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Modified Temporomandibular Joint Disc Repositioning With Miniscrew Anchor: Part I—Surgical Technique
Abstract
Anterior disc displacement is one of the most common conditions affecting the temporomandibular joint. In our previous publications we have reported on the basic technical elements of disc repositioning surgery. However, this article presents some critical modifications that have allowed us to perform this procedure safely and successfully over the past three years.
... However, many of these studies lacked MRI evaluations. Previous studies from our department have reported good disc position stability (DPS) on MRI follow-up from 88 to 98.6%, [14,[18][19][20][21] and positive condylar bone remodelling (CBR) from 30.1 to 86.7% [14,21,22] . The reason for the huge difference in CBR between the different studies may be related to the differences in the characteristics of the patients included in each study. ...
... Under general anaesthesia, a modified preauricular approach was used to expose the joint capsule [18] . After opening the upper joint cavity, the anterior disc attachment was fully released for passive disc repositioning. ...
... For MsA, selfdeveloped mini-screw anchor was implanted into the neck of the condyle. Two 3-0 non-resorbable mattress sutures were used to tie the posterior band of the disc [18] (Fig. 1A); For OSu, the disc was sutured to the posterior joint capsular wall by a self-developed instrument with 2-0 non-resorbable threads. The sutures were buried under the cartilage of the external auditory canal [24] (Fig. 1B). ...
Background and Objective
Open suturing (OSu) and Mini-screw Anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodeling (CBR) between these two surgical procedures in a single center.
Methods
A retrospective cohort study using magnetic resonance imaging (MRI) scans (preoperation, 1 week and 12 mo postoperation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one center through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting 5 factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression.
Results
385 patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% confidence interval [CI], 1.27 to 6.85) and better CBR (RR=1.58; 95%CI, 1.02 to 2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95%CI, 1.11 to 6.26) and overcorrected or posteriorly repositioned discs were more stable than normally-repositioned discs (RR=5.84; 95%CI, 2.58 to 13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95%CI, 0.89 to 0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95%CI, 1.76 to 3.83).
Conclusion
OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
... In 2010, Zhang et al [1] reported a new method to reposition the displaced discs using two bone anchors in 81 joints, and the immediate postoperative MRIs confirmed that over 96.3% of the joints had a successful disc repositioning. Since 2011, to improve the success rate and decrease the potential for relapse, the authors have modified the technique for open disc repositioning with only one miniscrew anchor and grafted subcutaneous fat flap from the earlobe into the anterior release space, which is called modified TMJ disc anchorage [7]. The effective rate could reach 98.6% according to postoperative MRI study [7]. ...
... Since 2011, to improve the success rate and decrease the potential for relapse, the authors have modified the technique for open disc repositioning with only one miniscrew anchor and grafted subcutaneous fat flap from the earlobe into the anterior release space, which is called modified TMJ disc anchorage [7]. The effective rate could reach 98.6% according to postoperative MRI study [7]. ...
... Based on the conventional methods, modified disc anchorage surgical methods use only one miniscrew anchor and additionally excise subcutaneous fat flap in front of the earlobe and grafted it in the gap left after the release of the anterior joint attachment to prevent scar contracture, thereby reducing the recurrence. We have explained the detailed procedures in our previous article by He D et al [7]. ...
Objective: The purpose of this study was to evaluate the incidence of Neurologic complications and time taken for its recovery following the surgery of modified temporomandibular joint (TMJ) disc anchorage. Methods: A total of 441 patients treated with the modified TMJ disc anchorage from July 2011 to December 2012 were included in this study. All patients were asked to fill in the questionnaires, which included facial paralysis (Cranial nerve VII injury), numbness (Cranial nerve V injury) and Frey Syndrome. The results were analyzed by using SPSS16.0 software package. Results: 402 patients (549 joints) had completed the follow-up questionnaire, with a follow-up rate of 91.16%. There were 72 male and 330 female patients with a mean (SD) age of (31.36 ± 15.18) years. There were 6 sides of difficulties in closing eye (1.09%), 37 sides of difficulties in raising eyebrow (6.74%), 7 sides of disappearing forehead wrinkles (1.28%), 79 sides of numbness (14.39%), 6 sides of symptoms of Frey’s syndrome after surgery. Accordingly, there were 1 side of difficulty in raising eyebrow (0.18%), 14 sides of numbness (2.56%) and 5 sides of symptoms of Frey’s syndrome (0.91%) persisted during the time of follow-up. Conclusions: Modified temporomandibular joint disc anchorage surgery is a safe and effective method to treat TMJ internal derangement. As long as proper care was taken during the surgery, permanent nerve injury was uncommon. The incidence of temporary nerve injury could be due to compression or stretching of nerve fiber resulting in neuropraxia.
... Later, Yang et. al designed a self-inserted titanium miniscrew anchor (5 mm in length and 2 mm in diameter), with a slot at the end for bolting sutures [12,13]. But for hypoplastic condyles which has normal morphology and structure but are diminished in size on radiographic examination [14], inserting a metal device (anchor) may interfere with the blood supply of the condyle and cause resorption. ...
... Surgical treatment was as follows: 1) disc repositioning by either open suturing to the posterior articular capsule [17] or mini-screw anchor [13] through modified preauricular small incision as we previously described (Fig. 1); 2) BSSRO was performed for all patients. Le Fort I osteotomy was lastly performed when indicated [18]. ...
Background
Disc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery.
Methods
Patients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes.
Results
Seventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group.
Conclusions
Disc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.
... Among all disorders affecting the temporomandibular joint (TMJ), anterior disc displacement (ADD) is the most frequently encountered, with a higher incidence among females. ADD often presents with pre-auricular pain, clicking sounds, and functional limitations, and may lead to osteoarthritic changes 1,2 . Various interventional methods, including disc repositioning, are recommended for patients with a predominance of degenerative findings who have failed to respond to conservative treatments 3,4 . ...
... The rationale for filling the anterior gap after anterior release with a fat graft is as follows: (1) to minimize scarring and fibrosis, which might incite relapse of the disc displacement. (2) In some cases, the disc is relatively short, and as a result, the disc is recaptured posteriorly after disc repositioning; the most anterior part of the condyle is then no longer covered by discal tissue, which might affect the joint mechanics. (3) The fat is usually sutured to the anterior edge of the disc, which makes the translation movement of the disc smoother. ...
The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) arthroscopic and open disc repositioning procedures in the management of anterior disc displacement (ADD). All consecutive patients treated with arthroscopic (group I) or open (group II) disc repositioning between April 2014 and August 2018 were included prospectively. The patients were assessed clinically (1, 3, 6, 12, 24, and 36 months postoperative) and with magnetic resonance imaging (MRI). The statistical analysis was performed using IBM SPSS Statistics v.22.0; P < 0.05 was considered significant. A total of 177 patients (227 joints) were included: 104 patients (130 joints) in group I and 73 patients (97 joints) in group II. There were statistically significant improvements in pain score, clicking, quality of life, diet, and maximum inter-incisal opening when comparing pre- and postoperative clinical parameters within the two groups (P < 0.05 at all time-points for all clinical parameters); however, improvements occurred earlier in group I (at 1 month) than in group II (6 months). Postoperative MRI revealed an overall success rate of 98.1% in group I and 97.3% in group II. New bone formation was found in 70.2% in group I and 30.1% in group II. Arthroscopy may be a better choice for ADD patients, with the advantages of faster clinical improvement and recovery, minimal invasiveness, and better condylar remodelling.
