Temporomandibular chronic dislocation: The long-standing condition

BACKGROUND: The temporomandibular joint (TMJ) dislocation can be categorised into three groups: acute, habitual or recurrent and long-standing. The long-standing or protracted lower jaw dislocation refers to a condition that persists for more than one month without reduction. There are a great variety of methods for its treatment, from the manual or non-surgical, to surgical ones like the indirect approach (conservative surgical approach) and direct approach (open joint). Additional procedures in unsuccessful cases may include extra-articular orthognathic techniques to correct a malocclusion until joint replacement. MATERIAL AND METHODS: We report four new cases with a minimum of 6 weeks dislocation who were seen since 1995 to 2015 in the Maxillofacial Department of the Clínico Hospital (Valencia, Spain), in which the mean age was 57.5 years. Most of them were bilateral and the gender was predominantly female. Additionally, we have reviewed the related literature. RESULTS: All of the cases were successfully treated and half of them required open surgery. CONCLUSIONS: The report confirms the difficulty of the treatment and reaffirms the necessity to bear in mind the wide variety of methods available for the treatment of this pathology. We stress the difficulties associated with managing the treatment and of suggesting new guidelines. The best option still remains not to delay the diagnostic and to select the appropriate initial treatment

Bilateral synovial chondromatosis of the temporomandibular joint.

PURPOSE: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. PATIENTS AND METHODS: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. RESULTS: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. CONCLUSION: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

The meridian incision: a technical modification in the conservative surgery of the impacted maxillary canine.

We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth's eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge. The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound's closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficient results.

The meridian incision: A technical modification in the conservative surgery of the impacted maxillary canine

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We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth’s eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge.The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound’s closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficientresults