Endoscopic surgery versus open reduction treatment of mandibular condyle fractures: A meta-analysis

The aim of the study was to compare open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) in adults in terms of reducing both needing of reoperation and/or facial nerve injury.An electronic search was undertaken (PubMed/MEDLINE, Web of Science, SCOPUS, and The Cochrane Library). The inclusion criteria were full text, published from their inception to June 2020, clinical trials, randomized or not, and retrospective studies, that compared ORIF and EORIF. The estimates of an intervention were expressed as the risk ratio (RR).From the 1338 articles found, 5 publications were included. There was no statistically significant difference between ORIF and EORIF regarding needing of reoperation (RR = 2.46, p = 0.42) or facial nerve injury (RR = 0.45, p = 0.14).Meta-analysis suggests that there is no difference between open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) regarding facial nerve injury risk or need for reoperation.     

Complications of total temporomandibular joint replacement: a systematic review and meta-analysis

The aim of this systematic review was to determine the most prevalent complications resulting from total temporomandibular joint (TMJ) replacement. An electronic search was performed using the Embase, LILACS, MEDLINE (via PubMed), SciELO, Scopus, and Web of Science databases up to June 2022. Prospective and retrospective clinical studies on patients who underwent TMJ replacement were included. Two reviewers performed the study selection, data extraction, and individual risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Tools. The pooled prevalence of each complication was calculated through a proportion meta-analysis using the random-effects model. Twenty-eight studies met the eligibility criteria and were included in the review. All of the eligible studies had a low risk of bias. The results of the meta-analysis revealed that the most prevalent complication was paresis or paralysis of the facial nerve branches (7.8%; 95% confidence interval (CI) 2.6–15.1%, I² = 94.5%), followed by sensory alterations (1.8%; 95% CI 0.6–4.9%, I² = 88.8%), heterotopic bone formation (1.0%; 95% CI 0.1–2.5%, I² = 75.8%), and infection (0.7%; 95% CI 0.1–1.6%, I² = 22.7%). In conclusion, TMJ replacement has a low prevalence of complications, and most of them can be managed successfully.     

Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials

Objective

The aim of this article was to assess the clinical evidence for or against acupuncture and acupuncture-like therapies as treatments for temporomandibular joint disorder (TMD).

Data

This systematic review includes randomized clinical trials (RCTs) of acupuncture as a treatment for TMD compared to sham acupuncture. The search terms were selected according to medical subject heading (MeSH).

Sources

Systematic searches were conducted in 13 electronic databases up to July 2010; Medline, PubMed, The Cochrane Library 2010 (Issue 7), CINAHL, EMBASE, seven Korean Medical Databases and a Chinese Medical Database.

Study selection

All parallel or cross-over RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. Finally, total of 7 RCTs met our inclusion criteria.

Conclusions

In conclusion, our systematic review and meta-analysis demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication.     

髁突骨折分型及手术治疗50例临床分析

目的 研究出现移位和功能障碍的下颌髁突骨折的分型和疗效.方法 2007年7月至2010年7月,收治有骨折移位和功能障碍的下颌髁状突骨折的患者50例(69侧),依据骨折线的水平分为髁突囊内,髁突颈部和髁突下骨折,采用不同手术方法和固定方法进行治疗.术后3天、1个月、3个月、6个月、1年进行临床随访,从临床和影像学两方面评估术后恢复情况.囊内骨折根据杨驰教授的骨折线分类方法,将骨折分为分为A、B、C、M四型,回顾性分析不同类型手术的特点.结果 50例患者中获得3个月以上随访的48例(66侧),术后平均随访10.45个月,随访期末平均开口度33.89 mm(31.5~43.7 mm),8侧出现暂时性额纹消失,3个月后7侧恢复.术后总体满意度97.92%(47/48),仅1例骨折患者因1年后伴有颞区皮肤麻木和额纹消失不满意,其余无严重并发症出现.结论 对于发生移位和功能障碍的下颌骨髁突骨折分型的不同采取不同的手术方法可达到良好的治疗效果,但对术者的手术技巧和经验要求较高.     

Management of mandibular angle fractures using 3- dimensional or standard miniplates: A systematic review and meta-analysis

Purpose

This study proposed to compare clinical outcomes between three-dimensional (3D) plate and standard miniplate fixation systems for the management of mandibular angle fractures (MAFs).

