A study of factors for successful splint capture of anteriorly displaced temporomandibular joint disc with disc repositioning appliance

The purpose of this study was to analyse the factors which influenced the success of disc recapture by the insertion of a disc repositioning appliance. Fifty-one joints with joint clicking that occurred at both middle to late opening and late closing (near maximum cuspation) of the mandible were splinted with a mandibular full-coverage repositioning appliance. The clinical and MR findings were compared between the joints with successful and unsuccessful splint disc capture. Thirty-two clicking joints with reducibly displaced discs (DDWR) had successful disc recapture, while six of 19 joints with displaced disc without reduction (DDWOR). Unsuccessful joints with DDWOR had significantly higher prevalence of deformed disc and joint effusion, higher VAS quantitative pain score, and severe disc displacement especially in medial part of the joint (P < 0.05). From the results of this study joints with DDWR can be expected to have successful disc recapture with the insertion of the appliance. In joints with DDWOR, presence of inflammatory conditions, changed disc morphology and extensive disc displacement in medial part of the joint are negative factors.     

The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement

Objective. The aim of this study was to investigate the effects of temporomandibular joint (TMJ) symptoms on skeletal morphologies of orthodontic patients with TMJ disc displacement (DD). Materials and methods. The sample consisted of 197 women seeking orthodontic treatment. The subjects were divided into two groups according to the presence of TMJ symptoms: the presence and absence of TMJ symptoms. Each group was sub-divided into three groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral disc displacement with reduction (DDR) and bilateral disc displacement without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by two-way analysis of variance to identify differences in skeletal morphologies with respect to TMJ symptoms and TMJ DD status. Results. Patients with TMJ DD were more likely to have short ramus height, short mandibular body length and backward positioning of the ramus and mandible. These skeletal morphologies became more severe as TMJ DD progressed to DDNR. However, the skeletal morphologies associated with TMJ DD were not significantly different between symptomatic and asymptomatic patients. As a result, patients with TMJ DD had backward positioning and clockwise rotation compared to those with bilateral normal TMJs, irrespective of the presence of TMJ symptom. Conclusions. This study suggests that TMJ DD is associated with altered skeletal morphology, but TMJ symptoms do not significantly influence the relationships between TMJ DD and skeletal morphology.     

偏侧咀嚼患者颞下颌关节盘位置及临床症状的影响

目的：探讨偏侧咀嚼不良习惯对颞下颌关节盘位置及临床症状的影响。方法：随机选取2012年12月至2013年12月在清华大学玉泉医院口腔科就诊的伴有偏侧咀嚼不良习惯的患者60名为受试对象,其中男性30名,女性30名,年龄26-35岁,常规进行口腔及颞下颌关节的临床检查并拍摄双侧颞下颌关节开闭口位核磁共振。结果：全部60名患者的120个关节中,使用侧和废用侧可复性盘前移分别为13个和10个,P〉0.05,差异无统计学意义。使用侧和废用侧不可复性盘前移分别为11个和14个,P〉0.05,差异无统计学意义。使用侧和废用侧盘内移分别为4个和13个,P〈0.05,差异有统计学意义。使用侧和废用侧盘外移分别为12个和3个,P〈0.05,差异有统计学意义。使用侧和废用侧关节腔积液分别为15个和12个,P〉0.05,差异无统计学意义。使用侧和废用侧关节弹响分别为7个和9个,P〉0.05,差异无统计学意义。结论：偏侧咀嚼对关节盘内外移位有显著影响,对颞下颌关节盘前移位,积液和弹响无显著影响。     

关节灌洗加透明质酸治疗不可复性关节盘前移位

目的　探讨颞颌关节不可复性盘前移引起的严重张口受限的非手术疗法。方法　对 5 9例不可复性盘前移 (包括 3 6例旋转移位 )的张口受限患者 ,行多次关节灌洗 ,配合木楔被动张口训练 ,透明质酸腔内注射治疗。结果　经 3次治疗后颞颌关节活动度明显增大 (P <0 .0 1)。基本无痛 ,无并发症。关节造影显示 :仅 3例关节盘部分复位。结论　该法操作简单 ,可反复进行 ,是治疗不可复性盘前移 (包括旋转移位 )引起张口受限的有效方法。     

颞颌关节上腔灌洗术治疗滑膜炎和关节囊炎疗效观察

目的 :观察颞颌关节上腔灌洗术治疗滑膜炎和关节囊炎的临床疗效。方法 :对 5 6例颞颌关节滑膜炎和关节囊炎病例进行关节上腔灌洗 ,然后注入强的松龙 0 .5ml。 2周后复诊 ,观察治疗效果。结果 :经治疗后显效3 8例 (67.9% ) ;好转 16例 (2 8.6% ) ;无效 2例 (3 .5 % )。结论 :关节上腔灌洗术治疗颞颌关节滑膜炎和关节囊炎疗效肯定。     

Variation of heads of lateral pterygoid muscle and morphology of articular disc of human temporomandibular joint – anatomical and histological analysis

To grasp the documented evidences available regarding the cause of the anteriorly displaced human temporomandibular joint (TMJ) disc. With 20 specimens of human TMJ from cadavers, at first the number of heads of lateral pterygoid muscle (LPM) bundles were analysed with macroanatomical method. Secondary histological procedure with haematoxyline and eosine staining and orceine staining were carried out for the same specimens. Macroscopically, in 13 specimens an upper and a lower head of the LPM were present. In the other seven specimens, not only an upper and a lower head, but also a third inner head of the LPM covered with a separate fascia was observed. Histochemically, the specific localization of certain bundles of thick elastic fibres in the antero-medial parts of the anteriorly displaced deformed TMJ disc were observed.     

Relationship between the TMJ disc and condyle position on MRI and occlusal contacts on lateral excursions in TMD patients

Confusion about the relationship between dental occlusion and the temporomandibular disorders (TMD) has been evident in the literature for many years. Previous studies have supported the concept of a multifactorial aetiology of TMD, the occlusal factor in general being of minor importance. The purpose of the study was to investigate the relationship between condyle and disc positions and occlusal contacts on lateral excursions of the mandible in patients with TMD. A total of 122 temporomandibular joints (TMJs) of 61 patients with TMD were evaluated using magnetic resonance imaging (MRI) and occlusal analyses were made clinically. Non-working-side contacts were found to be statistically significant in TMJ anterior disc displacement. No significant statistical correlation was found between the severity of anterior disc displacement and non-working-side contacts in both canine guidance and group function occlusions. There was no correlation between non-working-side contacts and condyle positions in both occlusion types in the present study. It was concluded that non-working-side contacts had some effect on disc position in TMD, however the presence of these contacts in both canine guidance and group function occlusions did not correlate with anterior disc displacement in TMD statistically. Therefore, non-working-side contacts are not to be regarded as the prime cause of anterior disc displacement.     

可吸收带线锚固钉与金属锚固钉治疗颞下颌关节盘不可复性前移位的短期疗效比较

目的:研究可吸收带线锚固钉与金属锚固钉应用于颞下颌关节盘锚固术治疗颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDWoR)的短期疗效比较.方法:选取2019年1月—2020年12月于我院行颞下颌关节盘锚固术的40例(52侧)患者,使用钛合金金属...     

颞颌关节强直续发OSAS外科治疗的进一步探讨

通过采用颞颌关节重建与不同的正颌外科术式组合的方法治疗１０例颞颌关节强直续发ＯＳＡＳ患者，结果表明：颞颌关节强直续发ＯＳＡＳ的治疗既要兼顾关节强直的解除，又要矫正畸形颌骨对面容及牙牙合造成的影响，更不容忽视其对口咽通气道所造成的影响；颞颌关节重建与不同的正颌外科术式组合的方法是治疗该病的有效手段     

The effect of disc repositioning and post-operative functional splint for the treatment of anterior disc displacement in juvenile patients with Class II malocclusion

Purpose

To evaluate the effect of temporomandibular joint (TMJ) disc repositioning and post-operative functional splint for the treatment of anterior disc displacement (ADD) in juvenile patients with Class II malocclusion.

Arthroscopic osteoplasty of the medial and anteromedial wall of temporomandibular joint: surgical technique and anatomical considerations

The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications     

颞下颌关节镜下关节盘复位固定术患者的围手术期护理

目的探讨颞下颌关节镜下行关节盘复位固定术患者的围手术期护理措施。方法总结13例(18侧)颞下颌关节镜下行关节盘复位固定术的围手术期护理经验。术前做好患者的心理护理,增加患者对手术的认知和信心,全面评估患者情况,做好术前准备。术中正确调试仪器,配合医生操作,稳定患者情绪。术后做好仪器保养、教会患者和家属如何进行功能训练,做好患者和家属的心理护理。结果 13例患者无感染及不可复性神经损伤等重大术后并发症。随访3～12个月,手术伤口均恢复良好,磁共振成像检查显示关节盘均复位良好。结论熟练掌握颞下颌关节镜下关节盘复位固定术的护理要点,同时注意围手术期的心理护理和术后功能训练对提高术后疗效有重要意义。     

