Maximum Interincisal Opening Research Articles

Accuracy of digital templates for guidance of custom-made total temporomandibular joint replacement

This study evaluated the application of digital templates to guide custom-made total temporomandibular joint (TMJ) replacement. Patients treated with a custom-made total TMJ prosthesis for TMJ osteoarthrosis, ankylosis, or tumours were included prospectively. Before surgery, two types of digital template (articular eminence and condyle neck templates) were designed to guide the bone osteotomy and prosthesis positioning. The reconstructive outcomes were assessed through clinical examinations and accuracy analysis by superimposing the postoperative three-dimensional craniomaxillofacial model onto the preoperative virtual plan. Thirty-seven patients (45 joints) underwent successful TMJ reconstruction with the custom-made TMJ prosthesis guided by the digital templates, without intermaxillary fixation. For all patients, the occlusal relationship was stable in reference to the preoperative state. There were significant improvements in pain and maximum inter-incisal opening. Through merging of the pre- and postoperative craniomaxillofacial models, the maximum implanted error was 1.17 ± 0.23 mm in linear measurement and 1.19 ± 0.14 mm in surface deviation. There was more deviation in the anteromedial part of the fossa and inferior part of the mandibular handle. The digital templates were able to assist in the accurate placement of the TMJ prosthesis without the need for intermaxillary fixation.

Comparing open and closed treatment strategy in adult patients with condylar head fractures. What is associated with a better functional outcome?

IntroductionIntracapsular condylar fractures are an important component of craniofacial trauma. The indication for open repair has been historically controversial. A review of the literature was performed to compare functional outcomes of open vs closed treatment strategies of condylar head fractures, as well as to identify indications for operative management.Few systematic reviews have been conducted specifically addressing condylar fractures, however none to our awareness specifically address the condylar head fracture. MethodA literature review was designed and implemented to evaluate the functional outcomes and indications for open reduction of condylar head fractures versus closed treatment. A comprehensive electronic search of studies published between 2001 and 2021 of adult patients with condylar head fractures was conducted. ResultsThe literature review identified 18 articles that met the inclusion criteria. The majority of studies showed improved functional outcomes in the open reduction group with regards to maximal interincisal opening, excursive movements, deviation of midline, malocclusion, ankylosis, and chronic pain. Indications for operative management of condylar head fractures vary, however ramus shortening with loss of vertical height seems to be the prevalent indication. ConclusionThere is not yet one overriding consensus dictating management of condylar head fractures. It appears more and more studies are supporting the idea that better functional outcomes (and quicker return to function) are achievable using an open reduction strategy. However, closed treatment remains a valid option in some cases. Therefore, the most appropriate treatment must still be personalised to the individual patient.

Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer

Trismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication. To assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus. This retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were referred for treatment of radiation-associated trismus. Intraoral MT (including or excluding external head and neck) targeting the muscles of mastication. Maximum interincisal opening (MIO) before and after the initial MT session compared with serial MT sessions. Covariates were examined to determine the association with response to MT for trismus. A total of 49 survivors of HNC (13 women [27%]; 24 [49%] 64 years or younger; 25 [51%] 65 years or older; mean [range] of 6.6 [0-33] years postradiotherapy were included, 9 [18.4%] of whom underwent a single MT session; 40 [81.6%] who underwent multiple sessions [mean, 6; median (range), 3 (2-48)]). The MIO improved after a single session by a mean (SD) of 4.1 (1.9) mm (0.45 effect size) and after serial MT sessions by a mean (SD) of 6.4 (4.8) mm with an effect size of 0.7. No covariates were found to be clinically meaningfully associated with MIO improvement following MT. The findings of this case series study suggest that MT improved MIO with a medium to large effect size in survivors of HNC with radiation-associated trismus. The results suggest that the largest increase in oral opening was achieved after the initial treatment and although gains were more modest, oral opening continued to improve with serial treatment. Covariates were not associated with MT response, suggesting that patients with clinical features often considered treatment refractory (eg, advanced disease, multiple lines of oncology treatment, ≥5 years posttreatment) may benefit from treatment with MT. Manual therapy may be a beneficial frontline or adjuvant treatment when combined with traditional stretching therapy. A clinically meaningful increase in oral opening has the potential to improve swallow function, speech, pain, and quality of life.

