An arthroscopic technique for closure of perforations in temporomandibular joint retrodiscal tissues

The objective of this retrospective study was to introduce and evaluate an arthroscopic discopexy for closure of retrodiscal tissue perforations. A total of 112 patients (135 joints) receiving an arthroscopic discopexy for management of retrodiscal tissue perforations between January 2016 and September 2019 were included. Pre- and postoperative visual analogue scale (VAS) pain scores and maximum inter-incisal opening (MIO), as well as magnetic resonance imaging (MRI) data, were collected and analysed. Success was recorded when the disc position was >11 o’clock, VAS pain score <3, and MIO>25 mm. For patients with a condyle deformity, postoperative bone remodelling was also recorded. The VAS pain score decreased from 3.04 ± 2.66 preoperatively to 0.88 ± 1.13 at 12 months postoperatively (P < 0.001) and MIO increased from 33.90 ± 7.39 mm to 35.19 ± 6.14 mm (P = 0.029). MRI evaluation revealed that 133 discs were successfully repositioned back on top of the condyle. Among these, 11 joints were associated with either VAS pain score ≥3 or MIO ≤25 mm. Therefore, a success rate of 90.4% (122/135) was achieved at 12 months postoperative. Bone remodelling was detected in 72 joints. Arthroscopic discopexy is a minimally invasive and effective treatment for retrodiscal tissue perforations that achieves the purpose of simultaneously restoring the intra-articular structures and relieving clinical symptoms.     

Single portal arthroscopic temporomandibular joint discopexy: Technique and results

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint.A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score.A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient.A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.     

Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement

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.     

The posterior double pass suture in repositioning of the temporomandibular disc during arthroscopic surgery: A report of 16 cases

Aim

Several procedures have been described to reposition and secure the disc during arthroscopic surgery of the temporomandibular joint. The usefulness of these procedures remains controversial since simple lysis and lavage shows a high percentage of clinical success and it is difficult to obtain radiological imaging of the surgically acquired new disc position. This report describes a new arthroscopic discopexy method, and the clinical as well as radiological results obtained with this new technique.

Methods

Sixteen patients with a clinical and radiological diagnosis of Temporomandibular Joint (TMJ) dysfunction (TMD) were treated using our discopexy method. Each patient was evaluated with a visual analogue scale (VAS) for pain, radiological and functional parameters. The evaluation also included a clinical examination. Each patient was recorded at baseline before surgery and at a one-year follow-up. Statistical analysis was performed to evaluate the differences in VAS, maximum opening and lateral movements before and after treatment and were considered statistically significant when p < 0.05.

Results

Patient evaluation showed an improvement in the clinical parameters. There were statistically significant reductions in the amount of pain according to the VAS (p < 0.01). Maximal interincisal opening (MIO) and contralateral translation movement (CTM) (p < 0.05) were substantially improved one-year after operation. In the post-surgical MRI study at the one-year follow-up, a significant improvement in the disc position was observed in 13 out of the 16 joints operated on.

Conclusion

This method of arthroscopic disc repositioning is an effective surgical method for treating symptomatic patients with a diagnosis of TMJ disc displacement. Because of the minimally invasive character of the procedure, it should be considered in the surgical treatment of TMJ dysfunction.     

Arthroscopic discopexy versus natural course of temporomandibular joint anterior disc displacement: a longitudinal study of clinical and radiological outcomes

The aim of this study was to assess the various outcomes of arthroscopic discopexy compared to the natural course of anterior disc displacement (ADD) longitudinally in the same patients. A retrospective review was performed of 108 patients (152 joints) who experienced the natural course of ADD for a period of time and then underwent arthroscopic discopexy. The outcome was evaluated clinically and by magnetic resonance imaging. The natural course of ADD showed significant deterioration in pain, diet, and quality of life, and also a significant reduction in inter-incisal opening (all P < 0.001), while significant improvements in all clinical parameters were observed at the final postoperative follow-up (all P < 0.001, compared to the last preoperative visit). During the natural course, there was a significant shortening of condylar height, mandibular height, and disc length, and an increase in disc displacement distance (all P < 0.001). Postoperative follow-up revealed the restoration of condylar height and mandibular height, and all discs were significantly repositioned with an increased disc length (unfolded) (all P < 0.001). Bearing in mind the assumption of a low evidence base due to bias resulting from the retrospective non-double-blinded study design and the variable duration of the natural disease course prior to surgery, this study found that the natural course of ADD led to degenerative changes in the joint structures and clinical symptoms, whereas arthroscopic discopexy led to a restoration of the bony structures and the alleviation of clinical symptoms.     

