Disc Repositioning Research Articles

Treating Malocclusion After TMJ Surgery for Internal Derangement

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 paients (72 joints) who presented with a Wilkes class III or V internal derangement that had failed conservative herapy and were proposed surgical correction. All paients underwent the same surgical technique for repoitioning of the TMJ disc using a Mitek mini anchor. All urgeries were performed by the same surgeon. Thirtyve patients were placed in class III guiding elastic mmediately postoperatively for 2 weeks. Seven patients id not receive class III guiding elastics. The patient’s cclusion was recorded before and after surgery. All atients completed a preand post-operative visual anaogue scale assessing their symptoms and occlusion. ostoperative MRIs in a small subset of these patients ere also obtained to corroborate surgical success and isc position. Results of Investigation: All 35 patients who received lass III guiding elastic did not experience any maloccluion postoperatively. All 7 patients that did not receive uiding elastics experienced malocclusion. Four of hose patients’ malocclusion did not resolve over time and re currently awaiting corrective jaw surgery. Three of the even patients who did not receive the guiding elastic had alocclusion that resolved after 3 to 4 months of heavy hysical therapy. All patients had improvement of their ain and resolution of their chief TMJ complaint at longest ollow up. Conclusion: The use of class III guiding elastic is a imple and noninvasive technique to treat malocclusion fter TMJ disc repositioning surgery.

The Efficacy of Arthroscopic Disc-Repositioning (Discopexy) in Internal Derangement of the Temporomandibular Joint

The purpose of this study is to assess the outcome of using temporomandibular joint (TMJ) arthroscopy disc repositioning (discopexy) as a minimally invasive surgical treatment for TMJ internal derangement (ID).

Arthroscopic Treatment for Intra-Articular Adhesions of the Temporomandibular Joint

To introduce arthroscopic surgery of intra-articulator adhesion of the temporomandibular joint (TMJ) upper compartment and evaluate its effect. One hundred forty-two patients (159 joints) with intra-articular adhesions confirmed by arthroscope were treated with lysis of the adhesions, intra-articular cleanup surgery, or capsule radiofrequency catheter ablation. One hundred ten patients (123 joints) with disc displacement were treated with the disc repositioning and suturing technique. The follow-up index includes jaw movement, visual analog scale pain value, and patients' self-evaluation. The therapeutic effect was divided into excellent, good, and poor. Excellent and good patients were defined as effective. Jaw movement and visual analog scale pain value before and after the operation were evaluated by a paired t test. The average follow-up period was 10.3 months (range: 2-27 months), and 33.80% (48/142) of all joints were excellent; 56.34% (80/142) were good, and 9.86% (14/142) were poor. The total effectiveness rate was 90.14% (128/142). Of all patients, 93.66% (133/142) felt more comfortable than they had before the operation. The interincisal opening increased from a preoperative 23.14 ± 5.93 mm (range: 10-40 mm) to postoperative 37.48 ± 3.51 mm (range: 30-40 mm; P < .01), and the pain scores were reduced from 28.94 ± 23.54 (0-80) to 4.44 ± 10.10 (0-40; P < .05). The effect of arthroscopic surgery on temporomandibular joint intra-articular adhesion was positive. It can increase the mouth's range of motion, improve jaw function, and reduce pain during jaw movement.

The posterior double pass suture in repositioning of the temporomandibular disc during arthroscopic surgery: A report of 16 cases

