An additional lysis procedure during arthrocentesis of the temporomandibular joint / 대한악안면성형재건외과학회지

Background@#Arthrocentesis of the temporomandibular joint (TMJ) is an easy, highly efficient, minimally invasive procedure for treating temporomandibular joint disorders (TMDs). However, in some cases of mouth opening limitation (MOL), routine arthrocentesis is ineffective due to severe fibrotic adhesion in the superior joint space of the TMJ. In this condition, mechanical lysis of the adhesions might be needed to resolve the MOL, as well as other symptoms, such as chronic pain. Currently, this can be achieved by arthroscopic surgery or open TMJ surgery. The objective of this study was to introduce and evaluate our trial of the adhesion lysis procedure during arthrocentesis of the TMJ using normal 18-gauge needles. @*Results@#In this study, 40 patients with MOL due to disc derangement underwent conventional arthrocentesis at first and then physical detachment was conducted using the same needle. The change in maximum mouth opening (MMO) and the pain at the TMJ were recorded before, during, and after treatment according to our protocol. The mean increase in MMO after conventional arthrocentesis was 6.6 ± 4.2mm. The mean increase in MMO after the detachment procedure with the same needle was 4.2 ± 2.0 mm. The MMO in ten patients was significantly increased after the detachment procedure than after arthrocentesis alone. In all cases, the pain intensity in the TMJ significantly decreased over time, whereas the MMO increased over time. No adverse effect was observed in all joints during our observation periods. @*Conclusion@#We confirmed that our simple lysis procedure with the same needle of the arthrocentesis of the TMJ could not only improve the MMO more than after a conventional arthrocentesis but also resolve severe adhesion of the joint space that was ineffective by conventional arthrocentesis. Although this additional lysis procedure is simple, it might reduce the number of cases of more invasive procedures such as arthroscopic surgery or open TMJ surgery.

Prosthetic Treatment after Oral Cancer Ablation / 대한연하장애학회지

Ablative surgery for oral cancer treatment results in tissue defect. Large tissue defect requires free flap reconstruction that requires long operation time. Maxillectomy involves the teeth and maxilla that separates the maxillary sinus and nasal cavity from oral cavity. Resection of the maxilla causes oro-antral or oro-nasal fistula, which results in difficulty while chewing and swallowing. Regurgitation of the ingested food into the maxillary sinus or nasal cavity makes it difficult for a patient to digest. Obliteration of the fistula is the most important part of dental prosthesis in patients who underwent maxillectomy. Local flap is indicated when the fistula is less than 10mm, however, larger sized defects are closed with free flap or obturator. The decision of treatments should be based on patient's general condition, risk of recurrence, size of the defect and financial aspect.

Surgical management of idiopathic bone cavity: case series of consecutive 27 patients

OBJECTIVES: Idiopathic bone cavity (IBC) is an uncommon intra-osseous cavity of unknown etiology. Clinical features of IBC are not well known and treatment modalities of IBC are controversial. The purpose of this study was to investigate the clinical characteristics of 27 IBC patients who underwent surgical exploration. MATERIALS AND METHODS: A total of 27 consecutive patients who underwent surgery due to a jaw bone cavity from April 2006 to February 2016 were included in this study. Nine male and 18 female patients were enrolled. Patients were examined retrospectively regarding primary site, history of trauma, graft material, radiographic size of the lesion, presence of interdental scalloping, erosion of the inferior border of the mandible, complications, results of bone graft, and recurrence. RESULTS: Female dominance was found. Maxillary lesion was found in one patient, and bilateral posterior mandibular lesions were found in two patients. The other patients showed a single mandibular lesion. The posterior mandible (24 cases) was the most common site of IBC, followed by the anterior mandible (5 cases). Two patients with anterior mandibular lesion reported history of trauma due to car accident, while the others denied any trauma history. Radiographic cystic cavity length over 30 mm was found in 10 patients. Seven patients showed erosion of the mandibular inferior border. The operations performed were surgical exploration, curettage, and bone or collagen graft. One bilateral IBC patient showed recurrence of the lesion during follow-up. Grafted bone was integrated into the native mandibular bone without infection. One patient reported necrosis of the mandibular incisor pulp after operation. CONCLUSION: Differential diagnosis of IBC is difficult, and IBC is often confused with periapical cyst. Surgical exploration and bone graft are recommended for treating IBC. Endodontic treatment of involved teeth should be evaluated before operation. Bone graft is recommended to reduce the healing period.