Manejo das disfunções temporomandibulares. Parte II: tratamento cirúrgico / Management of temporomandibular joint disorders. Part II: surgical treatment

Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ​​por dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.

Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.

Artrocentesis en el tratamiento de artritis séptica en articulación temporomandibular: reporte de un caso / Arthrocentesis in the treatment of septic arthritis in the temporomandibular joint: a case report

Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

A cirurgia ortognática no tratamento da DTM em pacientes classe II / The orthognatic surgery in treatment of TMJ in class II patients

Introdução: A má oclusão Classe II pode influenciar negativamente na qualidade de vida dos pacientes, tanto na aparência facial, quanto função oral ou até ambas. Atualmente, o tratamento ortodôntico-cirúrgico é comumente utilizado em pacientes com discrepâncias esqueléticas graves. Objetivo: Este estudo tem como objetivo analisar os resultados da cirurgia ortognática associada ao tratamento ortodôntico nos pacientes que possuem DTM e má oclusão de Classe II por retrognatismo mandibular. Metodologia: Foi realizada uma pesquisa bibliográfica nas plataformas de buscas científicas Google Acadêmico, CAPES/MEC, PubMed/Medline, Scielo, Elsevier, e nas revistas AJO-DO (American Journal of Orthodontics and Dentofacial Orthopedics) e The Angle Orthodontist (An International Journal of Orthodontics and Dentofacial Orthopedics), utilizando as seguintes palavras chave: retrognatismo, cirurgia ortognática e transtornos da ATM. Conclusão: A maioria dos pacientes que apresentam sinais e sintomas de DTM pré-operatórios melhoram a disfunção e diminuem os níveis de dor com o tratamento ortognático. Além disso, o tratamento ortodôntico é de suma importância para se obter o sucesso do procedimento cirúrgico, assim como na estabilidade pós-cirúrgica.(AU)

Introduction: Class II malocclusion can negatively influence patients in quality of life, in the facial and oral appearance or both. Currently, orthodontic-surgical treatment is commonly used in patients with severe skeletal discrepancies. Objective: The objective of this study was to analyze the results of orthognathic surgery associated with orthodontic treatment in patients who have TMD and Class II malocclusion due to mandibular retrognathism. Methodology: A bibliographic search was performed in the scientific search platforms Google Scholar, CAPES/MEC, PubMed/Medline, Scielo, Elsevier, AJO-DO (American Journal of Orthodontics and Dentofacial Orthopedics) and in The Angle Orthodontist (An International Journal of Orthodontics and Dentofacial Orthopedics), using the keywords: retrognathism, orthognathic surgery and TMJ disorders. Conclusion: With orthognathic treatment, most patients who had preoperative DTM signs and symptoms showed an improvement and a decrease in pain levels. In addition, orthodontic treatment is important for the success of the surgical procedure, as well as for post-surgical stability.(AU)

Clinical analysis of arthroscopy used in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint / 华西口腔医学杂志

OBJECTIVES@#To evaluate the value of arthroscopy in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint (TMJSC).@*METHODS@#The cases of 16 patients preliminarily diagnosed with TMJSC by magnetic resonance imaging (MRI) from July 2011 to December 2018 were analyzed retrospectively. If the diagnosis was confirmed by arthroscopy, the opening operation was performed. The preoperative MRI, arthroscopy and opening operation, postoperative pathology and postoperative MRI of confirmed cases were analyzed, and clinical follow-up was performed to evaluate the curative effect of open surgery. The degree of mouth opening and visual analogue scale (VAS) scores for pain pre-operation and during follow-up of the confirmed cases were analyzed by @*RESULTS@#Fourteen cases of TMJSC were diagnosed by arthroscopy, consistent with the postoperative pathological diagnosis. Postoperative MRI examination showed that articular cavity lesions basically disappeared. Ten patients with synovial chondromatosis were followed-up (follow-up rate, 71.4%) from 6 months to 7 years and 8 months (average follow-up time, 17.6 months); no recurrence was found, and clinical symptoms improved by varying degrees. Before operation and at follow-up, @*CONCLUSIONS@#Arthroscopy is essential in the diagnosis and treatment of TMJ synovial chondromatosis.