Aim Several procedures have been described to reposition and secure the disc during arthroscopic surgery of the temporomandibular joint. The usefulness of these procedures remains controversial since simple lysis and lavage shows a high percentage of clinical success and it is difficult to obtain radiological imaging of the surgically acquired new disc position. This report describes a new arthroscopic discopexy method, and the clinical as well as radiological results obtained with this new technique. Methods Sixteen patients with a clinical and radiological diagnosis of Temporomandibular Joint (TMJ) dysfunction (TMD) were treated using our discopexy method. Each patient was evaluated with a visual analogue scale (VAS) for pain, radiological and functional parameters. The evaluation also included a clinical examination. Each patient was recorded at baseline before surgery and at a one-year follow-up. Statistical analysis was performed to evaluate the differences in VAS, maximum opening and lateral movements before and after treatment and were considered statistically significant when p < 0.05. Results Patient evaluation showed an improvement in the clinical parameters. There were statistically significant reductions in the amount of pain according to the VAS ( p < 0.01). Maximal interincisal opening (MIO) and contralateral translation movement (CTM) ( p < 0.05) were substantially improved one-year after operation. In the post-surgical MRI study at the one-year follow-up, a significant improvement in the disc position was observed in 13 out of the 16 joints operated on. Conclusion This method of arthroscopic disc repositioning is an effective surgical method for treating symptomatic patients with a diagnosis of TMJ disc displacement. Because of the minimally invasive character of the procedure, it should be considered in the surgical treatment of TMJ dysfunction.

Malocclusion as a Common Occurrence in Temporomandibular Joint Arthroscopic Disc Repositioning: Outcomes at 49 Days After Surgery

To evaluate the incidence, clinical manifestation, and prognosis of malocclusion after arthroscopic disc repositioning and suturing of the temporomandibular joint (TMJ). The study included 211 patients (270 joints) with internal derangement of the TMJ who underwent arthroscopic disc repositioning and suturing from November 2005 to August 2006. The occlusion was checked and recorded preoperatively and at different intervals (0, 3, 7, 14, 21, 28, 35, 42, and 49 days after surgery) for all patients. The incidence of malocclusion after surgery was determined for every follow-up period. The χ(2) test was applied to assess the statistical significance of the changes of the incidence of malocclusion. The incidences of malocclusion were 100%, 80.1%, 67.8%, 46.9%, 28.9%, 18.0%, 15.7%, 14.6%, and 14.2% at 0, 3, 7, 14, 21, 28, 35, 42, and 49 days after surgery, respectively. There was a significant difference between neighboring follow-up periods within 28 days after surgery, whereas there was no significant difference from 28 to 49 days after surgery (P > .05). The main clinical manifestations of malocclusion were posterior open bite on the surgery side, incisal prematurities, and mandible midline deviated or nondeviated. Malocclusion commonly occurs after TMJ arthroscopic disc repositioning and suturing. However, it will improve within 28 days after surgery in most patients. If malocclusion lasts over 28 days, appropriate treatments should be considered.

Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by Magnetic Resonance Imaging

BackgroundOpen joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs.MethodsConsecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique.ResultsPostoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.ConclusionsThis procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

20-Year Follow-Up Study of Disc Repositioning Surgery for Temporomandibular Joint Internal Derangement

The purpose of this study was to assess the outcomes of temporomandibular joint (TMJ) disc repositioning as a surgical treatment for TMJ internal derangement (ID). By retrospective chart review, all patients who had TMJ disc repositioning for treatment of TMJ ID from 1984 to 1990 were identified. Attempts were made to locate these patients, and they were sent a TMJ questionnaire. The questionnaire provided subjective (pain and diet consistency) and objective (mandibular function) data. The chart review yielded 153 patients. Complete TMJ questionnaires were obtained from 18 patients (36 joints). Analysis of data showed a reduction in pain scores, an improvement in diet consistency, and an increase in mandibular range of motion. The majority (94%) reported an improvement in quality of life. Outcome data presented show that TMJ disc repositioning is an effective and successful surgical treatment for TMJ ID. This success has been maintained for 20 years in this specific patient population.

