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Bjornland T, Mork-Knutsen P. Surgical Treatment of Temporomandibular Joint Derangement: 30-Year Follow-Up of Temporomandibular Joint Discectomy, a Case Report and Literature Review. Dent Clin North Am 2023; 67:13-25. [PMID: 36404074 DOI: 10.1016/j.cden.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The improvement in diagnostic accuracy, improvement of the endoscopic equipment, better selection of patients for open TMJ surgery, and increased focus on research and education are promising for the treatment of the group of patients with TMJ derangements. In the future, prospective randomized clinical trials need to be performed to give the clinician guidelines as to which type of intervention should be chosen in a particular patient base on accepted criteria for diagnosis and treatment of TMJ derangement.
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Affiliation(s)
- Tore Bjornland
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, Oslo N-0371, Norway.
| | - Peer Mork-Knutsen
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, Oslo N-0371, Norway
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Mohanty S, Vijayaragavan R, Sharma P, Chaudhary Z, Verma A, Rathaur A. Is Modified condylotomy a better surgical option as compared to high-condylar shave with eminectomy in improving symptoms of Internal derangement of temporomandibular joint? J Oral Maxillofac Surg 2022; 80:1158-1173. [DOI: 10.1016/j.joms.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
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3
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Huang L, Tang S, Zou R, Ouyang KX, Piao Z. The three-dimensional evaluation of positional change in mandibular condyle after intraoral vertical ramus osteotomy. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:477-481. [PMID: 32977041 DOI: 10.1016/j.jormas.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the changes of the condylar axis, the anteroposterior condylar position relative to the glenoid fossa, after intraoral vertical ramus osteotomy (IVRO). STUDY DESIGN 21 patients diagnosed as skeletal class III malocclusion underwent IVRO and were followed according to the authors' postoperative management regimen. The three-dimensional positions of the condyles were evaluated by cone-beam computerized tomography (CBCT) at pre-op, post-op, and at follow-up. CBCT images were referenced to assess the condylar axis change and the anteroposterior condylar position in the glenoid fossa. A repeated-measures analysis of variance (P<0.05) also was performed. RESULTS After surgery, both the axial condylar angles and the anteroposterior condylar position were significantly different (P<0.05). The coronal condylar axis rotated outwardly. The anteroposterior condylar position in the glenoid fossa had moved from the concentric to the anterior position. But the condyle changes between post-op and follow-up (P>0.05) were insignificant. CONCLUSIONS With postoperative intermaxillary elastic traction, the condyles changed their positions physiologically for newly established jaw movement after IVRO.
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Affiliation(s)
- L Huang
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - S Tang
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - R Zou
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - K X Ouyang
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Z Piao
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China.
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Rokutanda S, Yamada SI, Yanamoto S, Sakamoto H, Furukawa K, Rokutanda H, Yoshimi T, Nakamura T, Morita Y, Yoshida N, Umeda M. Anterior relapse or posterior drift after intraoral vertical ramus osteotomy. Sci Rep 2020; 10:3858. [PMID: 32123263 PMCID: PMC7052185 DOI: 10.1038/s41598-020-60838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
This study aimed to evaluate the factors contributing to postoperative anterior relapse or posterior drift of the distal segment after intraoral vertical ramus osteotomy. A retrospective cohort study was conducted which included 31 patients who underwent setback surgery for mandibular prognathism by the intraoral vertical ramus osteotomy technique. Uni- and multivariate analyses were performed to determine the association of potential explanatory variables (sex, age, magnitude of setback, differences in setback magnitude between sides (right/left), duration of splint use, Angle’s classification of malocclusion, mandibular angle, and tightness of occlusion of the molars) with positional changes in the distal segment. The setback magnitude was only significant factor affecting (P = 0.015) for posterior drift, with significant posterior in setback magnitudes of less than 7.25 mm. Posterior drift after intraoral vertical ramus osteotomy is less likely if setback magnitude exceeds 7.25 mm. For setbacks less than 7.25 mm, posterior drift should either be carefully corrected postoperatively, or an alternative surgical technique should be used. The setback magnitude showed a significant association with the risk of posterior drift following intraoral vertical ramus osteotomy, and the determined cut-off value may serve as a predictor for postoperative outcomes.
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Affiliation(s)
- Satoshi Rokutanda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan. .,Department of Oral and Maxillofacial Surgery, Juko Memorial Nagasaki Hospital, 1-73 Akunoura Town, Nagasaki city, Nagasaki, 850-0063, Japan.
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matumoto City, Nagano, 390-8621, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Hiroshi Sakamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Kohei Furukawa
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Hiromi Rokutanda
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Tomoko Yoshimi
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Takuya Nakamura
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Yukiko Morita
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
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Lund B, Ulmner M, Bjørnland T, Berge T, Olsen-Bergem H, Rosèn A. A disease-focused view on the temporomandibular joint using a Delphi-guided process. J Oral Sci 2020; 62:1-8. [DOI: 10.2334/josnusd.19-0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Bodil Lund
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen
- Department of Dental Medicine, Karolinska Institutet
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital
| | - Mattias Ulmner
- Department of Dental Medicine, Karolinska Institutet
- P.F. Craniofacial diseases, Karolinska University Hospital
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Trond Berge
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital
| | - Heming Olsen-Bergem
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Annika Rosèn
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital
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Rokutanda S, Yamada SI, Yanamoto S, Sakamoto H, Morita Y, Rokutanda H, Kohara H, Yoshimatsu M, Yoshimi T, Nakamura T, Ino-Kondo A, Moriuchi E, Umeda M. Effects of the changes in the condylar long axis angle and condylar position on temporomandibular symptoms after intraoral vertical ramus osteotomy: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:597-605. [PMID: 31562034 DOI: 10.1016/j.oooo.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to characterize the effects of the changes in the condylar long axis and position on temporomandibular symptoms with respect proximal segment position after intraoral vertical ramus osteotomy (IVRO). STUDY DESIGN Twenty Japanese patients with diagnosed jaw deformity underwent IVRO without internal fixation. Long-term changes in condylar long axis and position were assessed during postoperative follow-up examinations by using computed tomography, and t tests were performed for comparison. In addition, changes in temporomandibular symptoms were examined. RESULTS The degree of axial rotation of the proximal segment changed significantly when the proximal segment was located laterally. Downward changes in condylar position significantly differed when the proximal segment was located posterolaterally. Forward changes in condylar position significantly differed when the proximal segment was located laterally; moreover, when the proximal segment was located laterally, temporomandibular symptoms disappeared. CONCLUSIONS Lateral location of the proximal segment may be an important factor in the positive effects of IVRO, with respect to temporomandibular symptoms.
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Affiliation(s)
- Satoshi Rokutanda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Oral and Maxillofacial Surgery, Juko Memorial Nagasaki Hospital, Nagasaki, Japan.
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Sakamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Oral and Maxillofacial Surgery, Juko Memorial Nagasaki Hospital, Nagasaki, Japan
| | - Yukiko Morita
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiromi Rokutanda
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruka Kohara
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masako Yoshimatsu
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoko Yoshimi
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuya Nakamura
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Airi Ino-Kondo
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Moriuchi
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Puricelli E, Artuzi FE, Ponzoni D, Quevedo AS. Condylotomy to Reverse Temporomandibular Joint Osteoarthritis in Rabbits. J Oral Maxillofac Surg 2019; 77:2230-2244. [PMID: 31128080 DOI: 10.1016/j.joms.2019.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Osteoarthritis (OA) of the temporomandibular joint (TMJ) is characterized by local tissue degeneration and pain. Treatments have been aimed at reducing symptoms, and only some can interfere with the progression of pathophysiologic changes caused by OA. Condylotomy is an alternative treatment for patients with OA refractory to conventional treatment. The aim of the present animal study was to investigate the influence of condylotomy on TMJ OA in New Zealand rabbits. MATERIALS AND METHODS The 36 rabbits were divided into 3 groups: the osteoarthritis group (OG; induced OA), treatment group (TG; induced OA plus condylotomy), and control group (CG; neither OA nor surgery). OA was induced using intra-articular monosodium iodoacetate injection for 40 days. The rabbits in the TG underwent condylotomy and were killed 20, 40, and 60 days after treatment. The rabbits in the CG and OG were killed at the same points. RESULTS The articular joint condition was better in the TG 60 days after surgery (P = .032). A direct comparison revealed regression of TMJ OA over time among the treated rabbits (P = .008). Surgical treatment promoted mandibular condylar remodeling in the TG, reversing the tissue degeneration caused by OA. CONCLUSIONS Our findings suggest that condylotomy could be an option for the treatment of OA and prevent damage to TMJ structures. This could be of particular importance for patients without satisfactory responses to more conservative treatment.
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Affiliation(s)
- Edela Puricelli
- Full Professor, Universidade Federal do Rio Grande do Sul; Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Ernesto Artuzi
- Surgeon, Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Deise Ponzoni
- Associate Professor, Universidade Federal do Rio Grande do Sul; Head, Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandre Silva Quevedo
- Assistant Professor, Universidade Federal do Rio Grande do Sul; Graduate Program in Neuroscience, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
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Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature. J Maxillofac Oral Surg 2018; 17:502-507. [PMID: 30344393 DOI: 10.1007/s12663-017-1066-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022] Open
Abstract
Purpose To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature. Patients and methods Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed. Results During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free. Conclusion Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.
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9
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Guidelines for Diagnosis and Management of Disorders Involving the Temporomandibular Joint and Related Musculoskeletal Structures. Cranio 2016. [DOI: 10.1080/08869634.2003.11746234] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Abstract
Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation.
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Affiliation(s)
- Naresh Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arun Pandey
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vishal Verma
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shreya Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Al-Moraissi EA, Ellis E. Is There a Difference in Stability or Neurosensory Function Between Bilateral Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy for Mandibular Setback? J Oral Maxillofac Surg 2015; 73:1360-71. [DOI: 10.1016/j.joms.2015.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/07/2015] [Accepted: 01/10/2015] [Indexed: 10/24/2022]
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Jung HD, Kim SY, Park HS, Jung YS. Orthognathic surgery and temporomandibular joint symptoms. Maxillofac Plast Reconstr Surg 2015; 37:14. [PMID: 26029683 PMCID: PMC4446569 DOI: 10.1186/s40902-015-0014-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/22/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.
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Affiliation(s)
- Hwi-Dong Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Sang Yoon Kim
- Private Practice Vienna VA; Former resident Harvard Oral & Maxillofacial Surgery, Boston, MA USA
| | - Hyung-Sik Park
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Young-Soo Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
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Lee JH, Park TJ, Jeon JH. Unilateral intraoral vertical ramus osteotomy and sagittal split ramus osteotomy for the treatment of asymmetric mandibles. J Korean Assoc Oral Maxillofac Surg 2015; 41:102-8. [PMID: 25922823 PMCID: PMC4411725 DOI: 10.5125/jkaoms.2015.41.2.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
In surgery for facial asymmetry, mandibles can be classified into two types, rotational and translational, according to the required mandibular movements for surgery. During surgery for rotational mandibular asymmetry, a bilateral sagittal split ramus osteotomy (BSSRO) may cause a large bone gap between the proximal and distal segments as well as condylar displacement, resulting in a relapse of the temporomandibular joint disorder, especially in severe cases. The intraoral vertical ramus osteotomy has an advantage, in this respect, because it causes less rotational displacement of the proximal segment on the deviated side and even displaced or rotated condylar segments may return to their original physiologic position. Unilateral intraoral vertical ramus osteotomy (UIVRO) on the short side combined with contralateral SSRO was devised as an alternative technique to resolve the spatial problems caused by conventional SSRO in cases of severe rotational asymmetry. A series of three cases were treated with the previously suggested protocol and the follow-up period was analyzed. In serial cases, UIVRO combined with contralateral SSRO may avoid mediolateral flaring of the bone segments and condylar dislocation, and result in improved condition of the temporomandibular joint. UIVRO combined with contralateral SSRO is expected to be a useful technique for the treatment of rotational mandibular asymmetry.
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Affiliation(s)
- Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Tae-Jun Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Ju-Hong Jeon
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
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Kitai N, Eriksson L, Kreiborg S, Wagner A, Takada K. Three-Dimensional Reconstruction of TMJ MR Images: A Technical Note and Case Report. Cranio 2014; 22:77-81. [PMID: 14964341 DOI: 10.1179/crn.2004.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
MR images of the temporomandibular joint at occlusion and at various stages of mouth opening were registered and reconstructed three-dimensionally before and after a modified condylotomy in a patient with painful disk displacement. Following the condylotomy, the condyle/disk relationship had become normalized in all three planes of space at closed mouth and during mouth opening. The post-operative distances of the condylar and diskal paths had increased when compared with the preoperative distances. The three-dimensional visualizing method may, besides providing diagnostic advantages, be a valuable tool for qualitative and quantitative documentation of the efficiency of different treatment methods for normalization of the disk/condyle relationship in patients with TMJ disk displacement.
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Affiliation(s)
- Noriyuki Kitai
- Dept. of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Choi YS, Jung HD, Kim SY, Park HS, Jung YS. Remodelling pattern of the ramus on submentovertex cephalographs after intraoral vertical ramus osteotomy. Br J Oral Maxillofac Surg 2013; 51:e259-62. [DOI: 10.1016/j.bjoms.2013.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
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16
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Liu MQ, Chen HM, Yap AUJ, Fu KY. Condylar remodeling accompanying splint therapy: a cone-beam computerized tomography study of patients with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:259-65. [DOI: 10.1016/j.oooo.2012.03.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 02/27/2012] [Accepted: 03/04/2012] [Indexed: 11/28/2022]
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Simmons HC. A critical review of Dr. Charles S. Greene's article titled "Managing the Care of Patients with Temporomandibular Disorders: a new Guideline for Care" and a revision of the American Association for Dental Research's 1996 policy statement on temporomandibular disorders, approved by the AADR Council in March 2010, published in the Journal of the American Dental Association September 2010. Cranio 2012; 30:9-24. [PMID: 22435173 DOI: 10.1179/crn.2012.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Dr. Charles Greene's article, "Managing the Care of Patients with TMDs A New Guideline for Care," and the American Association for Dental Research's (AADR) 2010 Policy Statement on Temporomandibular Disorders, published in the Journal of the American Dental Association (JADA) September 2010, are reviewed in detail. The concept that all temporomandibular disorders (TMDs) should be lumped into one policy statement for care is inappropriate. TMDs are a collection of disorders that are treated differently, and the concept that TMDs must only be managed within a biopsychosocial model of care is inappropriate. TMDs are usually a musculoskeletal orthopedic disorder, as defined by the AADR. TMD orthopedic care that is peer-reviewed and evidence-based is available and appropriate for some TMDs. Organized dentistry, including the American Dental Association, and mainstream texts on TMDs, support the use of orthopedics in the treatment of some TMDs. TMDs are not psychological or social disorders. Informed consent requires that alternative care is discussed with patients. Standard of care is a legal concept that is usually decided by a court of law and not decided by a policy statement, position paper, guidelines or parameters of care handed down by professional organizations. The 2010 AADR Policy Statement on TMD is not the standard of care in the United States. Whether a patient needs care for a TMD is not decided by a diagnostic test, but by whether the patient has significant pain, dysfunction and/or a negative change in quality of life from a TMD and they want care. Some TMDs need timely invasive and irreversible care.
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Affiliation(s)
- H Clifton Simmons
- Oral and Maxillofacial Surgery Department at Vanderbilt University School of Medicine
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Bouloux GF. Modified condylotomy for temporomandibular joint dysfunction. Atlas Oral Maxillofac Surg Clin North Am 2011; 19:169-175. [PMID: 21878250 DOI: 10.1016/j.cxom.2011.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Gary F Bouloux
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
TMJ surgeries are not always successful. Many potential pitfalls can occur during any phase of the treatment and can lead to complications, less than desirable results, and short- or long-term failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.
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Yano K, Nishikawa K, Sano T, Okano T. Relationship between appearance of a double contour on the mandibular condyle and the change in articular disc position after splint therapy. ACTA ACUST UNITED AC 2009; 108:e30-4. [PMID: 19717317 DOI: 10.1016/j.tripleo.2009.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 06/06/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim was to investigate the relationship between the appearance of double contours on the mandibular condyle and changes in articular disc position after splint therapy. STUDY DESIGN Panoramic radiographs and magnetic resonance images of 82 joints in 41 patients taken before and after treatment were studied. The number of cases showing a double contour after treatment was compared between the 2 groups with and without disc displacement before treatment, and between the 2 groups with and without reduction in the displacement group; a comparison was also made among age groups and among 3 groups showing improvement, aggravation, or no change in displacement after treatment. RESULTS All joints showing a double contour after treatment showed articular disc displacement before treatment. No double contours were observed after treatment on joints without articular disc displacement before treatment. All joints showing a double contour showed improvement in disc displacement. CONCLUSION The results indicate that a double contour on the mandibular condyle is the result of repositioning of, or positional improvement in, a displaced articular disc.
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Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Alam S, Okabe K, Yamamoto E. The effects of changing position and angle of the proximal segment after intraoral vertical ramus osteotomy. Int J Oral Maxillofac Surg 2009; 38:1041-7. [PMID: 19477622 DOI: 10.1016/j.ijom.2009.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 11/14/2008] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
Abstract
The authors evaluated changes in position and angle of the proximal segment, including the condyle, after intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy to verify whether displacement of the proximal segment could induce postoperative complications. Changes in condylar angle, ramus angle, and displacement of proximal segment were measured pre- and postoperatively. The position of the temporomandibular joint (TMJ) disc was examined pre- and postoperatively. Trigeminal nerve hypoesthesia in the lower lip was assessed bilaterally. The postoperative horizontal condylar angle was significantly smaller than the preoperative one on the deviated and non-deviated sides (P<0.0001). The postoperative coronal condylar angle was significantly larger than the preoperative one on the deviated side (P=0.0483). The postoperative sagittal ramus angle was larger than the preoperative one on the deviated (P<0.0001) and non-deviated (P=0.00005) side. Most joints with an anteriorly-displaced disc with and without reduction improved on the non-deviated side; 5 of 16 joints improved on the deviated side. Results suggest the position and angle of the proximal segment, including the condyle, could change after IVRO. This could be associated with symptomatic improvement in TMJ, and extreme medial displacement of the proximal segment could delay recovery from lower lip hypoesthesia.
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Affiliation(s)
- K Ueki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, Japan.
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Jung HD, Jung YS, Park HS. The Chronologic Prevalence of Temporomandibular Joint Disorders Associated With Bilateral Intraoral Vertical Ramus Osteotomy. J Oral Maxillofac Surg 2009; 67:797-803. [DOI: 10.1016/j.joms.2008.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 08/27/2008] [Accepted: 11/06/2008] [Indexed: 11/16/2022]
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de Leeuw R. Internal derangements of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2008; 20:159-68, v. [PMID: 18343322 DOI: 10.1016/j.coms.2007.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article discusses several types of internal derangements of the temporomandibular joint. It includes definitions, clinical characteristics, and management options. Nonsurgical and surgical treatment strategies are discussed taking into consideration the latest evidence-based literature.
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Affiliation(s)
- Reny de Leeuw
- Orofacial Pain Center, University of Kentucky, College of Dentistry, 800 Rose Street, Lexington, KY 40536-0297, USA.
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Modified condylotomy versus conventional conservative treatment in painful reciprocal clicking--a preliminary prospective study in eight patients. Clin Oral Investig 2008; 12:353-9. [PMID: 18548293 DOI: 10.1007/s00784-008-0204-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/30/2008] [Indexed: 01/18/2023]
Abstract
Modified condylotomy may be relevant in severe painful reciprocal clicking of the temporomandibular joint (TMJ) where conservative treatment is insufficient. The effect of the modified condylotomy was analyzed and compared with conventional nonsurgical treatment in a randomized pilot study of eight patients, 19-44 years of age, with severe painful reciprocal clicking. Before and after treatment, assessments were performed by subjective reports, clinical recordings, and blinded evaluations of radiography and magnetic resonance imaging (MRI). Based on the clinical evaluations before treatment, all conditions were disc displacements with reduction and arthralgia (Research diagnostic criteria for temporomandibular disorders), but based on MRI, one patient had disc displacement without reduction and another had normal disc position. The treatment effect was significantly better and the disorders were significantly more reduced with condylotomy than with conventional nonsurgical treatment (P < 0.05, Mann-Whitney U test). In the surgical group, the clicking and locking had disappeared, the pain during function was significantly reduced (P < 0.05, Friedman ANOVA), and in two patients the disc position was normalized. The clicking still persisted in the nonsurgical patients and the disc position was unchanged. Our conclusion is that modified condylotomy is a promising option to reduce symptoms and signs in severe painful reciprocal clicking.
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Yamauchi K, Takenobu T, Takahashi T. Condylar luxation following bilateral intraoral vertical ramus osteotomy. ACTA ACUST UNITED AC 2007; 104:747-51. [PMID: 17656127 DOI: 10.1016/j.tripleo.2007.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 03/11/2007] [Accepted: 03/13/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The intraoral vertical ramus osteotomy (IVRO) is widely used to treat mandibular prognathism and some forms of temporomandibular joint disorder (TMD). This retrospective report evaluated the incidence of condylar luxation following bilateral IVRO. STUDY DESIGN Clinical records and radiographs of 319 patients seen during a 13-year period between 1992 and 2005 were evaluated. The mean age of the patients (232 females, 87 males) at the time of surgical procedure was 26.1 years. All patients underwent a bilateral IVRO to treat mandibular prognathism or TMD. Postoperatively, the condylar position was evaluated from lateral and anteroposterior cephalograms and tomograms of the temporomandibular joint (TMJ). RESULTS An IVRO was performed on 638 sides in 319 patients. In 8 sides in 8 patients, the proximal segments were dislocated, and the condylar heads were located beyond the articular eminence. One patient underwent a closed reduction under local anesthesia, and 4 patients underwent an open reduction under sedation or general anesthesia. The average follow-up period was 4.3 years (1.2-9 years). Six of the 8 patients did not complain of any TMJ dysfunction. The objective clinical evaluation also did not reveal any dysfunctional patterns. A TMJ click on the affected side was observed in 1 patient, and mandibular deviation to the affected side upon opening the mouth was observed in 1 patient. CONCLUSION Although condylar sag is a consistent finding after IVRO, the mandibular condyles tend to return their preoperative positions. In this study, condylar luxation was observed in 1.3% (8/638) of the joints after bilateral IVRO. However, there were no severe clinical problems in these patients during a relatively long follow-up period.
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Affiliation(s)
- Kensuke Yamauchi
- Department of Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Reconstructive Surgery, Kyushu Dental College, Kitakyushu, Japan.
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Holmlund A. Disc derangements of the temporomandibular joint. Int J Oral Maxillofac Surg 2007; 36:571-6. [PMID: 17391923 DOI: 10.1016/j.ijom.2007.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 12/08/2006] [Accepted: 02/05/2007] [Indexed: 11/30/2022]
Abstract
Disc-related derangement of the temporomandibular joint is common and epidemiological research has found that about 20% of the population may be affected. Although very few of these people have the more prominent symptoms, recent data indicate that the numbers who need treatment is increasing. The two clinical variants of disc derangement, reciprocal clicking and closed lock, have long been recognized, but the association between them and their aetiology and pathogenesis is still unclear. As a consequence, there is still uncertainty on how to treat the conditions, and this is even more evident when surgery is involved. This paper describes new tissue research related to disc derangement. A simplified scheme is presented and implications for surgical treatment are discussed.
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Affiliation(s)
- A Holmlund
- Department of Oral and Maxillofacial Surgery, Institution of Odontology, Karolinska Institutet/Karolinska University Hospital, Box 4064, S-141 04 Huddinge, Sweden.
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Ueki K, Marukawa K, Shimada M, Yoshida K, Hashiba Y, Shimizu C, Nakgawa K, Alam S, Yamamoto E. Condylar and disc positions after intraoral vertical ramus osteotomy with and without a Le Fort I osteotomy. Int J Oral Maxillofac Surg 2007; 36:207-13. [PMID: 17239565 DOI: 10.1016/j.ijom.2006.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 06/01/2006] [Accepted: 09/24/2006] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy. Of 50 Japanese patients with mandibular prognathism with mandibular and bimaxillary asymmetry, 25 underwent IVRO and 25 underwent IVRO in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including disc tissue, were assessed preoperatively and postoperatively by magnetic resonance imaging and axial cephalogram. Improvement was seen in just 50% of joints with anterior disc displacement (ADD) that received IVRO and 52% of those that received IVRO with Le Fort I osteotomy. Fewer or no TMJ symptoms were reported postoperatively in 97% of the joints that received IVRO and 90% that received IVRO with Le Fort I osteotomy. Postoperatively, there were significant condylar position changes and horizontal changes in the condylar long axis on both sides in the two groups. There were no significant differences between improved ADD and unimproved ADD in condylar position change and the angle of the condylar long axis, although distinctive postoperative condylar sag was seen. These results suggest that IVRO with or without Le Fort I osteotomy can improve ADD and TMJ symptoms along with condylar position and angle, but it is difficult to predict the amount of improvement in ADD.
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Affiliation(s)
- K Ueki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
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Sato S, Kawamura H. Changes in condylar mobility and radiographic alterations after treatment in patients with non-reducing disc displacementof the temporomandibular joint. Dentomaxillofac Radiol 2006; 35:289-94. [PMID: 16798928 DOI: 10.1259/dmfr/92464710] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine changes in condylar mobility and morphological changes in the affected condyles after treatment in patients with non-reducing disc displacement of the temporomandibular joint (TMJ). METHODS Changes in condylar mobility and morphological changes of the condyle were examined radiographically in 55 patients who were diagnosed as having non-reducing disc displacement of the unilateral TMJ and had received pumping with injection of sodium hyaluronate. In all patients, standardized lateral oblique transcranial radiographs and panoramic jaw tomograms were taken both at initial visit and at 12 months or more follow-up (mean 28.1 months after treatment; range 12-104 months). 42 joints in 21 persons with no current or previous TMJ symptoms served as a control. RESULTS Clinical signs and symptoms improved after treatment in the patients. Condylar mobility significantly increased after treatment in patients (P<0.001), although it did not reach levels of the control group. Frequency of radiographic changes of the condyle significantly increased after treatment (P<0.005). In most of the patients, no or only mild changes were observed. Frequency of changes of the condyle in patients at follow-up was significantly greater than that in controls (P<0.001). CONCLUSIONS In the patients, condylar mobility increased in the subsequent course after treatment. However, bony changes of the condyle appeared more frequently. Long term-follow-up after treatment on bony changes of the condyle seems to be necessary in patients with non-reducing disc displacement of the TMJ.
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Affiliation(s)
- S Sato
- Division of Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan.
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Simmons HC. Guidelines for anterior repositioning appliance therapy for the management of craniofacial pain and TMD. Cranio 2006; 23:300-5. [PMID: 16353472 DOI: 10.1179/crn.2005.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- H Clifton Simmons
- Department of Dentistry, Vanderbilt University School of Medicine, USA
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Hall HD, Indresano AT, Kirk WS, Dietrich MS. Prospective Multicenter Comparison of 4 Temporomandibular Joint Operations. J Oral Maxillofac Surg 2005; 63:1174-9. [PMID: 16094587 DOI: 10.1016/j.joms.2005.04.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- H David Hall
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Fujimura K, Kobayashi S, Suzuki T, Segami N. Histologic evaluation of temporomandibular arthritis induced by mild mechanical loading in rabbits. J Oral Pathol Med 2005; 34:157-63. [PMID: 15689229 DOI: 10.1111/j.1600-0714.2004.00298.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We still lack knowledge of causative factors in arthritis related to temporomandibular disorders (TMD). The goal of the present study was to investigate whether applying a mechanical loading on the glenoid fossa can induce arthritis. METHODS Coil springs were placed in 24 rabbits so as to exert a force of 100 g between the orbital edge and the antegonial notch. At 1, 2, 4 and 8 weeks after the surgery, six samples of the temporomandibular joint (TMJ) were removed for histologic examination. RESULTS The results showed that mild synovitis began 1-2 weeks after the start of loading, and the degree of synovitis was significant at 4 weeks, and that morphologic changes occurred in the articular eminence and condyle, while type II collagen in the cartilage of the articular eminence degraded prior to that in the condyle. CONCLUSIONS Our results revealed that mild, continuous mechanical loading to the glenoid fossa induces synovitis of the articular capsule, and induces organic changes of the articular cartilage without destroying these tissues.
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Affiliation(s)
- Kazuma Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan.
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Fujimura K, Segami N, Sato J, Kaneyama K, Nishimura M. Comparison of the clinical outcomes of patients having sounds in the temporomandibular joint with skeletal mandibular deformities treated by vertico-sagittal ramus osteotomy or vertical ramus osteotomy. ACTA ACUST UNITED AC 2005; 99:24-9. [PMID: 15599345 DOI: 10.1016/j.tripleo.2004.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article describes the effects of the intraoral vertico-sagittal ramus osteotomy (IVSRO) procedure on the jaw of patients with temporomandibular joint (TMJ) disorders. STUDY DESIGN IVSRO was performed on 15 patients (30 sides) who had mandibular protrusion or asymmetry with TMJ dysfunction. IVRO was performed on another 15 patients (30 sides). All of the 30 patients had sounds in the TMJ uni- or bilaterally. The relative positions of the condyle and disc and the range of motion of the condyles were determined by magnetic resonance imaging (MRI) before and 12 months after the operations. RESULTS Sounds such as clicking improved in 92% (24/26) of the joints in the IVSRO group, and in 83% (20/24) of the joints in the IVRO group 12 months after the operation. The positional relationship between the condyle and disc on the MR images improved in 82% (9/11) of the joints with reduction of the anterior disc displacement; in 60% (3/5) of the joints without reduction of the anterior disc displacement in the IVSRO group; in 75% (9/12) of the joints with reduction of the anterior disc displacement; and in 40% (2/5) of the joints without reduction of the anterior disc displacement in the IVRO group. Immediately after the operation, the condyle was displaced anterio-inferiorly in all joints in both groups, but gradually returned to close to the preoperative position. There were no significant differences between the 2 groups regarding the extent of shift of the condylar head at 2 weeks and 12 months after the operation. CONCLUSION The clinical outcomes of the IVSRO procedure are similar to those of the IVRO procedure. Therefore, IVSRO may be a suitable procedure for patients having TMJ dysfunction with skeletal mandibular deformities, particularly when an IVRO is unsuitable.
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Affiliation(s)
- Kazuma Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa, Japan.
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Fujimura K, Segami N, Sato J, Kanayama K, Nishimura M, Demura N. Advantages of intraoral verticosagittal ramus osteotomy in skeletofacial deformity patients with temporomandibular joint disorders. J Oral Maxillofac Surg 2004; 62:1246-52. [PMID: 15452812 DOI: 10.1016/j.joms.2004.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE This preliminary study was performed to clarify the usefulness of intraoral verticosagittal ramus osteotomy (IVSRO) in patients with temporomandibular joint (TMJ) disorders. PATIENTS AND METHODS We examined 34 sides in 19 consecutive patients with dentofacial deformities with TMJ dysfunction undergoing IVSRO. Preoperatively, 15 patients had TMJ sounds bilaterally and 4 had sounds unilaterally. Five sides in 3 patients had pain in the TMJ, and 4 sides in 3 patients had masticatory muscle pain. The TMJ symptoms, including TMJ sounds, pain in the TMJ, and masticatory muscle pain in each patient, were assessed clinically before and approximately 12 months after IVSRO. Magnetic resonance imaging was also performed to determine joint status, including determination of the positions of the condyle and disc. RESULTS The symptoms of the TMJ after 12 months of orthodontic treatment showed marked improvements, with the disappearance of the TMJ sounds in 94% of the sides examined. Pain in the TMJ improved in 4 of 5 sides, and pain of the masticatory muscle improved in 3 of 4 sides. With regard to the relative positions of the condyle and disc on magnetic resonance imaging, 6 of 8 joints and 5 of 7 joints showed improvement in anterior disc displacement with and without reduction, respectively. The direction and mean amount of movement in the distal segment were 8 mm in setback, 4 mm in advance, and 5 mm counterclockwise. CONCLUSION IVSRO is potentially as useful for the treatment of TMJ disorders in orthognathic surgery patients as is intraoral vertical ramus osteotomy, and IVSRO can be used selectively in cases in which intraoral vertical ramus osteotomy is contraindicated.
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Affiliation(s)
- Kazuma Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa Prefecture 920-0293, Japan.
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Hall HD. Temporomandibular joint surgery meta-analysis; pain relief as an outcome measure. J Oral Maxillofac Surg 2003; 61:851. [PMID: 12862019 DOI: 10.1016/s0278-2391(03)00268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bjørnland T, Larheim TA. Discectomy of the temporomandibular joint: 3-year follow-up as a predictor of the 10-year outcome. J Oral Maxillofac Surg 2003; 61:55-60. [PMID: 12524609 DOI: 10.1053/joms.2003.50010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The study goal was to evaluate whether the 3-year follow-up evaluation of temporomandibular joint (TMJ) discectomy in a consecutive series of patients with TMJ internal derangement was a reliable predictor for the 10-year outcome of the operation. MATERIAL AND METHODS Twenty-nine patients with TMJ internal derangement were treated with discectomies, 6 bilaterally and 23 unilaterally. The patients were followed up for 10 years. RESULTS The dropout rate was zero at the 3-year follow-up, and 5 patients (17.2%) had dropped out at the 10-year follow-up. There was a significant reduction in the median visual analog scale recordings, and all but 1 patient reported reduction in the pain score. Mandibular motion increased significantly after 3 years, and similar or improved recordings were made at the 10-year follow-up. All but 5 patients showed an increased motion at the 10-year follow-up compared with the preoperative motion. The only complication seen at the 10-year follow-up examination was a slight anesthesia of the auriculotemporal nerve in 1 patient. All types of additional therapy decreased significantly after the operations. CONCLUSIONS Discectomy of the TMJ may significantly reduce pain and improve function in patients with internal derangement on a long-term basis. The 3-year follow-up examination proved to be a reliable predictor of the 10-year results.
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Affiliation(s)
- Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Pruitt JW, Moenning JE, Lapp TH, Bussard DA. Treatment of painful temporomandibular joint dysfunction with the sagittal split ramus osteotomy. J Oral Maxillofac Surg 2002; 60:996-1002; discussion 1002-3. [PMID: 12215982 DOI: 10.1053/joms.2002.34405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE We describe a new indication for the sagittal split ramus osteotomy with rigid fixation to treat patients with painful dysfunction of the temporomandibular joint. PATIENTS AND METHODS Ten patients for whom nonsurgical management failed were found to have a mandibular condyle positioned postero-superior within the glenoid fossa with reduced joint space on corrected-axis tomograms. The sagittal split ramus osteotomy was used to reposition the proximal segment and to increase joint space. Preoperative and long-term postoperative (average, 44.7 months) symptoms and tomographic findings were retrospectively compared. RESULTS Significant pain relief occurred postoperatively in all patients. One patient had a relapse after initial improvement. No patient developed a malocclusion. The long-term radiographic condyle-fossa relationship tended to return to its preoperative position with no relapse of clinical symptoms, except in the 1 patient. CONCLUSION The sagittal split ramus osteotomy with rigid fixation is another procedure that can be used to treat painful temporomandibular joint dysfunction by changing the position of the mandibular condyle in the glenoid fossa.
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Affiliation(s)
- John W Pruitt
- Indiana University School of Dentistry, Indianapolis, USA.
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McKenna SJ. Discectomy for the treatment of internal derangements of the temporomandibular joint. J Oral Maxillofac Surg 2001; 59:1051-6. [PMID: 11526578 DOI: 10.1053/joms.2001.26682] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S J McKenna
- Department of Oral and Maxillofacial Surgery, Vanderbilt University School of Medicine, Nashvillve, TN, USA.
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