Preoperative Arterial Coil Embolization for Temporomandibular Joint (TMJ) Surgery in Children with TMJ Ankylosis.

Temporomandibular joint (TMJ) ankylosis in children can alter facial development and affect oral hygiene and function. Surgical release of the ankylosis is the mainstay of treatment. The authors hypothesize that preoperative arterial coil embolization is safe and effective in preventing major blood loss during TMJ surgery (loss prompting blood transfusion or hemodynamic instability requiring vasoactive medication administration) in children with TMJ ankylosis. Patients < 16 years who were diagnosed with TMJ ankylosis (<15 maximal interincisal opening) and had embolization before surgery in the last 5 years were included. Out of 9 initial search results, 3 patients were excluded (age > 16). Information gathered were patient demographics, diagnostic imaging, procedural details, complications, and clinical outcomes. Six patients, mean age 11.14 years (range 7-15 years) year and a mean weight of 40.8 ± 19 kg were included. Underlying etiologies for TMJ ankylosis: Pierre Robin Syndrome (n = 2), juvenile rheumatoid arthritis (n = 1), Goldenhar's syndrome (n = 1), trauma (n = 1), and micrognathia (n = 1). Neck computed tomography angiogram before embolization demonstrated an intimate approximation between the internal maxillary artery (IMAX) and/or external carotid artery and ankylotic mass in all patients. Eight successful embolizations were performed without procedural complication. In 1 patient with angiographic evidence of surgical internal maxillary artery ligation, embolization was performed via collaterals. Surgery was performed within 48 hours of embolization. Airway access during surgery was via nasal intubation (n = 4), oral intubation (n = 3). The estimated blood loss (EBL) during surgery was 78.33 ± 47.08 ml. Three patients had subsequent TMJ surgery with a mean estimated blood loss of 73.33 ± 46.18 ml. After a mean follow-up of 17 ± 15 months, patients showed a 13.8mm mean increment of maximal interincisal opening with 95% CI (5.74-21.9), P < 0.007.

The Efficiency of Different Arthroscopic Discopexy Techniques Based on Clinical and Radiographic Findings: A Systematic Review.

The aim of this systematic review was to evaluate the effectiveness of different temporomandibular joint arthroscopic discopexy techniques. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and an electronic search was performed using MEDLINE (PubMed), The Cochrane Library, ScienceDirect databases using a combination of the terms ''discopexy,'' ''disc recapture,'' ''disc fixation,'' and ''temporomandibular joint'' to identify clinical trials published from 2010. In total, 493 records were screened, of which only 9 fulfilled the inclusion criteria and were included in qualitative data synthesis. The results of clinical findings evaluation showed that arthroscopic discopexy statistically significantly improved levels of pain (VAS) and maximum interincisal opening whereas magnetic resonance imaging evaluation showed disc position improvement of up to 90% to 100%. In conclusion, this review provides the evidence of the potential benefits of arthroscopic disc fixation in the treatment of patients with internal derangements : reduced pain, increased maximum interincisal opening, and improved disc position evaluated by magnetic resonance imaging, whereas disc fixation using suturing techniques seems to be the most appropriate method.

Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized, double-blind clinical study

To assess the efficacy of dextrose prolotherapy on the clinical signs and symptoms of patients having disc displacement with reduction (DDWR).This prospective, randomized, double-blind clinical study included thirty patients suffering from bilateral DDWR. The patients were randomly divided into two equal groups. After induction of local anesthesia, each joint was injected in two sites; one in the superior joint space and the other in the retrodiscal tissue, using 25% dextrose solution in group I and normal saline in group II. Pain intensity, maximal interincisal opening (MIO), and joint sounds (JS) were evaluated preoperatively, 1 week after each injection, and 3 months and 6 months after the last injection.Patients in group I showed significant improvement in pain and MIO, and higher satisfaction with treatment than patients in group II. Compared to saline injection, dextrose injection resulted in an improvement in JS but without significant difference within and between groups.Intra-articular injection of 25% dextrose is effective in the treatment of pain and dysfunction of TMJ DDWR as shown by significant improvement in pain and MIO and patient satisfaction. The technique is simple, easy to do, safe and should be adopted whenever appropriate.