Artroscopia diagnóstica en cirugía maxilofacial / Diagnostic arthroscopy in Maxillofacial Surgery

Introducción: los desarreglos internos de la articulación temporomandibular (ATM) son los más comunes. La artroscopia es de gran utilidad en cirugía maxilofacial como alternativa para el diagnóstico y el tratamiento de los desarreglos internos de la ATM. El objetivo de la presente revisión es describir la artroscopia diagnóstica de la ATM. Métodos: se realizó una revisión narrativa de la literatura y una búsqueda en las bases de datos PubMed, ProQuest, SciELO, Mendeley y Elsevier empleando los descriptores (artroscopia diagnóstica, articulación temporomandibular) en español e inglés. Se seleccionaron los artículos publicados en un período de 40 años (1980-2020), incluyendo en el estudio un total de 26 artículos y 6 libros de 702 documentos revisados. Discusión: en la artroscopia de la ATM se puede observar la posición, calidad y textura del cartílago articular, la vascularización y la redundancia de la membrana sinovial y se pueden realizar procedimientos como técnicas de artroscopia avanzada. Conclusiones: la artroscopia diagnóstica facilita el diagnóstico y manejo de las patologías intraarticulares, por lo que el conocimiento de esta técnica resulta imprescindible.

Introduction: Internal disorders of the TMJ are the most common. Arthroscopy is very useful in Maxillofacial Surgery as an alternative for the diagnosis and treatment of internal disorders of the Temporomandibular Joint. The aim of this review is to describe the diagnostic arthroscopy of the Temporomandibular Joint. Methods: A narrative literature review and search of PubMed, ProQuest, SciELO, Mendeley and Elsevier databases were performed in English and Spanish using the descriptors (Diagnostic arthroscopy, Temporomandibular Joint) in Spanish and English. Articles published over a period of 40 years (1980-2020) were selected, including a total of 26 articles and 6 books from 702 reviewed documents in the study. Discussion: In the arthroscopy of the Temporomandibular Joint the position, quality, texture of the articular cartilage, the vascularization, and the redundancy of the synovial membrane can be observed, and procedures such as advanced arthroscopic techniques can be performed. Conclusions: Diagnostic arthroscopy facilitates the diagnosis and management of intra-articular pathologies. Being necessary and essential knowledge of this technique.

Individuals requiring orthognathic surgery have more depression and pain than controls

Abstract The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.

Impacto da cirurgia ortognática na qualidade de vida em pacientes com diferentes deformidades orofaciais: revisão de literatura / Impact of orthognathic surgery on quality of life in patients with different orofacial deformities: literature review

Objetivos: analisar, por meio de revisão de literatura, o impacto da cirurgia ortognática na qualidade de vida de pacientes com diferentes deformidades orofaciais e identificar a concepção e a percepção dos pacientes em relação às correções de deformidades faciais de um quadro prévio ao procedimento até o momento da avaliação. Metodologia: foi realizado um levantamento da literatura nas bases de dados PubMed e Medline, utilizando os seguintes termos de busca: "ortognática", "distúrbios temporomandibulares", "qualidade de vida" e "psicossocial". Os artigos foram escolhidos nas línguas portuguesa e inglesa, dentre aqueles publicados entre os anos de 1990 a 2019. Considerações finais: a correção das deformidades esqueléticas faciais e das irregularidades dentárias associadas pela cirurgia ortognática apresenta um impacto positivo na qualidade de vida dos pacientes pela melhora harmônica dos ossos esqueléticos faciais, resultando em uma estética facial favorável e em um aprimoramento das funções do sistema estomatognático.(AU)

