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.

Discopexia e fisioterapia no tratamento do deslocamento de disco articular sem redução / Discopexy and physiotherapy in the treatment of articular disc displacement withou reduction

A articulação temporomandibular está vunerável a várias condições de anormalidades já bastante conhecidas, dentre elas, o deslocamento do disco articular sem redução, considerado pela literatura o mais comum das patologias desta região. A deterioração do quadro pode ser um indicativo da necessidade cirúrgica. Em específico, no deslocamento de disco sem redução, o reposicionamento definitivo pode ser adquirido através de discopexia e artrocentese. O presente trabalho tem como objetivo relatar um caso clínico de deslocamento de disco articular bilateral sem redução, apresentando a importância da fisioterapia associada à abordagem cirúrgia na recuperação da função mandibular, bem como, reforçar a importância de uma abordagem conjunta entre análise clínica e imaginológica para resolução de casos. Paciente feminino cursando com diversos sintomas em face e pescoço de forma progressiva ao longo de dois anos foi submetida a cirurgia na articulação temporo-mandibular, onde foi feita a discopexia através de ancoragem dos discos articulares com parafusos. A avaliação física, assim como, a imaginológica, ajudaram na confirmação do diagnóstico. A abordagem cirurgica adotada no tratamento deste caso foi descrita na literatura desde o final do século XIX. Conclui-se que, o método utilizado no tratamento do deslocamento de disco sem redução deve ser baseado nos sinais e sintomas do paciente, cuja abordagem deve ser readequada de acordo com as mudanças do quadro apresentado. Nesta análise, a abordagem cirúrgica associada à fisioterapia específica para as estruturas musculoesquelética da face trouxeram resultados positivos(AU)

The temporomandibular joint is responsible for several well-known conditions of abnormalities, among them, the joint disc displacement without reduction, considered by the literature the most common pathology of this region. Deterioration of the condition may be indicative of surgical need. Specifically, in displacement disc without reduction, definitive repositioning can be achieved through discopexy and arthrocentesis. The aim of the present study is to report a case of unilateral articular disc displacement without reduction, as well the importance of physiotherapy associated with the surgical approach in the recovery of mandibular function, as well as reinforcing the importance of a joint approach between clinical and imaging analysis for case resolution. Female patient with several symptoms in the face and neck progressively over two years, underwent surgery in the temporomandibular joint, where discopexy was performed by anchoring the articular discs with screws. The physical assessment, as well as the imaging, helped to confirm the diagnosis. The surgical approach adopted in the treatment of this case has been described in the literature since the end of the 19th century. In conclusion, the method used to treat articular disc displacement without reduction should be based on the patient's signs and symptoms, whose approach should be readjusted according to the changes in the presented picture. In this analysis, the surgical approach associated with specific physiotherapy for the musculoskeletal structures of the face brought positive results(AU)

Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture / 中华创伤杂志(英文版)

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.

Research progress on tissue engineering in repairing tempomandibular joint / 浙江大学学报·医学版

Temporomandibular joint osteoarthritis (TMJOA) is mainly manifested as perforation of temporomandibular joint disc (TMJD) and destruction of condylar osteochondral complex (COCC). In recent years, tissue engineering technology has become one of the effective strategies in repairing this damage. With the development of scaffold material technology, composite scaffolds have become an important means to optimize the performance of scaffolds with the combined advantages of natural materials and synthetic materials. The gelling method with the minimally invasive concept can greatly solve the problems of surgical trauma and material anastomosis, which is beneficial to the clinical transformation of temporomandibular joint tissue engineering. Extracellular matrix scaffolds technology can solve the problem of scaffold source and maximize the simulation of the extracellular environment, which provides an important means for the transformation of temporo joint tissue engineering to animal level. Due to the limitation of the source and amplification of costal chondrocytes, the use of mesenchymal stem cells from different sources has been widely used for temporomandibular joint tissue engineering. The fibrochondral stem cells isolated from surface layer of articular cartilage may provide one more suitable cell source. Transforming growth factor β superfamily, due to its osteochondrogenesis activity has been widely used in tissue engineering, and platelet-rich derivative as a convenient preparation of compound biological factor, gradually get used in temporomandibular joint tissue engineering. With the deepening of research on extracellular microenvironment and mechanical stimulation, mesenchymal stem cells, exosomes and stress stimulation are increasingly being used to regulate the extracellular microenvironment. In the future, the combination of complex bioactive factors and certain stress stimulation may become a trend in the temporomandibular joint tissue engineering research. In this article, the progress on tissue engineering in repairing COCC and TMJD, especially in scaffold materials, seed cells and bioactive factors, are reviewed, so as to provide information for future research design and clinical intervention.