Is the prevention of condylar sag with maxillomandibular fixation the key to functional reconstruction of a mandibular disarticulation resection?

The aim of this study was to evaluate the long-term outcomes of the use of the free fibula flap for reconstruction with mandibular disarticulation resections. A retrospective chart cohort review was performed in patients reconstructed with a fibula free flap for a mandibular disarticulation resection at an academic tertiary care institution over a 5-year period. Twenty-four patients were included in the study. Fourteen patients were treated for benign pathology, and 10 cases were malignant. Average follow-up was 20 months. Virtual surgical planning/3-dimensional models were used in all cases. Maxillomandibular fixation (MMF) with surgical wires was used in 65% (n = 13/20) of the dentate patients. Average maximum interincisal opening was 28.2 mm in patients receiving radiation and 38.7 mm in the nonradiated group (P = .01). No patient developed joint ankylosis. Neocondyle position was an average of 11.7 mm from condylar fossa, radiographically. Seventeen of the dentate patients (85%) had reproducible class I occlusion. Occlusion was superior in patients placed into MMF compared with those with elastics or no MMF (P = .06) and independent of the position of the neocondyle (P = .19). The vascularized fibula flap can be used to provide functional reconstruction of the mandibular condyle defect. The use of at least 2 weeks of MMF maintains an adequate occlusion irrespective of the fibula-glenoid fossa position. The neocondyle does not need to directly abut the articular disc or fossa for adequate functional outcomes.

Comparative clinical outcomes between stock vs custom temporomandibular total joint replacement systems

With the evolution of temporomandibular (TMJ) prosthetic total joint replacement, there has been much debate around the advantages of custom over stock prostheses. The aim of this study is to compare the clinical outcomes of a TMJ stock prosthesis (Zimmer-Biomet) to a custom prosthesis (OMX).Clinical data from 139 prosthetic joints placed in 117 patients was retrospectively collected and analysed. All patients were diagnosed with end-stage joint osteoarthritis and were treated by a single surgeon. Minimum follow up was 2 years post-surgery.The cohort was divided into 2 groups, 60 stock prosthetic joints in 54 patients and 79 custom prosthetic joints in 63 patients. This comprised of 110 males and 7 females. The average age at the time of surgery was 53.4yr ± 12.7yr. There was no statistical difference in pre-operative MIO and pain scores between the two groups. Post-operatively, patients fitted with a custom prosthesis showed statistically significant (P = 0.013) improvement in Maximum Interincisal Opening (MIO) (+6.33 mm vs +2.53 mm) and fewer complications. Following surgery, no difference noted in pain scores and patient satisfaction between the two groups.In experienced hands, both stock and custom TMJ implants work well. However, the added advantages of custom prostheses together with growing access to digital technology is likely to result in custom devices dominating the market in TMJ total joint replacement systems.

Are Outcomes of Temporomandibular Joint Arthroscopy Influenced by Central Sensitization?

A proportion of subjects with internal derangements of the temporomandibular joint (TMJ) may have a central sensitization disorder that may affect pain perception after surgery. This study aims to estimate the association between fibromyalgianess (FMness) score, a summed score of the Widespread Pain Index (WPI) and Symptom Severity Sore (SSS), and outcomes following TMJ arthroscopy. A retrospective cohort study including individuals who received arthroscopy for TMJ internal derangement at Michigan Medicine between 2011 and 2020 was performed. A predictor variable, FMness score, was assigned via the sum of WPI and SSS. Univariate and bivariate analyses were performed. Linear-mixed effects models were used to analyze 6 different outcomes, each in their own model: pain, jaw functional limitation scale (JFLS), JFLS-mobility domain, pain-related disability, comfortable maximum interincisal opening, and active maximum interincisal opening. Covariance structure was selected based on null model fit separately for each outcome. Thirty-one subjects were included in the study sample. Twenty-eight subjects were female. Average age was 45.9years. Bivariate analysis demonstrated that subject's FMness score was not correlated with pain (b=0.03 [-0.10, 0.17] P=.59) or JFLS score (b=1.00 [-.80, 2.81] P=.27). However, subject's FMness score was significant for predicting JFLS-mobility domain score (b=.61, [0.05, 1.18] P=.04). A greater extent of central sensitization was associated with lower comfortable mouth opening after surgery, greater limitations in opening wide enough to eat various foods (higher JFLS-mobility scores), and higher pain-related disability. Future studies with larger sample sizes and reconstructive TMJ operations such as total TMJ arthroplasty may help clarify the impact of SSS and WPI scores on outcomes of TMJ surgery.