... Among all disorders affecting the temporomandibular joint (TMJ), anterior disc displacement (ADD) is the most frequently encountered, with a higher incidence among females. ADD often presents with pre-auricular pain, clicking sounds, and functional limitations, and may lead to osteoarthritic changes 1,2 . Various interventional methods, including disc repositioning, are recommended for patients with a predominance of degenerative findings who have failed to respond to conservative treatments 3,4 . ...
... The rationale for filling the anterior gap after anterior release with a fat graft is as follows: (1) to minimize scarring and fibrosis, which might incite relapse of the disc displacement. (2) In some cases, the disc is relatively short, and as a result, the disc is recaptured posteriorly after disc repositioning; the most anterior part of the condyle is then no longer covered by discal tissue, which might affect the joint mechanics. (3) The fat is usually sutured to the anterior edge of the disc, which makes the translation movement of the disc smoother. ...
... 2,3 In our practice, we advocate for disk repositioning surgery after a period of conservative treatment with no improvement of symptoms, as described in reports of our previous studies. [4][5][6][7] Two techniques of repositioning the anteriorly displaced disk have been reported in the literature. The first is the arthroscopic technique, which has proven to be effective in the management of early IDs. ...
... The primary predictor variable was the procedure of open TMJ disk repositioning and anchorage, as described in previous reports. 5,6 The primary outcome variables were changes in the joint spaces and in condylar position. The secondary outcome variable was malocclusion (especially posterior open bite). ...
Objective:
This study aimed to explain the malocclusion resulting from the changes in condylar position after unilateral open disk repositioning surgery.
Study design:
Patients treated with unilaterally modified temporomandibular joint disk repositioning were reviewed. All patients underwent magnetic resonance imaging (MRI) before and immediately after surgery. Occlusion was checked, and the changes in the joint space and condylar position were measured by using MRI. The paired t test was used for analysis.
Results:
Thirty-two patients were included in the final analysis. The incidence rates of the posterior open bite in the affected side were 100%, 87.5%, 71.9%, 9.4%, 3.1%, and 3.1% at 0, 3, and 7 days and 3 and 6 months, and at the last follow-up after surgery, respectively. Mean distances of the condylar movements were 2.67 and 0.32 mm in the affected joints and normal joints, respectively. There were significant differences for the anterior (P = .03), superior (P < .001), and posterior (P < .001) joint spaces of the affected joints as demonstrated by MRI.
Conclusions:
The joint spaces significantly increased postoperatively, in addition to the changes in condylar position in anterior and inferior movements, leading to posterior open bite; however, the position returns to normal 3 months after surgery. We concluded that disk repositioning, when done unilaterally, results in stable occlusion over time.
... Nevertheless, the outcomes were only evaluated clinically, without an imaging assessment. Zhang et al. 7 and He et al. 8 introduced a method to reposition the displaced disc using Yang mini-anchors fixed on the back of the condyle, and immediate postoperative magnetic resonance imaging (MRI) confirmed that over 96.3% of the joints had successful disc repositioning. McCain et al. 1 reported an arthroscopic technique for TMJ disc repositioning that was used on 11 joints with pure anterior DD. ...
... This represents an effective technique for early internal derangement, but is often inadequate for longstanding cases of DD, as the posterior band is quite thick making arthroscopic repositioning challenging and often unstable. In these patients, open discopexy with mini-anchor fixation is the treatment of choice [6][7][8] . Regarding stability, the authors believe that disc fixation to the condyle using a Yang mini-anchor screw is more stable than arthroscopic suturing of the disc to the soft tissues anterior to the external ear. ...
Disc displacement is a common disorder affecting the temporomandibular joint. According to previous publications, the displaced disc can be categorized into pure anterior displacement and rotational displacement (anteromedial and anterolateral). However, the technique of arthroscopy treatment has only been reported for patients with pure anterior disc displacement. In this study, an arthroscopic discopexy for rotational anterior disc displacement was developed and its effectiveness evaluated over 24 months of follow-up. A total of 532 patients (749 joints) with rotational anterior disc displacement, admitted to Shanghai Ninth People's Hospital between January 2011 and December 2015, were included. The success rate was based on clinical parameters (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiographic data. The clinical and radiographic data were collected preoperatively and at 1, 6, 12, and 24 months postoperative. The VAS score decreased to 0.73 ± 1.43 following surgery (P < 0.001). A significant improvement in MIO (34.73 ± 6.28 mm) was also detected (P < 0.001). Magnetic resonance imaging showed discs repositioned in both sagittal and coronal images for 714 of the 749 joints, giving a success rate of 95.3%. This study reports an effective and predictable technique of arthroscopic discopexy for rotational anterior disc displacement. © 2018 International Association of Oral and Maxillofacial Surgeons
... Postoperative MRI showed a low reposition rate (65.7% in 35 patients). To improve the success rate, reposition stability and implant safety, He et al. [11] (2015) applied Chinese-made anchoring nails in modified disc anchorage surgery. As the shape of the anchoring nail does not fit perfectly with the anatomical structure of a condyle, 7.47% of patients experienced postoperative friction in the parotideomasseteric region [12]. ...
... Furthermore, a few patients using traditional anchoring nails complained of discomfort in the anterior wall of the external auditory canal, which may be related to the protrusion of the anchoring nail nut. We modified the design of the anchoring nail based on MiTek anchoring nails and the anchoring nails used by He et al. [11](2015). The improved anchoring nail is much easier to implant and extract. ...
Background:
Anchorage is one of the most important treatments for severe temporomandibular joint disorder (TMD). Anchoring nails have shown great success in clinical trials; however, they can break under pressure and are difficult to remove. In this study, we aimed to evaluate an improved anchoring nail and its mechanical stability.
Methods:
The experiment consisted of two parts: a tensile test and finite element analysis (FEA). First, traditional and improved anchoring nails were implanted into the condylar cortical bone and their tensile strength was measured using a tension meter. Second, a three-dimensional finite element model of the condyles with implants was established and FEA was performed with forces from three different directions.
Results:
The FEA results showed that the total force of the traditional and improved anchoring nails is 48.2 N and 200 N, respectively. The mean (±s.d.) maximum tensile strength of the traditional anchoring nail with a 3-0 suture was 27.53 ± 5.47 N. For the improved anchoring nail with a 3-0 suture it was 25.89 ± 2.64 N and with a 2-0 suture it was above 50 N. The tensile strengths of the traditional and improved anchoring nails with a 3-0 suture was significantly different (P = 0.033-< 0.05). Furthermore, the difference between the traditional anchoring nail with a 3-0 suture and the improved anchoring nail with a 2-0 suture was also significantly different (P = 0.000-< 0.01).
Conclusion:
The improved anchoring nail, especially when combined with a 2-0 suture, showed better resistance ability compared with the traditional anchoring nail.
... В течение последних двух десятилетий под руководством профессора Ч. Яна хирурги нашего отделения разрабатывают комбинированный подход к лечению патологии ВНЧС -так называемый протокол «сустав -нижняя челюсть -окклюзия» (Joint-Jaw-Occlusion -JJO), представляющий собой алгоритм обследования, постановки диагноза и лечения. Методы лечения патологии ВНЧС включают артроскопическую репозицию диска с фиксацией прошиванием [16,17], репозицию и иммобилизацию диска путем открытой операции [18,19], сплинт-терапию и реконструкцию сустава с помощью реберно-хрящевого трансплантата или эндопротеза ВНЧС. Само собой разумеется, что вмешательства на суставе всегда приводят к изменению прикуса и профиля лица, и наоборот. ...
