The use of intra-articular opioids and bupivacaine for analgesia following temporomandibular joint arthroscopy: a prospective, randomized trial.

PURPOSE: This investigation evaluated the efficacy of using intra-articular morphine, bupivacaine, or a combination of both in the management of postarthroscopy temporomandibular joint (TMJ) pain. MATERIALS AND METHODS: Thirty-two consecutive patients with internal derangements of the TMJ and persistent pain underwent TMJ arthroscopy. The patients were randomized equally into 4 groups. Group 1 received a sterile saline solution (control), group 2 received bupivacaine alone, group 3 received only a morphine solution, and group 4 received morphine mixed with bupivacaine. The patients recorded postarthroscopy pain using a visual analog scale (VAS), as well as analgesic consumption for 24 hours. The VAS and analgesic consumption were compared in the 4 groups. RESULTS: Group 3 (bupivacaine alone) consumed, on average, 5.1 fewer analgesic equivalents than did group 1 (control) over the 24-hour period of study (P <.05). Otherwise, there was no significant difference in the number of analgesic equivalents consumed by the 4 groups. Patients treated with bupivacaine alone and those with morphine alone had significantly lower pain scores than the controls. However, there was no significant difference between the pain scores of the morphine and bupivacaine groups at any time. Patients treated with the mixture of morphine and bupivacaine showed no significant difference from controls at any time. CONCLUSIONS: Bupivacaine alone provides a better analgesic effect than morphine alone or the combination of morphine and bupivacaine. Morphine alone has a longer time of onset, with less effect on the pain scores during the 24-hour observation period.

Surgical arthroscopy of the temporomandibular joint.

Currently, surgical arthroscopy of the TMJ is primarily confined to the superior joint space, unless there is a perforation in the disc. This is due mainly to the technical limitations imposed in attempting to manipulate a 0.69 mm arthroscope with advanced fibreoptics in the lower joint space. At the present time, operative arthroscopy is "state of the art" treatment for many pathological entities involving the TMJ. Disc entrapment, synovitis, adhesions, chondromalacia, osteoarthritis and lateral capsular impingement can be effectively treated with this technique. While many patients will achieve successful results with this form of therapy, operative arthroscopy is not a panacea, and the need for open arthrotomy must still be reserved for those patients with advanced intracapsular disease. Specifically, anterior disc displacement with reduction, extensive intra-articular fibrosis, failed arthroscopy, avascular necrosis, osteochondritis dissecans, and joint reconstruction often require open arthrotomy for their successful management.

Analysis of facial and trigeminal nerve function after arthroscopic surgery of the temporomandibular joint.

PURPOSE: This study analyzes facial and trigeminal nerver function after arthroscopic surgery. PATIENTS AND METHODS: Eighty-one consecutive patients (81 joints) who underwent unilateral temporomandibular joint (TMJ) arthroscopic surgery were assessed postoperatively for facial and trigeminal nerve function. RESULTS: Twenty-four of 81 patients (29.6%) had some degree of sensory or motor nerve dysfunction. Two patients (2.5%) showed signs of facial nerve dysfunction, which completely resolved in one patient in 11 weeks, but persisted mildly in the other at the 1-year follow-up examination. CONCLUSIONS: Auriculotemporal syndrome was not detected in any of the 40 patients tested. However, transient numbness over the distribution of the auriculotemporal nerve was present in 19 of 81 patients (23.4%). This numbness persisted for 3 days to 3 months with a mean duration of 14 days. Three of the 81 patients (3.6%) showed signs of inferior alveolar and lingual nerve involvement, which returned to normal in 4 to 12 weeks in all 3 patients.

Use of Hylan G-F 20 for viscosupplementation of the temporomandibular joint for the management of osteoarthritis: a case report.

Viscosupplementation is a relatively new treatment concept for restoring the normal rheologic properties of the osteoarthritic joint. It is most often used for the knee. This case report describes results that were achieved using viscosupplementation following conservative therapy for a patient with osteoarthritis of the temporomandibular joint. Further study in the use of these treatments is recommended.

Facial nerve function following temporomandibular joint surgery using the preauricular approach.

Sixty-eight patients (83 temporomandibular joints) consecutively operated on who had a variety of temporomandibular joint operations using a preauricular approach were assessed for facial nerve function following surgery. Nine patients (10.84%) showed signs of facial nerve injury in which the temporal and zygomatic branches were involved. The incidence of facial nerve injury was greater in patients who had undergone previous temporomandibular joint surgery (17.64%) than in patients with previously unoperated joints (9%). Normal facial nerve function returned in 9 to 14 weeks except in one patient who showed a mild deficit of the zygomatic branch at 20 weeks. The nature and duration of the surgical procedure did not correlate with facial nerve injury. Scarring of tissues as a result of previous temporomandibular joint surgery may significantly increase the risk of facial nerve injury during subsequent temporomandibular joint surgery.

The role of diagnostic arthroscopy in the management of temporomandibular joint dysfunction.

Temporomandibular joint (TMJ) dysfunction may manifest itself clinically by a variety of presentations ranging from headache, pre-auricular pain or tenderness, otalgia, to mandibular hypomobility. Some symptoms may mimic forms of facial pain such as: temporal arteritis, migraine, cluster headache, trigeminal or glossopharyngeal neuralgias, myofascial pain dysfunction, or muscle contraction (tension) headache. This article will focus on a relatively new diagnostic tool that may be used to examine the TMJ for intracapsular pathology which may be responsible for the presenting patients' symptoms.

Use of low-dose ketamine hydrochloride in outpatient oral surgery.

This study compares the quality of anesthesia achieved with low-dose ketamine with that of methohexital sodium. In a double-blind study of 40 healthy adult patients undergoing a variety of minor oral surgical procedures, the anesthetic techniques were assessed with respect to the following parameters: patients' subjective evaluation of the anesthesia, the level of response to injection of local anesthetic, psychomotor ability after surgery, recovery times, and the frequency of adverse effects. From these observations, it was deduced that when low-dose ketamine was used with diazepam, meperidine, and nitrous oxide, it proved to be a safe and effective supplement for minimizing pain, discomfort, and anxiety before injection of local anesthetic. Patients' appreciation of the level of anesthetic achieved, psychomotor ability, adverse reactions, and recovery time was not significantly different from the methohexital sodium group.

An assessment for auriculotemporal syndrome following temporomandibular joint surgery through the preauricular approach.

Twenty temporomandibular joints (TMJs) were operated on for the correction of arthrographically confirmed internal derangements using a modified preauricular approach. Postoperatively, three of the 20 patients tested exhibited auriculotemporal syndrome as deduced from a starch-iodine test. The manifestation was subclinical and consisted of sweating only over the distribution of the auriculotemporal and great auricular nerves in response to a gustatory stimulus. The response was variable from patient to patient.