Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc / 华西口腔医学杂志

OBJECTIVES@#This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy.@*METHODS@#A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed.@*RESULTS@#The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28).@*CONCLUSIONS@#Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

Effect of temporomandibular joint disc perforation on expression of type Ⅰ collagen in temporomandibular joint disc cells / 中华口腔医学杂志

Objective@#To investigate the effect of temporomandibular joint (TMJ) disc perforation on expression of type Ⅰ collagen in TMJ disc cells.@*Methods@#The fibroblastic-like cells from the surgical removed TMJ disc tissue (disc perforation or TMJ condyle hyperplasia) were cultured. The cultured cells were identified as fibroblastic-like cells by toluidine blue and immunofluorescence staining. The expression of type Ⅰ collagen was detected with Western blotting and the content of type Ⅰ collagen was examined by enzyme linked immunosorbent assay (ELISA).@*Results@#Fibroblastic-like cells were cultured from TMJ disc cells and the controls. The collagen-Ⅰ and collagen-Ⅱ were positive in both toluidine blue and immunofluorescence staining. In Western blotting, the expression of typeⅠcollagen in cells from joints with disc perforation was lower than that from normal joints. The content of collagen-Ⅰ was (1.62±0.52) μg/L from controls, and (0.85±0.33) μg/L from disc perforation respectively (P=0.0134).@*Conclusions@#The disc cells from TMJ with disc perforation expressed lower type Ⅰ collagen than that from controls, which may be related to the lower content of collagen-Ⅰ in TMJ disc and the formation of TMJ disc perforation.

MRI findings for diagnosis of the temporomandibular joint disc perforation

PURPOSE: This study is to report presurgical magnetic resonance imaging(MRI) findings of the temporomandibular joint which had perforation in the disc or its surrounding tissues and to improve its diagnostic rate using MRI. PATIENTS AND METHODS: The sample consisted of patients who visited the TMJ clinic at Yongdong Severance Hospital, Yonsei University, during the years, 1992 and 1997. They were diagnosed as TMJ internal derangement and received surgical treatment. We divided them into two groups. The first group comprised of 85 joints with perforated disc or its surrounding tissues and which were confirmed surgically. The second group of 62 joints which only had disc displacement without perforation, hyperemia or adhesion served as control. RESULTS: The preoperative diagnostic sensitivity of TMJ perforation using MRI was 74.1%. The MRI findings for diagnosis of the TMJ perforation were degenerative change of the condyle head or the articular fossa, bone to bone contact between the condyle head and the articular eminence or the articular fossa, bony spurring or osteophytosis of the condyle head, flattening of articular surface of the condyle head or the articular eminence, discontinuity of the disc and the arthrographic effect due to joint effusion. CONCLUSION: The preoperative diagnostic sensitivity of TMJ perforation using MRI in this study was 74.1% which was lower than the diagnostic rate using the arthrogram. Further investigations are needed to improve the diagnostic accuracy of TMJ perforation using MRI.