Criterio de diagnóstico para el tratamiento quirúrgico de los Meniscopatias de la Articulación Temporomandibular / Diagnostic criteria for the surgical treatment of temporomandibular joint disorders

La alteración en el normal funcionamiento de la Articulación Temporomandibular (ATM), puede tener repercusiones en forma aguda o crónica, con especial énfasis en los músculos de la masticación y/o inflamación de la articulación, que conecta la mandíbula con el cráneo. La principal causa es la hiperfunción o parafunción muscular, como en el caso del bruxismo, con repercusión en el sistema musculo-esqueletal de la cavidad oral, como también diferentes tipos de desplazamientos del disco en la ATM. El desorden trasciende los límites entre diferentes disciplinas de la salud, en particular, odontología y neurología que tienen diferentes enfoques de tratamiento. La ATM es susceptible a muchas otras afecciones que afectan a otras articulaciones del cuerpo, incluyendo anquilosis, artritis, trauma, luxaciones, desarrollo de anomalías, neoplasias y lesiones recidivantes. La decisión para intervenir una ATM debería ser tomada con cautela y basada en un análisis racional y apropiado de la enfermedad subyacente. En csos selectos, la cirugía de ATM es el tratamiento de elección para un subconjunto de desordenes Temporomandibulares, incluyendo trastornos articulares internos, enfermedad degenerativa de la articulación, artritis reumatoide, artritis infecciosa, luxación mandibular, anquilosis e hiperplasia o hipoplasia condilar. El objetivo del presente trabajo es enmarcar la cirugía de ATM como un ámbito indiscutible de la cirugía oral y maxilofacial, que bajo un diagnóstico certero y criterio quirúrgico apropiado lleva a una resolución definitiva del cuadro patológico.

Temporomandibular joint disorder a term covering acute or chronic pain, especially in the muscles of mastication and/or inflammation of the temporomandibular joint, which connects the mandible to the skull. The primary cause is muscular hyper or parafunction, as in the case of bruxism, with secondary effects on the oral musculoskeletal system, like various types of displacement of the disc in the temporomandibular joint. The disorder transcends the boundaries between several health-care disciplines in particular, dentistry and neurology there are a variety of treatment approaches. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, enoplasia and rective lesions. The decision to perform temporomandibularjoint (TMJ) surgery should be made carefully and must be based on a rational and appropiate analysis of the underlying disease. In selected cases, TMJ surgery is the preferred treatment for a subset of temporomandibular disorders (TMDs), incluiding internal derangement, degenerative joint disease, rheumatoid arthritis, infectious arthritis, mandibular dislocation, ankylosis, and condylar hyperplasia or hypoplasia. The aim of this article is to establish that TMJ surgery is the undisputed purview of the maxillofacial surgeon, thatunder accurate diagnosis and adquate surgical criteria leads to a definitive resolution of the pathology.

Fijación y estabilización quirúrgica de disco articular como tratamiento de la disfunción interna de la ATM / Surgical fixation and stabilization of the articular disc as a treatment of TMJ internal derangement

Se describe en detalle la técnica quirúrgica de artroplastia con fijación y estabilización de disco articular para el tratamiento de la disfunción interna de ATM en sus fases avanzadas, siguiendo los criterios de diagnóstico y tratamiento establecidos en la Clínica de ATM y Dolor Facial de la Escuela de Odontología de la Universidad De La Salle Bajío. Se presentan 3 casos para ilustrar la técnica quirúrgica. Actualmente el método más empleado es el de fijación de disco articular con miniancla Mitek® complementado con laserterapia y fisioterapia posoperatoria con el sistema Therabite® logrando reducir los tiempos de fisioterapia posoperatoria y haciendo a ésta más eficiente y menos dolorosan detalle la técnica quirúrgica.

Estudo comparativo da eminectomia e do uso de miniplaca na eminência articular para tratamento da luxacão recidivante da articulacão temporomandibular / Comparative study of eminectomy and use of bone miniplate in the articular eminence for the treatment of recurrent temporomandibular joint dislocation

