Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Sen ¹ , ZHANG Lin ¹ , GUO Liangying ¹ , MENG Xianbin ² ,  WU Zhigang ¹

1. Department of Stomatology, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233004, P. R. China;
2. Department of Stomatology, Bengbu Second People’s Hospital, Bengbu Anhui, 233400, P. R. China;

Corresponding author：

WU Zhigang, Email: wzg918@163.com

Keywords：

Temporomandibular joint anterior disc displacement; joint disc reduction and suture; arthroscopy; tragus incision

DOI：

10.7507/1002-1892.202407071

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Objective To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). Methods A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups (P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. Results All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation (P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased (P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group (P<0.05). There was no significant difference in the change value of VAS score between groups (P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups (P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. Conclusion Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.

Citation： LIU Sen, ZHANG Lin, GUO Liangying, MENG Xianbin, WU Zhigang. Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(11): 1352-1358. doi: 10.7507/1002-1892.202407071 Copy

1.	傅开元, 雷杰. 颞下颌关节紊乱病的分类、诊断及治疗进展. 口腔医学, 2024, 44(1): 6-10.
2.	Ballanti F, Ranieri S, Baldini A, et al. Gnathological features in growing subjects. Ann Stomatol (Roma), 2014, 4(3-4): 230-238.
3.	Liu Z, Yin J, Cao W, et al. Evaluation of clinical impact of two types of temporomandibular joint disc reduction and fixation. J Stomatol Oral Maxillofac Surg, 2024, 125(5S1): 101956. doi: 10.1016/j.jormas.2024.101956.
4.	Wadhokar OC, Kulkarni CA, Joshi M. Changing trends in publication regarding temporomandibular joint dysfunction from 1975 to 2021: A bibliometric analysis. Cureus, 2023, 15(9): e46179. doi: 10.7759/cureus.46179.
5.	Sah MK, Abdelrehem A, Chen S, et al. Arthroscopic discopexy versus natural course of temporomandibular joint anterior disc displacement: a longitudinal study of clinical and radiological outcomes. Int J Oral Maxillofac Surg, 2023, 52(1): 98-106.
6.	Hua J, Lu C, Zhao J, et al. Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles. BMC Musculoskelet Disord, 2022, 23(1): 387. doi: 10.1186/s12891-022-05337-2.
7.	Gaete C, Droguett C, Sáez F, et al. Clinical and demographic factors associated with the effectiveness of temporomandibular joint arthroscopy. Oral Maxillofac Surg, 2024, 28(1): 405-411.
8.	Abdelrehem A, Hu YK, Yang C, et al. Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study. Int J Oral Maxillofac Surg, 2021, 50(10): 1351-1360.
9.	郭梁影, 孟献斌, 吴志刚. 关节盘复位锚固术在下颌骨髁突囊内骨折伴关节盘移位治疗中的应用研究. 中国修复重建外科杂志, 2022, 36(5): 587-591.
10.	何冬梅, 杨驰, 黄栋, 等. 小切口下颞下颌关节盘复位缝合术. 中国实用口腔科杂志, 2017, 10(12): 760-763.
11.	Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. J Arch Otolaryngol Head Neck Surg, 1989, 115(4): 469-477.
12.	陈敏洁, 杨驰, 张善勇, 等. 经颞下颌关节镜射频冷消融技术治疗颞下颌关节内错乱. 中国口腔颌面外科杂志, 2005, 3(3): 189-192.
13.	王铁彪, 周五超, 肖寅, 等. 改良关节盘锚固术在颞下颌关节盘穿孔、破裂治疗中的应用. 华西口腔医学杂志, 2023, 41(4): 434-442.
14.	路茜, 王静, 庞淑婷, 等. 正畸修复联合疗法对改善深覆伴下前牙严重磨耗患者咀嚼功能的效果评价. 上海口腔医学, 2024, 33(2): 190-194.
15.	傅开元, 胡敏, 余强, 等. 颞下颌关节常规MRI检查规范及关节盘移位诊断标准的专家共识. 中华口腔医学杂志, 2020, 55(9): 608-612.
16.	Igarashi C, Kobayashi K, Ito H, et al. Clinical and magnetic resonance imaging findings in patients with and without improvement after mandibular manipulation and conservative physical therapy for temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol, 2023, 35(2): 294-302.
17.	Millón-Cruz A, Martín-Granizo López R. Long-term clinical outcomes of arthroscopic discopexy with resorbable pins. J Craniomaxillofac Surg, 2020, 48(11): 1074-1079.
18.	孙浩, 吴璇, 石涛, 等. 数字化再定位咬合板治疗颞下颌关节盘可复性前移位临床效果研究. 中国实用口腔科杂志, 2024, 17(2): 180-185.
19.	Karthikeyan P, Govindarajan A, Rasmika K. Review of radiofrequency ablation in tonsillectomy. J Indian J Otolaryngol Head Neck Surg, 2022, 74(Suppl 3): 5008-5011.
20.	刘国林, 董静博, 石雨, 等. 耳屏后切口颞下颌关节盘复位固定术手术入路及效果评价. 北京口腔医学, 2023, 31(3): 193-196.
21.	Hu YK, Abdelrehem A, Yang C, et al. Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study. J Sci Rep, 2017, 7: 45513. doi: 10.1038/srep45513.
22.	Patel K, Gerber B, Bailey K, et al. Juvenile idiopathic arthritis of the temporomandibular joint—no longer the forgotten joint. J Br J Oral Maxillofac Surg, 2022, 60(3): 247-256.
23.	Larheim TA, Hol C, Løseth G, et al. Temporomandibular joint pathologies: pictorial review. J Br J Radiol, 2024, 97(1153): 53-67.
24.	Zhou J, Yang H, Li Q, et al. Comparison of temporomandibular joints in relation to ages and vertical facial types in skeletal class Ⅱ female patients: a multiple-cross-sectional study. BMC Oral Health, 2024, 24(1): 467. doi: 10.1186/s12903-024-04219-4.

