Postoperative physiotherapy device for mandibular hypomobility

DESIGN, MANUFACTURE AND CLINICAL EVALUATION OF A NEW TMJ EXERCISER

Temporomandibular joint (TMJ) ankylosis or hypomobility is a major clinical problem that affects many patients suffering from facial trauma, infection, TMJ dysfunction, inflammatory diseases and tumors. Postoperative physiotherapy is recognized as essential for the prevention or treatment of TMJ hypomobility or ankylosis. Traditional methods using stacked tongue depressors and the reported TMJ opening exercisers all have disadvantages and cannot achieve clinical requires. This study employed CAD/CAM techniques to develop a new TMJ exerciser that would be user-friendly and performed clinical trails to test the efficacy of the device. A power screw was used to overcome the small force control difficulty, allowing gradually increased TMJ opening performance. The front end of the device was designed as U-shape platform that could be inserted into the patient's mouth to allow easy TMJ exercise performance. A streamlined handle also designed to be held by the patients to decrease the mouth loading. This device is convenient for long-term physiotherapy. The clinical trail results indicated that the improvements of the incisor opening range could increase from 108% to 258% within one mouth after postoperative physiotherapy. The developed TMJ exerciser is effective, convenient, easy to use, light weight and has long-term durability for postoperative physiotherapy.

Combined treatment protocol for temporomandibular joint ankylosis: an observation on a clinical problem

Various techniques have been defined for the treatment of temporomandibular joint ankylosis. However, in some cases, they are unsuccessful, resulting in continuing pain and limitation in interincisal distance after surgery. This report describes the case of a 32-year-old woman who has been experiencing temporomandibular joint ankylosis for a period of 8 years. Several surgical procedures failed. A treatment approach combining auricular cartilage interposition arthroplasty with postsurgical functional treatment using a spring activator is presented. Using this approach, pain settled and maximal interincisal distance was raised from 22 to 35 mm after 4 months and remained stable for further 10 months.

A device for temporomandibular joint exercise and trismus correction: design and clinical application

Temporomandibular joint (TMJ) hypomobility and trismus is a frequently seen clinical condition, and rehabilitation with mouth-opening exercises is mandatory for fast and successful recovery. As conventional methods and available devices are not without disadvantages, a new TMJ exerciser has been developed and clinically tested.

MATERIALS AND METHODS

The new device was designed and made using a computer-aided design/computer-aided manufacture program. The mouthpiece is opened using a power screw technique. The device was revised until it became acceptable for clinical trials. Nineteen patients with TMJ hypomobility or trismus used the new device: five after surgical release of TMJ ankylosis, five after facial fracture reduction and intermaxillary fixation, three after blunt facial trauma, five following orthognathic surgery, and one following facial bone-contouring surgery. The outcome was evaluated.

RESULTS

The new TMJ exercise appliance was convenient, durable and easy to use. The maximal incisor opening was 16.3+/-7.1 mm before use of the device, and 34.2+/-6.3 mm after the treatment period (P<0.05). Fourteen patients (74%), i.e. all except the five with release of ankylosis, recovered to normal range of mouth opening at longitudinal follow up. There was no mechanical failure and no complications from using the device, and the patients were satisfied.

CONCLUSION

The new exerciser is a satisfactory device for physiotherapy of TMJ hypomobility and trismus.

Treatment of TMJ ankylosis in Jordanian children - a comparison of two surgical techniques

INTRODUCTION

The aim of this study was to report Jordanian experience in surgical treatment of TMJ ankylosis in 22 children.

PATIENTS AND METHODS

This retrospective clinical study included children who were diagnosed with TMJ ankylosis and were treated in a dental teaching centre between 1993 and 2001. Patients underwent the release of 24 temporomandibular joint ankyloses and two different surgical techniques were used: either reconstruction of the condyle using costochondral grafts, or using the temporalis muscle as an interpositional material. Patients were followed up for 1-8 years.

RESULTS

Twenty-two children (13 males and 9 females) were included in the study. Costochondral grafts were used as a reconstruction material in 16 TMJs (67%), whilst temporalis muscle was used as an interpositional material in 8 joints (33%). The mean preoperative maximum interincisor distance was 6.6 mm+/-1.3, which was increased to a mean of 30.3 mm+/-2.5 postoperatively. Two female patients (9%) suffered recurrence of the ankylosis within 6-12 months postoperatively. In one of these, a costochondral graft was used and temporalis muscle interposition in the other.

CONCLUSION

Costochondral graft as a reconstruction material and temporalis muscle as an interpositional material showed comparable success rates when treating TMJ ankylosis in 22 children.

Physical medicine procedures affect temporomandibular disorders: a review

This article reviews the literature on the effectiveness of physical medicine procedures for treatment of temporomandibular disorders (TMD). Brief descriptions of some commonly used dental appliances, and pharmacological and surgical treatment methods are provided.

A critical evaluation of orthopedic interocclusal appliance therapy: design, theory, and overall effectiveness

Orthopedic interocclusal appliances have been evaluated in a number of research papers and clinical reports over the years. Various theories have been proposed about the method of action of the different appliances, but at present no conclusive controlled testing of these theories has occurred. Certainly, when the potential influence of the nonspecific treatment factors is considered, as well as those cognitive awareness factors common to all appliances, the use of "symptom improvement" as the definitive proof of the need for mandibular realignment or repositioning must be questioned. Specific, well-controlled research using more quantifiable measures of the treatment effect is necessary to make valid comparisons between the different therapeutic approaches. The full-arch occlusal stabilizing appliance is the design that has the most valid evidence about its effectiveness. Partial coverage interocclusal appliances have significant irreversible complications with tooth intrusion or eruption when used on an extended basis. There is little or no experimental support at present about repositioning, realignment, and pivot appliances and their effectiveness. Therefore, these appliances must be considered experimental treatments. When used to treat TM dysfunction in a program along with other methods, such as occlusal adjustments, and prosthetic care, the effectiveness of this treatment method is between 70% and 90%. As a general approach to managing TM pain and dysfunction, interocclusal appliances appear to be a highly effective, commonly used method.

Trismus after injection of local anesthetic

Persistent pain at the site of injection is the most common complication of local anesthesia in the oral cavity. The complication of trismus after local anesthetic injection is rare and may be prevented by the use of short needles for maxillary posterior injections, and by the avoidance of multiple injections in a short period time. Once trismus develops, its progression to chronic hypomobility and fibrous ankylosis may be prevented by the early institution of treatment consisting of heat, analgesics, muscle relaxants, and exercises.