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.

Evaluation of the short-term effect of modified temporomandibular joint disc anchor for irreversible disc displacement of temporomandibular joint / 实用口腔医学杂志

Objective: To evaluate the short-term effect of modified temporomandibular joint disc anchor for irreversible disc displacement of temporomandibular joint (TMJ). Methods: A modified temporomandibular joint disc anchor surgery was performed for 24 patients with stage Ⅲ-Ⅴ TMJ internal derangement (ID) of 30 TMJs. Magnetic resonance imaging (MRI) were used to evaluate ID before and 1 week after operation for all patients. Results: All incisions healed well and there was no severe complication. The postoperative MRI images showed that, the operation outcome of 26 joints (21 cases) was classified as excellent and 3 joints (2 cases) was good. Maximal interincial opening increased from(23. 63 ± 3. 31) mm before operation to (32. 17 ± 2. 30) mm 7 days after operation(P＜ 0. 05). Conclusion: Modified temporomandibular joint disc anchor surgery may produce good short-term effects for the treatment of TMJ ID.

Application of temporomandibular joint dics reduction in the operation of condylar sagittal fracture / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To explore the selection of temporomandibular joint (TMJ) disc reduction and fixation methods in condylar sagittal fracture surgery.</p><p><b>METHODS</b>A total of 36 patients with condylar fractures were chosen. The follow-up period was more 6 months. All 36 cases of condylar sagittal fracture were fixed with long screw. In the operation, the displaced joint disc was repositioned and fixed. The fixed method included direct suture (22 cases) and anchorage (14 cases). Clinical followups were performed before surgery and 1 month, 3 months, 6 months and 1 year after surgery. Clinicians recorded data related to the Fricton craniomandibular index (CMI) and evaluated the postoperative joint function during followup before surgery and 6 months after surgery.</p><p><b>RESULTS</b>In both groups, function of TMJ significantly improved after surgery. The CMI decreased from 0.213±0.162 and 0.273±0.154 to 0.059±0.072 and 0.064±0.068 (P<0.05), respectively. No statistical difference was observed between the two groups in palpation index (PI), dysfunction index (DI) and CMI (P>0.05) before or after surgery.</p><p><b>CONCLUSIONS</b>Both methods could effectively improve the dysfunction of the TMJ caused by trauma. The selection of joint disc reduction and fixation methods is based on the displacement and damage degree of the joint disc.</p>