In-vitro comparison of mechanical resistance between two straight plates and a Y-plate for fixation of mandibular condyle fractures

Objective

To compare the mechanical resistance of conventional plates with a modified Y-plate in mandibular condyle fracture.

A systematic review and meta-analysis of randomized controlled trials comparing arthrocentesis with conservative management for painful temporomandibular joint disorder

The aim of this study was to determine whether arthrocentesis is superior to conservative treatment in the management of painful temporomandibular joint disorders with restricted opening. A systematic review was undertaken of prospective randomized controlled trials (RCT) comparing arthrocentesis to conservative management, identified in the MEDLINE and PubMed databases. Inclusion criteria included a 6-month follow-up, with clinical assessment of the patients and painful restricted mouth opening. Data extracted included pain measured on a visual analogue scale and maximum mouth opening measured in millimetres. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2 for RCTs, and a meta-analysis with the random-effects model was undertaken. Of 879 records retrieved, seven met the inclusion criteria; these RCTs reported the results at 6 months for 448 patients. One study had a low risk of bias, four studies had an uncertain risk, and two had a high risk of bias. In the meta-analysis, arthrocentesis was statistically superior to conservative management at 6 months for an increase in maximum mouth opening (1.12 mm, 95% confidence interval 0.45–1.78 mm; P = 0.001; I² = 87%) and borderline superior for pain reduction (−1.09 cm, 95% confidence interval −2.19 to 0.01 cm; P = 0.05; I² = 100%). However, these differences are unlikely to be clinically relevant.     

Microbiological investigation of the mandibular condyle in patients with advanced osteoarthritis of the temporomandibular joint

PurposeThe aim of this study was to investigate the presence of bacteria in samples of the temporomandibular joint taken from patients suffering from advanced osteoarthritis of the temporomandibular joint (TMJ).Materials and methods25 fresh mandibular condyle samples were taken from 17 consecutive patients undergoing mandibular condylectomy (8 bilateral) for advanced TMJ osteoarthritis (Dimitroulis Category 5 joints). The joint samples were stained and cultured for the presence of microorganisms following a standardised joint culture protocol.ResultsNo evidence of bacteria was found on staining or solid culture mediums. Late growth (day 12) of commensal skin organisms (P. Acnes, S. Epidermitis, S. Capitis) were identified in enriched broth samples in 5 joint samples. No statistically significant associations were noted between positive broth samples and age or previous joint intervention (p > 0.05)ConclusionsWithin the limitations of this study, we have failed to identify meaningful bacterial growth in tissues (i.e. condylar head) of the TMJ that would suggest a contributory bacterial pathogenesis for arthritis of the TMJ.     

Mandibular advancement for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Objectives

Mandibular distraction osteogenesis and mandibular advancement, collectively referred to as mandibular advancement surgeries (MAS), have been used to treat children with mandibular insufficiency and obstructive sleep apnea (OSA). The objective is to perform a systematic review and meta-analysis for MAS as treatment for obstructive sleep apnea.

藻酸盐凝胶三维培养体系在TMJ骨关节病髁突软骨细胞体外培养中的应用

目的 将藻酸盐凝胶三维培养体系应用于颞下颌关节骨关节病（osteoarthritis of temporomandibular joint,TMJOA)髁突软骨细胞的体外培养。方法 利用机械与酶消化的方法从TMJOA患者手术切除患疾髁突软骨中获得髁突软骨细胞，部分细胞在二维贴壁培养条件下体外培养1周；部分细胞在高密度条件下转入藻酸盐凝胶培养介质，进行三维培养4周；分别对贴壁条件下培养细胞和藻酸盐细胞凝胶微球右蜡包埋切片进行Ⅱ型胶原和软骨特异性蛋白多糖的免疫组化鉴定。结果 从骨关节病髁突软骨组织中收获并行体外培养成活的细菌，鉴定为软骨细胞；体外培养的藻酸盐凝胶三维培养体系中的髁突软骨细胞生长状态良好；培养4周后细胞保持了良好的分化表型。结论 成功地体外培养成活了人TMJOA髁突软骨细胞；成功地将藻酸盐凝胶三维培养体系应用于人TMJOA髁突软骨细胞体外培养，在该体系中，软骨细胞生长状态与功能蛋白分泌能力良好。     

Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience

Purpose

The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.

