Temporomandibular joint (TMJ) arthroscopic lysis and lavage: Outcomes and rate of progression to open surgery.

PURPOSE: Arthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ (Temporomandibular joint) diseases. The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery. MATERIALS AND METHODS: A retrospective cohort study of a single operator series was performed over a 6-year period from 2006 to 2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. The data were analysed via Kaplan Meier method for time-to event analyses and Chi-squared tests for trend analyses. Pre-operative and post-operative Visual analogue scores and maximum inter-incisal opening results were analysed with the Student's t-test. RESULTS: A total of 167 patients and 216 joints underwent arthroscopy with a mean follow up of 6.9 years. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p < 0.005). The highest failure rate between age groups was in the 21-30 year age group (p < 0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p < 0.0001). CONCLUSION: Arthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e., Categories 1, 2 and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e., Categories 4 & 5) gained only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery.

Evaluation of isoamyl 2-cyanoacrylate tissue adhesive in management of pediatric lacerations: An alternative to suturing.

AIMS: A study was conducted to evaluate the benefits of cyanoacrylate tissue adhesive as an alternative to suturing in management of pediatric lacerations. MATERIALS AND METHODS: A total of 7 patients were evaluated and followed for 3-month. The wound was evaluated on 1(st), 3(rd), and 7(th) postoperative day for swelling, infection, gaping and pain and at 1(st) and 3(rd) postoperative month for scar evaluation. The evaluation was based on different superficial facial wound repairs (i.e., low tension) with an average length <3 cm; and if the surgeon subjectively felt that subcuticular sutures were justified to reduce wound tension, then these were used. Isoamyl 2-cyanoacrylate glue was applied over lacerated wound margins after cleaning the wound and holding together for 15 s by means of tissue holding forceps. STATISTICAL ANALYSIS: Statistical analysis was done using Chi-square test after collection of data. Mean and standard error were estimated from the sample. RESULTS: The mean total time taken for skin closure was 1-2.5 min. There was no wound infection in any of the cases; only one case showed wound dehiscence on 3rd postoperative day. The cosmetic was better as there were no suture marks. CONCLUSION: Isoamyl 2-cyanoacrylate can be considered as excellent "no needle" alternative for closure of selected pediatric lacerations, those that are short, clean and under low tension.

Temporomandibular joint ankylosis in child: a case report.

BACKGROUND: Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene. CASE REPORT: This report describes a case of a 12-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty with interpositional temporalis muscle flap followed by vigorous physiotherapy. CONCLUSION: The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Its treatment includes the orthodontist, oral and maxillofacial surgeon, pediatric dentist, and psychologist and physical therapist as part of the healthcare team.

Conservative management of unicystic ameloblastoma in a young child: a case report.

Unicystic ameloblastoma is a rare, benign, locally invasive odontogenic neoplasm of young age that shows clinical, radiographical or gross features of an odontogenic cyst, but it histologically shows typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. A case of asymptomatic unicystic ameloblastoma in an 11- year-old-female, who was treated by surgical enucleation followed by Carnoy's solution application for 5 minutes, is presented. The present case report describes the clinical and radiological behaviors, its importance and complexity of a differential diagnosis and treatment protocol of lesions in the mandibular molar-ramus area considering the special problems in children.