Paper-based microfluidic electro-analytical device (PMED) for magneto-assay automation: Towards generic point-of-care diagnostic devices.

Rapid diagnostic tests (RDTs) for point-of-care (POC) testing of infectious diseases are popular because they are easy to use. However, RDTs have limitations such as low sensitivity and qualitative responses that rely on subjective visual interpretation. Additionally, RDTs are made using paper-bound reagents, which leads to batch-to-batch variability, limited storage stability and detection of only the analytes they were designed for. This work presents the development of a versatile technology, based on short magneto-assays and inexpensive paper-based microfluidic electro-analytical devices (PMEDs). PMEDs were produced locally using low-cost equipment, they were stable at room temperature, easy to use, and provided quantitative and objective results. The devices served to detect alternatively a variety of magneto-assays, granting quantitation of streptavidin-HRP, biotinylated HRP and Pasmodium falciparum lactate dehydrogenase (Pf-LDH) in less than 25 min, using either commercial or customized screen-printed electrodes and measurement equipment. Furthermore, Pf-LDH detection in diluted lysed whole blood displayed a linear response between 3 and 25 ng mL-1, detection and quantification limits ranging between 1 and 3 ng mL-1 and 6-12 ng mL-1, respectively, and provided results that correlated with those of the reference ELISA. In short, this technology is versatile, simple, and highly cost-effective, making it perfect for POC testing.

Temporomandibular joint arthroscopy in advanced stages of internal derangement: a retrospective cohort study on the influence of age.

The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ2 test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.

The minimally invasive arthroscopic anterior myotomy in the treatment of internal derangement of the temporomandibular joint. A detailed description of the surgical technique.

PURPOSE: The aim of this report is to define a modification of the arthroscopic anterior myotomy that avoids disc suturing procedures for the treatment of advanced internal derangement (I D) of the temporomandibular joint (TMJ). SURGICAL TECHNIQUE: The minimally invasive arthroscopic anterior myotomy (MIAAM) is based on a partial resection of the superior belly of the lateral pterygoid muscle performed through a small incision of the articular capsule associated with a scarification of the posterior ligament of the TMJ. The high-frequency wave system, called Coblation, is extremely useful to be able to complete the MIAAM. CONCLUSION: This technique is indicated for patients with ID and Wilkes stages III-IV without response to conservative treatments, and the presence of an integral disc with an appropriate consistency is transcendent for the success of the procedure. Because of the unique characteristics of the MIAAM, it can be considered as an alternative to arthroscopic discopexy procedures.

Oral squamous cell carcinoma: epidemiological study and risk factor assessment based on a 39-year series.

Oral squamous cell carcinoma (OSCC) remains a challenge for head and neck surgeons, with low 5-year survival rates despite improvements in diagnostic techniques and therapies. This retrospective observational study was performed to evaluate the epidemiology and risk factors in a cohort of 666 patients with invasive OSCC over a 39-year period. Risk factors assessed were age, sex, toxic habits, premalignant lesions, tumour location and size, and neck involvement, and pathological factors such as surgical margins, tumour thickness, perineural invasion, and bone invasion. These factors were analysed over time, and their influence on recurrence and survival rates examined. Results were compared with those of current epidemiological studies in the literature. This series showed a tendency to diagnosis at older ages (P<0.001) and decreased differences in sex distribution (P<0.001) over time. Regarding risk factors, tobacco and alcohol drinking increased significantly in females, but remained stable in males. Forty percent of the patients developed recurrences during follow-up; the relapse rate did not improve over time (45.6% in the 1980s to 36.1% in 2010-2017). The 5-year survival rate also remained stable over time, ranging from 62.7% (1980s) to 71.7% (2010-2017). This epidemiological study analysed trends across four decades in a stable cohort, with results that may be extrapolated to the populations of European countries. The results confirmed that recurrence rates and survival rates have not improved over time, despite better surgical treatments and new therapies. Further studies are needed to improve knowledge about genetics and tumour behaviour in oral cancer.

Modified arthroscopic anterior myotomy for internal derangement of the temporomandibular joint: clinical and radiological results.

The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III-IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P < 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P < 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.

Immobilisation of electrochemically active bacteria on screen-printed electrodes for rapid in situ toxicity biosensing.

Microbial biosensors can be an excellent alternative to classical methods for toxicity monitoring, which are time-consuming and not sensitive enough. However, bacteria typically connect to electrodes through biofilm formation, leading to problems due to lack of uniformity or long device production times. A suitable immobilisation technique can overcome these challenges. Still, they may respond more slowly than biofilm-based electrodes because bacteria gradually adapt to electron transfer during biofilm formation. In this study, we propose a controlled and reproducible way to fabricate bacteria-modified electrodes. The method consists of an immobilisation step using a cellulose matrix, followed by an electrode polarization in the presence of ferricyanide and glucose. Our process is short, reproducible and led us to obtain ready-to-use electrodes featuring a high-current response. An excellent shelf-life of the immobilised electrochemically active bacteria was demonstrated for up to one year. After an initial 50% activity loss in the first month, no further declines have been observed over the following 11 months. We implemented our bacteria-modified electrodes to fabricate a lateral flow platform for toxicity monitoring using formaldehyde (3%). Its addition led to a 59% current decrease approximately 20 min after the toxic input. The methods presented here offer the ability to develop a high sensitivity, easy to produce, and long shelf life bacteria-based toxicity detectors.

The auricular cartilage graft used as interpositional material for disc replacement after failed TMJ operative arthroscopy.

OBJECTIVES: The aim of this study was to evaluate the preoperative and 2-years postoperative clinical and radiological findings in a group of patients after temporomandibular joint discectomy and interpositional autogenous auricular cartilage graft. MATERIALS AND METHODS: The technique involved a disc removal, condylar remodeling and fixation of the graft to the fossa-eminence region. Preoperative and 2-years postoperative clinical findings and magnetic resonance features were evaluated in a group of 13 patients (fourteen joints). RESULTS: In this series, a significant decrease of pain level (p<0.0001) was observed from the first month postoperatively whereas maximal interincisal opening improved significantly (p<0.05) after three months follow-up. Radiographically, the magnetic resonance imaging two years after surgery showed an increase on the condylar features of sclerosis and flattening. CONCLUSION: Discectomy and auricular cartilage interposition graft is an acceptable method for cases of temporomandibular joint dysfunction refractory to the arthroscopic treatment but progressive degenerative changes can be observed after this technique. Although this technique is a surgical option for patients with non-reducing displaced TMJ articular discs, the high failure rate indicates that there may be better alternative surgical procedures to consider.

Lip reconstruction technique: A modified Abbe-Estlander with a myomucosal advancement flap.

Lip cancer represents between 12-15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

Fuel cell-powered microfluidic platform for lab-on-a-chip applications: Integration into an autonomous amperometric sensing device.

The present paper reports for the first time the integration of a microfluidic system, electronics modules, amperometric sensor and display, all powered by a single micro direct methanol fuel cell. In addition to activating the electronic circuitry, the integrated power source also acts as a tuneable micropump. The electronics fulfil several functions. First, they regulate the micro fuel cell output power, which off-gas controls the flow rate of different solutions toward an electrochemical sensor through microfluidic channels. Secondly, as the fuel cell powers a three-electrode electrochemical cell, the electronics compare the working electrode output signal with a set reference value. Thirdly, if the concentration measured by the sensor exceeds this threshold value, the electronics switch on an integrated organic display. This integrated approach pushes forward the development of truly autonomous point-of-care devices relying on electrochemical detection.

Impedance biosensing using phages for bacteria detection: generation of dual signals as the clue for in-chip assay confirmation.

In the present work, we compare the use of antibodies (Ab) and phages as bioreceptors for bacteria biosensing by Electrochemical Impedance Spectroscopy (EIS). With this aim, both biocomponents have been immobilised in parallel onto interdigitated gold microelectrodes. The produced surfaces have been characterised by EIS and Fourier Transform Infra-Red (FTIR) Spectroscopy and have been applied to bacteria detection. Compared to immunocapture, detection using phages generates successive dual signals of opposite trend over time, which consist of an initial increase in impedance caused by bacteria capture followed by impedance decrease attributed to phage-induced lysis. Such dual signals can be easily distinguished from those caused by non-specific adsorption and/or crossbinding, which helps to circumvent one of the main drawbacks of reagentless biosensors based in a single target-binding event. The described strategy has generated specific detection of Escherichia coli in the range of 10(4)-10(7) CFU mL(-1) and minimal interference by non-target Lactobacillus. We propose that the utilisation of phages as capture biocomponent for bacteria capture and EIS detection allows in-chip signal confirmation.