Prognostic indicators of arthroscopic discopexy for management of temporomandibular joint closed lock

In order to optimize patient selection for temporomandibular joint (TMJ) arthroscopic discopexy to achieve favorable outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting surgical outcomes following arthroscopic discopexy for management of TMJ closed lock using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment was performed pre- and post-operatively. Multivariate analysis was used to evaluate various prognostic variables including gender, age, side, duration of illness, Wilkes staging, parafunctional habits, splint therapy and orthodontic treatment. A total of 147 patients (201 joints) were included. The outcome was categorized as excellent (n = 154/76.61%), good (n = 34/16.91%), or poor (n = 13/6.46%) with a success rate of 93.54%. Patients aged > 30 years old (p = 0.048), longer duration of illness (12–24 months: p = 0.034) and (> 24 months: p = 0.022), and patients with Wilkes stage IV (p = 0.002) were all significantly more likely to be in the poor outcome group. Finally, orthodontic treatment showed a significant association with excellent outcomes (p = 0.015). Age, duration of illness, Wilkes staging, and orthodontic treatment are considered significant prognostic factors that can predict the outcomes following the arthroscopic discopexy for management of TMJ closed lock.

Comparative Assessment of Clinical and Quality of Life Outcomes in Mandibular Angle Fractures Treated with Standard and Three-Dimensional Mini-Plates.

To undertake a multidimensional comparative assessment of the standard and three dimensional (3D) mini-plates in managing isolated mandibular angle fractures (MAFs). Thirty-six subjects were divided equally into two groups. Group A underwent fixation with a standard 2mm miniplate, while group B with 2mm 3D mini-plates. Evaluations were done preoperatively (T0), postoperatively at one week (T1), one month (T2) and three months (T3). Maximal inter-incisal mouth opening (MIO) and mean bite force (MBF) at the central incisors, right and left molars were calculated. Postoperative complications and Quality of life (QoL) outcomes were evaluated using the short form Oral Health Impact Profile (OHIP-14). Mean operative time was almost similar for both groups. Although mean MIO improved significantly from T1 to T3 in both groups, intergroup comparison of MIO was not significant. The MBF values were significantly higher in group B on the right and left molars at T2 and T3. Although significant improvement in OHIP-14 scores was seen from T2 to T3 in both the groups, intergroup comparison of OHIP was not significant. 3D plates demonstrated similar clinical and QoL outcomes compared to the standard mini-plates.

A five-year review of the OMX temporomandibular prosthetic total joint replacement system.

The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ). Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events. There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8years (range 20-76years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36months (range 12months to 73months), the average mouth opening improved from 30.8mm pre-surgery to an average of 39.1mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period. This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders.

The Comparison of the effect of two different doses of methylprednisolone on pain, swelling and trismus after 3rd molar surgery.

Objective The aim of this study was to compare the effects of intravenous administration of 1.5mg/kg and 3mg/kg of methylprednisolone sodium succinate on pain, swelling and trismus after third molar surgery.&#x0D; Study Design. Twenty five healthy patients with bilaterally symmetrical impacted mandibular third molars were included in this study. Either 1.5mg/kg or 3mg/kg of methylprednisolone was administered by intravenous route 1 hour before the operation. At the second operation the other dose was applied. Facial swelling was evaluated by using cotton sutures. Trismus was determined by measuring maximum interincisal opening. Pain was determined by using visual analogue scale.&#x0D; Results. There was no statistically significant difference in pain swelling and trismus between the two groups.&#x0D; Conclusion. No significant benefit of higher dose of methylprednisolone administered.&#x0D;

Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study

BackgroundArthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage.MethodsThis retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy.ResultsA total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474).ConclusionTo improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

Will Suprahyoid Muscle Release be Effective to Improve Swallowing in Patients with Temporomandibular Disorders? A Single Group Experimental Study