... Оценка по данным МРТ результатов ближайшего послеоперационного периода продемонстрировала ее высокую эффективность -95,42% [17]. Для фиксации суставного диска в ходе открытых оперативных вмешательств с 2003 г. применяется костная фиксация [18,19]. ...
Temporomandibular joint (TMJ) internal derangements, or TMJ disc displacement, is a commonly seen disease among adults, as well as children. It interacts with facial deformities and occlusion etiologically and pathologically, and the treatment often involves adjustment of occlusion as well. The aim of this article is to review relevant references and to introduce our combined methods of disc repositioning, occlusal therapy, orthodontics, and sometimes orthognathics, as the new Joint-Jaw-Occlusion (JJO) protocol, supported by sample case illustrations before the intervention and at follow-up. We analyze short- and long-term results of implementation JJO protocol in patients with various types of TMJ internal derangements and temporomandibular disc displacement. In our experience, the proposed protocol is a highly effective procedure, both functionally and cosmetically, and can help to avoid osteotomies.
... The results of objective cognitive testing in FM have been summarized in several reviews [135,146,147]. Many studies using cognitive testing find normal function in FM [148][149][150][151][152][153][154][155][156][157]. These negative results could truly define areas of normal function in these disorders or fail to detect dysfunction for a number of reasons [135]. ...
... These negative results could truly define areas of normal function in these disorders or fail to detect dysfunction for a number of reasons [135]. Other studies have found deficits in attention, executive control, and working memory [146,149,155,[158][159][160][161][162]. These are usually associated with heavy task demands or during distraction; often no deficits are found for less demanding tasks [163]. ...
Central sensitivity syndromes are characterized by distressing symptoms, such as pain and fatigue, in the absence of clinically obvious pathology. The scientific underpinnings of these disorders are not currently known. Modern neuroimaging techniques promise new insights into mechanisms mediating these postulated syndromes. We review the results of neuroimaging applied to five central sensitivity syndromes: fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular joint disorder, and vulvodynia syndrome. Neuroimaging studies of basal metabolism, anatomic constitution, molecular constituents, evoked neural activity, and treatment effect are compared across all of these syndromes. Evoked sensory paradigms reveal sensory augmentation to both painful and non-painful stimulation. This is a transformative observation for these syndromes, which were historically considered to be completely of hysterical or feigned in origin. However, whether sensory augmentation represents the cause of these syndromes, a predisposing factor, an endophenotype, or an epiphenomenon cannot be discerned from the current literature. Further, the result from cross-sectional neuroimaging studies of basal activity, anatomy, and molecular constituency are extremely heterogeneous within and between the syndromes. A defining neuroimaging "signature" cannot be discerned for any of the particular syndromes or for an over-arching central sensitization mechanism common to all of the syndromes. Several issues confound initial attempts to meaningfully measure treatment effects in these syndromes. At this time, the existence of "central sensitivity syndromes" is based more soundly on clinical and epidemiological evidence. A coherent picture of a "central sensitization" mechanism that bridges across all of these syndromes does not emerge from the existing scientific evidence.
... Patients who do not respond to the previously described techniques could be considered for surgical treatment. In the literature, different surgical techniques are described: discectomy [18,19], condylotomy [20], disc plication [21,22], disc repositioning [23], total joint prothesis [24], and functional arthroplasty [25]. The authors perform functional arthroplasty as a surgical technique for anterior disc displacement without reduction (ADDwoR) with persistent pain during jaw movement (jaw opening, chewing, lateral movements) and limited mouth opening (<40 mm) that has not responded to non-surgical and minimally invasive procedures. ...
Background: Anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ) often leads to persistent pain and reduced quality of life (QoL). Conservative treatments frequently fail to provide adequate symptom relief. Objective: To assess the short-term (≥6 months) effectiveness of functional arthroplasty in reducing pain and improving QoL in patients with ADDwoR unresponsive to conservative therapies. Methods: A retrospective cohort study was conducted on 105 patients (median age 38 years, 80% female) treated at Santa Maria Hospital from January 2018 to December 2021. All patients had unilateral painful ADDwoR confirmed via MRI and underwent functional arthroplasty. Primary outcomes included pain reduction (VAS) and QoL improvements (QoL-TMJ questionnaire). Covariates such as age, gender, and baseline mood disturbances were analyzed for associations with surgical outcomes. Statistical analyses included the Wilcoxon rank test, Friedman’s ANOVA, and Spearman’s rank correlation. Results: Postoperative VAS scores significantly decreased (8.0 pre-op vs. 2.0 post-op, p < 0.001). QoL-TMJ scores improved significantly in pain (p < 0.001), activity (p < 0.05), mood (p < 0.001), and anxiety (p < 0.01), but no significant changes were observed in chewing and speaking functions. Improvements in QoL correlated strongly with pain reduction. Gender and age did not influence the outcomes, though females reported higher baseline mood disturbances. Conclusions: Functional arthroplasty effectively reduces pain and improves QoL in patients with ADDwoR, regardless of age or gender. However, limited improvement in chewing and speaking abilities highlights the need for targeted interventions. Future studies should assess the long-term outcomes to confirm the sustained benefits of this procedure.
... Patients who do not respond to the previously described techniques could be considered for surgical treatment. In the literature, different surgical techniques are described: discectomy [18,19], condylotomy [20], disc plication [21,22], disc repositioning [23], total joint prothesis [24], and functional arthroplasty [25]. The authors perform functional arthroplasty as a surgical technique for anterior disc displacement without reduction (ADDwoR) with persistent pain during jaw movement (jaw opening, chewing, lateral movements) and limited mouth opening (<40 mm) that has not responded to non-surgical and minimally invasive procedures. ...
Our experience and the patients satisfaction for tmj arthroplasty in ADDwoR surgical treatment
... Some researchers consider ADDWoR a self-limiting condition, suggesting that its clinical symptoms, such as pain and restricted movement, may naturally resolve without treatment or without the need for aggressive disc repositioning (Sato et al., 1997). However, other scholars advocate for active conservative or surgical interventions to anatomically reposition the disc (He et al., 2015). A clinical study on the natural progression of ADDWoR patients revealed that most patients did not achieve complete symptom resolution. ...
Temporomandibular joint disorders (TMDs) is a broad term encompassing pain and/or functional impairment of the masticatory muscles and the temporomandibular joint. Currently, the clinical treatment principles for TMDs mainly include etiological treatment and symptomatic treatment. In addition, the development of personalized diagnostic and treatment plans is crucial for the effective management of TMDs. This review systematically outlines the patient intake process for TMDs and discusses the importance and methods of developing personalized etiological and symptomatic treatment plans based on patient characteristics such as age and symptoms, aiming to provide clinical practitioners with guidance on patient management.
... It was found that positional abnormalities of the joint elements may be the primary cause of the structural and functional abnormalities seen in ADD TMJ [13,14]. Therefore, some surgeons argue that surgical treatment in the form of TMJ disc repositioning (DR) surgery is the only way to fully restore the structure and function of ADDwoR joints [15,16]. ...
Objetives
To investigate the positional changes in the temporomandibular joint (TMJ) disc–condyle–fossa complex of patients with anterior disc displacement without reduction (ADDWoR) and to evaluate the effect of disc repositioning (DR) surgery.
Material and methods
Fifteen patients with unilateral ADDWoR (30 joints) were included. MRI of the TMJ was performed at T0 (1 week before surgery), T1 (1 month after surgery), and T2 (9–12 months after surgery). The glenoid fossa, disc, and condyle were reconstructed and analyzed using Mimics software.
