The Christensen prosthesis. A retrospective clinical study.

The objective of this study was to determine if the Christensen temporomandibular joint prosthesis system in an effective alternative in treating patients with severe temporomandibular joint disorders. A total of 69 patients who were not responsive to either nonsurgical or prior surgical treatments were placed into one of three treatment groups depending on the following diagnoses: (1) placement of a glenoid fossa-eminence prosthesis with meniscus retention (22 patients, 40 joints); (2) placement of a glenoid fossa-eminence prosthesis without retention of the meniscus (26 patients, 49 joints); (3) total joint replacement (21 patients, 34 joints). Patients were evaluated immediately before surgery and at regular intervals after surgery for an average of 3.1 years. Success was measured as a significant improvement of function and decrease in pain as measured on a visual analogue scale, as well as improved incisor opening as measured with a Therabite Scale (Lorenz Surgical, Jacksonville, Fla.). Comparison of mean and average pre- and postsurgical values for all groups and criteria showed significant improvement. Results of this study indicate that the Christensen temporomandibular joint prosthesis system may offer a viable method for the treatment of severe temporomandibular joint disease with a high degree of success.

Ludwig's angina: report of two cases and review of the literature from 1945 to January 1979.

Two cases of Ludwig's angina treated successfully led us to review the main English language literature from 1945 to January 1979. The most common cause of Ludwig's angina is dental, and the organism cultured most often is streptococcus. However, other avenues of infection and numerous pathogens have been implicated in this disease. Penicillin remains the preferred primary antibiotic, with combinations of this drug and other antibiotics being used by various authors. In both the pre-antibiotic and antibiotic era, the airway remains the prime concern of the surgeon in the management of this potentially life-threatening disease. Of the 75 cases reviewed, there were seven deaths, but four of these patients had pre-existing fatal systemic problems and Ludwig's angina was not the cause of death. The other three deaths were due to Ludwig's angina, yielding a 4% mortality rate. Thus, aggressive management of Ludwig's angina, with respect to airway, antibiotics, and early surgical intervention, has resulted in a significant drop in the mortality rate of this disease which once led "almost uniformly to a fatal ending."