Background: As for jaw opening force, hyoid resting position and hyoid dynam­ics are very important and are considered to be affected directly by the suprahyoid muscles. MFR is found to be effective in giving symptomatic relief and increasing jaw ROM in patients with myofascial TMD. The study will specify the importance of Suprahyoid MFR in improving swallowing &amp; jaw function in TMD.&#x0D; Objectives: The study aimed at finding out the effectiveness of suprahyoid muscle MFR on swallowing and jaw function in patients with TMD.&#x0D; Methods: 20 participants with myogenous TMD were included after fulfilling the selection criteria. Treatment strategies involved MFR to suprahyoid muscle for 3 sessions in a week for one week and home exercise program involving the tongue proprioception exercises. The outcome measures were evaluated through Sydney swallowing questionnaire (SSQ-17), LDF-TMD questionnaire and maximal interincisal opening (IIO). The data was analysed and inference was drawn through paired and unpaired t tests.&#x0D; Results: The result of the present study showed that participants improved significantly (p &lt;0.05) at post one week on all the outcome measures (IIO, SSQ &amp; LDF-TMD).&#x0D; Conclusion: This study demonstrated that suprahyoid release is effective in improving swallowing in patients with TMD.

Outcomes of total joint alloplastic reconstruction in TMJ ankylosis

The purpose of this study was to evaluate subjective and objective outcomes in patients with temporomandibular joint (TMJ) ankylosis treated with TMJ alloplastic reconstruction (TMJR). All patients diagnosed with TMJ ankylosis that underwent TMJR at our institution between 2010 and 2019 were retrospectively reviewed. Patients were divided into 2 cohorts: bony and fibrous ankylosis. Subjective variables assessed were facial pain and headaches, TMJ pain, jaw function, diet, and disability. Objective variables assessed were maximum interincisal opening and lateral excursions. The Mann-Whitney test was employed to analyze subjective variables and an unpaired t-test was used to analyze the objective variables. P < .05 was considered statistically significant. Twenty-eight patients met the inclusion criteria (21 female, 7 male). The mean age at the time of surgery was 42 years, and the mean number of prior TMJ surgeries was 3. A total of 52 TMJRs were performed in the 28 patients, and the mean follow-up time was 46 months. All subjective variables were significantly improved, and the mean maximum interincisal opening increased from 16.9 mm to 37.25 mm. The results of the study demonstrate that TMJR is an effective and reliable method for the management of both fibrous and bony TMJ ankylosis.

Dextrose prolotherapy versus BOTOX injection for the management of TMJ disc displacement with reduction

Background: Temporomandibular disc displacement is a widely faced clinical condition and the management options are vast with varying difficulty and success rates. This study aims to evaluate the use of Botulinum Toxin injection and dextrose prolotherapy for such cases. Methods: 20 joints were included in this study divided into 2 groups; Group 1 receiving 25% 3mL Dextrose injection (with local anesthetic and saline solution) into the retrodiscal region while group 2 received 35 U Botulinum Toxin – Type A injection in the lateral pterygoid muscle. Pain (according to the visual analogue scale), clicking and maximal interincisal opening were assessed preoperatively and at 4 months followup. Results: The results showed no statistically significant differences between the 2 groups. The click disappeared in 7/10 joints in group 1 and 9/10 in group 2. The maximal interincisal opening was regained and slightly increased in all participants of the study. All patients reported better pain scores at the end of the followup period. Conclusions: Within the limitations of this study, we conclude that both treatment options tested are considered acceptable in the management of TMJ anterior disc displacement with reduction. Moreover, the results do not allow recommending one over the other as no statistically significant differences were found.

Open Reduction and Internal Rigid Fixation of Unilateral Displaced Subcondylar Fractures Using a Single Trapezoidal Plate Versus the Traditional Two Miniplates. A Comparative Study.

