Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Management of an infected temporomandibular joint prosthesis and the use of bone cement with antibiotics / Manejo de la infección de una prótesis a medida de articulación temporomandibular y el uso de cemento óseo con antibiótico

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Miositis osificante traumática / Traumatic myositis ossificans

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Osteochondroma of the temporomandibular joint: report of 2 cases emphasizing the importance of personalizing the surgical treatment.

BACKGROUND: Osteochondromas (OCs) are rare in the craneofacial area (0.6%). We present 2 cases of OC of the mandibular condyle, emphasizing the surgical decision of each case. CASE 1: In a 48-year-old woman with facial asymmetry, left cross-bite, and mandible deviation to the left, a computerized tomographic (CT) scan confirmed the presence of a bony expansion of the right condyle. The clinical diagnosis was osteochondroma. The patient underwent condylectomy with costochondral reconstruction. CASE 2: In a 76-year-old woman with a 1-month history of right preauricular pain, CT showed a deformed right condyle with a bony mass at the base of the temporal bone and the articular fossa. OC of the skull base was diagnosed, with possibly a concurrent lesion of the condyle. The patient underwent condylectomy with the removal of the skull base mass and an inmediate TMJ reconstruction by means of an appropriately sized stock total TMJ prosthesis. CONCLUSIONS: It is necessary to personalize the temporomandibular joint reconstructive options.

Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida. Planificación quirúrgica virtual / Post-traumatic reconstruction with custom prosthesis of the temporomandibular joint. Computerized surgical planning

Introducción: Las nuevas técnicas de planificación quirúrgica virtual, como la tecnología CAD/CAM, así como los avances en biomateriales, permiten abordar casos cada vez más complejos de reconstrucción de la articulación temporomandibular. La planificación y la fabricación de dispositivos aloplásticos a medida permiten una adaptación excelente a las estructuras anatómicas. Las deformidades dentofaciales coexisten en muchas ocasiones con la afección articular. Con estos métodos de planificación es posible asociar procedimientos de cirugía ortognática, a la vez que reconstruimos la articulación temporomandibular en un solo tiempo quirúrgico. Material y métodos: En este artículo presentamos nuestra experiencia en la planificación virtual y posterior cirugía de 3 casos de anquilosis articular bilateral (6 articulaciones), con simulación de osteotomías, movimientos maxilomandibulares y diseño de prótesis totales aloplásticas a medida de la articulación temporomandibular. Conclusiones: El abordaje integral de la biomecánica articular, la relación intermaxilar y la oclusión dental es imprescindible para obtener resultados predecibles y satisfactorios. La planificación virtual y la utilización de dispositivos aloplásticos a medida permiten la reconstrucción total articular de una forma precisa y segura (AU)

Introduction: New virtual surgery planning techniques like CAD/CAM and advances in biomaterials have made it possible to undertake increasingly complex cases of temporomandibular joint reconstruction. The planning and preparation of custom alloplastic devices makes it possible to accurately accommodate anatomic structures. Dental and facial deformities often coexist with articular pathology. Using computerized planning methods, orthognathic surgery procedures can be combined with temporomandibular joint reconstruction in a single procedure. Material and methods: The authors' experience with computerized planning and surgical execution of three cases of bilateral articular ankylosis (6 joints) is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction (AU)

Osteochondroma of the temporomandibular joint treated by means of condylectomy and immediate reconstruction with a total stock prosthesis.

BACKGROUND: Osteochondromas are one of the most common benign tumours of bone, but they are rare in the craniofacial region. These condylar tumours have been variably treated, including resection through local excision or condylectomy with or without reconstruction. METHODS: A case of osteochondroma of the mandibular condyle and cranial base arising concurrently in the 76 years old patient was presented. The surgical excision of the skull base lesion and condylectomy with immediate reconstruction of temporomandibular joint was applied. RESULTS: Based on the history, clinical examination and radiographic findings, osteochondroma of the skull base was diagnosed, with a concurrent lesion of the condylar process. Treatment methods for this patient included excision of the skull base tumour and condylectomy with immediate temporomandibular joint reconstruction using appropriately sized stock total temporomandibular joint prosthesis. At the 24 month follow-up, patient was free of pain and her maximal incisal opening was maintained, with no radiographic evidence of tumour recurrence or failure of the device. CONCLUSIONS: Temporomandibular joint stock total replacement prosthesis became a good option to reconstruct both the fossa and the condyle in a one-stage surgery, due to the fact that both the condylar/mandibular and the fossa implants were stable in situ from the moment of fixation, with a good outcome at 24 month follow-up, with no loosening of the screws nor failure of the device.

Sodium hyaluronate improves outcomes after arthroscopic lysis and lavage in patients with Wilkes stage III and IV disease.

PURPOSE: Among patients with Wilkes stage III and IV disease undergoing arthroscopic lysis and lavage, does the use of an intra-articular injection of sodium hyaluronate (SH), when compared with Ringer lavage, result in better postoperative pain control and temporomandibular joint (TMJ) function? PATIENTS AND METHODS: We designed and implemented a randomized, double-blind, pilot controlled clinical trial. The study sample was composed of patients with middle Wilkes stage (late stage III and early stage IV) disease. Subjects were randomized to 1 of 2 treatment limbs. The treatment group received Ringer lactate plus an injection of 1 mL of SH after arthroscopy, whereas the control group was given Ringer lactate during arthroscopy. The primary outcome variables were pain and TMJ function measured by use of visual analog scales. Appropriate descriptive and bivariate statistics were computed. A P value less than .05 was considered statistically significant. RESULTS: The study sample was composed of 40 patients with 20 subjects enrolled in both treatment groups. There were no statistically significant differences between the 2 groups in terms of demographics and preoperative variables. Postoperative analgesia was statistically significant in the treatment group with respect to the control group on the visits on days 14 and 84. No statistically significant differences were observed between the 2 groups in the maximum interincisal opening and tolerance. CONCLUSIONS: An intra-articular injection of SH after arthroscopic lysis and lavage is effective in reducing pain in patients with TMJ dysfunction, enhancing postsurgical recovery. The analgesic effect of treatment with SH is maintained in the long term.