [OSu]). Magnetic resonance imaging (MRI) and lateral cephalometric films before and more than 12 months after surgery were collected from all patients. Changes of SNA, SNB, ANB, incisor overjet, pogonion position (pg'-G'), and condylar height were measured before and after surgery in different disc reposition surgeries and compared by statistical analysis. Eighty-four patients with an average age of 16.44 years and follow-up time of 14.60 months (12 to 33 months) were included in the study. Among them, 16 patients had a mean follow-up of 14.8 months without treatment before disc repositioning. Their condylar height was significantly decreased (P = .004) by MRI measurement. Six patients who had cephalometric films showed significantly decreased SNB (P = .042) and increased overjet (P = .037). After disc repositioning by either OSu (54 cases) or MsA (30 cases), condylar height, SNB were significantly increased and overjet, Pg'-G', ANB were decreased in both groups (P < 0.001). There was more new bone height in OSu than MsA (P = .004), but no significant differences in SNB, ANB, overjet and Pg'-G' between the 2 groups (P > .05). The new bone height was significantly correlated with the surgical method (P = .029), age (P = .015), SNB (P = .008), overjet (P = .048) and pg'-G' (P = .001). Both types of disc repositioning method can effectively promote condylar regeneration and improve skeletal Class II malocclusion in adolescents with ADD. Disc repositioning by OSu obtained more new bone height than MsA.

Single portal arthroscopic temporomandibular joint discopexy: Technique and results

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint.A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score.A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient.A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.

Does arthroscopic lysis and lavage in subjects with Wilkes III internal derangement reduce pain?

The aim of this study was to determine the efficacy of arthroscopic lysis and lavage on pain in patients with unilateral Wilkes stage III derangement of the temporomandibular joint. Authors retrospectively evaluated whether the arthroscopic lysis and lavage has an impact on pain decrease in patients with moderate osteoarthritis. Patients with unilateral Wilkes III of temporomandibular joint were included in this study. All patients underwent arthroscopic lysis and lavage (ASC-L), assessed pain before and after the procedure (primary outcome variable), maximal interincisal opening (MIO) was recorded as secondary outcome variable. The patients also subjectively assessed whether they were satisfied with the outcome of the arthroscopy or whether their condition required further interventions. The disc position was evaluated by magnetic resonance imaging (MRI) 24 months after the arthroscopy and compared with the disc position on the MRI prior to the arthroscopy. The R Project for Statistical Computing 3.4.1 and the Gretl Pro programs were used for statistical analysis. In addition to the descriptive statistics methods, the Shapiro-Wilk normality test was used to verify data normality and the two sample t test used to test the hypotheses themselves. The sample consisted of 62 patients who underwent arthroscopic lysis and lavage (ASC-L) in 2015 and 2016. It included 6 men and 56 women with an average age of 34.37. Pain and MIO were recorded during regular check-ups 1, 3, 6, 12, and 24 months. A therapeutic effect (MIO over 34 mm, VAS score 0-1) was recorded in 69% of cases 24 months after the ASC-L. Nonetheless, the work demonstrated the importance of subjective assessment, as 87% of patients perceived their condition as satisfactory after 24 months and not requiring further intervention, while 8 patients (13%) perceived it as unsatisfactory. Disc reposition 24 months following the ASC-L was recorded in only 44% of patients who assessed their condition as satisfactory. Patients with persistent disc dislocation 24 months after the arthroscopy were older, had a lower average maximal interincisal opening value before the ASC-L and a longer duration of mandibular movement restriction before the ASC-L (evaluated as a statistically significant difference). In this study, the authors confirmed that ASC-L is an effective therapeutic method in patients with WIII, from both clinical and subjective perspectives. This work demonstrated that improvement in patients with Wilkes stage III is not related to disc reposition. Postoperative physiotherapy is an integral component of ASC-L and is reflected in the final results.