Diagnosis and management of temporomandibular joint dysfunction before surgery: a case report

We present a case of colorectal cancer with temporomandibular joint dysfunction and discuss the management of the case. Type IIIb temporomandibular disorder involves anterior dislocation of the articular disk, trismus and difficult intubation. A 68-year-old woman was scheduled for colectomy. The day before surgery, the patient had temporomandibular pain. On examination, the mouth opening was 13 mm. We diagnosed type IIIb temporomandibular disorder. A simple splint was fabricated with gauze and she bit it. The mouth opening was 55 mm on the day of surgery. The pain disappeared, and intubation was uneventful. Temporomandibular disorders are generally treated by dentists. It is beneficial for general hospitals without a dentistry department to employ a dental anaesthesiologist to assist in potentially difficult intubations in patients with temporomandibular disorders.

Methods of Airway securing in patients treated for temporonandibular joint ankylosis

Background: - Temporomandibular joint (TMJ) is a complex structure composed of several components including glenoid fossa of the temporal bone, the condylar head of the mandible, articular disk, as well as several ligaments and associated muscles. Its ankylosis causes distressing conditions including, both functional and aesthetic problems. An anesthetic management is challenging and surgery of TMJ ankylosis falls into the category of difficult airway as direct vocal cord visualization is difficult due to an inability to open the mouth. Fiberoptic intubation is considered as a safest approach and gold standard in TMJ ankylosis surgery as means of airway securing.Objectives: - The aim of this study was to assess method of airway securing in patients treated for temporomandibular joint ankylosis at Addis Ababa University Oral and Maxillofacial surgery affiliate Hospitals. Materials and Methods: - A retrospective cross sectional study was conducted in 22 patients (n=14 male and n=11 female) with mean age of 21.7(ranged 6-50) diagnosed with temporomandibular joint ankylosis at Addis Ababa University, Oral and Maxillofacial Surgery affiliate Hospitals both Yekatit 12 Hospital medical college and St. Peter specialized Hospital. Data was collected from patients’ medical records registered in a period of 3 years from January 2017 to December 2019. EPI- INFO 7 computer software was used for data analysis. Results: - The highest incidence of ankylosis was reported between the age of 11 and 20 (40.91%). Unilateral ankylosis was reported in (59.09%) and (68.18%) was bony ankylosis based on tissue involved. In majority 17 (77%) of patients tracheostomy was used as intubation technique and securing the airway and fibroptic technique is used only in 2(9%) patients. Conclusion: - The findings of this study tracheostomy was the most commonly used intubation technique, due unavailability of fibroptic and skilled professional in practice of other intubation techniques. Institutional capacity building of facilities, increasing service availability and experts for practice of fiberoptic and bland nasal intubation technique is recommended.

FEATURES OF OCCLUSAL THERAPY IN FUNCTIONAL DISORDERS OF TEMPOROMANDIBULAR JOINTS

Temporomandibular joint (TMJ) dysfunctions are known as being highly prevalent, having multifactorial etiology, progressive course, and high recurrence rate. This combination of features typical of this pathology places it among pressing medical issues nowadays. The variety of concepts and approaches to the analysis of the etiopathogenesis of TMJ dysfunction causes a particular interest in both highly informative diagnostic techniques and functional methods of treatment. A complex pathological morphofunctional syndrome involving parafunctions of masticatory muscles, dysfunctional TMJ states and occlusal disorders ultimately leads to deformation and a low functional disproportion in the TMJ kinetics. The work analyzes the reports on the research of various occlusal splints, and in particular, the mechanism of their action, classification of their effectiveness in various types of TMJ disorders, advantages, and disadvantages of splints, as well as materials used for their manufacturing. It is important to emphasize that the choice of the optimal therapeutic approach to internal TMJ disorders should be chosen taking into account the position of the mandibular condyle, the nature of the articular disk displacement, the presence or absence of pain, its possible causes, and concomitant local and general aggravating factors. The study was performed as a part of the research project of the Department of Orthopaedic Dentistry, Danylo Halytskyi Lviv National Medical University.

