Postobstructive pulmonary edema as a sequela of temporomandibular joint arthroscopy: a case report

Complications of arthroscopic lysis and lavage in internal derangement of the temporomandibular joint - A single institutional experience with review of literature

PURPOSE

To evaluate the complications of arthroscopic lysis and lavage with joint sweep (ALL) procedure in the management of disc derangement of the temporomandibular joint.

METHODS

Patients with internal derangement of the TMJ who were treated by ALL in a tertiary institution from July 2018 to December 2021 were studied retrospectively.

RESULTS

The study included 39 patients (males, n = 14; females, n = 25) and 50 joints. The complications observed in the study were classified into intra and post operative complications. Post operative complications such as pain (16%), swelling (6%), reduced mouth opening (22%) and neurological complications were the most commonly observed ones. Rare complications such as ipsilateral palatal swelling (6%), parapharyngeal swelling (4%), and post operative malocclusion (2%) were also observed.

CONCLUSION

Although the complications of ALL are entirely unavoidable, their incidence can be reduced by strict adherence to standard techniques. Three-dimensional awareness and orientation of the dangerous angles and depth around the TMJ region is mandatory to reduce the complications.

Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.

Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures

OBJECTIVE(S)

Negative pressure pulmonary edema (NPPE) is a rare perioperative complication with a potentially fatal outcome. The aim of this study was to perform a systematic review of NPPE in adult otolaryngology procedures with the goal of identifying risk factors, clinical presentation, diagnosis, management and outcomes.

METHODS

Systematic review performed using PubMed, Scopus, Web of Science, and Cochrane databases.

RESULTS

Sixty-nine studies including data from 87 individual patients were included in this review. Fifty-six (68%) patients were male and the average patient age was 37 years old. Type 1 NPPE occurred in 63 (72%) cases, while type 2 NPPE accounted for 20 (23%) cases. The most common procedures leading to NPPE were septoplasty, rhinoplasty or sinus surgery (n = 22, 25%), directly laryngoscopy or bronchoscopy (n = 13, 15%), and tracheostomy or cricothyroidotomy (n = 11, 13%). The most employed treatment options included diuretics (n = 55, 63%) and mechanical ventilation (n = 54, 62%). Seventy-eight (90%) patients made a full recovery with an average time to NPPE resolution of 33 hours and an average length of hospitalization of 5.6 days. Five (6%) patients had a long-term morbidity and four (5%) patients died, with age and ICU stay increasing risk for death and long-term morbidity (OR 1.044 and 7.42, respectively, P < .05).

CONCLUSION

Septoplasty, rhinoplasty and sinus surgery account for the majority of NPPE cases in adult otolaryngology procedures. Young, healthy patients are the most commonly involved with a slight male predominance. The vast majority of patients recover fully, however there is a significant risk for morbidity and mortality.

Complications of Diagnostic TMJ Arthroscopy: An Institutional Study

Introduction

The prevalence of using arthroscopy for the diagnosis of the TMJ disorders is increasing due to its superiority to conventional methods of imaging. Although considered to be safe, complications do occur.

Patients and Method

A single operator single-institution retrospective study consisting of 50 patients taken up for diagnostic arthroscopy was analysed for complications.

Results

Lacerations of external acoustic meatus was found in 03 patients (6%); immediate partial hearing loss was seen in 01 patient (2%); transient facial nerve palsy was found in 05 patients (10%); sensory disturbances over the distribution of auriculotemporal nerve was evident in 01 patient (2%); haemorrhage as visualised by excessive bleeding through trocar skin puncture wound was seen in 05 patients (5%). Post-operative pain more than the pre-operative pain on assessment by visual analogue scale was noted in 05 patients (10%) on the immediate post-operative day. Reduction in spontaneous mouth opening was noted in 15 patients (30%).

Conclusion

Though the complication rate was found to be higher than most of the other studies, they were minor which resolved without any intervention. The cases with complications were clustered at the beginning of the series which suggests the steep learning curve and the importance of surgeons' experience and skill involved in this procedure.

Postobstructive pulmonary edema: a case for hydrostatic mechanisms

BACKGROUND

Postobstructive pulmonary edema is a well-recognized complication of upper airway obstruction. The mechanisms of edema formation are unclear and may be due to increased hydrostatic forces generated by high negative inspiratory pressure or by increased permeability of the alveolar capillary membrane. Measurement of the edema fluid/plasma protein ratio and the rate of net alveolar fluid clearance are two well-validated methods for classifying the underlying mechanism of edema formation. The goal of the current study was to investigate the mechanisms of pulmonary edema formation in patients with postobstructive pulmonary edema by serial sampling of undiluted pulmonary edema fluid.

METHODS

A retrospective review of 341 patients who had pulmonary edema fluid collected prospectively after the acute onset of pulmonary edema. All patients had serial samples of edema fluid and plasma collected over the first 8 h after intubation.

RESULTS

Ten of the 341 patients with acute pulmonary edema were identified as having postobstructive pulmonary edema. The mean (+/- SD) edema fluid/plasma protein ratio in these patients was 0.54 +/- 0.15. The mean rate of alveolar fluid clearance over 8 h was 14.0 +/- 17.4% per hour. Nine of the 10 patients survived the hospitalization.

CONCLUSION

Measurement of the edema fluid/plasma protein ratio and the presence of net alveolar fluid clearance in 10 patients with postobstructive pulmonary edema supports a hydrostatic mechanism for edema fluid formation. The predominantly fast rates of alveolar fluid clearance may explain the rapid resolution of clinical postobstructive pulmonary edema that is typically described.

Complications of temporomandibular joint arthroscopy: a retrospective analysis of 301 lysis and lavage procedures performed using the triangulation technique

PURPOSE

This study evaluated the complications of temporomandibular joint (TMJ) arthroscopic lysis and lavage performed using the triangulation technique.

PATIENTS AND METHODS

The 202 consecutive patients (301 joints) who underwent arthroscopic lysis and lavage between 1992 and 1995 were retrospectively surveyed. The preoperative diagnosis of all patients was anterior disc displacement without reduction.

RESULTS

Complications were observed in 31 (10.3%) of 301 cases of arthroscopic lysis and lavage. Of these, otologic complications were found in 26 cases (8.6%): blood clots in the external auditory canal in 9; laceration of external auditory canal in 7; partial hearing loss in 5; ear fullness in 2; vertigo in 1; and perforation of tympanic membrane with laceration of external auditory canal in 1. Neurologic injuries were found in 5 cases (1.7%): fifth cranial nerve injuries in 3; and seventh cranial nerve injuries in 2. No other complications were observed.

CONCLUSIONS

A high level of understanding of the regional anatomy helps reduce the complications associated with arthroscopic lysis and lavage in the TMJ.