Objectives: to analyze, through literature review, the impact of orthognathic surgery on the quality of life of patients with different orofacial deformities and to identify the patients' conception and perception about corrections of facial deformities prior to the procedure until the moment of evaluation. Methods: a literature review was performed using the PubMed and Medline databases using the following search terms: "orthognathic", "temporomandibular disorders", "quality of life" and "psychosocial". The articles were chosen in Portuguese and English between 1990 and 2019. Final considerations: correction of facial skeletal deformities and associated dental irregularities, by orthognathic surgery, have a positive impact on patients' quality of life through the harmonious improvement of skeletal facial bones, resulting in a favorable facial esthetics and an improvement of the functions of the stomatognathic system.(AU)

Reabsorción Condilar como Complicación Postoperatoria en Pacientes Sometidos a Cirugía Ortognática. Revisión Narrativa / Condylar Resorption as a Postoperative Complication in Patients Undergoing Orthognathic Surgery. Narrative Review

RESUMEN: La reabsorción condilar como complicación postoperatoria en cirugía ortognática es una causa frecuente de recidiva de anomalías dentomaxilares, existiendo diversos factores que se relacionan con su aparición. El objetivo de este estudio fue describir mediante una revisión narrativa la reabsorción condilar como complicación postoperatoria en cirugía ortognática. Se realizó una búsqueda electrónica de la literatura en las bases de datos electrónicas PubMed, EBSCO, TripDatabase y Epistemonikos sin límite de años, en idioma inglés y español, incluyendo revisiones sistemáticas, ensayos clínicos y estudios observacionales. Se excluyeron reportes de casos, estudios en animales y aquellos que no relacionaran la complicación con cirugía ortognática. Se evaluaron los estudios según grado de recomendación y calidad de reporte. Veintiún artículos fueron seleccionados según los criterios de selección establecidos en esta revisión. La literatura reportada sugiere que la reabsorción condilar es una patología de frecuencia relativa en pacientes postoperados de cirugía ortognática (1,4-32 % de los casos) y que está asociada a factores de riesgo preoperatorios tales como género, edad, tipo de anomalía dentomaxilar y técnica quirúrgica utilizada. La reabsorción condilar es una complicación postoperatoria a cirugía ortognática que debemos considerar en la planificación del tratamiento e identificar pacientes con factores de riesgo. Luego de la intervención quirúrgica es de vital importancia realizar un seguimiento estricto a este tipo de pacientes e identificar de forma temprana cambios clínicos y radiográficos. Finalmente, es importante seguir investigando sobre esta materia para establecer criterios de prevención y diagnóstico, con mayor claridad.

ABSTRACT: Condylar resorption as a complication following orthognathic surgery is considered to cause dento-facial anomalies, relating to different pre and intra-operative factors. The aim of the research was to describe condylar resorption as a postoperative complication after orthognathic surgery. A review of the literature was made in four databases: PubMed, EBSCO, Trip database and Epistemonikos. The search was carried out without year limiting, articles in English and Spanish, including systematic reviews, observational studies and clinical trials. Exclusion criteria were applied for report cases, animal studies and articles that do not relate condylar resorption with orthognathic surgery. Quality of evidence and strength of the recommendations were assessed for the chosen studies. For this study 21 articles were selected following the inclusion criteria. The literature found reported that condylar resorption is a relatively frequent complication following orthognathic surgery (1.4-32 % of frequency) and that it can be associated with several factors such as genre, age, dento-maxillary anomaly and surgical technique. Condylar resorption is a complication that we must consider in the planning of orthognathic surgery, in order to identify risk factors and patients who are more likely to present this post-surgical complication. Following surgery, strict follow-up is a key factor to determine early clinical and radiographic changes. Finally, further research is needed to establish stronger prevention and diagnostic criteria.

