Implant of articular eminence for recurrent dislocation of the temporomandibular joint.

Hypermobility of the temporomandibular joint is often caused by trauma, by opening the mouth too wide, by having a mouth forced open during general anesthesia procedures, or by dental procedures. The capsule may be stretched to an extent that dislocation occurs more easily thereafter. An implant of Vitallium mesh attached to the zygoma to restrict anterior movement of the condyle is used to prevent recurrent dislocation of the temporomandibular joint.     

A new surgical approach for the treatment of chronic recurrent temporomandibular joint dislocation

Chronic recurrent temporomandibular joint (TMJ) dislocation is defined as the complete loss of articular relationships, during mouth-wide opening, between the articular fossa of the temporal bone and the condyle-disk complex. The most frequent pathogenetic factors involved in chronic recurrent dislocation of the TMJ are supposed to be trauma, abnormal chewing movements, TMJ ligaments, capsule laxity, and masticatory muscles disorders. In fact, TMJ dislocation occurs more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbance.Management of TMJ dislocation remains a challenge. Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to be the real cause of TMJ dislocation in most cases.The authors present a mini-invasive modified technique of eminectomy, which aims to act on both the obstacle and the cause with respect and restoration of TMJ biomechanical constraints.     

Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation

Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy. In some patients, this can become a chronic recurrent condition. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy. 11 patients treated for recurrent temporomandibular dislocation between 2004 and 2010 were retrospectively analyzed. Electrothermal capsulorrhaphy was performed using a standard double puncture operative arthroscopy with a Hol:YAG laser and/or electrocautery. Postoperatively the patients were monitored for 6 months to 6 years. Of the 11 subjects, 2 suffered a recurrence of temporomandibular dislocation and required open arthrotomy for correction. The other 9 patients had no signs of recurrence or any significant postoperative loss of function. Electrothermal capsulorrhaphy is an effective and minimally invasive method for the treatment of RTD.     

Autologous blood injection for treatment of recurrent temporomandibular joint dislocation

OBJECTIVE: The purpose of this study was to reintroduce a rather simple, safe, minimally invasive, and rapid alternative procedure for the treatment of recurrent dislocation of the condyles. STUDY DESIGN: Subjects were 3 patients (5 joints) who suffered from recurrent condyle dislocation. The technique consisted of visually identifying a line from tragus to the eye angle. Then the articular fossa point was identified in this line, 10 mm anteriorly to tragus and 2 mm below the line. A 19-gauge needle was inserted at the articular fossa point. After injection of saline in the superior compartment, 5 cc of autologous blood drawn from the cubital fossa was injected (4 cc in the superior compartment and 1 cc in the pericapsular tissue). After this an elastic bandage was applied and left for the first 24 hours. Patients were advised to constrain their mandibular motion and to eat only soft foods for a week. They received cephalosporin antibiotics and nonsteroidal anti-inflammatory drugs for 7 days. A week after the procedure, supervised physiotherapy was started and the patients were encouraged to increase their mandibular opening to 40 mm. RESULTS: Postoperative recoveries were uneventful. Dislocation of condyles did not reoccur; however, patient no. 3 experienced an episode of unilateral subluxation. At follow-up all patients presented with normal mouth opening. CONCLUSION: Bleeding resulted from the introduction of a needle for injection in the pericapsular tissue. Blood coming from this wound, associated with autologous blood injected in the superior compartment, generates a bed for fibrous tissue formation in the region, creating a limitation of mandibular movement, thus ceasing dislocation of the condyles. Temporomandibular joint autologous blood injection is a simple procedure performed on an outpatient basis that we advise as an alternative treatment for patients with recurrent dislocation of the condyles.     

Autologous blood injection into the articular cavity for the treatment of recurrent temporomandibular joint dislocation: a case report

Autologous blood injection around the articular capsule and/or into the articular cavity, which is one of the treatments for recurrent temporomandibular joint dislocation, was recently reintroduced. Here, we present the management of recurrent temporomandibular joint dislocation by autologous blood injection in an 84-year-old female. After the treatment, although the right condylar process had settled just beneath the articular tubercle, the dislocation had improved and the patient was able to close her mouth without difficulty.     

Synovial chondromatosis of the temporomandibular joint with articular eminence extension

Synovial chondromatosis (SC) of the temporomandibular joint is a rare benign lesion that can extend to the adjacent bony tissue. Most studies in the literature reported cases of SC of the temporomandibular joint with extension to the skull base, but there has been no report of intracranial extension through the articular eminence. The current study reports on the case of SC with articular eminence extension that was treated via combined trans-zygomatic tempora and preauricular approach and acquired good effect with 44 months of follow-up.     

Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation

Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17–59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year's follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ.     