殆垫及关节灌洗术治疗颞下颌关节盘不可复性前移位的临床分析

目的：对不可复性关节盘前移位的不同治疗方法进行临床分析和总结,进一步探索合理的治疗不可复性关节盘前移位的方法。方法：将48例不可复性关节盘前移位的关节病患者分成3组,即[牙合]垫治疗组、关节灌洗组、关节灌洗术联合[牙合]垫治疗组。将3种治疗方法对不可复性关节盘前移位治疗前后的疼痛指数、最大开口度进行统计分析,比较3种治疗方法的临床疗效。结果：疼痛指数：3组患者治疗前后疼痛指数的改变值,[牙合]垫治疗组〈关节灌洗组〈关节灌洗术联合[牙合]垫治疗组（P〈0.05）,关节灌洗组与关节灌洗术联合[牙合]垫治疗组治疗前后开口度的改善度,差异无显著性,但均优于[牙合]垫治疗组（P〈0.05）。结论：对不可复性关节盘前移位的治疗,关节灌洗术联合[牙合]垫治疗的临床疗效优于[牙合]垫治疗或关节灌洗术,同时,关节灌洗术的临床疗效显效方面优于[牙合]垫。     

颞下颌关节镜下盘复位固定术的疗效评价

目的:介绍颞下颌关节(temporomandibular joint,TMJ)镜下盘复位固定术的磁共振(magnetic resonanceimaging,MRI)和临床评价的初步效果。方法:选取门诊就诊的TMJ疾病患者进行临床检查,在初步诊断为结构紊乱(internal derangement,ID)后进行MRI检查,以获取评价关节盘情况的影像学依据,并按照Wilkes-Bronstein分期标准进行分期,将处于Ⅱ～Ⅴ期的患者纳入治疗范围,进行关节镜下盘复位固定手术。术后对接受关节镜下盘复位固定术的911例患者(1103侧关节)再次进行MRI检查,根据MRI评价标准,评价关节盘复位的效果。对复位"差"者再次进行手术,或改为开放性锚固术。结果:MRI评价显示,1032侧关节达到良以上,有效率达93.56%(1032/1103);仅有71侧、6.44%(71/1103)的关节进行了二次关节镜手术或开放性手术。临床评价的平均随访期为15.3个月(2～29个月),结果为优者32.88%(48/146),良者57.53%(84/146),差者9.59%(14/146);总有效率为90.41%(132/146)。92.47%(135/146)的患者自主感觉较术前明显改善。有效组开口度改善(14.34±5.87)mm(P<0.001)。VAS术前29.76±23.35(0～80),术后3.71±7.91(0～50)(P<0.05)。失败组开口度改善不明显(P>0.05)。VAS术前3.33±5.77,术后36.67±30.55(P<0.01)。对MRI评价与临床评价2种方法进行χ2检验,两者之间无显著性差异。结论:TMJ内镜下盘复位固定术是一种能将关节盘复位的、有效的微创术式,但其长期稳定性尚需进一步评价。     

Adolescent internal condylar resorption (AICR) of the temporomandibular joint,part 1: A review for diagnosis and treatment considerations

Background: Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation.

Clinical and imaging presentation: The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement.

Treatment protocol: AICR can be successfully treated when the condyles and discs are salvageable with the following surgical protocol: (1) Removal of bilaminar tissue surrounding the condyle; (2) Reposition the disc with the Mitek anchor technique; and (3) Orthognathic surgery to advance the maxillo-mandibular complex in a counterclockwise direction.

Conclusion: AICR can be successfully treated using the specific protocol presented herein to provide stable and predictable outcomes.     

颞下颌关节灌洗术治疗不可复性关节盘前移位的临床研究

目的 评价颞下颌关节上腔灌洗术治疗不可复性关节盘前移位的临床疗效。方法 ３８例因不可复性关节盘多位引起张口受限的患者行关节上腔灌洗治疗,分析治疗不同时期患者的疼痛值、下颌运动度变化,通过关节造影判定治疗前后关节盘位置的变化。结果 治疗后不同时期的下颌运动均较治疗前的显著增加（Ｐ〈０．００１）,特别在治疗后１个月内增加明显,疼痛亦有显著缓解（Ｐ〈０．０１）。关节造影显示仅有２患者的关节盘部分复位。结     

Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study

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.     

New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I - technique introduction

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.