Condromatosis Sinovial Primaria de la Articulación Temporomandibular con Extensión a Hueso Temporal. Reporte de un Caso y Revisión de la Literatura / Primary Synovial Chondromatosis of the Temporomandibular Joint with Temporal Bone Extension. Case Report and Literature Review

RESUMEN: La condromatosis sinovial (CS), es una lesión benigna poco frecuente y de clínica bastante inespecífica. Suele afectar articulaciones de huesos largos como la rodilla, el codo y la cadera, presentándose generalmente de manera unilateral. Se cree que solo un 3 % de los casos de CS afecta la articulación temporomandibular. Esta condición se caracteriza por ser un trastorno metaplásico del tejido conectivo sinovial que suele manifestarse con la formación de pequeños y múltiples nódulos de cartílago que posteriormente pueden desprenderse, calcificarse y formar cuerpos libres dentro del espacio articular. Presentamos el caso de una mujer de 55 años con condromatosis sinovial de la articulación temporomandibular, tratada desde hace 3 años bajo el diagnóstico de desórdenes temporomandibulares. A pesar de ser considerada una lesión de tipo benigna, esta puede llegar a ser localmente agresiva, extendiéndose como en nuestro reporte hacia la fosa craneal media, adelgazando parte del hueso temporal.

ABSTRACT: Synovial chondromatosis (CS) is a benign lesion that is rare and clinically quite nonspecific. It usually affects the joints of long bones such as the knee, elbow and hip, usually occurring unilaterally. It is believed that in only 3 % of cases of CS the temporomandibular joint. This is a condition its characterized by being a metaplastic synovial connective tissue that manifests itself with the formation of small and multiple cartridges that detach, calcify and form free bodies within the joint space. We present the case of a 55-year-old woman with synovial chondromatosis of the temporomandibular joint, treated for 3 years under the diagnosis of temporomandibular disorders. Despite being considered a benign lesion, this can become locally aggressive, extending as in our report to the cranial fossa, thinning part of the temporal bone.

Management of temporomandibular joint ankylosis in yemeni children by metatarsal bone grafts

Aim: This study aimed to evaluate temporomandibular joint reconstruction in Yemeni children with metatarsal bone graft after release of ankylosis. Methodology: Ten patients ≤12 years of age, comprising eight unilateral and two bilaterally TMJ ankylosis, were selected for this study. These patients underwent reconstruction with 10 non-vascularized metatarsal grafts. The reconstructed joints were then followed for an average of 1 year. Measures of opening, symmetry, and clinical symptoms relating to the reconstructed joints were assessed. Results: Mean pre-operative interincisal aperture was 8.2mm, and immediate post-operative aperture 23.4mm. At the end of the follow-up period, acceptable results were achieved in 8 out of 10 cases, with adequate mouth opening of 35.6mm in 8 out of 10 patients and overall interincisal aperture of 30.3mm. Re-ankylosis occurred in two bilaterally-treated patients at the end of follow-up. Subjectively, 80 percent of the patients rated their function as satisfactory and were able to occlude and masticate without any difficulty. Conclusion: Reconstruction of TMJ after release of ankylosis utilizing metatarsal bone graft shows a satisfactory interincisal aperture in 80 percent of patients.

La importancia del tratamiento multidisciplinario en los trastornos temporomandibulares / The importance of multidisciplinay treatment intemporomandibular disorders / A importância do tratamento multidisciplinar das desordens temporomandibulares

Introducción: las disfunciones temporomandibulares constituyen un grupo heterogéneo de afecciones que involucran a la articulación temporomandibular y los músculos masticadores y del cuello. Existe consenso acerca que las disfunciones temporomandibulares son de naturaleza multifactorial en relación a factores musculares, articulares, oclusales, psicológicos e inmunológicos. Objetivo: Valorar los beneficios del tratamiento multidisciplinario en pacientes diagnosticados de disfunción temporomandibular, llevado a cabo en el Servicio de Cirugía Maxilofacial de la Unidad Asistencial Hospital César Milstein. Material y método: Estudio retrospectivo descriptivo de 206 pacientes que consultaron por algún tipo de disfunción temporomandibular desde enero de 2011 a diciembre de 2015. Se evaluaron un total de 111 pacientes (103 mujeres y 8 hombres) con una edad promedio de 65,6 (24-82), con diagnóstico de desorden interno de la articulación temporomandibular, utilizando la Clasificación de Wilkes. Los 111 pacientes recibieron tratamiento conservador como primera medida. Resultados: 89 pacientes se vieron beneficiados en cuanto a la reducción del dolor y al aumento en el rango de la apertura oral; 21 pacientes necesitaron tratamiento quirúrgico mínimamente invasivo y 1 paciente necesitó intervención quirúrgica a través de cirugía abierta. El 80% respondió al tratamiento conservador, mientras que el 20% necesitó algun tratamiento quirúrgico. La escala visual analógica de dolor inicial fue 7,6 cm (3-10) y la final 1,14 cm (0-5). La máxima apertura oral inicial fue de 34 mm (21-50) y la final de 40 mm (35-50). Conclusión: Debido a la etiologia multifactorial de las disfunciones temporomandibulares, el fracaso en el tratamiento puede deberse a la falta de abordaje interdisciplinario. La combinación de diferentes terapéuticas nos permite alcanzar resultados más favorables, en contraposición a la realización de modalidades terapéuticas únicas y aisladas.

Introduction: temporomandibular disorders are an heterogeneous group of disorders related to the temporomandibular joint and to the masticatory and neck muscles. There exists agreement regarding the nature of temporomandibular disorders, including muscular, joint, oclussal, psycological and immunological factors. Objective: To assess the benefits of the multidisciplinary treatment in patients with temporomandibular disorders, carried out at the Maxillofacial Surgery Department of the Cesar Milstein Hospital Material and method: A retrospective descriptive study of 206 patients, assessed for temporomandibular disorders between january 2011 and december 2015. A total of 111 patients with diagnosis of internal temporomandibular joint disorder were evaluated using the Wilkes Classification. 103 females and 8 males, with a mean age of 65.6 years old (24-82). All of the patients received conservative treatment as a first choice. Results: 89 patients improved pain score and increased mouth opening range. 21 patients required minimally invasive surgical treatment and 1 patient needed open surgery. 80% responded to conservative treatment, while 20% required some type of surgical treatment. The initial Visual Analog Scale for pain was 7.6 cm (3-10) and the final 1.14 cm (0-5). The Maximum Mouth Opening was 34 mm (21-50) and the final 40 mm (35-50). Conclusions: Due to multifactorial ethiology of temporomandibular disorders, failure on its treatment may be because of the lack of an interdisciplinary approach. The combination of different therapies allows to achieve better results, in comparison with unique and isolated therapeutic modalities.

Introdução: as disfunções temporomandibulares (DTM) são um grupo heterogeneo de condições que envolvem a articulação temporomandibular (ATM) e os músculos mastigatórios e do pescoço. Há consenso que as disfunções temporomandibulares são de natureza multifactorial relacionada a fatores musculares, articulares, oclusais, psicológicos e inmunologicos. Objetivo: Avaliar os benefícios do tratamento multidisciplinar em pacientes diagnosticados de disfunção temporomandibular realizados no Serviço de Cirurgia Maxilofacial da Unidade Assistencial Hospital César Milstein. Material e método: estudo retrospectivo descritivo de 206 pacientes que consultaram por algum tipo de disfunção temporomandibular desde janeiro 2011 a dezembro 2015. Um total de 111 pacientes (103 mulheres e 8 homens) com idade média de 65,6 (24- 82) foram avaliados, com diagnóstico de transtorno interno da articulação temporomandibular, utilizando a Classificação de Wilkes. Os 111 pacientes receveron tratamento conservador como primeira medida. Resultados: 89 pacientes foram beneficiados na redução do dor e aumento no rango de apertura oral. 21 pacientes necessitaram de tratamento cirúrgico minimamente invasivo e 1 paciente necessitou de intervenção cirúrgica através de cirurgia aberta. 80% responderam ao tratamento conservador, enquanto 20% exigiram algum tratamento cirúrgico. A escala visual analógica de dor (EVA) inicial foi de 7,6 cm (3-10) e a final 1,14 cm (0-5). A máxima abertura oral (MAO) inicial foi de 34 mm (21-50) e a final de 40 mm (35-50). Conclusões: Devido à etiologia multifatorial dos disfunções temporomandibulares, o fracasso no tratamento pode ser devido à falta de abordagem interdisciplinar. A combinação de diferentes terapias nos permite obter resultados mais favoráveis, em oposição à realização de modalidades terapêuticas únicas e isoladas.