Proximal Horizontal Flap Tears of TFCC Diagnosed by Computed Tomography Arthrography: Six Case Series

Background Proximal horizontal tears of the triangular fibrocartilage complex (TFCC) represent the tears at the proximal surface of the articular disk with a normal appearance of the distal surface. Preoperative diagnosis of TFCC flap tears is challenging. Objectives This report aims to present a diagnostic method using computed tomography (CT) arthrography for the proximal horizontal flap tears of the TFCC and to report our clinical outcomes. Patients and Methods Six patients were included who were preoperatively suspected to have proximal horizontal flap tears of the TFCC via CT arthrography. Arthrography was conducted by injecting dye into the distal radioulnar joint (DRUJ), and CT images were obtained immediately following arthrography. We performed arthroscopic or direct flap debridement with concomitant surgeries: ulnar shortening with positive ulnar variance and corrective osteotomy with the malunion following distal radius fracture. Results Preoperative CT arthrography clearly revealed the flaps to be flipped over toward the radiopalmar side of the DRUJ in four cases and a teardrop-shaped dye defect in two. We were able to identify the dislocated flap by arthroscopy avulsed from the proximal aspect of the articular disk within the DRUJ in all six cases. The mean pain level decreased from 10 preoperatively to 0.3 postoperatively on the visual analog scale. The mean patient-rated wrist evaluation score decreased from 43.5 preoperatively to 11.2 postoperatively. Conclusions Our study shows that CT arthrography can be a promising method for diagnosing proximal horizontal flap tears of the TFCC. Debridement of the flaps and concomitant surgeries showed satisfactory clinical results. Level of Evidence This is a Level 4, diagnosis study.

Value of magnetic resonance tomography in the evaluation of the efficiency of conservative treatment of various types ventral dislocation of the intraarticular disk temporomandibular joint

Background. Magnetic resonance imaging (MRI) is a highly informative method for the diagnosis of various types of temporomandibular joint dysfunction (TMJ), which makes its use an integral component in choosing a treatment algorithm and evaluating its effectiveness.Objective. Determine the value of MRI in the diagnosis, planning and effectiveness of conservative treatment of patients with various types of ventral dislocation of the intra-articular disk TMJ.Design and methods. We analyzed the results of clinical and instrumental studies at the stages of planning, treatment and evaluating the effectiveness of conservative therapy in dynamics in 62 patients with complaints of pain in the joint area, difficulty opening the mouth and joint noise. Results. In patients from the dynamic observation group with complete ventral dislocation of the disc identified prior to treatment, conservative treatment underwent positive dynamics of clinical manifestations and the absence or negative dynamics of MRI results. In patients with partial ventral dislocation of the disk, there was a positive dynamic of both clinical manifestations and MR images after conservative treatment.Conclusion. MRI is a fundamental method in the complex diagnosis of various types of ventral dislocation of the disk, the use of which in certain cases allows us to predict the ineffectiveness of conservative therapy and becomes a decisive factor in the appointment of invasive treatment methods.

Three-dimensional comparative evaluation of articular disc position and other temporomandibular joint morphology in Class II horizontal and vertical cases with Class I malocclusion:

ABSTRACT Objective To evaluate and compare articular disk position, condylar position, and joint spaces in Class II vertical, Class II horizontal, and Class I cases. The purpose was to assess the potential for development of temporomandibular disorders (TMDs) in the three groups. Materials and Methods A sample of 75 cases, 25 cases in each group of Class I, Class II vertical, and Class II horizontal, were selected based on inclusion and exclusion criteria. Magnetic resonance imaging (MRI) assessments were made with a 1.5-Tesla basic system with a closed-mouth technique for evaluating articular disk position in the sagittal and transverse planes, condylar position, and joint spaces in the sagittal plane. Philips 3.0 software was used to analyze the MR images. Results There was evidence of alterations in the temporomandibular joint (TMJ) morphology in both Class II vertical and Class II horizontal cases, with maximum discrepancy in Class II vertical cases. MRI evaluation suggested a tendency for antero-medial disk displacement with anteriorly positioned condyles in Class II vertical cases. The discrepancy was milder in the Class II horizontal group. Conclusions Class II vertical cases are more susceptible to the development of TMDs and should be subjected to TMJ evaluation before starting any orthodontic treatment to intercept and prevent a mild asymptomatic TMD from developing into a more severe form. Class II vertical cases should be subjected to MRI evaluation before starting any orthodontic treatment.