颞下颌关节镜治疗关节盘前移伴穿孔患者的全程康复护理探讨

目的: 探讨颞下颌关节镜下盘复位手术对治疗关节盘前移伴穿孔患者全程康复护理的应用效果。方法: 回顾分析2017年1月—2018年12月间因颞下颌关节盘前移伴穿孔而接受颞下颌关节镜下盘复位治疗的54例患者,配合实施全程康复护理干预。比较治疗前、后的疼痛视觉模拟量表(VAS)和最大开口度(MIO),以及术后生活质量评分指标。评价全程康复护理配合关节镜治疗的疗效。采用SPSS 24.0 软件包对数据进行统计学处理。结果: 所有患者全程配合度好、依从性好,均能定期复诊,无失访病例,并按规定完成术后开口训练及垫配戴。术后6个月随访显示,MIO平均值由术前的(31.76±7.40)mm增至(35.24±6.22)mm(P=0.001);VAS平均得分由术前的(3.13±2.76)分降至(0.96±1.26)分(P=0.04)。治疗后生活质量评分指标的平均得分为42.11±2.21,患者满意度为90%(≥40)。结论: 全程康复护理通过对患者进行术前、术中、术后一体化、个体化优质护理,有助于提高颞下颌关节镜下盘复位手术对关节盘前移伴穿孔的治疗效果,改善开口功能,缓解疼痛。     

Arthroscopic disc fixation to the condylar head. Use of resorbable pins for internal derangement of the temporomandibular joint (stage II–IV). Preliminary report of 34 joints

AimThe study describes the arthoscopic use of resorbable pins for the internal derangement of the temporomandibular joint with McCain's technique. Clinical and image features are reported retrospectively.MethodsTwenty-seven consecutive patients (34 joints) were included. Symptomatic internal derangement and anterior-medial disc displacement with or without reduction in magnetic resonance images (MRI) were diagnosed in all cases. Two resorbable pins (SmartNail) were placed in each joint employing arthroscopic surgery with a third portal for disc recapture and fixation to condylar head.Clinical data 24 months after surgery are reported (movements, pain score, clicking, laterodeviation, occlusal changes). In eight joints a MRI control was required between 1 and 2 years after surgery.ResultsVisual analogue scale values (0–100) decreased from 70.8 to 11.9 (p < 0.001) in the first control (week) and kept down after 24 months of follow-up (VAS: 4.8). Movements began to recover in 3 months and mouth opening increased from 34 mm to 43.2 mm 1 year after surgery (p < 0.001). Clicking, laterodeviation and contralateral excursions improvement were statistically significant (p < 0.001). MRI showed disc fixation to condyle head in closed and opened mouth.ConclusionDisc fixation to condylar head with resorbable pins is a safe and satisfactory procedure. Pain becomes drastically reduced and mandibular function recovers normal parameters in patients with internal derangement     

Temporomandibular joint arthroscopy in advanced stages of internal derangement: a retrospective cohort study on the influence of age

The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ² test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥ 45 years group (P = 0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.     

The relationship between temporomandibular joint effusion and pain in patients with internal derangement

ObjectivesThe purpose of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusion and joint pain in patients with internal derangement based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).MethodsA total of 240 TMJs from 120 patients with unilateral painful joints (103 females and 17 males, mean age 29.9 ± 12 years) were evaluated. Clinical assessments were carried out according to the DC/TMD guidelines. Magnetic resonance imaging (MRI) was used to evaluate the degree of effusion in each joint. The radiological and clinical findings were analysed for statistically significant correlations.ResultsAlthough the results indicated a statistically significant association between moderate joint effusion and disc displacement (p < 0,05), there was no statistically significant association between moderate effusion and joint pain (p > 0,05). There were, however, statistically significant associations between marked effusion and both disc displacement and joint pain (p < 0,05).ConclusionTMJ effusion is associated with both disc displacement and joint pain: the effusion increased in direct proportion to the severity of pain and disc displacement. The possibility that there are various aetiologies for the condition should also be considered.     