自体血注射治疗复发性颞下颌关节脱位的临床观察

对19例复发性颞下颌关节脱位患者行关节腔和囊周组织自体血注射治疗。1年后随诊,16例无关节脱位复发,有效率为84.2%。也没有观察到TMJ骨质破坏和关节强直的现象。自体血注射治疗复发性颞下颌关节脱位是一种简单、安全、经济、有效的微创治疗方法。     

45例复发性颞下颌关节前脱位的分类及治疗探讨

目的 介绍一种基于MRI上关节盘与髁突相对位置的颞下颌关节复发性前脱位分类方法,以及针对不同类型采用不同手术方法治疗的经验。方法 选择2003年5月—2016年5月治疗的45例颞下颌关节复发性前脱位患者。依据MRI分为Ⅰ型（关节盘无移位）、Ⅱ型（关节盘移位）、Ⅲ型（骨关节病）及Ⅳ型（存在精神或神经功能障碍）,依据分类选择不同的手术治疗方法。结果 Ⅰ型28例（62.2%）,Ⅱ型12例（26.7%）,Ⅲ型2例（4.4%）,Ⅳ型3例（6.7%）。Ⅰ型患者采用关节结节增高术或关节镜下硬化剂注射术;Ⅱ型患者采用颞下颌关节盘复位固定术（锚固）及关节镜下关节盘复位固定术,辅助关节结节增高术;Ⅲ型患者根据临床症状进行手术;Ⅳ型患者均采用关节结节凿平术。随访期间未发现开口受限、开口疼痛、脱位复发。结论 基于MRI影像学特点对颞下颌关节脱位进行分类,对术者选择合适的治疗方案具有指导意义。     

A technique to verify adequacy of eminectomy for recurrent temporomandibular joint dislocation

Recurrent dislocation of the temporomandibular joint (TMJ) can be highly debilitating, especially if the dislocation cannot be reduced by the patient. Despite being regarded as a ‘gold standard’ or ‘salvage’ procedure for refractory TMJ dislocations, complete mediolateral removal of the articular eminence can still lead to recurrences. A technique aimed at intraoperatively verifying the adequacy of osseous reduction in order to minimize the risk of re-dislocation of the TMJ is described.     

关节镜辅助治疗陈旧性颞下颌关节脱位临床疗效研究

目的探讨借助关节镜采用微创的方法治疗陈旧性颞下颌关节脱位的临床价值。方法对2007年3月至2011年5月在中国医科大学口腔医学院口腔颌面外科手术治疗的19例陈旧性颞下颌关节脱位患者,按就诊顺序随机分为A、B两组,A组(10例)采用关节镜辅助微创手术治疗,B组(9例)采用传统的开放性手术治疗。通过术后随访及问卷调查来评价关节镜在治疗陈旧性颞下颌关节脱位的应用价值。结果经过术后6个月至2年的随访发现,两组患者在面瘫、颞下颌关节紊乱病(TMD)的发生率以及创口预后满意度和疼痛程度方面差异有统计学意义(P<0.05),在复发方面差异无统计学意义(P>0.05);关节镜辅助治疗组术后满意度高于传统手术组,而并发症远远低于传统手术组。结论关节镜辅助治疗陈旧性颞下颌关节脱位的方法安全可行。因其创伤小,并发症少,更适用于高龄患者。     

Augmentation of the articular tubercle in treatment of chronic recurrent temporomandibular joint luxations. A preliminary case report

Chronic recurrent luxation of the temporomandibular joint requires surgical intervention in certain cases. Following a review of the literature the authors describe their own method for augmentation of the articular tubercle by implantation of hydroxyapatite. A case report shows a good result after 9 months.     

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.     

Increasing the articular eminence by the use of blocks of porous coralline hydroxylapatite for treatment of recurrent TMJ dislocation

Surgical operations are performed on some patients with recurrent dislocation of the temporomandibular joint. The surgical procedures applied are usually eminectomy and augmentation of the articular eminence. In this article, a surgical procedure for increasing the articular eminence using coralline porous hydroxylapatite is described. The implant is used as an interpositional bone graft placed into a gap created by an osteotomy of the articular eminence. Meniscoplasty is performed simultaneously as an additional operation. This procedure has been performed on eight TMJ's in five patients who had had severe recurrent dislocation. The immediate and further postoperative results were highly successful and no recurrence of dislocation was observed during this period of time.     

Surgical treatment of chronic temporomandibular joint dislocation: A case report

Introduction

Chronic dislocation of temporomandibular joint is usually treated with conservative approaches, but in some cases, surgery is needed to avoid recurrencies. The present paper described a case report of a bilateral intervention for articular tubercle height augmentation by means of calvaria bone grafts.

Materials and Methods

A 32-year-old woman attended the Department of Maxillofacial Surgery, University of Padova, Italy, in January 2007 seeking treatment for a bilateral recurrent temporomandibular joint dislocation. She was treated with a surgical procedure providing an antero-posterior osteotomy of the caudal portion of the articular eminence and the insertion of a calvaria bone graft, preserving the periosteum of the borders of the osteotomic beach. The newly remodeled articular eminence has an increased height, thus representing a barrier to condylar dislocation out of the glenoid fossa. No ostheosynthesis fixation was provided, and physiotherapic rehabilitation was started in the immediate postoperative phases to help the patient gain a good jaw function as soon as possible.

Results

Such a technique showed to be effective, as during an 8-month follow-up span, the patient referred no recurrencies of joint dislocation. Jaw motion parameters maintained good over the entire follow-up period, and radiological assessments showed no signs of bone grafts reabsorption.

Conclusions

The technique described in the present case report has some potential advantages over other surgical approaches to the treatment of recurrent temporomandibular joint dislocation that need to be assessed with future studies.