M.J. Chen

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.

Arthroscopic management of septic arthritis of temporomandibular joint.

This article reports on 7 patients with septic arthritis of the temporomandibular joint (TMJ) who were managed with arthroscopy between 1998 and 2007. The common symptoms were trismus and pain. A series of imaging studies showed widening of joint space in 1 patient with plain film; MRI demonstrated increased joint effusion in 4 patients; accompanying cellulitis in adjacent tissues was discerned by CT in 2 patients. Under the arthroscope, a reddened and swollen synovial membrane was found in 2 patients who were in the acute stage, whereas strong adhesions, destruction of cartilage, and bony defects were discovered in other 5 patients in the chronic stage. Additionally, the disc was ruptured in 3 patients, and fibrosis was confirmed for 2 patients. Lavage, lysis of adhesion, and debridement of articular surface were common procedures for treatments. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proven to be a useful method for management of septic arthritis of TMJ, especially for patients in the chronic stage.

Arthroscopic management for synovial chondromatosis of the temporomandibular joint: a retrospective review of 33 cases.

PURPOSE To present clinical, radiologic, and arthroscopic results of patients with synovial chondromatosis of the temporomandibular joint; to introduce a technique for removal of loose bodies in different areas; and to summarize the indications of therapeutic arthroscopy according to the magnetic resonance imaging (MRI) features. PATIENTS AND METHODS From April 2001 to April 2010, 33 consecutive patients underwent arthroscopy. Their demographics, clinical manifestations, imaging studies, arthroscopic findings, treatments, and outcomes were reviewed. RESULTS The predominant symptoms were pain, limitation of mouth opening, and joint sounds. Obvious joint effusion was shown on MRI in 21 of 33 patients. Mass lesions were shown on MRI in 29 of 33 cases. The presence of loose bodies was shown in 31 cases under an arthroscope. Synovial hyperplasia was noted in 12 patients. Bony erosion of the articular surface was discovered in 11 patients. Thirty-two patients underwent therapeutic arthroscopy. Smaller loose bodies were commonly removed with joint lavage or biopsy forceps in 24 patients. Fragmentation with forceps or a wider additional incision was applied to remove larger loose bodies in 7 patients. Debridement was applied to remove intrasynovial lesions in 7 patients. Coblation was used to remove the hyperplastic synovium in 10 of 32 patients. Eight patients were lost to follow-up. The mean follow-up period was 38 months. No recurrence was suspected clinically and radiologically. CONCLUSIONS Therapeutic arthroscopy was appropriate for patients with separate mass lesions and no extra-articular extension. Surgical treatment comprised thorough removal of loose bodies and affected synovial tissues.

Superior half of the sternoclavicular joint pedicled with the sternocleidomastoid muscle for reconstruction of the temporomandibular joint: a preliminary study with a simplified technique and expanded indications

The sternoclavicular joint (SCJ) has similar anatomical and physical characteristics to the temporomandibular joint (TMJ). The purpose of this article is to introduce a modified technique for the pedicled SCJ and the expanded indications for its use. During the period June 2011 to June 2014, six TMJs were reconstructed using the superior half of the SCJ pedicled with the sternocleidomastoid muscle. The inclusion criteria were (1) poor vascularization jeopardizing a non-vascularized TMJ replacement, and/or (2) a large defect of both bone and soft tissue. The average follow-up period was 14.8 months (range 7-39 months). Fracture of the clavicle occurred in one patient (16.7%). No recurrence, graft resorption, or secondary deformity was found. Reconstruction of the TMJ using the superior half of the SCJ pedicled with the clavicle head of the sternocleidomastoid muscle and sternocleidomastoid branch of the superior thyroid artery benefited patients who had a poor blood supply and a medullary condition or who had a defect in both the condyle and surrounding soft tissue.

Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint.

Synovial chondromatosis of the joint is a rare benign condition characterized by the formation of metaplastic cartilage in the synovium of the joint resulting in numerous attached and unattached osteocartilagenous bodies. Involvement of the temporomandibular joint (TMJ) is uncommon. Arthrotomy is usually applied to remove the larger particles and the affected synovial tissues. The authors report the case of a 48-year-old female with a large solitary synovial chondroma in the left TMJ. The larger mass was removed successfully via an additional incision in the anterior wall of external auditory meatus under the guidance of arthroscopy. The patient has been symptom-free for 5 years postoperatively.

Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint.

This retrospective study reports on four patients with intra-articular pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) who were managed with arthroscopy between 2002 and 2009. There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-auricular swelling or mass was detected. Magnetic resonance imaging (MRI) and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroscopy, a yellow nodule and loose bodies were found in one patient, and a yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces with electric shaving and coblation. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ.