Distracción osteogénica vertical de injerto microvascularizado de peroné para reconstrucción mandibular y optimización de la rehabilitación implantológica / Vertical distraction osteogenesis of microvascularised fibular grafts for mandibular reconstruction and optimisation of rehabilitation implantology

Introducción: En la actualidad, se considera que el injerto microvascularizado de peroné es la mejor opción de tratamiento para las reconstrucciones mandibulares de defectos óseos mayores de 6 cm. No obstante, debido a su limitada altura, presenta una importante desventaja en cuanto a la rehabilitación protésica, particularmente en aquellos casos de resecciones mandibulares parciales con una hemimandíbula contralateral dentada. Material y métodos: Presentamos un caso clínico de mixoma mandibular tratado mediante resección quirúrgica y reconstrucción mandibular primaria mediante injerto microvascularizado de peroné, al que se sometió a distracción osteogénica vertical para optimizar la posterior rehabilitación implantológica. Resultados: La discrepancia de altura se solucionó completamente y se colocaron tres implantes osteointegrados en el área distraída, lo cual permitió una rehabilitación protésica muy satisfactoria, tanto estética como funcionalmente. Conclusiones: La distracción osteogénica vertical de peroné constituye una excelente opción terapéutica para igualar la altura del peroné a la del reborde alveolar de la hemimandíbula dentada contralateral, tras la reconstrucción de defectos mandibulares extensos, de cara a una posterior rehabilitación implantológica, lo que permite llevar a cabo ésta con resultados, tanto funcionales como estéticos, muy satisfactorios. Además, no presenta los inconvenientes de otras técnicas empleadas en estos pacientes, como el peroné en doble barra (mayor dificultad técnica y mayor riesgo de trombosis en el pedículo) y el empleo de injertos “onlay” (morbilidad añadida en la zona de toma del injerto)(AU)

Introduction: Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it doesn’t offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. Materials and methods: We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma. The distraction device was applied intraorally. Distraction of 0.5 mm per day was performed followed by 3 months of consolidation period. Results: The vertical discrepancy between the fibula and the native hemimandible was corrected. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. Conclusions: We believe that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumour surgery(AU)

La influencia de la superficie articular y la membrana sinovial en la evolución de pacientes afectos por bloqueo crónico de la articulación temporomandibular tratados mediante artroscopia / Influence of the joint surface and the synovial membrane on the evolution of patients affected by chronic temporomandibular joint block who were treated with arthroscopic surgery

Introducción: Se ha referido la artroscopia de la articulación temporomandibular (ATM)como una técnica efectiva en el tratamiento del bloqueo crónico (BC) articular. El propósitodel presente estudio es evaluar si el estado de la superficie articular y la membrana sinovial directamente visualizados por artroscopia pueden determinar el resultado posoperatorio de pacientes afectos por BC de la ATM. Pacientes y método: Doscientos cincuenta y siete de 500 pacientes (344 articulaciones) cumplieronlos criterios de inclusión para BC de la ATM. Para el presente estudio se seleccionaron 172 pacientes con afectación unilateral. Se eligieron los parámetros "sinovitis" y "condromalacia" para la evaluación de la membrana sinovial y la superficie articular, respectivamente. Se establecieron dos grupos de pacientes: a) pacientes con afectación leve: sinovitisgrados I/II más condromalacia I/II, y b) pacientes con afectación grave: sinovitis gradosIII/IV más condromalacia grados III/IV. Se eligieron el dolor y la máxima apertura oral(MAO) interincisal como variables dependientes. Todos los pacientes se revisaron de modo posoperatorio al mes, 3, 6, 12 y 24 meses. Se utilizó la prueba de la “t” de Student paramuestras pareadas para comparar los valores medios de dolor (escala visual analógica, EVA) y función (MAO), de modo preoperatorio y posoperatorio. Se utilizó la “t” de Student para muestras independientes para la comparación de los diferentes grupos establecidos.Se consideró estadísticamente significativo un valor de p <= 0,05. Resultados: Artroscópicamente se observó sinovitis grados I/II en 87 (50,58%) pacientes, y sinovitis grados III/IV en 72 (41,86%), mientras que se objetivó condromalacia grados I/IIen 66 (38,37%) pacientes y condromalacia grados III/IV en 54 (31,39%)...(AU)

Introduction: Arthroscopy of the temporomandibular joint (TMJ) has been considered aneffective technique to treat close lock (CL). The purpose of this study is to evaluate if thestatus of the joint surface and the synovial membrane directly seen via arthroscopy candetermine the post operative results of patients with chronic block of the TMJ. Patients and methods: Two hundred and fifty-seven out of the 500 patients (344 joints) met thecriteria for chronic block of the TMJ. One hundred and seventy-two patients with unilateralaffectation were selected for this study. Synovitis and chondromalacia are the parameters chosen to evaluate the synovitis membrane and joint surface, respectively. Two groups ofpatients were formed: a) patients with light affectation: level I/II synovitis and level I/II chondromalacia, and b) patients with severe affectation: level III/IV synovitis and level III/IV chondromalacia. The dependent variables were pain and interincisal maximum oralopening (MOO). All of the patients had post operative follow-up at 1, 3, 6, 12, and 24 months.The "t" Student test was used before and after surgery to match evidence to compare the average values of visual analogical scale (VAS) and function (MOO). The "t" Student test wasused for independent samples to compare the different groups that were established. Avalue of p <= 0.05 was considered statistically significant. Results: Level I/II synovitis was seen using arthroscopy in 87 (50.58%) patients, and level III/IV synovitis was seen in 54 (31.39%) of patients, while level I/II chondromalacia was observed in 66 (38.37%) patients and level III/IV chondromalacia was observed in 54 (31.39%).During the follow-up period a significant decrease in pain and a parallel increase in oral opening were observed after arthroscopy in patients affected by level I/II and III/IV synovitis and level I/II and III/IV chondromalacia (AU)

