Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis.

BACKGROUND: Internal derangement of the temporomandibular joint (TMJ) is one of the most common forms of temporomandibular disorders. The minimally invasive treatments such as arthrocentesis as well as arthroscopic lysis and lavage are often used as a first-line surgical treatment or in conjunction with nonsurgical modalities with low morbidity and high efficacy. Sodium hyaluronate (SH) has been proposed as an alternative therapeutic agent with similar therapeutic effects. OBJECTIVE: A prospective study was carried out for evaluation of efficacy of TMJ arthrocentesis with and without injection of SH in management of internal derangements. MATERIAL AND METHODS: A total of 30 patients suffering from internal derangement of TMJ were selected for this study. Patients were randomly divided into the following two groups: group 1-arthrocentesis-only group and group 2-arthrocentesis + SH group. Each group constituted 15 patients. RESULTS: Six-month postoperative mean mouth opening (MMO) increase was 13.61 ± 1.64 and 15.53 ± 3.01 mm in group 1 and group 2, respectively. At 6 months, there was marked improvement in masticatory efficiency with mean increase of 5.07 ± 0.13 in group 1 and 6.40 ± 0.04 in group 2. Mean pain reduction was 5.27 ± 0.67 and 6.48 ± 0.44 in group 1 and group 2, respectively. CONCLUSION: Although our series comprised a limited number of cases and a short follow-up period, initial results suggested that arthrocentesis with SH injection seemed to be superior to art.

Surgical defect coverage in oral submucous fibrosis patients with single-stage extended nasolabial flap.

PURPOSE: Long standing oral submucous fibrosis (OSMF) is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. The aim of the study was to evaluate the postoperative mouth opening in patients of OSMF after excision of fibrous bands followed by coronoidotomy and surgical defect coverage by extended nasolabial flap. METHODS: We evaluated the use of extended nasolabial flaps and coronoidectomy in the management of 11 randomly selected patients with histologically confirmed oral submucous fibrosis. They all had interincisal opening of less than 25 mm and were treated by bilateral release of fibrous bands, coronoidectomy or coronoidotomy, and extended grafting with a nasolabial flap. RESULT: Their interincisal opening improved significantly from a mean of 8.68±7 mm to a mean of 36.75±4.05 mm at 6-month follow-up. CONCLUSION: The procedure was effective in the management of patients with oral submucous fibrosis, the main disadvantage being the extraoral scars.

Unilateral coronoid hyperplasia treated by coronoidectomy using a transzygomatic approach.

Coronoid hyperplasia is a rare disorder, which effectively is a mechanical problem associated with limited mouth opening. In some cases, enlarged coronoid pushes the zygoma forward causing facial asymmetry. This article looks at the case of a 15-year-old boy reporting in OPD of Government College of Dentistry, Indore, with chief complaint of facial asymmetry. Transzygomatic approach was taken to get proper access to the enlarged coronoid. Coronoidectomy was performed which significantly reduced facial asymmetry. Postoperative healing was uneventful and recurrence was not reported.