Limits...
Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by magnetic resonance imaging.

Zhang S, Liu X, Yang X, Yang C, Chen M, Haddad MS, Chen Z - BMC Musculoskelet Disord (2010)

Bottom Line: Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints).Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, People's Republic of China.

ABSTRACT

Background: Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs.

Methods: Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique.

Results: Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.

Conclusions: This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

Show MeSH
Titanium anchors and sutures during the procedure. A showed the titanium anchor in the condyle (green arrow). B showed the sutures tied in the titanium anchor (green arrow). C and D showed the disc repositioned and sutured (green arrow). E showed the actual anchor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2992481&req=5

Figure 1: Titanium anchors and sutures during the procedure. A showed the titanium anchor in the condyle (green arrow). B showed the sutures tied in the titanium anchor (green arrow). C and D showed the disc repositioned and sutured (green arrow). E showed the actual anchor.

Mentions: In addition to the pre-operative routine examinations, MRI was also carried out with all patients to determine the disc position, shape and condylar changes. The procedure was carried out in the following sequence: ①The patient was put under general anesthesia through nasal intubation and disinfected routinely. A modified "L" shape incision was used by the authors to gain access to the TMJ area and avoid damaging the facial nerve. The superior and inferior joint spaces were entered, and the disc was identified and mobilized. The disc shape, disc length and condyle were evaluated visually. If the condylar bone spur was present, it had to be repaired during the disc repositioning. ②Anterior release was carried out in the same way as in the arthroscopic anterior release [9]. The anterior, lateral, and sometimes the medial ligamentous attachments were released completely using 11th blade, if indicated, to permit passive repositioning of the disc freely over the condylar head. ③Two TMJ anchors were implanted into the trailing edge of the posterior condylar slope, which was 8 to 10 mm below the top of the condyle just in the middle of lateral-middle junction and medial-middle junction using a standard anchor inserting device. ④After being tied in to two anchors, the 2 Ethibond sutures were then secured to the disc in a horizontal mattress fashion in the junction of the posterior zone and the bilaminar zone. One suture is placed through the medial aspect of the posterior band of the disc, and the other is placed through the lateral aspect of the posterior band. ⑤The assistant pushed the bilaminar zone and the disc to the normal position with the suture strained, and made the patients re-open and close their mouth for two times, to ensure the appropriate position of the condyle fixed 6 to 7 knots. For the partial lateral or medial displaced disc, a single anchor was used near the medial or the lateral in the condyle. ⑥The remaining tissues including the capsule, subcutaneous tissue, and skin were then closed in a routine manner. The position of anchor screws and sutures are shown in Figure 1-2. MRI evaluations were taken to confirm the disc position within one to seven days post surgery.


Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by magnetic resonance imaging.

Zhang S, Liu X, Yang X, Yang C, Chen M, Haddad MS, Chen Z - BMC Musculoskelet Disord (2010)

Titanium anchors and sutures during the procedure. A showed the titanium anchor in the condyle (green arrow). B showed the sutures tied in the titanium anchor (green arrow). C and D showed the disc repositioned and sutured (green arrow). E showed the actual anchor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992481&req=5

Figure 1: Titanium anchors and sutures during the procedure. A showed the titanium anchor in the condyle (green arrow). B showed the sutures tied in the titanium anchor (green arrow). C and D showed the disc repositioned and sutured (green arrow). E showed the actual anchor.
Mentions: In addition to the pre-operative routine examinations, MRI was also carried out with all patients to determine the disc position, shape and condylar changes. The procedure was carried out in the following sequence: ①The patient was put under general anesthesia through nasal intubation and disinfected routinely. A modified "L" shape incision was used by the authors to gain access to the TMJ area and avoid damaging the facial nerve. The superior and inferior joint spaces were entered, and the disc was identified and mobilized. The disc shape, disc length and condyle were evaluated visually. If the condylar bone spur was present, it had to be repaired during the disc repositioning. ②Anterior release was carried out in the same way as in the arthroscopic anterior release [9]. The anterior, lateral, and sometimes the medial ligamentous attachments were released completely using 11th blade, if indicated, to permit passive repositioning of the disc freely over the condylar head. ③Two TMJ anchors were implanted into the trailing edge of the posterior condylar slope, which was 8 to 10 mm below the top of the condyle just in the middle of lateral-middle junction and medial-middle junction using a standard anchor inserting device. ④After being tied in to two anchors, the 2 Ethibond sutures were then secured to the disc in a horizontal mattress fashion in the junction of the posterior zone and the bilaminar zone. One suture is placed through the medial aspect of the posterior band of the disc, and the other is placed through the lateral aspect of the posterior band. ⑤The assistant pushed the bilaminar zone and the disc to the normal position with the suture strained, and made the patients re-open and close their mouth for two times, to ensure the appropriate position of the condyle fixed 6 to 7 knots. For the partial lateral or medial displaced disc, a single anchor was used near the medial or the lateral in the condyle. ⑥The remaining tissues including the capsule, subcutaneous tissue, and skin were then closed in a routine manner. The position of anchor screws and sutures are shown in Figure 1-2. MRI evaluations were taken to confirm the disc position within one to seven days post surgery.

Bottom Line: Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints).Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, People's Republic of China.

ABSTRACT

Background: Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs.

Methods: Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique.

Results: Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.

Conclusions: This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

Show MeSH