Results
In the patients with unilateral ADDWoR, the disc on the ADD side showed a tendency to downward shift in the coronal direction and forward shift in the sagittal direction; the condyle of ADD side showed a tendency to backward shift in the sagittal direction and upward shift in the coronal direction. When comparing the same ADDwoR TMJ at T0, T1, and T2, the disc was found to move upward and backward after DR surgery at T1 and T2, and the condyle was found to move upward and backward after DR surgery at T1 but returned to the original position at T2.
Conclusions
ADDWoR leads to forward and downward displacement of the disc relative to the condyle and upward displacement of the condyle relative to the tuberosity. DR surgery improved upon the structural abnormalities of the TMJ complex, for which stability was maintained as determined in the 9 to 12 month postoperative follow-up.
Clinic relevance
DR surgery effectively and constantly improves the positional abnormalities of the TMJ complex.
... Yang modified the technique with a self-designed MsA for easy reimplantation and retied the sutures [16]. The MRI follow-up studies showed that 10 months and 2 years stability was 98.6% and 95.3%, respectively [23,35]. In a 5-year follow-up study, 89% of the discs were stable by MRI evaluation [36]. ...
Background
Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied.
Objective
This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion.
Methods
A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups.
Results
After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001).
Conclusion
These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS.
Trial registration
This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019
... Mehra and Wolford fixed the disc with a special suture and inserted one bone anchor (Mitek anchor) into the condyle to address TMJ ADD in 2001 [7]. Based on this technique, several surgeons have modified the open suture discopexy with or without a miniscrew anchor technique and obtained clinical success in symptom change and magnetic resonance imaging (MRI) examination [8][9][10][11]. The common characteristic of these surgeries was suturing traction to replace the disc to the normal position. Unfortunately, the lower space of the joint needs to be exposed, and sutures need to be punctured on the disc multiple times and fixed to the disc to hard or soft tissue after the anterior attachment is released. ...
Objective
To evaluate the feasibility and effectiveness of using a suture-free titanium screw in repositioning anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ).
Methods
A consecutive sample of twelve patients (fifteen joints) was included in this study. All patients were diagnosed with ADDwoR and showed limited mouth opening or temporomandibular joint pain symptoms. Suture-free titanium screw was placed in the condyle directly following the disc repositioning. Pre- and postoperative evaluation parameters include operation time, the visual analogue scale for pain (VAS), lateral excursion movements (LEM), maximum interincisal opening (MIO), and disc length and position on MRI. In addition, the mandibular condyle height was also measured. Statistical significance was considered when p < 0.05.
Results
The unilateral operation time was 58.54 ± 5.43 min; during the 6-month period after the operation, the VAS values decreased from 87 ± 6.34 to 14.08 ± 6.65. The MIO increased from 30.07 ± 4.73 to 39.89 ± 1.69 mm (p = 0.01). The TMJ disc length was prolonged from 8.23 ± 1.12 to 11.51 ± 1.29 mm. The condyles showed significant remodeling, and the height of the condyle increased from 18.24 ± 4.12 increase to 19.6 ± 4.31 mm. The LEM was increased from 5.27 ± 0.51 to 6.36 ± 0.62 mm. The MRI images showed the stability of the disc in position during the opening and closing of the mouth. The TMJ disc position was stable during the follow-up period.
Conclusion
Anteriorly displaced articular disc can be repositioned by a suture-free titanium screw strategy. This technique is an alternative method to address ADDwoR.
... 21 Therefore, many surgeons also agree that reduction and fixation of the TMJ disc is one of the key factors for successful surgical treatment of ICF. 22,23 For patients with displacement or tear of the TMJ disc, surgical management should be the first choice of treatment. ...
Purpose
The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.
Methods
From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area, (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program; and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.
Results
All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.
Conclusion
Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
... He et al. use a self-drilling miniscrew and have modified the technique to include a complete anterior release and overcorrection of the disc position for better stability of the repositioning. They report stable short-term (mean 10 months) disc position on MRI in 98.6% of patients [84]. Zhou et al. evaluated the same technique in 149 joints and the long-term stability of the repositioned disc on MRI at a mean longest follow-up of 23.4 months (range 12-84 months) and reported that 95.3% of discs were still in position, whereas 4.7% had relapsed anteriorly [85]. ...
Temporomandibular joint (TMJ) disorder (TMD) is a broad term encompassing many diseases affecting the TMJ and the surrounding structures and includes internal derangement or disc displacement disorders. Our understanding of internal derangement, its causation, and treatments have evolved over the years, and we are now able to offer effective nonsurgical and surgical management strategies. This chapter will discuss the evolution of our understanding of TMJ internal derangement, diagnosis, causation, and management strategies.
... • Meniscopexy through an open incision or arthrotomy (described in 4 articles within our search) [16,19,22,23] • Meniscopexy with the use of suture anchors or mini-anchors to aid disc fixation (described in 10 articles within our search) [13,15,[24][25][26][27][28][29][30][31] • Arthroscopic meniscopexy (described in 4 articles within our search) [3,14,17,32] Disc repositioning techniques first developed, such as that initially described by McCarty and Farrar in 1988, rely on an endaural open incision to access the TMJ, which remains to be the approach of choice for many surgeons. Dissection is carried out to access the disc and is released anteriorly, repositioned and subsequently sutured, either to the capsule or auricular cartilage. ...
Disc repositioning for temporomandibular joint dysfunction (TMD) is a known and established procedure. Indications for the surgery and outcomes vary. A review of the available literature on the indications, surgical technique, and outcomes of TMJ Meniscopexy as a means of management of temporomandibular joint disease was performed. This was carried out using PubMed, MEDLINE, Scopus, and Google Scholar and was limited to the past 11 years using key medical search terms relevant to the subject area while being consistent with our exclusion criteria. The search yielded a total of 23 articles containing 3 reviews, 6 technical notes, 11 retrospective studies, and 3 prospective studies. Multiple techniques were described in the literature including arthroscopic techniques (n = 4), open suturing techniques (n = 4), mini-anchor techniques (n = 9), and splint-assisted surgery (n = 1). Several variables were used to determine success including both qualitative and quantitative measures determined clinically, through MRI or via patient questionnaire. When considering various combinations of these functional outcomes, all studies showed a significant improvement post-operatively. This demonstrates the success of disc repositioning procedures as an option in certain cases of TMD. Although there is evidence to show improvement in functional outcomes associated with Meniscopexy as a means of TMD management, there remains to be a lack of high-level evidence to further support this.
... Correct disc positioning is assessed by gently translating the condyle forward onto the eminence and back into the fossa. 40,41 If the disc is damaged and cannot be reused, then it must be replaced with suitable interpositional material. Various tissue grafts are available, and each has advantages and disadvantages. ...
Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons' preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.
... The clinical and experimental results showed that disc displacement could cause an increased load on the condyle and promote it to resorb and degenerate to osteoarthritis or even ankylosis [13][14][15][16][17][18][19][20][21] . Our previous clinical observation showed that disc repositioning could stimulate condyle growth in growing patients 16 . ...