Open surgery assisted with arthroscopy to treat synovial chondromatosis of the temporomandibular joint

Open surgery and arthroscopy for the treatment of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) have their advantages and disadvantages. The aim of this study was to report the application and results of the combined use of these two methods in the treatment of SC and the indications for use. A total of 36 patients with magnetic resonance imaging (MRI) confirmation of SC, treated from 2010 to 2015, were included. Patients with tumours in the upper articular cavity and with the extended margin of the medial groove still in-between the medial crest of the condyle and infratemporal space on coronal MRI were selected to undergo open surgery with the assistance of arthroscopy to clear the loose bodies and affected synovium. All 36 patients first went through open surgery. Subsequent arthroscopy examinations indicated the presence of loose bodies in the medial groove in 14 patients (in the anterior or posterior recess), which were removed using a cup-shaped clamp. Thirty-three of the patients were followed up for an average of 33.3 months; there was no recurrence in these patients. This technique has the benefits of the complete elimination of diseased tissues with a minimal osteotomy and a short surgical duration.

A novel approach to neoplasms medial to the condyle: a condylectomy with anterior displacement of the condyle

Resecting neoplasms involving the infratemporal space has a high risk of damaging critical nerves and vessels, in addition to joint form and function. The purpose of this study was to introduce a novel approach to lesions medial to the condyle, which comprises a condylectomy with anterior displacement of the condyle. The indications evaluated using digital surgical simulation, the critical surgical technique, and the preliminary clinical effects are presented here. Five cases underwent this approach between January 2006 and December 2014. The common characteristics of the five masses were (1) that they were non-malignant neoplasms involving the posterior-medial region of the condyle; (2) the upper and lower borders were between the skull base and the lingula, while the anterior border did not exceed the coronoid process. All masses were resected successfully with no damage to any critical nerves or vessels. The average follow-up period was 29.8 months (range 6-56 months). There was no recurrence, secondary deformity, or facial paralysis. The average mouth opening improved from an original 27 mm to 34 mm after surgery. The condyles were well fixed, with no resorption, as shown on computed tomography scans.

Digital cutting guide and endoscopically-assisted vertical ramus osteotomy to treat condylar osteochondroma: a long-term study

We have introduced an effective treatment for mandibular condylar osteochondroma with a digital cutting guide and endoscopically-assisted vertical ramus osteotomy (VRO). Eleven patients with unilateral condylar osteochondroma, who did not require orthognathic surgery or had less than 3mm deviation of the chin and a stable occlusion, were treated during the period April 2013-January 2017 with a digital cutting guide and endoscopically-assisted VRO. Clinical data collected included the occlusion, facial contour, and maximum mouth opening (MMO). Computed tomographic (CT) scans were taken before and after operation. Two patients also had additional shaping of the mandibular contour. The pathological diagnosis was confirmed to be osteochondroma in all cases. A mean (range) 19 (12-40) months of follow-up for all 11 cases showed stable postoperative occlusion and facial aesthetics. There were no functional disturbances, recurrence, or condylar absorption. VRO is an alternative to orthognathic surgery for patients with osteochondroma who do not have severe malocclusions. The digital cutting guide and endoscopically-assisted VRO make it possible to achieve precise resection of the tumour and maintain the occlusion with minimal invasion.

Transzygomatic approach for the resection of large condylar osteochondromas using computer-assisted preoperative planning.

The purpose of this study was to evaluate the outcomes of patients with large osteochondromas (OCs) treated via transzygomatic approach for exposure and local resection. All patients with large OCs treated by transzygomatic approach from 2006 through 2014 were investigated. The inclusion criteria were (1) condylar OC of exogenous type; (2) a mass that could be treated only via transzygomatic approach, as assessed using computer-assisted preoperative planning. The preliminary results evaluated included recurrence, joint form and function, occurrence of facial deformity, facial nerve function, and the condition of the zygomatic arch fixation. Other parameters assessed included tumour size and location and the length of follow-up. Ten patients with OCs were included in this study. All masses were located anteromedial to the condyle; the average maximal diameter was 33.15mm. During follow-up (average 28.5 months), the average maximum inter-incisal opening increased from 25.4mm to 32.0mm. Nine patients recovered without recurrence, a change in occlusion, secondary deformity, or nerve dysfunction. One patient had severe disc perforation and condylar resorption. The transzygomatic approach is applicable for the resection of large condylar OCs protruding anteromedially into the infratemporal space. Surgical simulations may help to identify the indications for this approach and to design the surgery.