Minimum 5-Year Outcomes and Return to Sports After Resection Arthroplasty for the Treatment of Sternoclavicular Osteoarthritis

Background: Osteoarthritis of the sternoclavicular (SC) joint is a rare condition that leads to decreased function and persistent pain, ultimately altering the function of the shoulder and keeping individuals from their desired activities. SC resection in the setting of primary and posttraumatic osteoarthritis is the most common surgical treatment for these patients, but midterm results are lacking. Purpose/Hypothesis: The purpose was to assess the clinical outcomes, pain levels, return to sports rate, and survivorship after open SC joint resection in the setting of painful primary SC joint osteoarthritis. We hypothesized that an SC joint resection of maximum 10 mm would result in a significant improvement in clinical outcomes, decreased pain levels, a high rate of return to sports, and a high survivorship. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent SC joint resection (maximum 10 mm) by a single surgeon between the years 2006 and 2013 with minimum 5-year follow-up were reviewed. The following clinical outcomes were collected prospectively during this time period: 12-Item Short Form Health Survey Physical Component Score (SF-12 PCS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and patient satisfaction. Return to sports and pain were assessed through use of a customized questionnaire. Survivorship of SC joint resection was defined as not requiring further surgery on the affected joint. Results: A total of 21 SC joints were treated with resection of the medial clavicle and intra-articular disk and capsulorrhaphy for SC joint osteoarthritis in 19 patients with a mean age of 39.4 years (range, 12.5-66.7 years). At minimum 5-year follow-up, 19 SC joint resections were assessed in 16 of 19 patients (84%) with a mean follow-up of 6.7 years (range, 5.0-10.4 years). All outcome scores improved significantly from pre- to postoperative assessments: ASES (from 54 to 90.5; P = .003), SANE (from 61.8 to 90.4; P = .004), QuickDASH (from 43.1 to 13.8; P = .004), and SF-12 PCS (from 39.8 to 51.3; P = .004). Median satisfaction with surgical outcomes was 9 (range, 2-10), and pain levels improved from a score of 8 out of 10 to 3 out of 10 (scale of 0 to 10 with 0 being pain free and 10 worst possible pain). Of the 13 patients who answered the optional sports participation question, 13 (100%) patients had participated in sports before their injury. A total of 14 patients answered the question on sports participation after injury, with 12 (86%) indicating successful return to sports. Pain at its worst ( P = .003) and pain with competition ( P = .017) significantly decreased pre- to postoperatively. Resection survivorship at final follow-up was 84.2% at 5 years. We found that 3 patients (15%) had recurrent SC joint pain and were treated with revision surgery. Conclusion: Open SC resection arthroplasty with capsulorrhaphy in the setting of pain for SC osteoarthritis results in significant improvement in clinical outcomes, patient satisfaction, return to sports, and pain reduction at minimum 5-year follow-up.

Interpositional Arthroplasty for Treatment of ATM Ankylosis

Introduction: The temporomandibular joint ankylosis is the union between the surface of the temporal bone in its articular portion and the complex made out of articular disk and the condyle. Its etiology is multifactorial being the trauma with condylar fracture most cited. This alteration causes several functional disorders to the patient, among them the main one is the limitation of mouth opening, which causes difficulty eating, speaking, hygiene, speech and others. The diagnosis is made through a clinic image test. The goal is to show a report of case of ankylosis as well as a literature review.