M. Franklin Dolwick

Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening.

Seventeen patients complaining of suddenly occurring, severe, and persistent limited mouth opening were treated by irrigation of the upper compartment of the affected temporomandibular joint with lactated Ringers solution. This simple treatment was found to be highly effective in reestablishing normal opening and relieving pain for a follow-up period of 4 to 14 months.

Silicone-induced foreign body reaction and lymphadenopathy after temporomandibular joint arthroplasty

Eight patients with previously placed silicone temporomandibular joint (TMJ) implants were operated on again. Excised tissues from in and around the joint were histologically evaluated. In one case, a parotid lymph node was also examined. All specimens revealed fragmented, amorphous, refractile, but nonbirefringent, irregularly spherical foreign material consistent with fragmented silicone. Granulomatous inflammation and multinucleated giant cells were associated with the silicone material. These findings demonstrated that silicone may not be a totally inert material and that its biomechanical properties are not ideal for use in the TMJ.

Modified techniques for internal fixation of sagittal ramus osteotomies

Conventional wire fixation of a sagittal split OSteotomy of the mandible has been associated with more than 50 per cent relapses in some published’.* and unpublished reports.§ n Most such relapses occur during or shortly after the period of maxillomandibular fixation. Techniques to correct or accommodate such a relapse have included cervical collars, skeletal fixation, overcorrection, inferior border wires, posterior bite opening splints, and suprahyoid myotomies.2-4 Spiessl,5-7 among others 8,9J has recommended rigid internal fixation as a Method to promote more rapid healing, to allow early or immediate restoration of function, and to decrease relapse potential. Moreover, additional maxillary, midfacial, or nasal procedures can be performed concomitantly without possible airway embarrassment. The purpose of this article is to describe a modification of Spiessl’s technique in which minimal skin incisions are used, and the need for screw removal is unlikely.

An alternative explanation for the genesis of closed-lock symptoms in the internal derangement process

Clinical and surgical data on 194 operated joints (135 patients) were used to substantiate a new concept challenging the presumed natural history of temporomandibular internal derangement (ID). A number of findings were incompatible with the traditional depiction of a progressive process based on gradual changes in disc position and shape. These findings were a lack or correlation between increasing age and the stages of the process; the percentage of patients in the third stage (closed lock) with limited opening (less than 25 mm) too severe to be caused solely by a nonreducible, displaced disc; the unexpectedly high incidence (greater than 50%) of normally shaped discs in the third stage of the process. A specific condition of severe and stubborn limited maximal mouth opening caused by total cessation of gliding, liable to occur at any age and unrelated to disc shape or position, which responds successfully to simple treatment by lavage and lysis, pressured injection, or arthrocentesis, was discerned. Lack of gliding was attributed to adherence of the disc to the fossa by a reversible effect such as a vacuum and/or decreased volume of synovial fluid of high viscosity. This condition was deemed worthy of an independent identity, dissociated from disc displacement, as a causative factor in the second and third stages of ID, and particularly as an aid to accurate diagnosis and treatment.

Estrogen receptors in the temporomandibular joint of the baboon (Papio cynocephalus): An autoradiographic study☆

Using an autoradiographic method, the temporomandibular joint (TMJ) complex of five aged female baboons was studied for the presence of receptors for estradiol-17 beta. The study was performed in an effort to learn more of the pathophysiology of this joint and in an attempt to provide a scientific basis to explain the reported preponderance of women who seek and undergo treatment for signs and symptoms referable to the TMJ. This experiment revealed that the TMJ complex contains numerous cells with receptors for estrogen, particularly the articular surface of the condyle, articular disk, and capsule. Muscles of mastication contained relatively fewer receptors. As a result, one may postulate a role for the sex steroid hormones in the maintenance, repair, and/or pathogenesis of the TMJ. Additional studies are necessary to fully determine the significance of hormone receptors in this site and any correlation between diseases of the TMJ and the endocrine status of affected patients.

The effects of orthognathic surgery on mandibular range of motion.

A prospective study of 55 orthognathic surgical patients was done to determine the effects of surgery on mandibular range of motion. None of the patients had oral physiotherapy during the course of the study. Nineteen patients had mandibular osteotomies, 21 had maxillary osteotomies, and 18 had two-jaw operations. Maximal interincisal opening (MIO), right and left lateral excursion, and protrusive measurements were obtained preoperatively and at six or more months following surgery. MIO was significantly reduced in both categories of mandibular osteotomies. A sagittal split osteotomy to advance the mandible was associated with the greatest mean reduction of 29%, while a vertical subcondylar osteotomy to set the mandible back had a mean reduction of 10%. Likewise, decreases in MIO were noted with combined surgical procedures. Le Fort I and sagittal split osteotomies were associated with a mean decrease in MIO of 28%, while Le Fort I and vertical subcondylar osteotomies had a mean decrease of 9%. Minimal change in MIO were noted with isolated maxillary osteotomies. These results are similar to the findings of other investigators and indicate the critical need for a sound postoperative rehabilitation program following orthognathic procedures to prevent hypomobility.

The role of temporomandibular joint surgery in the treatment of patients with internal derangement

Surgery of the temporomandibular joint (TMJ) has made considerable progress, although significant failures have plagued this field in recent years. Despite the controversies, surgery of the TMJ continues to have a small but important role in the management of specific temporomandibular disorders. This article presents an overview of TMJ surgery. It is concluded that careful case selection is the most important aspect for a successful outcome.

Contemporary Imaging of the Temporomandibular Joint

This article discusses imaging techniques for visualization of the temporomandibular joint. Conventional plain film modalities are discussed briefly, with an emphasis on the more contemporary modalities, such as CT with cone-beam technology, MRI, and nuclear imaging, including single-photon emission computed tomography, and positron emission tomography. Indications, advantages, and limitations are discussed. As advancements in this area continue, our understanding of this complex joint and its pathology will follow, which will lead to more defined imaging indications and ultimately, to improved treatment outcomes.

A review of techniques of lysis and lavage of the TMJ

We systematically reviewed publications in the English language about techniques of lysis and lavage of the temporomandibular joint (TMJ). We describe these techniques and describe their advantages and disadvantages.

Autologous blood injection for the treatment of chronic recurrent temporomandibular joint dislocation.

PURPOSE Many different surgical techniques for the treatment of chronic recurrent temporomandibular joint (TMJ) dislocation have been described. This article discusses a technique of autologous blood injection to the TMJ for treatment of chronic recurrent TMJ dislocation. MATERIALS AND METHODS Twenty-five patients diagnosed with chronic recurrent TMJ dislocation were treated by bilateral injections of autologous blood into the upper joint space and around the TMJ capsules bilaterally. RESULTS Eighty percent had a successful outcome and required no further treatment at their 1-year follow-up. CONCLUSION This procedure has proven to be safe, simple, and cost effective for the treatment of chronic recurrent TMJ dislocation.