Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients

Abstract

Abstract: PURPOSE: To explore the diagnosis, treatment results and sequela of traumatic temporomandibular joint disc displacement (ATDD) in 42 consecutive patients. METHODS: Patients diagnosed of ATDD and treated from 2010 to 2015 were recruited. Their clinical and radiologic characters were analyzed based on 3 stages: acute phase, subacute phase and chronic phase. Conservative and surgical treatment results were evaluated and compared with SPSS software package. RESULTS: Forty-two patients with 59 joints were included in the study. Among the acute and sub-acute phases patients (18 cases with 27 joints), 18.5% of the joints had condylar surface bone destruction, whereas 75% in the chronic phase (24 cases with 32 joints). Twenty-two cases with 30 joints accepted conservative treatment; among them, 90% developed osteoarthritis after a mean follow-up period of 8.8 months. Thirty-one cases with 47 joints accepted surgical treatment after injury or conservative treatment. Among them, 23 cases with 34 joints had disc reposition, 95.5% were effective (15 cases with 22 joints, mean follow-up period of 22 months). Eight cases with 13 end-stage joints accepted condylar resection and joint replacement. Their maximal incisor opening after surgery was significantly increased compared with that before surgery and conservative treatment (P<0.01). CONCLUSIONS: ATDD is easy to lead to osteoarthritis and ankylosis, disc reposition in the acute and sub-acute phases can significantly reduce the occurrence of above sequel; however, in the chronic phase, joint replacement may be necessary in selected patients.

Key words: Temporomandibular joint, Acute traumatic disc displacement, Joint ankylosis

CLC Number:

R782.6

HE Dong-mei, YANG Xiu-juan, YANG Chi. Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients[J]. China Journal of Oral and Maxillofacial Surgery, 2016, 14(5): 425-429.

References

[1] Wang P, Yang J, Yu Q. MR imaging assessment of temporomandibular joint soft tissue injuries in dislocated and nondislocated mandibular condylar fractures [J]. AJNR Am J Neuroradiol, 2009, 30(1): 59-63.
[2] Merrill RG. Discussion: the arthroscopic appearance of acute temporomandibular joint trauma [J]. J Oral Maxillofac Surg, 1990, 48(8): 784-785.
[3] Goss AN, Bosanquet AG. The arthroscopic appearance of acute temporomandibular joint trauma[J]. J Oral Maxillofac Surg, 1990, 48(8): 780-783.
[4] Goss, AN, Whyte A. Discussion: magnetic resonance imaging assessment of acute soft tissue injuries to the temporomandibular joint [J]. J Oral Maxillofac Surg, 1995, 53(7): 766-767.
[5] Sullivan SM, Banghart PR, Anderson Q. