Arthroscopic reduction and rigid fixation of the anteriorly displaced temporomandibular joint disc without reduction using titanium screw: a case series

OBJECTIVES

To evaluate the effectiveness of arthroscopic reduction and rigid fixation (ARRF) using a suture-free titanium screw as a treatment approach to temporomandibular joint's (TMJ) anterior disc displacement without reduction (ADDwoR) and assess its impact on clinical outcomes, including improvements in symptoms related to TMJ disorders.

MATERIALS AND METHODS

A series of twenty patients presented to the Department of Orthognathic and Temporomandibular Surgery at West China Hospital of Stomatology between September 2022 and January 2023, complaining of symptoms such as pain, clicking, and limited mouth opening. Standard magnetic resonance image (MRI) imaging T1 and T2 sequences in both sagittal and coronal views study with closed and maximal open mouth positions were taken preoperatively to assess the disc's position, integrity, and shape. Also, cone-beam computed tomography (CBCT) scans images to find any degenerative changes and evaluate the condylar bone's features and volume. Additionally, the clinical examination assesses limited oral opening, mechanical pain, and the presence of any noises such as clicking and crepitus. All cases were treated under general anesthesia using the arthroscopic release, reduction, and rigid fixation of the TMJ's ADDwoR to establish a normal disc-condyle relationship and to restore the functional position.

RESULTS

Patients' symptoms, such as pain and mouth opening, improved significantly following the arthroscopic treatment. Postoperative MRI and CBCT imaging follow-up conducted at 6 months demonstrated the stable position of the reduced TMJ disc and the fixation screw. Notably, none of the patients exhibited signs of relapse during this follow-up period.

CONCLUSION

Overall, the ARRF of TMJ's ADDwoR using a suture-free titanium screw proved to be safe and provides satisfactory results, in addition to the several advantages of using suture-free titanium screws, such as biocompatibility, strong fixation, and durability. However, it is a technically demanding procedure requiring extensive, long-term training.

CLINICAL RELEVANCE

ARRF using a cost-effective fixation titanium screw to treat ADDwoR emerges as a clinically effective minimally invasive approach.

Arthroscopic Disc Repositioning Techniques of the Temporomandibular Joint Part 2: Resorbable Pins

Arthroscopic rigid fixation (ARF) of the temporomandibular joint (TMJ) with resorbable pins and other advanced arthroscopic disc repositioning (ADR) techniques by sutures has provided a renewed interest in the role played by the disc in the treatment of the most severe cases of TMJ ID with anterior disc displacement with severe limitation of mouth opening. These techniques may be the last step prior to open TMJ surgery, if other less complex operative arthroscopic techniques (OAT) have previously failed, or for those cases in which no predictable results are expected with simpler OAT due to the presence of a severe displaced disc or closed lock. In this article, ARF with resorbable pins is being approached, with a special focus on describing the technique while reporting its advantages and disadvantages. Also, potential complications and postoperative management and recovery, together with some advice in terms of pearls and pitfalls will be exposed.

Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture

PURPOSE

The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.

METHODS

From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.

RESULTS

All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.

CONCLUSION

Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.