Reasons for failure of total temporomandibular joint replacement: a systematic review and meta-analysis

The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33–0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.     

MRI as a method of evaluation and predicting mandibular growth based on temporomandibular joint

BackgroundCondylar cartilage acts as a centre of craniofacial complex growth and magnetic resonance imaging (MRI) is the most suitable examination to differentiate tissues and identify pathological conditions of TMJ. Condylar growth disturbance can alter the maxillofacial morphology, including occlusal relationship, and the affected children may not present symptoms. Although TMJ in children is similar to that in adults, the anterior condylar inclination is straight and increases with age, presenting slight condylar flattening and slight contrast enhancement.ObjectiveThe present work aimed to review the literature focussing to assess how MRI and the development of TMJ can contribute to orthopaedic/orthodontic diagnosis in growing patients.Main resultsMRI can also complement the predictive diagnosis of growth in which the image of a double contour of the condyle reveals proliferation of cartilage cells with immature ossification. Considering that orthodontic therapy usually begins after eruption of permanent teeth, the moment of alternation of the double contour-like structure is close or coincident with the eruption of upper second molars.ConclusionClinically, the advantage of diagnosis of double contour is not to use any ionizing radiation related to scan in these subjects. Therefore, MRI could be a choice for the follow-up of growing patients.     

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n = 42, 59%) and falls (n = 20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3–193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p = 0.02). Increasing age was significantly related to reduction in the intensity of pain (p = 0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.     

Fractures of the mandibular condyle: evidence base and current concepts of management

Management of mandibular condylar fractures remains a source of ongoing controversy. While some condylar fractures can be managed non-surgically, recognition of fracture patterns that require surgical intervention and selection of an appropriate operative procedure are paramount to success in treating these injuries.The objective of this review is to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.     

Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic review

The purpose of this study was to perform a systematic review of morphological alterations in the condyles after orthographic surgery involving a sagittal split ramus osteotomy (SSRO), with or without surgery on the maxilla. Searches were performed on three databases and registered in the PROSPERO. The selected studies fulfilled the criteria established by the following PICO model: (1) population: individuals with skeletal dentofacial deformities (class II or III facial patterns), without asymmetry; (2) intervention: orthognathic surgery for mandibular setback using an SSRO, with or without a Le Fort I osteotomy, and fixed with bicortical screws or plates and screws; (3) comparison: orthognathic surgery for mandibular advancement using an SSRO, with or without a Le Fort I osteotomy, and fixed with plates and screws or bicortical screws; and (4) outcome: condylar resorption rate and relapse. Initially, 1,371 articles were identified and 636 articles were screened after elimination of duplicates, and 6 articles were selected for qualitative analysis based on the inclusion and exclusion criteria. Five studies had data regarding the rate of condylar resorption, varying from 0.0% to 4.2%. In conclusion, condylar resorption and relapses were present in a small percentage of patients studied.     

体外培养的兔下颌骨髁突对机械压力的反应和变化

目的: 探索体外培养的下颌骨髁突组织块对机械压力的反应和变化。方法: 兔下颌骨髁突组织块分别在0（对照）、15和75 kPa机械压力下体外培养3 d,观察髁突的大体形态、组织切片,进行micro-CT扫描,分别采用RT-PCR和Western免疫印迹检测Ⅱ型胶原蛋白(COL2)、X型胶原蛋白 (COL10)、SOX9和MMP13的mRNA及蛋白表达。采用SPSS 16.0 软件包对数据进行统计学分析。结果: 15 kPa组,髁突关节面光滑,软骨呈白色,关节面中心受压后变平,但软骨仍完整。75 kPa组,髁突关节面变粗糙,颜色变黄、暗淡,关节面中央受压变平的面积更大,中心区域软骨破裂。镜下可见,15 kPa组的软骨层变薄,软骨细胞排列比对照组更紧密。75 kPa 组中,整个软骨层被破坏并与中心区域的软骨下骨分离。COL2和SOX9的表达在15 kPa压力下显著增加（P<0.01）,在75 kPa压力下显著下降。COL10和MMP13的表达在75 kPa压力下显著增加（P<0.01）。Micro-CT扫描结果显示,压力组的骨密度（BMD）、骨体积/总体积比值（BV/TV）和 骨小梁厚度（Tb.Th）显著增加（P<0.01）。结论: 体外培养的髁突组织块在15 kPa机械压力下保持完整性和功能,并发生适应性改建。75 kPa的压力对软骨产生破坏,软骨层受损、破裂并从软骨下骨处剥离,可能进一步导致骨关节炎的发生。     

