Bruce Sanders

Arthroscopic surgery of the temporomandibular joint: Treatment of internal derangement with persistent closed lock

Arthroscopic surgery to correct symptoms of persistent closed locking of the temporomandibular joint appears, in the short term, to be an alternative to arthrotomy. Obviously, long-term follow-up will be necessary.

Temporomandibular joint arthroscopy: A 6-year multicenter retrospective study of 4,831 joints

Four health outcomes (range of motion, pain, diet, and disability) were measured in six diagnostic categories (internal derangement with closed lock, internal derangement with painful click, osteoarthritis, hypermobility, fibrous ankylosis, and arthralgia) in a 6-year retrospective multicenter study of 4,831 temporomandibular joints having undergone arthroscopic surgery. After arthroscopic surgery, 91.6% of all patients had good or excellent motion; 91.3% had good or excellent pain reduction; 90.6% had good or excellent ability to maintain a normal diet; and 92% had a good or excellent reduction in disability. These health outcomes compare favorably with all other known treatments for these conditions. Also, the surgical technique was relatively free of complications (4.4%).

Custom CAD/CAM total temporomandibular joint reconstruction system: Preliminary multicenter report☆

PURPOSE The purpose was to test the outcome of a custom computer assisted design/computer assisted manufactured (CAD/CAM) total temporomandibular joint (TMJ) reconstruction system. PATIENTS AND METHODS There were 215 patients (13 males and 202 females); the average age at reconstruction was 40.9 +/- 10.3 years (range, 15 to 77 years). There were 363 joints placed, 296 bilateral and 67 unilateral. The patients had TMJ problems for an average of 10.3 +/- 7.0 years (range, 1 to 44 years), and had undergone a mean of 5.4 +/- 4.8 (range, 0 to 28) prior unsuccessful surgeries. Preoperative and postoperative data were collected for up to 48 months using a standardized data collection format. Subjective data related to pain, function of the lower jaw, and diet, were obtained using a visual analogue scale. Objective measures of mandibular range of motion were made directly on the patient preoperatively and postoperatively. RESULTS Preliminary analysis of these data reveals a statistically significant decrease in pain, an increase in function, and improvement in diet (P < .0001) from the preoperative measurements to 1 and 2 years postoperatively. There was also improvement in mandibular vertical range of motion. The number of previous surgeries was a strong predictor of postoperative pain, function, and diet scores, as well as of maximal interincisal opening. A life table analysis of failures indicates good durability of the prosthesis over time. CONCLUSION These preliminary data indicate that this custom CAD/CAM total TMJ reconstruction system seems to be useful in the treatment of the multiply operated, and/or anatomically mutilated TMJ.

Bilateral coronoid hyperplasia resulting in severe limitation of mandibular movement. Report of a case.

A case of bilateral coronoid hyperplasia with limitation of mandibular motion in a female patient has been presented. Her symptoms began to develop around the age of 44. We believe that this is the first case to be reported in a female. Also, in all other reported cases symptoms began to develop around the onset of puberty. The literature has been reviewed with specific reference to the etiology of bilateral coronoid hyperplasia. This case brings the total number of reported cases to twenty-two. We hope that if similar cases are identified in female patients the practitioners will report them promptly. Only in this way will we be in a better position to understand the etiology of bilateral coronoid hyperplasia with special reference to heredity.

Aseptic osteomyelitis and necrosis of the mandibular condylar head after intracapsular fracture

Aseptic osteomyelitis and necrosis of the mandibular condylar head is a rare complication which may occur several months after an untreated intracapsular fracture. Clinical symptoms are pain in the temporomandibular joint on the affected side and limitation of opening of the mouth. Radiographically, the condylar head is characteristically eroded and irregular. Treatment consists of surgical removal of the necrotic condylar head and débridement of the area, which are performed via a preauricular approach.

Management of internal derangements of the temporomandibular joint

This article discusses the orthodontists involvement in treating patients with complex temporomandibular joint (TMJ) disorders. It includes a review of the literature and information regarding classification, epidemiology, incidence, and diagnosis of TMJ internal derangements. Controversies in management discussed include the importance of disc position, the consequences of not repositioning the disc, and the predictability of progression of disease. Considerations regarding home care, medical care, and surgical care are also presented.

Arthroscopic surgery for treatment of temporomandibular joint hypomobility after mandibular sagittal osteotomy

Arthroscopic surgery is an effective method for treating painful hypomobility of the temporomandibular joint. Decreased range of motion after sagittal ramus osteotomies of the mandible has been reported. Causes may include intra-articular factors. These cases may be effectively treated with arthroscopic lysis and lavage after failure of nonsurgical modalities. A series of 15 patients is presented.

Augmentation rib grafting to the inferior border of the atrophic edentulous mandible: A 5-year experience

Inferior border rib grafting appears to be a useful procedure in providing bony augmentation for severely atrophic edentulous mandibles. Major advantages to the prosthodontic patient are that (1) remodeling and changes in the denture-bearing surfaces are minimal following surgery, (2) the interocclusal space is unaltered, (3) in nonunion body fractures occurring in severely atrophic mandibles, the ribs applied to the inferior-buccal and inferior-lingual aspects of the mandible hold the fragments in a much more favorable position, thus preventing superior elevation of the posterior segment and inferior displacement of the anterior segment, and (4) resorption rates seem acceptable. The patient should be informed of possible consequences. As with all preprosthetic special procedures, a psychosocial analysis may also be indicated.

Radiology of maxillofacial gunshot injuries

The relative advantages and disadvantages of conventional facial radiographic techniques, facial tomography, and carotid arteriography for gunshot injury cases are discussed. The conventional series of skull, facial, or cervical spine projections forms a base line upon which the more complex procedures may be added. Five cases illustrate the radiographic principles involved in the determination of gunshot fragment localization, bone fracture, soft-tissue swelling, and maxillary sinus involvement.

Silicone rubber fossa implant removal via partial arthrotomy followed by arthroscopic examination of the internal surface of the fibrous capsule

Thirteen temporomandibular joints were examined arthroscopically for evaluation for fibrous encapsulation of silicone elastomer disk replacement implants. Partial arthrotomies were performed with removal of silicone rubber implants, followed by arthroscopic examination of the internal surfaces of the fibrous capsule as a pseudodisk and to verify the continuity of the fibrous barrier between the condyle and the fossa.