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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.

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The disc position on MRI before and after operation. A, B, C showed the displaced disc anterior to the condyle (green arrow). D, E, F, G showed the displaced disc repositioned in normal position (green arrow)
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Figure 3: The disc position on MRI before and after operation. A, B, C showed the displaced disc anterior to the condyle (green arrow). D, E, F, G showed the displaced disc repositioned in normal position (green arrow)

Mentions: Pre and postoperative MRI scans were obtained using a 1.5-T imager (Signa, General Electric, Milwaukee, WI) with bilateral 3-inch TMJ surface coil receivers according to the routine sequence [10,11]. Pre- and postoperative MRIs were performed to obtain the evidently repositioned disc, and postoperative MRIs were taken at varying intervals between 1 and 7 days after the operation. The parameters for the sagittal and coronal images were as follows: repetition time (TR), 500 ms; echo time (TE), 25 ms; number of excitations, 2; field of view, 12 cm. A slice thickness of 1 mm with a skip of 0.3 mm and a matrix of 512 × 256 pixels was used. To eliminate any biases, the imaging diagnoses were completed as described by Holmlund [12]. All MRI films were interpreted blindly before the operation by the same TMJ specialist and a radiologist who regularly evaluated the TMJ diseases. They assessed the images separately and made similar evaluations. When their evaluations differed, a third specialist evaluated the images. We also made three levels of 1 cm, 2 cm, 3 cm tongue depressors placed between the upper and lower teeth to stabilize the mandibular position and to achieve the consistent mouth opening, so as to get more accurate comparison of the disc position for the MRI evaluation before and after the operation. For the same patient, three sagittal planes and three coronal planes on MRI films in the same position before and after surgery (Figure 3) were compared under 3 different levels. This evaluation method had proved its effectiveness, based on Zhang SY, et al [13]. The evaluation criteria were as follows: 1) reposition in 3 sagittal parts is excellent, 2) reposition in 2 parts is good, and 3) none or only 1 reposition is poor. Excellent and good evaluations were regarded as successes (if there was disc displacement in only 1 or 2 levels, only replacement of all levels was regarded as a success).


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)

The disc position on MRI before and after operation. A, B, C showed the displaced disc anterior to the condyle (green arrow). D, E, F, G showed the displaced disc repositioned in normal position (green arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: The disc position on MRI before and after operation. A, B, C showed the displaced disc anterior to the condyle (green arrow). D, E, F, G showed the displaced disc repositioned in normal position (green arrow)
Mentions: Pre and postoperative MRI scans were obtained using a 1.5-T imager (Signa, General Electric, Milwaukee, WI) with bilateral 3-inch TMJ surface coil receivers according to the routine sequence [10,11]. Pre- and postoperative MRIs were performed to obtain the evidently repositioned disc, and postoperative MRIs were taken at varying intervals between 1 and 7 days after the operation. The parameters for the sagittal and coronal images were as follows: repetition time (TR), 500 ms; echo time (TE), 25 ms; number of excitations, 2; field of view, 12 cm. A slice thickness of 1 mm with a skip of 0.3 mm and a matrix of 512 × 256 pixels was used. To eliminate any biases, the imaging diagnoses were completed as described by Holmlund [12]. All MRI films were interpreted blindly before the operation by the same TMJ specialist and a radiologist who regularly evaluated the TMJ diseases. They assessed the images separately and made similar evaluations. When their evaluations differed, a third specialist evaluated the images. We also made three levels of 1 cm, 2 cm, 3 cm tongue depressors placed between the upper and lower teeth to stabilize the mandibular position and to achieve the consistent mouth opening, so as to get more accurate comparison of the disc position for the MRI evaluation before and after the operation. For the same patient, three sagittal planes and three coronal planes on MRI films in the same position before and after surgery (Figure 3) were compared under 3 different levels. This evaluation method had proved its effectiveness, based on Zhang SY, et al [13]. The evaluation criteria were as follows: 1) reposition in 3 sagittal parts is excellent, 2) reposition in 2 parts is good, and 3) none or only 1 reposition is poor. Excellent and good evaluations were regarded as successes (if there was disc displacement in only 1 or 2 levels, only replacement of all levels was regarded as a success).

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