Acute traumatic temporomandibular joint disc displacement (ATDD) and its sequelae are not familiar for most surgeons. This study is to discuss its sequelae in cases without disc reduction after failed conservative treatment. From 2010 to 2015, 26 patients with 34 joints were included in the study. All patients had at least 3 months conservative treatment. Their maximal incisor opening (MIO) was measured during follow-ups and MRI examination was used to check the condylar bone degeneration. The mean follow-up for conservative treatment after admission was 8.69 months, the patients reached an average of 25.7 mm MIO. MRI showed condylar bone intact in 8 joints (23.5%), condylar surface bone destruction (Wilks IV, V stages) in 14 joints (41.2%), and severe bone resorption in 12 joints (35.3%). 15 patients with 23 joints were asked for surgical treatment after a mean conservative treatment of 5.4 months (3-12 months) to improve mouth opening and relieve chronic pain. 12 joints had total joint replacement (TJR). 11 joints had disc repositioning. Their mean MIO before operation was 19.8 mm and significantly improved to 33.9 mm after operation (p = 0.0000). ATDD may cause severe osteoarthritis or ankylosis. Disc repositioning and TJR could significantly improve MIO.
This study aimed to investigate the prognosis of adolescent patients with anterior disk displacement without reduction (ADDwoR) who were treated with disk repositioning through suturing or arthrocentesis plus hyaluronic acid (HA) combined with stabilization splint (SS). A total of 96 ADDwoR patients aged ranging from 12 to 18 years, were divided into two groups, including 52 patients in Group A (underwent disk repositioning by suturing) and 44 patients in Group B (underwent arthrocentesis plus HA combined with SS). Condylar height, disk length, maximum mouth opening (MMO), maximal protrusive movement (PM), left/right maximal lateral movement (LLM/RLM) and visual analogue scale (VAS) pain scores were comparatively analyzed between the two groups before and after treatment. Baselined data analysis showed there was no statistical significance in condylar height, disk length, MMO, PM, LLM, RLM, and VAS values between two groups preoperatively. Postoperatively, values of condylar height and disk length in Group A were larger than those in Group B (all P < 0.001); whereas PM, LLM, and RLM values of Group B were all significantly larger than those of Group A (all P < 0.001). However, no statistical difference was obtained in MMO and VAS score between two groups after treatment (all P > 0.05). Both two surgical techniques can effectively relieve pain and improve MMO of adolescent patients with ADDwoR. The maximal protrusive and lateral movement of Group B were superior to those of Group A, while the latter can effectively enhance condylar development and prevent mandibular deformities.
Objective
To assess the influence of unilateral open disc repositioning surgery (ODRS) of the temporomandibular joint (TMJ) on the internal derangement (ID) of the contralateral joint.
Methods
Patients with bilateral ID of TMJ who underwent unilateral ODRS were enrolled and followed-up for one year. They were divided into two groups based on the contralateral disease: the anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Postoperative evaluation included clinical and MRI evaluation. Indices measured were unilateral intermaxillary distance (UID), visual analogue scale (VAS), disc length (DL), condylar height (CH), and disc-condyle angle (DCA). Paired t tests were used to compare the clinical and MRI indices between different time points.
Results
Ninety-six patients were enrolled, including 47 in the ADDWR group and 49 in the ADDWoR group. One-year post-surgery, ODRS led to significant increases in MMO, DL, and CH, and decrease in VAS and DCA on the operated side (P < 0.05). In ADDWR group, UID, DL, and CH increased significantly, and VAS decreased (P < 0.05), with no significant change in DCA (P > 0.05). In ADDWoR group, clinical and MRI variables worsened slightly, except for UID, which remained unchanged (P > 0.05).
Conclusions
ODRS is a promising method for correcting TMJ ID and may improve condition of ADDWR and decrease progress of ADDWoR at the contralateral joint. Preoperative bilateral TMJ evaluation is essential for better outcomes.
Clinical relevance
ODRS can effectively treat TMJ ID and produce adaptive changes in the contralateral ID, for which continuous monitoring of the contralateral joint is essential.
Purpose:
Open disk repositioning has been long achieving excellent functional and stability outcomes. However, still remains some relapses for whom a second open surgery is often challenging. This study aimed to evaluate the effectiveness of arthroscopic disk reposition as an alternative surgery for unsuccessful cases of anterior disk displacement (ADD) after an initial open disk repositioning.
Materials and methods:
This retrospective study included all patients who underwent secondary arthroscopy for disk repositioning of the relapsed ADD after an initial open surgery between January 2012 to June 2017. The redo arthroscopic disk repositioning and suturing procedure was the primary predictor input variable in this study. Outcome evaluation was based on both clinical (visual analog scale and maximal interincisal opening) and magnetic resonance imaging data.
Results:
Twenty-seven joints fulfilling the inclusion criteria were included. A significant improvement was detected at 24-month postoperatively compared with the baseline visual analog scale. The maximal interincisal opening showed a statistical improvement from 25.07 mm preoperatively to 38.44 mm at 24-month postoperatively. Twenty-six joints maintained a stable disk position with only 1 joint relapsed to ADD without reduction.
Conclusion:
Arthroscopic disk reposition and suturing technique is a reliable and effective repeat surgery after failed initial open disk repositioning for management of ADD.
Anterior disc displacement (ADD) is a common type of temporomandibular joint (TMJ) internal derangement. In adolescents, the relationship between ADD and dentofacial deformities are brought into focus. Whether treatment is needed, or by what kind of treatment are effective are still without a consensus. From the literature review, the consequences of ADD without treatment and the effect on disc repositioning were summarized. The results showed that after ADD, condylar height was prone to reduce that may lead to or aggravate dentofacial deformities in adolescents. Disc repositioning could promote the regeneration of condylar bone, thus improve the development of dentofacial deformities.
Purpose
: To evaluate the stability of the contralateral temporomandibular joint (TMJ) disc position after disc repositioning on one side.
Methods
: Patients with unilateral anterior disc displacement (ADD) treated by disc repositioning from 2015 to 2019 were included in the study. The contralateral disc status was classified as normal, ADD with reduction (ADDwR) and medial/lateral displacement. During 1 year follow-up, changes in the contralateral disc position were evaluated by MRI.
Results
: Two hundred and thirty-four patients were included in the study. There were 84 discs with normal position, 51 with ADDwR, and 99 with medial/lateral displacement (M/LD) in the contralateral joint. During 1 year follow-up, all the repositioned discs were stable without relapse. In the contralateral joints, 75% of the discs with normal position were unchanged compared with 43.1% of the ADDwR and 54.5% of the M/LD. ADDwR had the highest rate of changing to ADDwoR compared with the discs in normal position (4.8%) and M/LD (7.1%, χ 2=16.13, P<0.001). There were 28.3% M/LD discs and 3.9% ADDwR that changed to normal position.
Conclusions
: After unilateral disc repositioning, most of the contralateral discs with normal position were stable. M/LD discs tended to move to normal position, while ADDwR was largely changed to ADDwoR.
Objective:
This study aims to investigate the clinical effects of the combination of rhytidectomy and temporomandibular joint (TMJ) disc repositioning surgery in internal derangement (ID) stage IV-V and facial aging patients.
Methods:
Eighteen facial aging with bilateral ID IV-V patients were enrolled in this study. All of them had undergone temporomandibular disc repositioning surgery and rhytidectomy by the same surgeon (Yao Min Zhu). Pre-/post-surgical clinical manifestations, facial photography, radiographic data were recorded and analyzed, as well as doctor, patient, third-party evaluation of postsurgical facial appearance satisfaction.
Results:
The average age of 18 female patients was 52.9. The average of presurgical visual analog pain scale score was 5.94, ranged from 4 to 8. After 6 months, the average of postsurgical visual analog pain scale score was 0.28, ranged from 0 to 1 (P > 0.05). The average maximal mouth opening of presurgical and postsurgical was 2.19 and 3.29 cm, ranged from 1.2 to 2.8 cm and 3.0 to 3.5 cm, respectively (P < 0.05). Postoperative magnetic resonance imaging showed the location of the bilateral TMJ discs directly above the mandibular condyle. The satisfaction rate of doctors, patients and third-party with facial appearance was 95% to 98%, 96% to 99% and 96% to 99%, respectively, with an average of 95.72%, 98.11%, and 97.50%.