Elevación de seno maxilar. Análisis clínico de nuestra experiencia en más de 100 casos / Clinical analysis of our experience in over 100 cases of maxillary sinus lift

Objetivos: La elevación de seno maxilar es uno de los procedimientosmás versátiles en cirugía oral, de modo que hay descritos diversos abordajes,tipos de injertos, posibilidad de asociar otras técnicas preprotésicas y colocarimplantes de manera simultánea o diferida, dependiendo de la altura ósea inicial.Nuestro propósito es comunicar nuestra experiencia después de intervenir131 casos. Materiales y métodos: Se analizó una serie de 131 procedimientosllevados a cabo en 91 pacientes consecutivos, entre 1996 y 2007. La edadmedia fue de 50,43 años (23-69). El control radiológico pre y postoperatoriose realizó mediante ortopantomografía y TC dental. Se analizó la tasa de éxitoimplantario (implantes osteointegrados y cargados) comparando los distintosinjertos, el hábito tabáquico, las patologías asociadas y la colocación simultáneao diferida de los implantes. Así mismo, el tiempo (meses) necesario paracargar la prótesis se ha comparado entre los diferentes tipos de injerto. Resultados:En las zonas aumentadas se colocaron un total de 228 implantes roscados.La altura preoperatoria media del suelo del seno fue de 6,59±2,11 mmy la postoperatoria de 14,57±2,33 mm. El seguimiento medio fue de 2,94 años(1-12). La tasa de éxito implantario global fue de 96,91%, no habiéndoseencontrado diferencias significativas entre los distintos injertos, patologías asociadaso el hábito tabáquico. Conclusiones: En base a este análisis retrospectivo,se concluye que la elevación de seno es una técnica versátil, eficaz, seguray predecible; con una tasa de éxito implantario muy alta independientedel tipo de injerto, comorbilidad, hábito tabáquico y colocación simultánea odiferida de los implantes. El empleo de injerto óseo autólogo requiere un tiempode espera para la carga protésica significativamente menor(AU)

Purpose: Maxillary sinus elevation surgery is one ofthe most versatile surgical procedures in maxillofacial surgery:there are various approaches to the sinus, different materials forsinus grafting, other preprosthetic procedures can be associatedand the implants placement can be simultaneous or delayed,depending on the initial bone height. The aim of this studywas to demonstrate this versatility by means of reporting theclinical outcome of sinus augmentation surgery in 131 cases.Materials and Methods: 131 sinus augmentation procedureswere undertaken on 91 consecutive patients (mean age 50,43years (26-69)). The preoperative and postoperative radiologicalstudy was developed by means of orthopantomography andDental-TC. The survival rate of implants, as measured by integrationand succesfull loading, was compared between differentgraft materials, smoking/non-smoking patients, differentgroups of associated pathologies and simultaneous/delayedimplants placement. The time (months) necessary for prosthesisloading was measured and compared between the differentgraft material groups. Results: 228 screw-type implantswere placed in sinus lifted regions. The mean residual ridge heightwas 6,59±2,11 mm. The mean postsurgical ridge height was14,57±2,33 mm. After a mean follow-up period of 2,94 years(range 1 to 12 years) the global implant survival rate was96,91%. There were not significant differences between differentbone grafts, associated comorbidity and smoking habits.Conclusions: On the basis of this retrospective study, it mightbe concluded that the sinus augmentation surgery is a very versatileprocedure. Its efficacy and predictability in terms of implantsurvival rate is extremely high and independent on the bonegraft material, surgical technique, associated morbility, smokinghabit and immediate/delayed implant placement. The useof autologous bone requires less time to load the prosthesis(AU)

Hipertrofia bilateral de apófisis coronoides / Bilateral Hypertrophy of the coronoid process