New Arthroscopic Disc Repositioning and Suturing Technique for Treating Internal Derangement of the Temporomandibular Joint: Part II—Magnetic Resonance Imaging Evaluation

To evaluate the efficiency of an arthroscopic suturing technique for stabilizing anteriorly displaced discs in patients with internal derangement of the temporomandibular joint (TMJ) by magnetic resonance (MR) imaging. Six hundred thirty-nine patients (764 joints) diagnosed as having stages II to V of internal derangement were treated with arthroscopic disc repositioning and suturing from August 2004 to March 2007. Consecutive MR images were used to evaluate internal derangement before and approximately 1 to 7 days after the operation for all 639 patients. The disc position of the TMJ was judged according to the success criteria, which included 3 different sagittal planes (lateral, central, and medial). Operative efficiency in those patients, whose discs of the TMJ were affirmed to be in a normal position in all 3 planes, was evaluated to be excellent. Those patients whose discs were in a normal position in 2 planes were evaluated to be good. The others were evaluated to be poor. Cases evaluated as excellent and good were considered success cases (if the disc is displaced only in 1 or 2 planes before operation, the efficiency of the operation would be evaluated as a success only if the whole disc was in normal position). Postoperative consecutive MR images for all 764 joints confirmed that 95.42% (729/764) of the joints were excellent, 3.14% (24/764) were good, and only 1.44% (11/764) were poor. Repeated arthroscopic surgery or open surgery was carried out for the joints that were evaluated as poor. This study indicates that the TMJ arthroscopic suturing technique is effective in repositioning the TMJ disc as confirmed by an MR imaging examination, but long-term follow-up is necessary.

Surgical Management of Mandibular Condylar Hyperplasia Type 1

This study compared outcomes of two surgical methods for patients diagnosed with active condylar hyperplasia type 1. Group 1 (n = 12) was treated with orthognathic surgery only, while group 2 (n = 42) was treated with high condylectomies, articular disc repositioning, and orthognathic surgery. There was no statistically significant difference between the two groups for maximum incisal opening, lateral excursions, and subjective jaw function before surgery. Group 2 showed more active presurgical mandibular growth (P < 0.05). At long-term follow up, no differences were found in lateral excursions and subjective jaw function. Group 2 showed a greater increase in maximum incisal opening (P < 0.01) and stability (P < 0.05) at long-term follow-up. All of the patients in group 1 grew back into skeletal and occlusal Class III relationships requiring secondary intervention, whereas all patients in group 2 remained stable in a Class I skeletal and occlusal relationship. Thus, patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery had stable, predictable outcomes compared with those treated with orthognathic surgery only. The high condylectomy effectively arrests disproportionate mandibular growth while maintaining normal jaw function.

P.258 Modifled intra-oral inverted “L” osteotomy

To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models.Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery, immediately after surgery, and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base.The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA.One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.

P.380 Immediate maxilla prosthesis for maxillectomy patients

To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models.Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery, immediately after surgery, and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base.The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA.One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.

Arthroscopy Surgery for the Treatment of Chronic Closed Lock of the Temporomandibular Joint: A Clinical Study in 344 Arthroscopic Procedures

cant surgical changes, but remained stable at long-term follow-up. All 15 patients had statistically significant reduction in the incidence and severity of facial pain and headaches (61.5%), and TMJ pain (100%). There was significant improvement of jaw function (63.3%), dietary restrictions (57.9%) and disability (60%). There was significant reduction post surgery of average MIO (9.2%) and lateral excursions (right side 37.5% and left side 30.8%). Conclusions: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor (no recurrence of the tumor was encountered in any of the cases) and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction. The significant long-term stability of TMJ and orthognathic surgery movements and significant reduction of TMJ dysfunction and pain symptoms demonstrate the benefits and predictability of managing these complex patients with this treatment protocol.