Magnetic resonance imaging applied to the diagnosis of perforation of the temporomandibular joint

ObjectiveTo investigate the diagnostic accuracy of magnetic resonance imaging (MRI) for perforation of temporomandibular joint (TMJ).MethodsConsecutive 1845 patients (2524 joints) diagnosed as internal derangement (ID) of TMJ were collected from April 2003 to March 2010 in our department. All the patients were examined by MRI and treated by arthroscopy or open surgeries. The findings of interpreting MRI were recorded as positive, suspicious and negative according to the MRI radiographic criteria. After comparing the findings of MRI with those of arthroscopy or open surgeries, the numbers of true positive, true negative, false positive and false negative were obtained. Through SPSS16.0, receiver operator characteristic curve (ROC curve) was made with 1-specificity as abscissa and the sensitivity as ordinate, and the area under the ROC curve was calculated. According to the area, the diagnostic value of MRI was evaluated.ResultsArthroscopic or open surgeries findings confirmed that 207 joints had disc perforation among all joints. MRI findings showed 189 joints were positive, 197 joints suspicious, and 2138 joints negative. The true positive accuracy of MRI findings was 102/189 while true negative accuracy was 2075/2138. 42 of the 197 suspicious joints had perforation. The area under the ROC curve was 0.808 (0.77, 0.85), P < 0.05.ConclusionWe concluded that MRI proved to be a good modality to diagnose disc perforation of TMJ, and the diagnostic result of disc perforation by MRI had certain guiding significance in our clinical work.     

Transformation of temporomandibular joint disc configuration in internal derangement patients using magnetic resonance imaging

PurposeThe normal disc configuration is biconcave; however, the deformed disc can be found in internal derangement (ID) of the temporomandibular joint (TMJ). The purpose of this study was to evaluate the relationship between the transformation patterns of TMJ disc configuration during mouth opening and disc displacement status, disc reduction ability and TMJ clinical symptoms.MethodsTMJ MR images from volunteers and ID patients were analyzed for closed and open mouth positions. MR images of ID patients were classified into 4 groups: symptomatic joint with anterior disc displacement with or without reduction (ADW or ADWo) and asymptomatic joint with ADW or ADWo. The disc configurations in both positions were categorized as biconcave, biplanar, convex or folded; then the patterns of transformation were observed.ResultsFor the ADW group, the most common disc configuration for closed and open mouth positions were biplanar (66.7%) and biconcave (86.3%). The transformation pattern was significantly related to disc reduction ability (p < 0.05).ConclusionsThe transformation patterns of disc configuration during opening were related to anterior disc displacement and disc reduction ability.     

The effect of arthroscopic disc repositioning on facial growth in juvenile patients with unilateral anterior disc displacement

ObjectiveTo investigate the effect of arthroscopic disc repositioning on condylar development and mandibular asymmetry in juvenile patients with unilateral temporomandibular joint (TMJ) anterior disc displacement (ADD).Patients and methodsA retrospective cohort study was conducted on unilateral juvenile anterior disc displacement (UJADD) patients of 10–20 years of age treated in Shanghai Ninth People's Hospital from 2010 to 2017. The primary predictor was TMJ arthroscopic disc repositioning surgery, according to which patients were divided into a surgery group and a control group. Initial and re-examined (with at least 6-month interval) magnetic resonance imaging (MRI) and posteroanterior cephalometric radiographs (PA) were collected. The condylar heights on both sides of the TMJ were measured by MRI and the difference between them was calculated. Menton (Me) deviation was measured based on PA. Changes in condylar height difference and Me deviation were compared between the two groups.ResultsA total of 108 UJADD patients were collected in this study, including 55 patients in the surgery group and 53 patients in the control group. There were no significant differences in age, sex and follow-up time between the two groups. The condylar height difference was (−0.61 ± 2.02) mm in surgery group and (1.68 ± 1.73) mm in control group (P < 0.0001); while the Me deviation was (−1.00 ± 1.15) mm in surgery group and (1.81 ± 1.96) mm in control group (P < 0.0001), indicating that TMJ arthroscopic disc repositioning surgery could significantly improve condylar height difference and Me deviation.ConclusionsUJADD should be treated as early as possible, especially in juvenile patients, in order to improve condylar development and avoid jaw deformities.     