Conclusions:
For patients with bilateral ID IV-V and facial aging, the combination of disc repositioning surgery and rhytidectomy is a very feasible procedure to treat TMJ disorders and improve patients' facial appearance and satisfaction.
Purpose
To confirm the effectiveness and stability of an improved anchoring nail through a prospective study using clinical evaluation and magnetic resonance imaging (MRI).
Methods
Patients undergoing TMJ disc reduction and fixation were followed up for 1 year.Visual analogue scale (VAS) pain scores and TMJ range of motion (maximum interincisal opening, protrusive excursion, lateral excursion) data were gathered pre- and postoperatively, and patient satisfaction was recorded. Four time points were investigated: before surgery (T0), 1 month post-surgery (T1), 6 months post-surgery (T2), and 1 year post-surgery (T3).
Results
Twenty-five patients (50 joints) participated in the study. The overall success rates of the improved and traditional anchoring nails were 88% and 92%, respectively. One year post-surgery, the patients’ TMJ motion improved significantly (p < 0.001), and their pain was significantly alleviated (p < 0.001). Condyle height did not change significantly within 6 months (p = 0.801), but had increased by approximately 1.35 mm (p < 0.001) at 1 year post-surgery. The MRI scans also confirmed that new bone mass growth was present 1 year post-surgery.
Conclusion
Compared with the traditional anchoring nail, the improved anchoring nail had a similar success rate and was associated with fewer foreign body sensations and less pain. Its clinical application should be further tested in studies with longer follow-up times and larger sample sizes.
Purpose
To evaluate the effect of different temporomandibular joint (TMJ) disc repositioning surgeries for the treatment of anterior disc displacement (ADD) in juvenile patients with skeletal Class II malocclusion.
Methods
Patients (<20 years, cervical vertebral maturation stage, CVMS IV-V) who had bilateral TMJ ADD with skeletal Class II malocclusion were treated by disc repositioning surgery (mini-screw anchor, MsA; or opening suturing, OSu). Magnetic resonance imaging (MRI) and lateral cephalometric films before and more than twelve months after surgery were collected from all patients. Changes of SNA, SNB, ANB, incisor overjet, pogonion position (pg’-G’), and condylar height were measured before and after operation in different disc reposition surgeries and compared by statistical analysis.
Results
Eighty-four patients with an average age of 16.44 years and follow-up time of 14.60 months (12-33 months) were included in the study. Among them, 16 patients had a mean follow-up of 14.8 months without treatment before disc repositioning. Their condylar height was significantly decreased (p=0.004) by MRI measurement. Six patients who had cephalometric films showed significantly decreased SNB (p=0.042) and increased overjet (p=0.037). After disc repositioning by either OSu (54 cases) or MsA (30 cases), condylar height, SNB were significantly increased and overjet, Pg’-G’, ANB were decreased in both groups (p<0.001). There was more new bone height in OSu than MsA (p=0.004), but no significant differences in SNB, ANB, overjet and Pg’-G’ between the 2 groups (p>0.05). The new bone height was significantly correlated with the surgical method (p=0.029), age (p=0.015), SNB (p=0.008), overjet (p=0.048) and pg’-G’ (p=0.001).
Conclusion
Both types of disc repositioning method can effectively promote condylar regeneration and improve skeletal Class II malocclusion in adolescents with ADD. Disc repositioning by OSu obtained more new bone height than MsA.
Objective
: The aim of this study is to present a systematic review of the effectiveness of discopexy in managing internal derangement of the temporomandibular joint (TMJ).
Study Design
: We searched MEDLINE® through PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature been accessed through Google Scholar, Openthesis and hand-searching from inception to July 2020. Search strategy yielded 363 potentially relevant studies. After screening titles and abstracts, 41 full-text articles were assessed for eligibility and 7 studies were included in the meta-analysis.
Results
: There was an overall decrease in VAS pain score of 4.59 cm (CI 95% 2.03 to 7.16; P < 0.001) during the follow-up time and an overall increase of 10 mm (CI 95% 6.93 to 13.01; P < 0.001) in mouth opening after TMJ surgeries with discopexy.
Conclusions
: The available evidence showed an overall decrease in VAS pain score and an improvement in mouth opening after TMJ surgeries with discopexy. Changes in maximal interincisal opening were greater after arthroscopic disc repositioning compared to open-joint procedure.
Objective
To evaluate the effect of combined TMJ disc repositioning by suturing through open incision and orthodontic functional appliance (OFA) treatment for adolescents with mandibular asymmetry.
Study Design
Adolescent patients (12–20 years old) with mandibular asymmetry combined with unilateral TMJ disc displacement without reduction were treated with disc repositioning by suturing through open incision with and without post-operative OFA. MRI and posteroanterior cephalometric radiographs were used to measure and compare the changes of condylar height, joint space and deviation of menton before and after the operation.
Results
Twenty-six patients were included in the study. Joint space was significantly increased after operation and new bone which mostly formed at the superior or posterior superior parts of the condyle after 6-18 months in all operated joints. Among them, 14 patients with OFA had significant increase in the condylar height and deviation of the menton compared with 12 patients without OFA (2.29±0.91 mm vs. 1.22±0.69 mm, p=0.003; and 4.56±1.48 mm vs. 2.01±0.74 mm, p=0.000).
Conclusions
Combined treatment with TMJ disc repositioning by suturing through open incision and OFA can promote condylar growth and correct mandibular deviation in adolescent patients. Post-operative OFA can maintain the increased joint space created by disc repositioning and further promote new bone formation at the superior and posterior parts of the condyle.
Purpose
Although open temporomandibular joint (TMJ) arthroplasty with discopexy is a common treatment for patients with anterior disc displacements without reduction (ADDWo) unresponsive to medical management, there are no studies in literature comparing disc repositioning with bone anchors and conventional discopexy procedure. The purpose of the study was to compare the efficacy of disc repositioning with bone anchors to the conventional discopexy procedure for ADDWo of TMJ refractory to medical management.
Patients and Methods
A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening(primary outcome variable) between the two treatment(primary predictor variable) groups- disc repositioning with bone anchors versus conventional disc plication.Secondary outcome variables were pain measured by visual analogue scale (VAS), lateral excursions and position of disc in magnetic resonance imaging (MRI). Other variables of interest were age, gender and duration of symptoms. The parameters were evaluated at preoperative, postoperative -one day and 1, 6 and 12 months periods. Categorical variables were compared with Chi square test and continuous variables with ANOVA and adjusted for multiple comparisons with Bonferroni test.
Results
The study sample was composed of 14 patients (7 in each group) with MRI proven ADDWo. Statistically significant differences were found in the improvement of mouth opening between the two groups, with better improvement with bone anchors (14.42±5.96 vs 7.57±7.25mm (p <0.05)). The reduction in VAS also showed statistically significant difference with better pain reduction achieved with bone anchor(4.57±1.61 vs 3.28±0.75 (p<0.05)). There was no statistically significant difference in lateral excursions and postoperative position of disc in MRI between the groups. All the observations were made over a 12 month follow-up period.
Conclusion
Disc repositioning with bone anchors provides better clinical outcomes in terms of maximal mouth opening and pain scores compared to conventional disc plication.
This article describes the experience with the endoscopically assisted fixation of the customized total temporomandibular joint (TMJ) prosthesis in TMJ Yang's system only through a modified preauricular approach. Twenty patients (23 joints) treated with the custom-made total TMJ prosthesis were retrospectively recruited. An endoscopically assisted technique was used through a modified preauricular approach to fix the mandibular component for all these patients. These reconstructions were evaluated by surgical records, clinical examinations, and radiographic observations. All patients had successful fixation of the prosthesis. No patient had permanent weakness of the facial nerve and malocclusion or any other severe complications. The mean operative time was 111 min per joint (range, 85-133 min). The average surgical bleeding was 195 ml per side. The mean follow-up period was 16.2 months (range, 5-32 months). The mean scores were 8.3 for surgical satisfaction and 9.2 for scar healing evaluation. All patients experienced positive clinical outcomes, with a mean 75.2% reduction in pain and 53.7% increase in mouth opening with significant differences (P<0.05). The endoscopically assisted TMJ reconstruction with the customized prosthesis in TMJ Yang's system through the modified preauricular approach could produce good aesthetic and functional results.
Objectives:
The aim of this study was to assess and compare oral health-related quality of life (OHRQOL) in women with temporomandibular joint (TMJ) disk displacement without reduction, before disk repositioning and anchoring surgery, in short-term follow-up, in different age groups, and with use of the Oral Health Impact Profile (OHIP-14).
Study design:
Fifty women ages between 17 and 60 years were divided into 4 age groups: 17-27, 28-38, 39-49, and 50-60 years. All the patients were asked to answer the OHIP-14 form before surgery and during their short-term follow-up. Seven domains of OHRQOL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domains' scores and total OHIP-14 were compared between times by using Student's t test in the whole sample and in the 4 age groups.
Results:
Both the whole sample and the age groups (17-27, 28-38, 39-49 years) showed a statistically significant decrease in all scores (P < .01). The age group 50-60 years showed a decrease in scores significant only in functional limitation (P = .05) CONCLUSIONS: TMJ disk anterior displacement had a negative impact on women's OHRQOL because of physical pain, physical disability, and psychological discomfort. TMJ disk repositioning and anchoring surgery improved overall OHRQOL in patients between 17 and 49 years of age; however, in patients between 50 and 60 years of age, there was improvement only in physical pain.
Abstract The presence or absence of disc perforation (DP) has great value for the treatment planning of temporomandibular disorders (TMDs). Epidemiologic features of DP are limited in the literature. The present study investigated the epidemiologic features of DP by retrospectively reviewing 13,556 temporomandibular joint arthrographic examinations. Pearson Chi-squared test demonstrated that the rate of male patients who received the examinations more than once was significantly lower than that of female patients and the rate of DP in males was significantly lower than that in females. The age of all patients showed a bimodal distribution, with a 1st peak around 21 years of age, and a 2nd peak around 53 years of age. Linear regression analysis showed that the rate of DP was positively correlated with ages. The DP rate was increased by 0.3% for every 1 year of age. This retrospective cross-sectional study validated some findings about the gender and age differences of temporomandibular joint DP in the literature, and more importantly uncovered the exact relationship between the DP rate and the age in a large TMD patient population.
Purpose:
The purpose of this study was to evaluate the stability of disc position and condylar status by magnetic resonance imaging (MRI) after temporomandibular joint (TMJ) disc repositioning surgery with a miniscrew anchor technique.
Materials and methods:
Patients diagnosed with anterior disc displacement (ADD) and operated on for disc repositioning from 2010 through 2016 were included in the study. MRI scans within 1 week after operation (T1) and during at least 1-year follow-up were used to evaluate changes in disc position and condylar bone. During follow-up, ADD without reduction was considered relapse and the bone status was classified as regeneration or degeneration.
Results:
One hundred seven patients with 149 joints were included in the study. Postoperative MRI scans (T1) showed that all discs were repositioned. During an average 23.40-month follow-up (range, 12 to 84 months), 95.3% of discs (142 of 149) were still in position, whereas 4.7% of discs (7 of 149) had relapsed anteriorly. New condylar bone formation was observed in 74.50% of joints (111 of 149), no bone change was observed in 23.49% of joints (35 of 149), and bone resorption was observed in 2.01% of joints (3 of 149).
Conclusions:
TMJ disc repositioning by a miniscrew anchor provides stability for treatment of ADD. Disc repositioning also can stimulate condylar bone regeneration.
Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs.
Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique.
Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.
This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.
This study aims to evaluate the effect of using free fat grafts in preventing adhesion in the temporomandibular joint (TMJ) disc anchor and to observe the outcomes of free fat. Six 3-month-old mini-pigs were included in our study. The left joints were the experimental sides which had undergone releasing the anterior attachments, and free fat from the front of the ear lobe was grafted to the anterior gap. The right joints were the control group, where only the anterior attachments were released. MRIs were carried out and the maximal passive mouth openings were measured before operation, 3 months, and 6 months after operation. The joint tissues and fat specimens were excised after 3 and 6 months. The volume of fat was measured and hematoxylin and eosin (HE) staining was performed. Maximal passive mouth openings were analyzed with SPSS software package by Wilcoxon signed rank test. Maximal passive mouth openings were reduced gradually after 3 and 6 months, accompanied with the deviation of the mandible to the right side. There were significant differences between the 3 groups (P < 0.01). HE staining showed that the surface of the experimental joints was smooth while there was adhesion formation in the control joints. The volume of fat reduced respectively to 67.7% and to 42.6% after 3 and 6 months. HE staining showed new fat lobules were formed after 6 months with obvious fibrosis among the lobules. This study suggested that free fat can survive steadily 6 months after operation, with a surviving volume about 42.6% and it can also prevent adhesion formation in the TMJ disc anchor.
Anterior disc displacement is one of the most frequent types of temporomandibular joint disorders. Various arthroscopic disc repositioning and suturing techniques were reported to treat patients with disc displacement in the 1990s, but the success rate and long-term stability was not satisfactory. This report describes a new repositioning and suturing technique and discusses its advantages and disadvantages.
The management of temporomandibular joint (TMJ) disorders in secondary care has progressed through the 1990s from a condition dealt with by generalists to one with an increasing number of surgeons with a subspecialist interest. Within this latter group there is a subgroup of those with a specific training towards joint replacement surgery.Increasingly patients who previously had surgery for pain are being managed with non-surgical options. Alternative pain management regimens with the introduction of botulinum toxin as well as tricyclic medication have reduced the need for any invasive management. The surgical management of the TMJ has been revolutionised by the introduction of arthroscopy in the late 1970s. The use of arthroscopy and arthrocentesis has lead to a reduction in indications for open joint surgery. There is no longer a perceived need to correct internal derangement with disc repositioning surgery. The primary management of acute restriction of opening and joint pain is now with arthrocentesis and arthroscopy.Degenerative and ankylotic conditions of the joint can be safely treated by the use of alloplastic joint replacement, which has less morbidity and more predictable outcomes than costochondral grafting, with the latter still the method of choice in children.The revolution continues with the introduction of national guidelines and databases supported by BAOMS.
To quantitatively assess the changes in disc position relative to the condyle, disc length, and condylar height, with magnetic resonance imaging in patients with anterior disc displacement of the temporomandibular joint who had received no treatment, to provide useful information regarding treatment planning.
The study included 83 joints in 62 patients. The joints were assessed quantitatively for the disc position relative to the condyle, disc length, and condylar height on magnetic resonance imaging scans of the temporomandibular joint at initial and follow-up visits. Student t tests were used to assess the statistical significance of the changes.