Analysis of estrogen binding sites of the posterior ligament of the human TMJ

Conflicting results have been reported regarding the presence or absence of estrogen-binding sites (EBS) in the human temporomandibular joint (TMJ). The possible role of female sex hormones in the pathophysiology of internal derangement of the TMJ has been suggested to explain the prevalence of TMJ symptoms in female patients. Posterior bilaminar tissue excised during TMJ articular disc repositioning and posterior ligament repair was taken from 28 patients (26 female, 2 male) for evaluation. Cryosections were stained using a monoclonal antibody (Mab) against EBS. To ensure efficacy of the antibody staining procedure, an internal positive control consisting of human breast tissue previously proven EBS-positive was used. No asymptomatic control TMJ tissue was available for our study. None (0%) of 28 TMJ tissue specimens showed nuclear-staining positive for the presence of EBS in the posterior bilaminar tissue of the TMJ. However, estrogen-binding sites associated with probable inflammatory cells were observed. Our results are consistent with the probability of positives as high as 0.1234 using a 95% confidence interval. The lack of EBS of the posterior ligament of the TMJ suggests that the role of estrogen contributing to internal derangement of the TMJ appears not to be significant.

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.

Temporomandibular Joint Arthroscopic Arthroplasty with Rigid Disc Fixation— Preliminary Results in Treatment of Wilkes Internal Joint Derangement Stages II-V: A 3-Year Retrospective Study

Temporomandibular Joint Arthroscopic Arthroplasty with Rigid Disc Fixation— Preliminary Results in Treatment of Wilkes Internal Joint Derangement Stages II-V: A 3-Year Retrospective Study

Posttraumatic temporomandibular joint ankylosis: clinical development and surgical management

To investigate the patterns of condylar fractures associated with temporomandibular joint ankylosis (TMJA) and treatment methods and results based on the different types of ankylosis. Forty-two joints of ankylosis in 31 patients with were categorized to four groups according to Sawhney's classification and undergone surgical treatment as follows: a joint release and disc reposition for Type I ankylosis, a dissection of bony block and disc reposition for Type II; a dissection of full-joint and employment of the temporal myofascial flap as interposition for Type III; a radically dissection of full joint followed by ramus distraction osteogenesis and genioplasty for Type IV. All of patients were followed up for 9 to 54 months with an average of 30 months. The range of mouth opening and temporomandibular joint (TMJ) function were assessed. Condylar fractures were retrospectively investigated on the patterns and the course of ankylosis development. Macroscopical visualization on the osseously ankylosed sites and disc displacement were analyzed in comparison with the radiological findings. Condylar sagittal and comminuted fractures were most susceptible to TMJA. Early fibrous ankylosis occurred usually at the 4th or 5th month post-traumatically with an average month opening of 18.3 mm. The articular discs were found displaced in all cases and early bony bridge formed at a limited area where there was no disc as cushion. During fellow-up, considerable improvement in mandibular movement was attained with a stable joint function and mouth opening range of over 30 mm except for two cases in which ankylosis relapsed. Condylar sagittal and comminuted fractures are most likely to cause ankylosis. Early surgical intervention could reduce the disc and avoid the later ankylosis.

P.351 Umbrella perforated screw for treatment of painful non-reducing disk displacement in TMJ disord

Purpose: The aim of the present study was to present a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the head of the mandibular condyle. Patients and Methods: Six patients (4 females and 2 males) with an average age of 22.3 years (range, 13 to 32 years) and with an osteochondroma of the mandibular condyle were treated with conservative condylectomy. The remaining condylar neck stump was recontoured, and the articular disc was repositioned and stabilized over the “new” condyle. Any indicated orthognathic surgical procedures were then performed to optimize occlusion, function, and aesthetics. Clinical and radiographic evaluation was performed before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3). Results: Average follow-up for the patients was 51 months (range, 22 to 108 months). No recurrence of the tumor was encountered in any of the cases. Subjective and objective evaluations of postsurgical temporomandibular joint function and range of mandibular motion were normal. Associated maxillary and/or mandibular orthognathic procedures were found to be stable in the long term. Conclusion: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:262-268, 2002