A prospective study of 138 arthroscopies of the temporomandibular joint / Estudo prospectivo de 138 artroscopias da articulação temporomandibular

INTRODUCTION: Internal derangements (ID) of the temporomandibular joint (TMJ) have a multifactorial etiology and are most often treated conservatively by splints, physical therapy and medications. Only in 2-5% of cases are the treatment surgical, either by arthroscopy or arthrotomy.OBJECTIVE: To evaluate improvement of mouth opening, pain relief during function, position of the articular disk and complications following Arthroscopic Lyse and Lavage (ALL).METHODS: A prospective study of 78 patients (138 TMJs) with TMJ ID, 5 males and 73 females, mean age 29.7 years, treated between January 2010 and April 2013, who were refractory to conservative treatment, had limited mouth opening and pain localized to the TMJ during function, and who were submitted to TMJ ALL and followed for a period of 12 months, with periodic reviews.RESULTS: ALL was effective in 93.6% of cases, with 85.3% experiencing improvement in mouth opening and 91.2% in pain reduction during function, 63% improvement in disk position and a rate of complications of 6.2%.CONCLUSION: In this study the ALL exhibited a high rate of success with low morbidity in internal derangements of the TMJ.

INTRODUÇÃO: Os desarranjos internos (DI) da articulação temporomandibular (ATM), possuem etiologia multifatorial, sendo tratados na maioria das vezes de forma conservadora através splints, fisioterapia e medicamentos. Apenas 2% a 5% dos casos tem indicação cirúrgica, seja através de artroscopia ou artrotomia.OBJETIVO: Avaliar melhora da abertura bucal, melhora da dor, posicionamento do disco articular e complicações pós Lise e Lavagem Artroscópica (ALL).MÉTODO: Estudo prospectivo com uma serie de 78 pacientes (138 ATMs) com DI da ATM, sendo 5 homens e 73 mulheres, com média etária de 29,7 anos, atendidos entre janeiro de 2010 e abril de 2013, refratários ao tratamento conservador, apresentando limitação de abertura bucal e dor localizada em ATM em função, sendo submetidos à ALL da ATM e acompanhados por um período de 12 meses, com avaliações periódicas.RESULTADOS: A ALL foi eficiente em 93,6 % dos casos estudados, com 85,3% melhora na abertura bucal e 91,2% na redução da dor em função, 63% de melhora na posição discal em IRM de controle e índice 6,2% de complicações.CONCLUSÃO: No presente estudo a ALL mostrou-se um tratamento com um alto índice de sucesso, com baixa morbidade, nos desarranjos internos da ATM.

Temporomandibular Joint Ankylosis in Young Adult: A Case Report.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition. It involves the mouth opening, dentofacial deformity, diet problem, and quality of life. When it occurs in a child, it can have devastating effects on the future growth and development of the jaws and teeth. Furthermore, in many cases it has a profoundly negative influence on the psychosocial development of the patient, because of the obvious facial deformity, which worsens with growth. TMJ ankylosis results in a limitation of the mouth opening. This disorder can result in an array of problems with diet, facial deformity, and poor oral hygiene. Three main surgical modalities described in the literature for its management are gap arthroplasty, interpositional arthroplasty and total joint replacement. Recurrence remains the main problem after surgery. Aggressive resection and intensive postoperative physiotherapy are recommended to prevent re-ankylosis.

Artritis infecciosa de la articulación temporomandibular consecutivo a otitis necrotizante: reporte de un caso / Septic arthritis of the temporomandibular joint: Report of one case

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon condition, caused by hematic bacterial migration or direct migration of other head and neck infections. We report a 41 year old female who presented a right temporomandibular joint involvement, with bone destruction of the mandibular condyle and an infectious process spreading to the temporal space, following a necrotizing medial and external otitis with associated mastoiditis. A septic arthritis of the TMJ by continuity was diagnosed and treated with antimicrobials, TMJ arthrocentesis and occlusal stabilization, with a positive evolution. However, the patient remains in control due a secondary TMJ osteoarthritis caused by the septic arthritis.

