TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow-up study.

This prospective study evaluated the 5 to 8 year subjective and objective results of 42 consecutive patients who had TMJ reconstruction using the TMJ Concepts/Techmedica custom made total joint prosthesis. Criteria for use of the prosthesis included the following TMJ conditions: (1) multiply operated, (2) previous alloplastic implants, (3) osteoarthritis, (4) inflammatory or resorptive arthritis, (5) connective tissue or autoimmune disease, (6) ankylosis, and (7) absent or deformed structures. Thirty-eight of 42 patients (90%) with 69 TMJs reconstructed using the TMJ Concepts/Techmedica total joint prosthesis had appropriate data for inclusion in the study. The average age at surgery was 36 years and average follow-up was 73.5 months. The entire group and three subgroups were objectively evaluated for incisal opening, lateral excursions, and occlusal stability, while subjectively assessed for pain and jaw function. Paired t-test and comparison analyses were used to assess outcomes. For the group of 38 patients, there was statistically significant improvement in incisal opening (P=0.001), jaw function (P=0.001), and pain level (P=0.0001). Lateral excursion movements significantly decreased (P=0.04). The occlusion remained stable in all cases. Complications occurred in six patients. Comparison analysis of the three groups demonstrated significantly better outcomes for patients with fewer previous TMJ surgeries and without exposure to Proplast-Teflon or Silastic TMJ implants. This study demonstrated that the TMJ Concepts/Techmedica total joint prosthesis is a viable technique for TMJ reconstruction as a primary procedure and for patients with previous multiple TMJ surgeries and mutilated anatomy of the TMJ.

Mitek anchors for treatment of chronic mandibular dislocation.

OBJECTIVE: The purpose of this study was to present a new technique for limiting mandibular translation in patients with chronic mandibular dislocation. TECHNIQUE DESIGN: This relatively simple procedure uses 2 Mitek mini bone anchors with osseointegration potential. One anchor is placed in the lateral pole of the condyle, and the other is placed in the posterior root of the zygomatic arch. Heavy suture material is threaded through the eyelet of each anchor and tightened to function as a restraining ligament. RESULTS: This technique has been used on 5 patients with a follow-up of 2 to 4 years, with no failures. CONCLUSIONS: This technique provides an effective method for the prevention of condylar dislocation while permitting some controlled translation.

Use of Gore-Tex tubing as a conduit for inferior alveolar and lingual nerve repair: experience with 6 cases.

PURPOSE: This report evaluates treatment outcomes associated with the use of Gore-Tex (GT; W.L. Gore & Associates, Flagstaff, AZ) vein graft tubing as a conduit for repair of inferior alveolar nerve (IAN) and lingual nerve (LN) continuity defects. PATIENTS AND METHODS: Six patients (5 female and 1 male) with painful dysesthesia secondary to injuries of the IAN (n = 3) or LN (n = 3) underwent surgical exploration and resection of pathologic tissue. Reconstruction of the resultant continuity defects was performed using 3-mm diameter GT tubing sutured to the epineurium of the proximal and distal nerve trunks. Nerve reconstruction was performed an average of 20 months after injury (range, 4 to 48 months). Patients were tested before and after surgery with the following tests: subjective pain level using an analogue scale, sharp stimulus, touch, cold sensation, directional sense, and 2-point discrimination. RESULTS: Four patients reported no change in subjective pain level, and 2 patients had minimal decrease in pain. Two patients reported some sensation to sharp stimulus, and 1 patient was hypersensitive. Three patients responded to touch, and 3 had no response. Four patients had no response to cold sensation, and 2 had a delayed response. Only 1 patient could detect brushstroke direction. Three patients had no response to 2-point discrimination, and 3 responded at greater than 20 mm. CONCLUSIONS: Use of GT tubing in this group of patients produced poor clinical outcomes and is not recommended for nerve reconstruction of IAN and LN continuity defects.

Frequency of chlamydial antibodies in patients with internal derangement of the temporomandibular joint.

PURPOSE: This study investigates whether an increased frequency of serum antibodies to Chlamydia trachomatis is found in patients with internal derangement of the temporomandibular joint (TMJ). PATIENTS AND METHODS: An indirect immunofluorescence antibody assay for the detection of serum immunoglobulin G antibodies for C trachomatis was used for most patients. Forty-one female patients were evaluated. RESULTS: Three of 41 patients (7%) had serum antibody titers that were considered positive for active C trachomatis infection. Eleven patients (27%) were considered to have had a past infection based on the immunoglobulin G or immunoglobulin A titer results. Using the binomial test, we found that the probability of observing 14 positive results (34%) was significant (P < .0001). CONCLUSIONS: An increase in the frequency of serum antibodies to C trachomatis was found in patients with internal derangement of the TMJ. Serologic testing for antibodies to bacteria associated with reactive arthritis might be useful in the evaluation of patients with internal derangement of the TMJ.