High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint

The article shows the 1-yr results comparing the efficacy of open-surgery high condylectomy and disc repositioning and the arthroscopic procedure of lysis, lavage and capsular stretch in patients with chronic closed lock of the temporomandibular joint (TMJ). Twenty patients with a clinical and radiologic diagnosis of chronic closed lock were randomly chosen to be treated with either open surgery or arthroscopy. Each patient was evaluated with a visual analog scale (VAS) for pain and a mandibular functional impairment questionnaire (MFIQ). The evaluation also included a clinical examination. Each patient was recorded at baseline before surgery and at 1-yr follow-up. Statistical analysis was made to evaluate whether differences in MFIQ, VAS, maximum opening and protrusion, lateral joint tenderness, muscle tenderness, crepitation, and clicking at 1-yr follow-up from baseline were significant. Results were considered statistically significant when P < .05. Both open surgery and arthroscopic surgery reduced pain and improved mandibular function. The severity of pain was significantly reduced in both groups (P = .005). In both the open and arthroscopy groups mandibular function improved significantly (P = .005). The clinical examination showed similar good results for the 2 surgical procedures. At 1-yr follow-up a majority of patients from both the open (80% of the patients) and the arthroscopy (70% of the patients) groups fulfilled the criterion of a cutoff point for maximum interincisal opening of equal or more than 35 mm (P = 0.005); all the patients in both groups fulfilled the criterion of the cutoff point for maximum protrusion of more than 5 mm (P = .007). At 1-yr follow-up, clicking was the same as before surgical procedures; no patient in the open group showed crepitation, but crepitation was found in patients in the arthroscopy group. Joint tenderness and pain on lateral palpation as well as muscle tenderness and pain were reduced in all the cases, disappearing in some of them, but the difference was significant only regarding joint tenderness (open surgery, P = .016; arthroscopy, P = .031). Open-surgery high condylectomy and disc repositioning and the arthroscopic procedure of lysis, lavage and capsular stretch are both effective surgical methods to treat symptomatic patients with a diagnosis of chronic closed lock of the TMJ. Because of the minimally invasive character of the arthroscopic procedure, it should be considered as the first choice in the surgical treatment of the TMJ.

Prospective Multicenter Comparison of 4 Temporomandibular Joint Operations

This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. A prospective, controlled study of arthroscopy, condylotomy, discectomy, and disc repositioning was conducted at 3 sites. All sites used the same inclusion and exclusion criteria. Trained, independent examiners assessed pain, diet, and range of motion before operation and 1 month and 1 year after operation. There were statistically significant reductions in the amount of pain ( P < .001) and daily time in pain ( P < .001) that were similar for all 4 operations 1 month and 1 year after the procedures. The degrees of change after each of the 4 procedures were not statistically different from each other (amount: P = .453 and time: P = .416). Ability to chew, as measured by diet visual analog scale, was substantially improved 1 year after operation ( P < .001). The degrees of change for diet at 1 year also were not different from each other ( P = .314). There were, however, statistically significant differences ( P < .05) in range of motion that varied with procedure. All 4 operations were followed by marked improvements in pain and diet. The amounts of improvement varied slightly by operation, but these differences were not statistically significant. There were small but statistically significant differences between procedures for range of motion. If these findings are confirmed, they have an important implication for procedure selection.

Function of disk reposition in the treatment of traumatogenic temporomandibular joint ankylosis

To investigate the method and results of disk reposition in the treatment of traumatogenic TMJ ankylosis. In 19 cases of traumatogenic ankylosis of TMJ, the dislocated disks were repositioned during anthroplasty. In the operation, the dissection of dislocated disk was performed carefully around the TMJ. The disk was repositioned to its anatomic location over the top of condylar stump, then the lateral aspect of the disk was sutured to the soft tissue of zygomatic root. At the last follow-up examination, interincisal opening distance ranged from 24 to 43 mm in all cases (mean 32.63 mm), which approached or reached the normal level. No recurrence and TMJ symptom were found during the period of follow-up. The disk repositioning in treatment of traumatogenic TMJ ankylosis is a feasible and effective approach to reconstruct the structure and function and prevent recurrence.