Post-traumatic-Zygomaticocoronoid Ankylosis: A Rare Clinical Case Report.

Fusion of the zygomatic bone to the coronoid process of the mandible is a rare phenomenon reported in the literature and commonly called as zygomaticocoronoid ankylosis. It can be sequel of trauma or infection in the midfacial region, mimicking a wide range of problems including the common temporomandibular joint ankylosis and dysfunction. Maxillofacial trauma involving the displaced fracture of zygoma can obstruct the movement of coronoid and if not treated can cause ankylosis between both bones. It is very diffi cult to identify zygomaticocoronoid ankylosis on conventional radiographs and requires the through clinical and advanced radiological evaluation like cone-beam computed tomographic (CBCT) to diagnose it. CBCT can be a great help to identify the size and extension of ankylotic mass and decide the approach to remove it. Zygomaticocoronoid ankylosis can be approached intraorally by Keen’s incision, and extraorally through a hemicoronal approach we have approached intraorally. Here, we present surgical management of post-traumatic zygomaticocoronoid ankylosis in 42-year-old male patient who had trismus for 18 years.

Interpositional Arthroplasty with Temporomyofascial Flap to Correct TMJ Reankylosis in Child: A Case Report.

Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the temporomandibular joint (TMJ) is replaced by scar tissue. Most frequently reported complications after surgical treatment are limited mouth opening and re-ankylosis. Reankylosis happens due to inadequate bone removal, lack of sufficient interpositional material, fibrous tissue adhesions and elongation of coronoid process and regrowth of bone in the sigmoid notch area. In gap arthroplasty treatment chances to recurrence is 53% than interpositional arthroplasy. We treated a case of right sided TMJ reankylosis by interpositional arthroplasty with temporomyofacial flap and physiotherapy was started 3 days after surgery and maintained for 6 months. In 2 years follow-up, no signs of recurrence and maximum mouth opening 45 mm were observed. The success in preventing reankylosis after TMJ interpositional arthroplasty with temporomyofacial flap is relatively better than gap arthroplasty alone.

Treatment of Unilateral TMJ Ankylosis in a Pediatric Patient with Temporalis Fascia Flap A Case Report.

The definite cause of temporomandibular joint (TMJ) ankylosis is still an unknown fact. TMJ ankylosis may result from, infection, trauma or insufficient surgical treatment of the mandibular condyle region. Different techniques have been described so far for the treatment of TMJ ankylosis, but no technique has successfully given uniform results. Relapse causing limited mouth opening, infection, open bite, reankylosis are the complications. Many authors agree that aggressive physiotherapy immediately after the surgical procedure, interpositional graft as spacer and wide bone resection are the basic principles in treating TMJ ankylosis. In this article, we discussed a case of unilateral TMJ ankylosis, in a 9-year-old boy, treated with the intre-positional gap arthroplasty with superficial temporalis fascia flap.

Evaluation and Management of Occlusal Disturbances among Temporomandibular Disorders Patients: A Report of Two Cases.

Th e occlusal interference is considered as contributing factor in temporomandibular disorders. It has a strong association with occlusal interferences causing occlusal disturbances leading to orthopedic instability of temporomandibular joint. Digital evaluation should be made to eliminate the premature contacts of the teeth and to establish the harmonious, functional occlusion. T-scan is a grid-based sensor technology and occlusal system that allows an easier and more accurate way to measure occlusal timing and the force. Th ese two case reports explains the steps involved in the correction of chronic myofacial pain dysfunction and premature occlusion of teeth with balancing side interferences, which are highly destructive for joint and teeth structure due to the amount and direction of force generated in temporomandibular patients.

