Influence of Depression and Anxiety in Temporomandibular Disorders Six Months Postarthrocentesis.

Introduction: Temporomandibular disorders may be influenced by a lot of factors. Most patients with joint problems and especially in the facial muscles present some level of psychological pathology. Materials and Methods: A prospective study was carried out to evaluate whether depression and anxiety influence the prognosis of 108 arthrocentesis in patients with temporomandibular disorders after 6-months follow-up. Results: Patients with depression and anxiety were worse than patients without psychological comorbidities, after six months postarthrocentesis. Both factors: anxiety and depression were significantly related to presenting degenerative joint pathology before and after arthrocentesis. Conclusions: Diagnosis and treatment of psychological factors are important to improve the results in the treatment of temporomandibular disorders.

Prospective study to evaluate the influence of joint washing and the use of hyaluronic acid on 111 arthrocentesis.

BACKGROUND: Temporomandibular dysfunction is a generic term that covers a large number of clinical problems affecting not only temporomandibular joint but also the masticatory musculature and related structures. Arthrocentesis is used in patients with joint pathology in which conservative treatment has failed. METHODS: A prospective, observational, analytical cohort study has been carried out to evaluate the results of 111 arthrocentesis. We have performed an inferential statistics study between the variables: improvement of pain and improvement in the oral opening with the variables and access joint, washing joint, hyaluronic acid infiltration, and type of joint pathology. RESULTS: Joint washing and intra-articular hyaluronic acid injection significantly improved the pain at 1-week, 1-month, and 3-month postarthrocentesis, although this improvement was limited in time, at 6 months, joint washing and hyaluronic acid infiltration are no longer significant. Only the joint access (p = 0.014) and the type of joint pathology (p = 0.028) are significant. CONCLUSIONS: The effectiveness of joint access in the arthrocentesis at 6 months is high, although less than at 1-month and 3-month postarthrocentesis. The type of joint pathology is another important factor. Patients with degenerative pathology worsen the most after 6-month postarthrocentesis. Arthrocentesis could avoid the evolution of acute pathology.

Malar Augmentation with Pedicled Buccal Fat Pad in Orthognathic Surgery: Three-Dimensional Evaluation.

BACKGROUND: Contemporary orthognathic surgery contemplates three-dimensional facial soft-tissue harmonization as one of the basic pillars in treatment planning. In particular, prominent malar regions are regarded as a sign of beauty and youth by Western societies. The aim of this article was to perform a subjective and objective three-dimensional evaluation of the pedicled buccal fat pad technique for malar augmentation in the context of orthognathic surgery. METHODS: Six consecutive patients with underlying dentofacial anomalies and bilateral malar hypoplasia were managed with simultaneous orthognathic surgery and pedicled buccal fat pad malar augmentation. Patient morbidity and satisfaction with the procedure were evaluated with a visual analogue scale. Cone-beam computed tomographic data were used to perform a volumetric analysis at 1- and 12-month follow-up by means of image superimposition. RESULTS: Subjective analysis revealed excellent patient satisfaction and minimal pain. Mean malar volume was 115,480.91 mm preoperatively, 124,586.32 mm 1 month after surgery, and 119,008.77 mm 12 months after surgery. Thus, the final mean increase 1 year after surgery was 3527.86 mm and the average amount of resorption was 5577.55 mm. The median variations in volume were 7.77 percent at 1-month follow-up and 3.52 percent at 12-month follow-up. CONCLUSIONS: In conclusion, the pedicled buccal fat pad technique is a reasonable alternative for malar augmentation in the context of orthognathic surgery. The results of this preliminary report suggest that it provides satisfactory soft-tissue augmentation; avoids the use of foreign materials; and has minimal morbidity, high patient satisfaction, and adequate stability at 12-month follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.