Simon Weinberg

Cervical extension-flexion injury (whiplash) and internal derangement of the temporomandibular joint

Twenty-eight patients with post-whiplash temporomandibular joint (TMJ) symptoms were assessed. Internal derangements were seen arthrographically in 22/25 patients. These observations were confirmed in the 10 patients who elected to have surgery.

Eminectomy and meniscorhaphy for internal derangements of the temporomandibular joint

To date, most reports of surgical procedures to correct anterior meniscal displacement have focused on excision and repair of redundant posterior attachment tissue in conjunction with some form of arthroplasty. A procedure involving direct plication of the fibrous disk to the articular capsule (meniscorhaphy) and excision of the articular eminence (eminectomy) has yielded good results in most of the thirty-three patients with internal TMJ derangements on whom this operation has been performed within the past 44 months. The procedure is uncomplicated and physiologically sound, and it satisfies the concept of intracapsular decompression which is developed and described in this article. When surgical intervention is indicated for patients with internal TMJ derangements, eminectomy and meniscorhaphy should be given strong consideration.

Facial Nerve Function Following Temporomandibular Joint Surgery Using the Preauricular Approach

Sixty-eight patients (83 temporomandibular joints) consecutively operated on who had a variety of temporomandibular joint operations using a preauricular approach were assessed for facial nerve function following surgery. Nine patients (10.84%) showed signs of facial nerve injury in which the temporal and zygomatic branches were involved. The incidence of facial nerve injury was greater in patients who had undergone previous temporomandibular joint surgery (17.64%) than in patients with previously unoperated joints (9%). Normal facial nerve function returned in 9 to 14 weeks except in one patient who showed a mild deficit of the zygomatic branch at 20 weeks. The nature and duration of the surgical procedure did not correlate with facial nerve injury. Scarring of tissues as a result of previous temporomandibular joint surgery may significantly increase the risk of facial nerve injury during subsequent temporomandibular joint surgery.

Morphology of the developing articular disc of the human temporomandibular joint

The morphology of the developing articular disc of the temporomandibular joint in eight human fetuses, ranging in age from 13 weeks to 17.5 weeks, was studied. The shape of the articular disc at the time of initial delineation resembled the shape of the adult articular disc, suggesting a predominantly genetic determination. Elastin fibers were not demonstrated. The vascularity of the fetal articular disc was confined to the anterior and posterior thickened peripheral zones, with no evidence of capillaries in the thinner intermediate zone. Lateral pterygoid muscle fibers inserted into the medial aspects of the developing articular disc.

Meniscocondylar plication: a modified operation for surgical repositioning of the ectopic temporomandibular joint meniscus. Rationale and operative technique.

A historical review of temporomandibular joint (TMJ) surgical meniscal repositioning procedures is presented, and three operations that are currently used to manage this problem are compared and contrasted. Each operation produces iatrogenic deviations in intra-articular anatomy and retains the potential to create significant alterations in TMJ biomechanics. Meniscocondylar plication has been performed on 84 patients (89 joints) with arthrographically confirmed internal derangement of the TMJ. A 90.7% success rate was achieved. The operation is technically facile, surgically uncomplicated and clinically effective. It should rank as a justifiable and viable alternative to those operations that are presently being performed to treat patients with internal derangement of the TMJ.

Calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint: A case report and review of the literature

An asymptomatic preauricular swelling in a 58-year-old man appeared as a parotid mass and was diagnosed as calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint. This article describes the diagnostic criteria and management of this rare condition and reviews the 13 cases that have been reported to date.

Osteoblastoma of the Mandibular Condyle: Review of the Literature and Report of a Case

The first case of osteoblastoma of the mandibular condyle is reported. The clinical, radiographic and histologic features of this benign neoplasm are described and the differential diagnosis is discussed.

Analysis of facial and trigeminal nerve function after arthroscopic surgery of the temporomandibular joint

PURPOSE This study analyzes facial and trigeminal nerver function after arthroscopic surgery. PATIENTS AND METHODS Eighty-one consecutive patients (81 joints) who underwent unilateral temporomandibular joint (TMJ) arthroscopic surgery were assessed postoperatively for facial and trigeminal nerve function. RESULTS Twenty-four of 81 patients (29.6%) had some degree of sensory or motor nerve dysfunction. Two patients (2.5%) showed signs of facial nerve dysfunction, which completely resolved in one patient in 11 weeks, but persisted mildly in the other at the 1-year follow-up examination. CONCLUSIONS Auriculotemporal syndrome was not detected in any of the 40 patients tested. However, transient numbness over the distribution of the auriculotemporal nerve was present in 19 of 81 patients (23.4%). This numbness persisted for 3 days to 3 months with a mean duration of 14 days. Three of the 81 patients (3.6%) showed signs of inferior alveolar and lingual nerve involvement, which returned to normal in 4 to 12 weeks in all 3 patients.

Methemoglobinemia induced by high doses of prilocaine

Abstract Two cases of iatrogenic methemoglobinemia are presented to emphasize the need for careful scrutiny of the quantity and concentration of anesthetic solution injected, with a brief discussion of the cause of methemoglobinemia peculiar to prilocaine.

An assessment for auriculotemporal syndrome following temporomandibular joint surgery through the preauricular approach

Twenty temporomandibular joints (TMJs) were operated on for the correction of arthrographically confirmed internal derangements using a modified preauricular approach. Postoperatively, three of the 20 patients tested exhibited auriculotemporal syndrome as deduced from a starch-iodine test. The manifestation was subclinical and consisted of sweating only over the distribution of the auriculotemporal and great auricular nerves in response to a gustatory stimulus. The response was variable from patient to patient.