Effectiveness and satisfaction evaluation of patients submitted to TMJ arthrocenthesis: a case series

The aim of this study was to evaluate the effectiveness and level of satisfaction of patients who underwent TMJ arthrocentesis under local anesthesia by considering the following parameters: joint pain, mouth opening, mastication, and satisfaction. Fourteen patients (13 women and one man; mean age, 37.6 years with TMJ arthralgia were selected. The patients underwent arthrocentesis under local anesthesia, and pain intensity was measured before, during, and 1 year after treatment using a visual analog pain scale (VAS 0–100 mm). A Likert scale was used to assess patients’ opinion regarding the improvement of mouth opening and mastication. After treatment, patients were questioned on levels of satisfaction provided by arthrocentesis in regard to their quality of life. At the end of 1 year, patients showed a marked improvement in their pain clinical picture (p < 0.0001). Mouth opening and mastication, evaluated separately and then correlated (R2 = 0.925, p < 0.0001), also showed a marked improvement. When questioned, all patients reported being satisfied with the treatment outcome.

Lise e lavagem artroscópica da ATM - uma análise de 102 pacientes e 175 articulações / Tmj arthroscopic lysis and lavage - an analysis of 102 partients and 175 joints

O tratamento dos desarranjos internos (DI) da articulação temporomandibular (ATM), é um grande desafio para cirurgiões e clínicos. Na maioria das vezes o tratamento é realizado de forma conservadora através de placas oclusais, fisioterapia e medicamentos. Apenas 2% a 5% dos casos tem indicação cirúrgica, seja através de artroscopia ou artrotomia. No presente estudo foram incluídos 102 pacientes (175 ATMs) com DI da ATM, sendo 8 homens e 94 mulheres, com uma média etária de 32,4 anos, atendidos entre janeiro de 2010 e outubro de 2013, refratários ao tratamento conservador, diagnosticados por exame clínico e por imagem de ressonãncia magnética (IRM), apresentando limitação de abertura bucal e dor localizada em ATM em função. O objetivo do estudo foi avaliar melhora da abertura bucal, melhora da dor, posicionamento do disco articular e complicações pós LLA Os pacientes foram submetidos à lise e lavagem artroscópica (LLA) da ATM sob anestesia geral, e acompanhados por um período de 12 meses com avaliações periódicas. Os resultados mostraram que dos 102 pacientes envolvidos no estudo," (8,8%), após 6 meses de acompanhamento, foram indicados para artrotomia, devido manutenção da limitação de abertura bucal e/ou dor em função. A LLA foi eficiente em 91,2% dos casos estudados, com 90,7% melhora na abertura bucal e 93,6% na redução da dor em função, 68% de melhora na posição discal e índice 6,9% de complicações, as quais foram transitórias

The treatment for internal derangement (10) of the temporomandibular joint (TMJ), is a major challenge for surgeons and clinicians. Most often the treatment is performed conservatively using splints, physical therapy and medications. Only 2% to 5% of cases the treatment is surgical,Only 2-5% of patients require surgery, which is performed by arthroscopy or arthro- tomy. In this study, 102 patients (175 temporomandibular joints) with temporomandibular joint (TMJ) internal derangement (10),8 men, 94 women; mean age, 32.4 years, who were treated between January 2010 and October 2013 were included. These patients did not respond to conservative treatment and were diagnosed by clinical examination and magnetic resonance imaging (MRI) with limited mouth opening and localized functional temporomandibular join pain. This study aimed to assess improvements in mouth opening, pain reduction, articular disc positioning, and postoperative complications of arthroscopic Iysis and lavage (ALL) under general anesthesia. The patients underwent ALL and were monitored for a 12-month perioc with periodic evaluations. Of the 102 patients in the study, 9 (8,8%) required arthrotomvê months into the follow-up period, as they still presented with limited mouth opening and/or joint movement-associated pain. ALL was effective in 93.6% of the analyzed patients: 90.7 reported improved maximum interincisal opening (MIO), 93.6% experienced a decrease in join• movement-associated pain, and 68% reported improved disc positioning. The complicaties were transient and its rate was 6,9%