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Colgajo frontal. Método sencillo en la reconstrucción de defectos cutáneos nasales extensos / Forehead flap. A simple method for the reconstruction of extensive nasal skin defects

Las aplicaciones del colgajo frontal en la cirugía de los defectosnasales son destacables, pues la práctica totalidad de las sub-unidades nasales,incluidos el vestíbulo nasal, el reborde alar y la columela pueden serreconstruidos satisfactoriamente. Su técnica de tallado es sencilla y las complicacionesde la zona donante escasas. El color de la piel, su textura y la posibilidadde obtener una amplia cantidad de tejido, con o sin expansión tisularprevia, lo hacen de primera elección en la reconstrucción de defectos cutáneosnasales extensos. Referimos muestra experiencia reciente en el uso deeste colgajo y revisamos el estado del arte actual en el empleo del mismo(AU)

The use of the forehead flap in the surgery of nasal defectsis noteworthy because almost all of the nasal subunits, includingthe nasal vestibule, alar margin, and columella nasi can bereconstructed satisfactorily. The cutting technique is simple andthere are few donor zone complications. The color of the skin, itstexture, and the feasibility of obtaining a large amount of tissue,with or without previous tissue expansion, make forehead flaps thetechnique of choice in the reconstruction of extensive nasal skindefects. We report our recent experience with this flap and we reviewthe current state-of-the-art in the use of this flap(AU)

Transoral endoscopic-assisted management of subcondylar fractures in 17 patients: an alternative to open reduction with rigid internal fixation and closed reduction with maxillomandibular fixation.

The authors evaluate the results of transoral endoscopic-assisted open reduction and miniplate fixation of subcondylar fractures. Seventeen patients were treated from August 2005 to April 2007. Inclusion criteria were: adult patients, inability to achieve adequate occlusion with closed reduction, dislocation of the condylar fragment between 10 and 45 degrees , and 2-mm inter-fragment overlapping. Regular panoramic radiographs were taken postoperatively. Transbuccal incisions were used to place the screws for fixation in 15 patients. Pure intraoral access and angulated drills and screwdrivers were used in 2 patients. The condyle was placed into the condylar fossa in all cases. No damage to the facial nerve was observed. No visible scars were present. Mean surgical time was 80.36 minutes. Transitory hyposthesia was observed in 3 cases. Adequate reduction and consolidation of the fracture was achieved in 16 patients. No condylar reabsortion was present at the end of the follow-up period. The authors consider that transoral endoscopic-assisted open reduction constitutes a valid alternative to a transcutaneous approach for the reduction and fixation of subcondylar fractures in selected cases. It provides the benefits of open reduction and internal fixation without the potential complications. Advice is given on how to achieve adequate reduction and stability of the proximal fragment.

C-modified osteotomy for bilateral advancement of the orbital rim in Graves orbitopathy: a technical note.

The authors present a modification of the classical three-wall orbital decompression for the treatment of Graves' orbitopathy. It consists of two 'C' osteotomies for the bilateral projection of the superolateral, lateral and inferolateral orbital rims, associated with the removal of the lateral orbital walls. This technique is performed following a coronal approach. Ultrasound cutting instruments were used for the osteotomies. They avoided lesion of surrounding soft tissues, such as the duramater and the periorbital tissues. Stabilization of the advanced structure was achieved by interposition of autologous bone graft obtained from the outer cortex of the calvaria. An extreme advancement of the orbital rim with resolution of diplopia, ocular pain and eyelid incompetence was obtained. Using this procedure, a good functional and aesthetic outcome was achieved.

Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: a clinical study of 344 arthroscopic procedures.

Arthroscopic surgery has been reported to decrease pain in relation to the TMJ, improving maximal interincisal opening (MIO). The aim of the present study was to report the clinical outcome of arthroscopic surgery for the treatment of chronic closed lock (CCL) of the TMJ. Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analysed. All were classified as II-V according to Wilkes. Within the series, various arthroscopic procedures were performed. The inclusion criteria for CCL of the TMJ were met by 257 patients (344 joints). The mean age was 30.24 years; 237 (92%) were female and 20 (8%) male. Mean preoperative visual analogue scale score for evaluation of TMJ pain was 53.21+/-23.02. Mean MIO was 24.75+/-4.89 mm. Following arthroscopy, a significant decrease in TMJ pain was achieved (p<0.0001). For MIO, mandibular protrusion and lateral excursion movements, a significant increase in mean values was observed following surgery (p<0.0001). No statistical differences were observed between arthroscopic lysis and lavage and operative arthroscopy in relation to postoperative pain or MIO at any stage of the follow-up period. Arthroscopy should be considered as a first-line treatment for CCL of the TMJ.