Current thinking in open temporomandibular joint surgery. Is this still indicated in the management of articular temporomandibular joint disorder?

Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients.

Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice.

Background: 'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous.

Post-traumatic management of condylar fracture complications.

Management of issues following condylar fracture is dependent on the effect on joint function and pain and an assessment of the degree of deformity. The following article aims to guide the reader in the assessment of these issues and the preservation of as much as is normal as possible. "First do no harm" is a phrase coined from the writings of Hippocrates, the Greek philosopher and physician.

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures.

Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment.

Prospective outcome analysis of total replacement of the temporomandibular joint with the TMJ Concepts system in patients with inflammatory arthritic diseases.

We report the outcomes of patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, who had total replacement of the temporomandibular joint (TMJ) using the TMJ Concepts system between 2005 and 2014. We prospectively measured mouth opening (mm), and pain and dietary function (visual analogue scale (VAS), 1 - 100) before operation, and at 6 weeks, 6 months, one year, and beyond. Forty-six joints were replaced in 26 patients (mean age 40, range 16 - 71), 22 of whom were female.

UK temporomandibular joint replacement database: report on baseline data.

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually.

Alloplastic or autogenous reconstruction of the TMJ.

Reconstruction of the irreparably damaged temporomandibular joint (TMJ) is dependent on the cause of damage and the patient's age. In childhood the current preference is for autogenous reconstruction which can potentially "grow" with the child. This is either with soft tissue interposition (temporalis fascial interposition), local osteotomy, distraction osteogenesis, non-vascularised tissue (costochondral, sternoclavicular) or vascularised tissue (second metatarsal).

TMJ pain and cryoanalgesia.

Temporomandibular (TMJ) joint pain is a complex issue involving several factors in a spectrum including myofascial pain, internal derangement and degenerative disease, all of which are reciprocally affected by psychological factors. Current assessment of TMD (temporomandibular disorder) can be assisted by standardised protocols, but often there is a combination of disease processes which each need to be addressed. Initial management should always be conservative with a preference for non-invasive measures which do no harm and have evidential support.

The TN Chawla Lecture - The current management of midfacial trauma.

The management of mid-facial trauma has changed very little in the last decade with minor modifications related to orbital trauma and minimal access approaches particularly related to secondary reconstruction. In the UK the introduction of major trauma centres has tended to concentrate the management of polytrauma patients to individual regional sites. From a maxillofacial perspective this increases craniofacial cases treated in these units.

How accurate is arthroscopy of the temporomandibular joint? A comparison of findings in patients who had open operations after arthroscopic management failed.

We examined the accuracy of arthroscopy to diagnose disease in the temporomandibular joint (TMJ) and to allocate an appropriate Wilkes' stage. We compared findings made during arthroscopy with those at subsequent open operation in the same patient. Overall, arthroscopy had 87% sensitivity and 99% specificity in diagnosing disease in the TMJ, and it also accurately allocated the Wilkes' stage (sensitivity 94%, specificity 98%).

Outcomes of open temporomandibular joint surgery following failure to improve after arthroscopy: is there an algorithm for success?

We reviewed the results of one surgeon's experience of open surgical management of the temporomandibular joint (TMJ) in patients who fail to respond to arthroscopy and aimed to identify groups of patients that may or may not benefit from the intervention. Over a 7-year period (2005-2012) we retrospectively collected data from the medical notes of patients who underwent discectomy, disc plication, eminectomy, eminoplasty, and adhesiolysis, according to the clinical findings for joint pain, restriction, and locking. A total of 22 patients (71%) reported improvement in pain score and 19 (61%) reported an improvement in mouth opening 12 months postoperatively.

How do I manage restricted mouth opening secondary to problems with the temporomandibular joint?

Restricted mouth opening is a common problem that presents to secondary care, and management depends on the primary cause. The most common differential diagnoses related to the temporomandibular joint (TMJ) include muscle spasm secondary to pain, anchored disc phenomenon, irreducible anterior disc displacement, rheumatoid diseases, and ankylosis. In this paper each is considered in turn.

Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study.

We prospectively analysed the outcome after botulinum injection in patients who did not recover after conservative measures to manage masticatory myofascial pain, and who were not willing to take low dose tricyclic antidepressants as a muscle relaxant. We prospectively 62 patients were assessed with visual analogue scores (VAS) for pain on the affected side before, and 6 weeks after botulinum injection(s) (50 units Dysport in up to 3 sites), and measured mouth opening in mm. Of those treated 49 (79%) showed at least some improvement (pain reduced by more than 25%).

Management of recurrent ankylosis in arthrogryposis: new solutions to a rare problem.

Arthrogryposis is a rare condition that comprises contracture of the joints, muscular weakness, and fibrosis. Restricted mouth opening caused by coronoid hyperplasia has been reported but to our knowledge, ankylosis of the temporomandibular joint (TMJ) has not. Standard management of ankylosis includes creation of a gap arthroplasty and possible reconstruction with autogenous or alloplastic materials.

Current thinking in temporomandibular joint management.

The management of temporomandibular joint (TMJ) disorders in secondary care has progressed through the 1990s from a condition dealt with by generalists to one with an increasing number of surgeons with a subspecialist interest. Within this latter group there is a subgroup of those with a specific training towards joint replacement surgery. Increasingly patients who previously had surgery for pain are being managed with non-surgical options.

Guidelines for the replacement of temporomandibular joints in the United Kingdom.

BAOMS has requested that guidelines be formulated for the replacement of the temporomandibular joint (TMJ). This is an expensive and technique sensitive method of TMJ reconstruction and in the current climate warrants an agreed approach. The following document states the indications and contraindications for this technique as discussed and agreed amongst surgeons currently carrying out this procedure in the UK.