A luxacão da articulacão temporomandibular ocorre quando o côndilo mandibular move-se para fora da cavidade glenóide e permanece travado anteriormente à eminência articular, sendo sua ocorrência repetitiva (luxacão recidivante) geralmente associada a hipermobilidade mandibular e a inclinacão da eminência articular. OBJETIVO: Neste estudo avaliou-se, clínica e radiograficamente, a técnica de eminectomia e do uso de miniplaca na eminência articular para tratamento da luxacão recidivante da articulacão temporomandibular de pacientes operados no Hospital Universitário Osvaldo Cruz (HUOC/UPE), no período de janeiro de 2001 a setembro de 2003. FORMA DE ESTUDO: Retrospectivo. MATERIAL E MÉTODO: A amostra foi composta por 11 pacientes. A cirurgia de eminectomia foi realizada em nove articulacões de cinco pacientes, enquanto a cirurgia para colocacão de miniplaca na eminência articular em 11 articulacões de seis pacientes. A obtencão dos dados foi efetuada através da análise de prontuários e de nova consulta pós-operatória. RESULTADOS: Os resultados mostraram não haver maiores complicacões pós-operatórias para as duas técnicas. A abertura bucal máxima foi maior nos pacientes operados pela técnica de eminectomia e nenhum dos pacientes apresentou recorrência da luxacão. CONCLUSAO: Concluiu-se que as duas técnicas mostraram-se eficientes para o tratamento da luxacão recidivante da articulacão temporomandibular.

Tratamento cirúrgico dos desarranjos internos da articulaçäo temporomandibular / Surgical treatment of the internal derangements of the temporomandibular joint

Este artigo discute as indicaçöes, evoluçäo e complicaçöes associadas com os procedimentos cirúrgicos atualmente utilizados no tratamento dos desarranjos internos da circulaçäo temporomandibular (ATM). Os desarranjos internos compreendem as várias patologias intracapsulares, as quais comprometem o funcionamento harmonioso da articulaçäo (disfunçäo), causando dores e, em certos casos, incapacitando o paciente. Discute-se, assim, as artrotomias (discoplastia, discectomia), a artroscopia, a artrocentese e a condilotomia. Conclui-se que cada técnica tem sua efetividade para estágios específicos dos desarranjos internos da ATM. Sugere-se a seleçäo do procedimento com maior potencial de sucesso para determinado caso, sem que utilizaçäo exclusiva de uma só técnica, que pode näo atender de maneira satisfatória a todas as situaçöes

Protocolos de diagnóstico y tratamiento quirúrgico de la disfunción interna de la ATM / Protocols for the diagnosis and surgical treatment of the TMJ internal derangements

Se describen los criterios de diagnóstico y tratamiento de la disfunción interna de la articulación temporomandibular, sus manifestaciones clínicas cardinales y las técnicas quirúrgicas empleadas para su solución, en aquellos casos en los que la cirugía está indicada, en la Clínica de Articulación Temporomandibular de la Escuela de Odontología de la Universidad del Bajío

Influencia del desplazamiento del disco de la articulación temporomandibular sobre el crecimiento de la mandíbula / Effect of the disk displacemment of the temporomandibular Joint in The Mandibular Growth

El propósito del presente trabajo de investigación es evaluar la contribución que provoca el desplazamiento del disco de la articulación temporomandibular en el crecimiento mandibular. El objetivo del estudio está dirigido a encontrar la etiología y fisiopatología de las asimetrías faciales y retrognatismos observados en seres humanos. El protocolo empleado consistió en el desplazamiento anterior unilateral y bilateral en forma quirúrgica del disco articular en 2 grupos de conejos jóvenes albinos de Nueva Zelandia en etapa de crecimiento. El seguimiento de estos grupos fue comparado con un grupo control a fin de evaluar los efectos provocados a nivel del cóndilo mandibular y rama ascendente. Los animales fueron sacrificados a las 16 semanas y sus mandíbulas fueron radiografiadas y colocadas en el computador para efectuar mediciones entre los grupos. Las modificaciones fueron evaluadas estadísticamente por el Test de Aleatorización de Fisher para muestras independientes y Test Permutacional de Fisher para muestras apareadas. Los resultados obtenidos demostraron que cuando el disco se desplaza de la posición normal se provoca estadísticamente el acortamiento de la rama ascendente mandibular de animales en crecimiento. Cuando dicho procedimiento es efectuado en forma bilateral se obtiene alteración del crecimiento de ambas ramas ascendentes. En ambos grupos aparecen también modificaciones en la cabeza condilar y proceso mandibular. Esto sugeriría la posibilidad que en niños, los cambios discales serían responsables de provocar asimetrías mandibulares y retrognasia mandibular

Perforación del disco de la articulación temporomandibular: presentación de un caso / Perforation of the temporomandibular joint disc: report of a case

Se presenta una breve revisión biliográfica acerca de las posibles causas desencadenantes y/o predisponentes que conducen a una perforación de menisco de la articulación temporomandibular (ATM), tomándose como apoyo la presentación de un caso, del sexo femenino, de 21 años de edad, que asistió a cosulta por primera vez hace 7 años aproximadamente, por presentar dolor y ruidos articulares constantes. Fue atendida por diversos especialistas dentro del período expuesto anteriormente hasta el año 1994, en el cual se le diagnosticó de forma definitiva la perforación del menisco articular de la ATM del lado izquierdo, en su banda posterior, tratándose quirúrgicamente.