Arteriovenous fistula of the middle meningeal artery--a rare complication after arthroscopic temporomandibular joint surgery readily amenable to endovascular treatment.

The development of a traumatic arteriovenous fistula after arthroscopic surgery of the temporomandibular joint (TMJ) is an unusual event that has been limited to a few case reports. These have generally involved the superficial temporal artery and surrounding venous outlets. No cases of either postoperative or post-traumatic arteriovenous fistulas involving the extracranial middle meningeal artery (MMA), which is located on the medial surface of the TMJ, have been previously reported. We report, to our knowledge, the first case of this unusual complication and describe its successful endovascular management.

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints.

PURPOSE: The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints). STUDY DESIGN: The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years. RESULTS: Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy. CONCLUSION: Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.

Temporomandibular joint arthroscopic findings in patients with cervical flexion-extension injury (whiplash): a preliminary study of 30 patients.

PURPOSE: To investigate arthroscopic findings for the temporomandibular joint (TMJ) in 30 patients with refractory TMJ symptoms who had suffered cervical flexion-extension injury (whiplash). METHODS: The clinical data and operative reports of all patients with a diagnosis of TMJ whiplash injury who underwent TMJ arthroscopic procedures from 1997 to 2002 were reviewed. All patients underwent preoperative clinical, panoramic, arthrographic, magnetic resonance imaging evaluation or computed tomography (or some combination). The same surgical team performed all diagnostic and therapeutic arthroscopic procedures in patients for whom conservative therapy had failed. Before the arthroscopic surgery, all of the patients had received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy (specifically transcutaneous electrical nerve stimulation, moist heat, cold laser, and ultrasonography) and a soft diet. RESULTS: A spectrum of arthroscopic findings, ranging from chondromalacia (softening of the articular fibrocartilage) to moderate or severe synovitis and adhesions, was observed, as well as combinations of these abnormalities. CONCLUSION: The primary intracapsular pathologic changes observed during TMJ arthroscopic examination of 30 patients who suffered cervical whiplash injury appear to be nonspecific, varying along a wide spectrum of findings.