Interincisal Mouth Opening Research Articles

Influence of Discoplasty and Discectomy of the Temporomandibular Joint on Elimination of Pain and Restricted Mouth Opening

The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.

A review of 56 cases of chronic closed lock treated with temporomandibular joint arthroscopy

Purpose: The aims of this prospective clinical study were to look at the features that constitute chronic closed lock of the temporomandibular joint (TMJ) and to assess the effectiveness of TMJ arthroscopic lavage and lysis in the management of this condition. Patients and Materials: Sixty joints in 56 patients who presented with mandibular hypomobility suggestive of chronic closed lock were prospectively examined and treated with TMJ arthroscopic lavage and lysis during a 3-year period from 1996 to 1999. Results: Eighty-seven percent (49 of 56) of patients were found to have chronic closed lock of the TMJ. The most common intra-articular findings were fibrillation (76%) and synovitis (54%). TMJ arthroscopic lavage and lysis were found to be effective in the management of chronic closed lock in 84% (47 of 56) of patients, with an average 66% reduction in pain levels and a mean improvement of 9.8 mm in interincisal mouth opening up to 6 weeks after the procedure. Conclusions: Chronic mandibular hypomobility is a clinical sign that is often but not always caused by chronic closed lock of the TMJ. The intra-articular findings of this study suggest that cartilage degradation and synovial inflammation are important components of chronic closed lock of the TMJ that respond well to arthroscopic lavage. Patients with mandibular hypomobility not caused by closed lock of the TMJ (ie, myofascial pain and dysfunction, osteoarthrosis, and others) are less likely to derive benefit from arthroscopic lavage and lysis, so other treatment methods should be considered. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:519-524, 2002

関節洗浄マニピュレーション法の治療成績の検討

To evaluate the efficacy of lavage manipulation technique, 15 patients with persistent closed lock of the TMJ were treated by this method. The patients consisted of 1 male and 14 females. Age of the patients ranged from 18 to 66 years, with an average age of 33 years.This technique was followed by pumping of the upper compartment to distend the joint space after local anesthesia with sedation in the outpatient clinic. Two 18-gauge needles were inserted into the superior compartment to enable a free flow of the solution through the joint space. Physiological saline solution was injected via one of the needles under a sufficient pressure to irrigate 200 to 500 ml of the solution a during 20-minute period. During a 3-month follow-up of the method, interincisal mouth opening of the patients improved from a range of 7 to 25 mm, with an average opening of 14.9 mm.The results indicate that lavage manipulation technique is an effective method for treating patients with closed lock which can be performed under local anesthesia with sedation in the outpatient clinic.

Facial growth after treatment of unilateral temporomandibular joint ankylosis in childhood without growth centre transplantation: A serial cephalomorphometric study

Our aim was to study the influence of early surgical treatment of temporomandibular joint ankylosis on further facial growth and development. At the Department of Maxillo-Facial Surgery, Zurich, 11 children with a unilateral TMJ-ankylosis met the criteria of a maximal preoperative interincisal mouth opening of 15 mm, of a minimal long-term postoperative interincisal mouth opening of 30 mm, and of excellent documentation. 30 anatomical landmarks were defined on the copies of the follow-up cephalograms using the structure-superimposition technique. The points were perforated and digitized. Analysis and graphic-plotting were followed by computer. The hypothesis that mandibular growth continues once the ankylosis was successfully treated (without transplantation of a growth centre) and mandibular function definitely restored, was confirmed. The treatment does normalize the growth rate, but it seems that abnormal growth patterns cannot be influenced by it. As a consequence, the surgical release of the ankylosis should be performed as early as possible.