Correlation between joint effusion and clinical symptoms,magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease

ObjectivesThe aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables.MethodsWe designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion.ResultsA total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery).ConclusionJoint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.     

Long-term clinical outcomes of arthroscopic discopexy with resorbable pins

IntroductionDiscopexy using resorbable pins is an arthroscopic technique to treat internal derangement of the TMJ, restoring the normal relationship between disc, condyle, and temporal bone. The objective of our study was to assess the 5-year clinical outcome of a series of patients treated with this technique.MethodsA study was conducted on a series of patients who underwent arthroscopic discopexy using resorbable pins between January 2007 and February 2018. All the patients were refractory to conservative treatment and classified as Wilkes stage III. Clinical data were recorded at 1-year, 3-year, and 5-year visits. Pre- and postoperative evaluation parameters were: joint pain (VAS scale), mandibular movements (mm), and articular locking and clicking.ResultsThe study included 33 patients and the technique was performed in 38 joints. Mouth opening increased significantly with each visit after surgery compared with preoperative scores (mean value of 10.65 mm, p < 0.001), with the mean value increasing significantly at the 5-year visit in relation to the mean value obtained at the 3-year visit. Patients reported significant decreases in pain after surgery, obtaining VAS values of under 10 at the 5-year visit (mean improvement of 56.95 points, p < 0.001).ConclusionsDiscopexy using resorbable pins resulted in a good and stable clinical outcome at the long-term follow-up.     

Temporomandibular dysfunction post-craniotomy: Evaluation between pre- and post-operative status

ObjectiveTo identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy.MethodsThe study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods.ResultsThe maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p < .05) associated with an increased risk for TMD post-surgery.ConclusionA significant correlation between surgery follow-up time and maximal opening mouth was found. Pre-operative bruxism was associated with increased risk for temporomandibular joint dysfunction after craniotomy.     

Arthroscopic assisted release of lateral pterygoid versus scarification of retrodiscal tissue in management of internal derangement of temporomandibular joint-A randomized clinical trial

The purpose of this study was to compare the effectiveness of arthroscopic-assisted lateral pterygoid muscle release versus scarification of retrodiscal tissues in the treatment of temporomandibular joint internal derangement.A prospective, comparative, randomized clinical trial involved 16 patients with TMJ internal derangement. Arthroscopic assisted release of lateral pterygoid muscle was assigned to one group of patients (Group I). Group II patients received arthroscopic assisted scarification of retrodiscal tissues. Data collected through functional examination including visual analogue scale (VAS), maximum mouth opening, lateral excursion, and clicking sound immediately and after 3, 6, and 12 months. Pre- and post-operative MRI was used to assess disc position.The VAS scores decreased in both groups at the end of the follow-up period (0.45 vs 6.75, and 1.13 vs 6.50 in group I and II respectively; P<0.001). The maximum mouth opening improved to 32.9.50 ± 1.69 mm in group I, and 30.49 ± 0.93 in group II (P<0.001). Lateral excursion improved in both groups (P<0.001). Clicking sounds disappeared in all patients.Within the limitations of the study, it seems that arthroscopic assisted release of lateral pterygoid and scarification of retrodiscal tissues may be beneficial in management of anteriorly displaced discs that don't respond to conservative treatments.     

Repeated sodium hyaluronate injections following multiple arthrocenteses in the treatment of early stage reducing disc displacement of the temporomandibular joint: A preliminary report

PurposeThe aim of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporomandibular joint (TMJ).Patients and methodsTwenty patients, who have early stage temporomandibular dysfunction (TMD), were treated with intraarticular sodium hyaluronate injection and arthrocentesis. The patients received sodium hyaluronate (15 mg/ml) (1 ml) injections two times a week first following arthrocentesis with 200 ml Ringer’s Lactate and the second without. The procedure was repeated for three times at weekly intervals for 3 weeks. Pre- and postinjection pain intensity, the presence of joint sounds, and interincisial distance were recorded. These data were evaluated by visual analog scale (VAS).ResultsThe follow-up period was 6 months. There was a statistically significant reduction of pain intensity (p < 0.001) and joint sound (p < 0.001) in all patients. Initial measurement of maximal mouth opening (MMO) was 33.40 ± 3.75 mm. At the end of the follow-up period, the same measurements were repeated and interincisal distance was 49.3 ± 3.74 mm. The difference between these measurements was statistically significant (p < 0.001).ConclusionWe suggest that repeated sodium hyaluronate injections following multiple arthrocenteses with Ringer’s Lactate is an effective and safe method for the treatment of early stage reducing disc displacement of TMJ.     

MRI evaluation of the classification,frequency, and disc morphology of temporomandibular joint disc displacements: a multicenter retrospective study in a Turkish population

Objectives  Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) and temporomandibular disorders (TMDs) have been discussed in detail for various populations. As no such study has examined the Turkish population, we determined the frequency of TMDs in the Turkish population through a multicentric investigation using MRI. Methods  This retrospective study examined 504 TMJs of 252 symptomatic patients who had undergone bilateral MRI investigation in four different dental schools. The image analysis included the assessment of disc position and morphology, and recaptured the coronal and sagittal planes in the closed and open mouth positions. The TMJ disorders were classified using the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The correlations among the groups of TMJs and disc morphologies were analyzed statistically using the chi-square test (P ≤ 0.05). Results  Disc displacement and abnormal disc morphology were detected in 69.5% of the symptomatic TMJ patients. Of the joints examined using MRI, 154 were normal, 135 had anterior disc displacement with reduction (ADDwR), 145 had anterior disc displacement without reduction (ADDwoR), 30 had partial anterior disc displacement, and 18 had sideways disc displacements. Regarding disc morphology, enlargement in the posterior band was the most commonly encountered type and was observed in 152 TMJs. Overall, the average time for referral for treatment, which was defined as the time from symptom onset until the time of referral, was 1.5 years. Conclusions  The most common type of disc displacement found in the Turkish population studied was ADDwoR. In addition, patients did not perceive the symptoms of TMDs as a disease and did not seek help until the TMJ derangement caused a major complaint.     

Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.     

Effects of soft tissue injury to the temporomandibular joint: report of 8 cases

Our aim was to describe the effects of soft tissue injury to the temporomandibular joint (TMJ), to analyse possible reasons for it, and to evaluate the results of treatment. Eight patients (12 joints) who developed disorders of the TMJ after trauma to the mandible without fracture of the condyle were treated in our department from 2009 to 2010. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to check the condition of the joint. Five patients had their joints explored to relieve pain and improve mouth opening. MRI showed all 12 joints had displaced discs. CT showed that the surface of the condylar bone was “intact” immediately after injury but destroyed later in 8 joints. Exploration showed fibrous ankylosis in 5, osteoarthritis with intra-articular adhesions in 2, and internal derangement in 1. Four were treated by costochondral graft (CCG) with 7 symptomatic joints. The disc was repositioned in 1 case with 1 affected joint. The mean maximal incision opening at follow-up were significantly better than the one before treatment (mean 34 compared with 23 mm, p = 0.02). Pain in the TMJ was relieved by operation in all patients so treated. The other 3 patients (4 joints) had no treatment because their symptoms were minor and mouth opening was not restricted. Soft tissue injuries of the TMJ can potentially lead to internal derangement, osteoarthrosis, and possibly fibrous ankylosis, which should be considered during follow-up. Displacement of the disc and damage to the condylar cartilage seem to be the causes of these complications. Surgical management is effective in the short term.