The mean age at first visit was 30.4 years. The mean follow-up interval was 10.9 months. Thirty-nine joints were shown to have disc displacement with reduction at the initial visit. Of these joints, 27 changed to having disc displacement without reduction after follow-up. The mean disc position relative to the condyle changed from 5.28 to 6.73 mm, whereas the mean disc length changed from 8.31 to 6.91 mm and the mean condylar height from 5.21 to 4.65 mm. Differences were all statistically significant.
The disc would likely become more anteriorly displaced and shortened and the condylar height would decrease during its natural course. However, further stratified studies with longer follow-up are necessary.
This article reports a modified preauricular approach for intracapsular condyle fracture (ICF) of the mandible and evaluates the stability of various internal fixation methods in the temporomandibular joint (TMJ) division of the Shanghai Ninth People's Hospital.
One hundred fifty-one patients with 208 ICFs diagnosed by panoramic radiograph and computed tomographic (CT) scan received open treatment in the TMJ division from 1999 to 2008. Their charts were reviewed. Classification of the fracture was based on coronal CT scan. Forty-three patients also underwent magnetic resonance imaging before the operation to check displacement of the disc. A modified preauricular approach was used for all patients. Various internal fixation methods from wire, to screw, to plate were evaluated for stability.
There were 110 ICFs of type A fracture, 60 of type B fracture, 9 of type C fracture, 25 of type M fracture, and 4 fractures without displacement. A modified preauricular approach was used for open treatment, which can better expose and protect the TMJ and superficial temporal vessels. Wire and plate is the commonly used stable fixation method for type A, B, and M fractures, which accounted for 56.7% (101/178). Small fracture fragments were removed with disc repositioning for all type C fractures (n = 9) and some type B (n = 9) and M fractures (n = 5). Three type M fracture and 3 nondisplaced ICFs were treated closed. Eighty-nine patients with 115 ICFs had postoperative CT scan, which showed anatomic and nearly anatomic fracture reduction rates of 95.6%. Thirty-five patients with 44 ICFs had long-term follow-ups from 3 months to 5 years. Among them, 63.2% (n = 12/19) pediatric ICFs had continuous condyle growth after open reduction and rigid fixation; 92% adults had ICFs that healed well (n = 23/25). Postoperative complications were facial nerve injury (n = 3), TMJ clicking (n = 1), and condyle resorption that required plate removal (n = 4).
A modified preauricular approach provides better exposure and protection of the TMJ and superficial temporal vessels. Wire and plate provides stable fixation for type A and some type B and M fractures. Open reduction and rigid fixation produce good results for adult patients.
The purpose of this study was to assess the outcomes of temporomandibular joint (TMJ) disc repositioning as a surgical treatment for TMJ internal derangement (ID).
By retrospective chart review, all patients who had TMJ disc repositioning for treatment of TMJ ID from 1984 to 1990 were identified. Attempts were made to locate these patients, and they were sent a TMJ questionnaire. The questionnaire provided subjective (pain and diet consistency) and objective (mandibular function) data.
The chart review yielded 153 patients. Complete TMJ questionnaires were obtained from 18 patients (36 joints). Analysis of data showed a reduction in pain scores, an improvement in diet consistency, and an increase in mandibular range of motion. The majority (94%) reported an improvement in quality of life.
Outcome data presented show that TMJ disc repositioning is an effective and successful surgical treatment for TMJ ID. This success has been maintained for 20 years in this specific patient population.
To evaluate the efficiency of an arthroscopic suturing technique for stabilizing anteriorly displaced discs in patients with internal derangement of the temporomandibular joint (TMJ) by magnetic resonance (MR) imaging.
Six hundred thirty-nine patients (764 joints) diagnosed as having stages II to V of internal derangement were treated with arthroscopic disc repositioning and suturing from August 2004 to March 2007. Consecutive MR images were used to evaluate internal derangement before and approximately 1 to 7 days after the operation for all 639 patients. The disc position of the TMJ was judged according to the success criteria, which included 3 different sagittal planes (lateral, central, and medial). Operative efficiency in those patients, whose discs of the TMJ were affirmed to be in a normal position in all 3 planes, was evaluated to be excellent. Those patients whose discs were in a normal position in 2 planes were evaluated to be good. The others were evaluated to be poor. Cases evaluated as excellent and good were considered success cases (if the disc is displaced only in 1 or 2 planes before operation, the efficiency of the operation would be evaluated as a success only if the whole disc was in normal position).
Postoperative consecutive MR images for all 764 joints confirmed that 95.42% (729/764) of the joints were excellent, 3.14% (24/764) were good, and only 1.44% (11/764) were poor. Repeated arthroscopic surgery or open surgery was carried out for the joints that were evaluated as poor.
This study indicates that the TMJ arthroscopic suturing technique is effective in repositioning the TMJ disc as confirmed by an MR imaging examination, but long-term follow-up is necessary.
This study evaluated our treatment outcomes in 105 patients (188 discs) using the Mitek mini anchor for temporomandibular joint (TMJ) articular disc repositioning surgery, with 88 patients having simultaneous orthognathic surgery. Criteria for inclusion into the study were: (1) Presurgical TMJ disc displacement with salvageable disc; (2) No prior TMJ surgery; (3) TMJ disc repositioning with the Mitek mini anchor; (4) Absence of connective tissue/autoimmune disease; (5) Absence of postsurgical trauma; and (6) Minimum of 12 months postsurgery follow up. Presurgery (T1), immediately postsurgery (T2), and longest follow up (LFU) clinical and radiographic evaluations were performed. The mean age of the patients was 32.6 years (range 14-57 years), and mean follow-up time was 46.2 months (range 14-84 months). Radiographic evaluation at LFU demonstrated no significant condylar resorption or positional changes of the anchors. At LFU, there was a statistically significant reduction in: TMJ pain, facial pain, headaches, TMJ noises and disability, and improvement in jaw function and diet. Maximum incisal opening improved slightly and lateral excursive movements decreased slightly. The Mitek mini anchor provides a predictable method for stabilizing the TMJ articular disc to the condyle and a high success rate in decreasing TMJ dysfunction and pain in patients with no previous TMJ surgery.
The goal of this study was to evaluate the clinical results of simple disc reshaping (SDR) surgery alone for treating dysfunctional internal derangement of the temporomandibular joint.
Eleven patients with symptomatic unilateral anterior disc displacement with disc deformation were treated using reshaping of the inferior surface of the disc without disc repositioning. This was performed as an open-joint procedure. All patients were evaluated clinically for joint pain and jaw motion 5 years after surgery. Structural changes of the joint tissues such as disc displacement and deformation were evaluated using magnetic resonance imaging. The postoperative results were compared with preoperative findings.
Joint pain during mastication or opening was reported by all patients before surgery. In 10 of 11 patients (91%), the joint pain disappeared postoperatively. Preoperatively, all 11 patients had limitation of mouth opening: the mean opening was 24.9 mm (standard deviation [SD], 4.13 mm). Postoperatively, the mean opening increased to 43.0 mm (SD, 3.00 mm). Based on the preoperative magnetic resonance imaging, all cases were diagnosed as anterior disc displacement without reduction and with disc deformation. Five years postoperatively, the disc configuration had maintained the reshaped status with decreased thickness of the deformed disc in 5 patients, and was changed to an almost normal biconcave shape in 3 patients. In the remaining 3 patients, the disc was unchanged from its preoperative condition. The position of the disc was unchanged in 8 patients, and in 3 patients disc position improved to near normal.
The 5-year follow-up results suggest that SDR is a stable and favorable surgical procedure. Successful outcomes were attained in 91% of the patients.