Role for arthrocentesis in the treatment of temporo-mandibular joint dysfunction

Abstract: The Temporo-mandibular joint [TMJ] is the joint directly in front of the ear on either side of the head where the upper jaw [maxilla] and lower jaw [mandible] meet. This joint is a typical sliding "ball and socket" that has a disc sandwiched between it. The TMJ is used throughout the day to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most frequently used joints of the body [Beuscher J., 2007]

Patients and Methods: The present study was conducted on 25 patients presented at outpatient clinic of Maxillo-facial Surgery Department. Patients with primary TMD [Intermittent joint pain, joint clicking, and normal mouth opening, MRI showing partial anterior disc displacement with reduction] were selected irrespective of their age and gender

Results: Arthrocentesis was done for 25 patients showing success in 23 patients and failure in 2 patients who required open surgery

Conclusion: Arthrocentesis is the least invasive TMJ surgery. It is also the least expensive. Since it is usually done in the office or in an outpatient clinic. It shows success rate 92% in patients with inclusion criteria

Surgery for orbital osteomas

Eleven patients with orbital osteomas [three primary orbital and eight originating from adjacent paranasal sinuses with secondary extension into orbit], were treated surgically through a craniofacial approach [8 patients] and degloving mid-face procedure [3 patients]. Osteotomies of the orbital, nasal or maxillary walls were performed to get access into the lesion followed by replacement of the osternatized bone. Immediate reconstruction of the resulting bone defects were performed which helped in preservation of both the function and appearance of the involved orbit. Complete removal of the orbital osteomas was aschieved in all patients with minimal postoperative complications

Fronto-orbital advancement and cranial vault remodeling for craniosynostosis

Twenty-eight patients with different types of synostoses had been operated upon during a period of four years, the average age at the time of surgery was two years. Through an intra-cranial approach the deformed cranio-facial skeleton was managed by cranial and orbital ostotomies with reshaping, repositioning and advancement to give the child the appropriate cranio-facial form with increase in both the cranial and orbital volumes. The resulting cranio-facial form, according to the classification of Whitaker and associates 1987, showed that 19 patients were in category 1, 3 patients in category 2, 4 patients in category 3 and 2 patients in category 4. Reoperation was necessary in only 2 patients, no major or life threatening complications were encountered in this series. Correction of this deformity is recommended at an early age, preferably the second half of the first year of life to make use of the enlarging and growing brain in improving and maintaining the result obtained both functionally and esthetically

Blow out orbital fracture reconstruction with using autogenous cancellous iliac bone graft, a modified technique

Twenty-three patients were having blow out orbital fractures. All of these cases were evaluated clinically and radiologically. Exploration of the orbital floor was indicated. The orbital floor was explored through either infra-orbital or blepharoplasty incision or through the traumatic wound; the defect in the orbital floor was reconstructed by cancellous bones graft harvested from the iliac bone. The results showed that using the cancellous iliac bone graft minimized the postoperative limbing, pain and markedly reduced the hypoesthesia of the lateral cutaneous nerve of the thigh. The second important advantage is the fact that being rapidly revascularized, there is no need for over correction with its temporary discomfort to the patient