Intubation risk factors for temporomandibular joint/facial pain.

Endotracheal intubation has been proposed as a risk factor for temporomandibular joint dysfunction (TMD) in a limited number of published case reports and systematic studies. Symptoms may result from forces applied with the laryngoscope, or manually in an attempt to complete the intubation, and may be related to the duration in which temporomandibular joint (TMJ) structures are stressed. The objective of this study was to examine risk factors for TMD complaints associated with endotracheal intubation. One hundred twenty-two patients who underwent endotracheal intubation for surgery at the University of Washington Medical Center participated. Exclusions included surgery of the head or neck, cognitive deficit, or emergency surgery. Subjects were assessed presurgically, and at 7 and 14 days postoperatively. Gender, interincisal distance, and age were found to be significantly associated with TMD symptoms lasting as long as 14 days following intubation. For both TMD pain and TMD nonpain symptoms, the most reliable predictor of a complaint following intubation was a history of TMD complaints within a year preoperatively. Any association between endotracheal intubation and the development of short-term TMD symptoms is likely to be found in patients with prior report of such conditions, and we therefore recommend a review of TMD complaint history when planning general anesthesia.

Lateral pterygoid myotomy with reattachment to the condylar neck: an adjunct to restore function after total joint reconstruction.

OBJECTIVE: The purpose of this study was to investigate the results of performing a lateral pterygoid myotomy with reattachment to the condylar stump to restore more normal function after total joint reconstructive surgery. STUDY DESIGN: Twenty-four joints were reconstructed in 14 patients with stock Christensen chrome-cobalt prostheses. Patients were separated into 2 groups. Group I consisted of 4 joints without reattached lateral pterygoid muscle (-LPM), and group II consisted of 20 joints with reattachment of the lateral pterygoid muscle to the condylar stump (+LPM). Patients were evaluated at an average of 15 months postoperatively to assess mandibular movement. Group I was compared with group II, and statistical analysis was performed through the use of the Mann-Whitney test. Patient satisfaction was evaluated by using postoperative questionnaires. RESULTS: Group II had an average interincisal opening 7.3 mm greater than Group I (P <.001). Lateral movements averaged 3.86 mm in Group II versus 0.5 mm in Group I (P <.05). Protrusion was 2.83 mm greater in Group II than in Group I (P = 0.53). CONCLUSION: The reattachment of the lateral pterygoid muscle to the condylar stump during total joint reconstructive surgery may provide the patient with greater interincisal opening, lateral excursions, and protrusive movement. The preliminary data from these small, nonrandomized groups are promising for improved function following total joint reconstruction.