创伤性颞下颌关节强直的病程特点与分类治疗

目的调查创伤性颞下颌关节强直（TMJA）的髁突骨折类型及病程特点；探讨各分类治疗方法及疗效。方法31例42侧创伤性TMJA，按Sawhney分类分成4型。Ⅰ型和Ⅱ型强直分别行关节松解和融合骨切除术＋关节盘复位术；Ⅲ型和Ⅳ型强直分别行全关节切除和全关节扩大切除术＋颞肌筋膜瓣衬垫术、选择性下颌支后缘垂直骨牵引及颏成形术。术后复查9～54个月（平均30个月），评价治疗效果。回顾调查引起强直的髁突骨折类型和强直发生的过程。手术与CT及MRI对照观察早期骨化部位、关节盘移位和关节残余运动方式。结果创伤性TMJA均继发于髁突矢状和粉碎性骨折，且关节盘发生移位者。I型（纤维性）强直通常出现在伤后4～5个月，平均张口度18．3mm。术中探及的关节盘全部发生移位，早期强直骨化发生在无关节盘区域。随诊期内，2例（6．45％）复发，其他患者张口度均稳定维持在30mm以上。结论髁突矢状和粉碎性骨折是最容易导致关节强直的骨折类型。关节盘移位是强直形成的重要因素。早期手术可以复位关节盘，避免后期强直时必须切除全关节。     

可吸收螺钉双皮质骨固定羊髁突矢状骨折的实验研究

目的 通过髁突矢状骨折（sagittal fractures of mandibular condyle,SFMC）动物模型,检验侧向可吸收螺钉手术治疗SFMC的效果,以及利用该螺钉稳定固位和不稳定固位的区别。方法 16只成年绵羊,制备成右侧SFMC动物模型,随机分为4组,每组4只。对照组采用保守治疗,实验1组采用侧向钛螺钉双皮质骨固定技术予以治疗,实验2组采用侧向可吸收螺钉以拉力螺钉的方式行切开复位内固定手术（open reduction and internal fixation, ORIF）治疗（不稳定固定）,实验3组采用侧向可吸收螺钉以双皮质固定方式行ORIF治疗（稳定固定）,分别在截骨术后、骨折内固定术后即刻、保守治疗或骨折内固定治疗3个月后行颞下颌关节（temporamadibular joint,TMJ）计算机断层扫描（computed tomography,CT）,对TMJ的形态改变进行放射学评分。治疗3个月后处死动物,解剖、观察、测量TMJ形态变化及组织学改变。采用SPSS 18.0软件包中的配对t检验和两样本t检验对结果进行统计学分析。结果 对照组、实验2组动物实验侧TMJ CT影像及髁突的前后径和内外径明显异常,关节盘与髁突黏连,质地变脆,部分区域关节盘破损,关节窝有不同程度虫蚀状骨质破坏。实验1组和3组实验侧TMJ基本正常,反映TMJ形态改变的放射学评分2.60±0.94（实验1组）和2.90±1.06（实验3组）显著低于对照组（11.40±1.98）和实验2组（10.20±2.18）。组织学检查提示,对照组、实验2组动物实验侧关节盘出现纤维软骨黏液变性,髁突和关节窝表面软骨也出现黏液样变性,髁突骨质不规则增生,实验1组和3组实验侧关节盘、髁突和关节窝表面软骨未见明显改变。结论 髁突矢状骨折后精确复位和稳定固定,是TMJ恢复正常解剖形态的前提,只要操作得当,可吸收螺钉与钛螺钉一样,均可获得稳定的固位和良好的治疗效果,由于不需二次手术取出,可吸收螺钉作为SFMC内固定材料,具有一定的优越性。保守治疗或不稳定的ORIF治疗,会导致TMJ严重病理改变。