1. 傅开元, 雷杰. 颞下颌关节紊乱病的分类、诊断及治疗进展. 口腔医学, 2024, 44(1): 6-10.
2. Ballanti F, Ranieri S, Baldini A, et al. Gnathological features in growing subjects. Ann Stomatol (Roma), 2014, 4(3-4): 230-238.
3. Liu Z, Yin J, Cao W, et al. Evaluation of clinical impact of two types of temporomandibular joint disc reduction and fixation. J Stomatol Oral Maxillofac Surg, 2024, 125(5S1): 101956. doi: 10.1016/j.jormas.2024.101956.
4. Wadhokar OC, Kulkarni CA, Joshi M. Changing trends in publication regarding temporomandibular joint dysfunction from 1975 to 2021: A bibliometric analysis. Cureus, 2023, 15(9): e46179. doi: 10.7759/cureus.46179.
5. Sah MK, Abdelrehem A, Chen S, et al. Arthroscopic discopexy versus natural course of temporomandibular joint anterior disc displacement: a longitudinal study of clinical and radiological outcomes. Int J Oral Maxillofac Surg, 2023, 52(1): 98-106.
6. Hua J, Lu C, Zhao J, et al. Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles. BMC Musculoskelet Disord, 2022, 23(1): 387. doi: 10.1186/s12891-022-05337-2.
7. Gaete C, Droguett C, Sáez F, et al. Clinical and demographic factors associated with the effectiveness of temporomandibular joint arthroscopy. Oral Maxillofac Surg, 2024, 28(1): 405-411.
8. Abdelrehem A, Hu YK, Yang C, et al. Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study. Int J Oral Maxillofac Surg, 2021, 50(10): 1351-1360.
9. 郭梁影, 孟献斌, 吴志刚. 关节盘复位锚固术在下颌骨髁突囊内骨折伴关节盘移位治疗中的应用研究. 中国修复重建外科杂志, 2022, 36(5): 587-591.
10. 何冬梅, 杨驰, 黄栋, 等. 小切口下颞下颌关节盘复位缝合术. 中国实用口腔科杂志, 2017, 10(12): 760-763.
11. Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. J Arch Otolaryngol Head Neck Surg, 1989, 115(4): 469-477.
12. 陈敏洁, 杨驰, 张善勇, 等. 经颞下颌关节镜射频冷消融技术治疗颞下颌关节内错乱. 中国口腔颌面外科杂志, 2005, 3(3): 189-192.
13. 王铁彪, 周五超, 肖寅, 等. 改良关节盘锚固术在颞下颌关节盘穿孔、破裂治疗中的应用. 华西口腔医学杂志, 2023, 41(4): 434-442.
14. 路茜, 王静, 庞淑婷, 等. 正畸修复联合疗法对改善深覆伴下前牙严重磨耗患者咀嚼功能的效果评价. 上海口腔医学, 2024, 33(2): 190-194.
15. 傅开元, 胡敏, 余强, 等. 颞下颌关节常规MRI检查规范及关节盘移位诊断标准的专家共识. 中华口腔医学杂志, 2020, 55(9): 608-612.
16. Igarashi C, Kobayashi K, Ito H, et al. Clinical and magnetic resonance imaging findings in patients with and without improvement after mandibular manipulation and conservative physical therapy for temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol, 2023, 35(2): 294-302.
17. Millón-Cruz A, Martín-Granizo López R. Long-term clinical outcomes of arthroscopic discopexy with resorbable pins. J Craniomaxillofac Surg, 2020, 48(11): 1074-1079.
18. 孙浩, 吴璇, 石涛, 等. 数字化再定位咬合板治疗颞下颌关节盘可复性前移位临床效果研究. 中国实用口腔科杂志, 2024, 17(2): 180-185.
19. Karthikeyan P, Govindarajan A, Rasmika K. Review of radiofrequency ablation in tonsillectomy. J Indian J Otolaryngol Head Neck Surg, 2022, 74(Suppl 3): 5008-5011.
20. 刘国林, 董静博, 石雨, 等. 耳屏后切口颞下颌关节盘复位固定术手术入路及效果评价. 北京口腔医学, 2023, 31(3): 193-196.
21. Hu YK, Abdelrehem A, Yang C, et al. Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study. J Sci Rep, 2017, 7: 45513. doi: 10.1038/srep45513.
22. Patel K, Gerber B, Bailey K, et al. Juvenile idiopathic arthritis of the temporomandibular joint—no longer the forgotten joint. J Br J Oral Maxillofac Surg, 2022, 60(3): 247-256.
23. Larheim TA, Hol C, Løseth G, et al. Temporomandibular joint pathologies: pictorial review. J Br J Radiol, 2024, 97(1153): 53-67.
24. Zhou J, Yang H, Li Q, et al. Comparison of temporomandibular joints in relation to ages and vertical facial types in skeletal class Ⅱ female patients: a multiple-cross-sectional study. BMC Oral Health, 2024, 24(1): 467. doi: 10.1186/s12903-024-04219-4.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy

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