Purpose: The aim of this study was to compare clinically and radiographically between the single three-dimensional Trapezoidal plate versus the traditional two non-parallel miniplates in ORIF of unilateral displaced subcondylar fractures. Patients and Methods: A total of 24 patients suffering from unilateral displaced subcondylar fractures were randomly divided into two equal groups; Group I patients were treated using single trapezoidal plates while Group II patients were treated using the traditional two miniplates. The clinical parameters include; the Hardware application time, maximum interincisal opening, Protrusive, ipsilateral and contralateral movements, mandibular mobility index, Helkimo index of mandibular dysfunction, facial nerve weakness and plate fracture. Radiographic parameters included: Vertical height of the ramus, anteroposterior and mediolateral condylar angulations. All the clinical and radiographic outcomes were assessed and statistically analysed preoperatively and at all post-operative follow-up intervals. Results: Group I showed a statistically significant lower hardware fixation time in comparison to Group II. Both groups showed no significant difference regarding MMO, protrusive, ipsilateral and contralateral movements. Moreover, the difference regarding vertical ramus height, anteroposterior, and mediolateral condyle angulations was statistically insignificant. Two patients of group II had Plate fracture at the 1-month follow-up interval. Transient weakness of the frontal branch of the facial nerve was observed immediately post-operatively in two patients of group II and recovered completely within 3 months. Conclusion: The results of the present study support the superiority of the single Trapezoidal plates in ORIF of displaced subcondylar fractures with special recommendation for high subcondylar fractures.

Functional outcomes after using the glenoid fossa as a fixed anchorage for the temporomandibular joint discopexy in patients with disc displacement without reduction

The aim of the present study was to evaluate the use of the glenoid fossa as an anchorage for the temporomandibular joint (TMJ) disc repositioning in patients with a disc displacement (DD) without reduction.A prospective case series study included patients with DD without reduction. According to the Wilkes staging system for the TMJ internal derangement, preoperative magnetic resonance imaging (MRI) scans and clinical examinations determine the stage of the DD. The discopexy treatment consists of combined endaural/preauricular incision on the tragus, and freeing the anteromedial displaced disc from its attachments. An intra bony hole was drilled 2 mm away from the postero-lateral lip of the glenoid fossa and perpendicular to it. The disc was securely fixed to the roof of the fossa via a Prolene 0 suture in a double-pass suture fashion. The functional assessment was based on the pain visual analogue scale (VAS) and measurements of the maximum inter-incisal opening (MIO) after 1, 6, 12, and 18 months. P values ≤ 0.05 were considered significant.Thirteen of 25 joints were diagnosed with Wilkes stage III. The mean VAS score significantly decreased to 2.2 ± 1.0 and the MIO also significantly improved with a mean of 35.9 ± 3.5 mm after 18 months (P < 0.001). The rest of the cases (12 joints) were diagnosed with Wilkes stage IV, and the VAS score decreased to 1.6 ± 0.7. The MIO increased to 34.2 ± 3.3 mm at the end of the follow-up (P < 0.001).Within the limitations of the study, it seems that using the glenoid fossa as anchorage for the TMJ disc might have some clinical relevance and therefore might be taken into consideration whenever it is deemed appropriate.

An arthroscopic technique for closure of perforations in temporomandibular joint retrodiscal tissues

The objective of this retrospective study was to introduce and evaluate an arthroscopic discopexy for closure of retrodiscal tissue perforations. A total of 112 patients (135 joints) receiving an arthroscopic discopexy for management of retrodiscal tissue perforations between January 2016 and September 2019 were included. Pre- and postoperative visual analogue scale (VAS) pain scores and maximum inter-incisal opening (MIO), as well as magnetic resonance imaging (MRI) data, were collected and analysed. Success was recorded when the disc position was >11 o’clock, VAS pain score <3, and MIO>25 mm. For patients with a condyle deformity, postoperative bone remodelling was also recorded. The VAS pain score decreased from 3.04 ± 2.66 preoperatively to 0.88 ± 1.13 at 12 months postoperatively (P < 0.001) and MIO increased from 33.90 ± 7.39 mm to 35.19 ± 6.14 mm (P = 0.029). MRI evaluation revealed that 133 discs were successfully repositioned back on top of the condyle. Among these, 11 joints were associated with either VAS pain score ≥3 or MIO ≤25 mm. Therefore, a success rate of 90.4% (122/135) was achieved at 12 months postoperative. Bone remodelling was detected in 72 joints. Arthroscopic discopexy is a minimally invasive and effective treatment for retrodiscal tissue perforations that achieves the purpose of simultaneously restoring the intra-articular structures and relieving clinical symptoms.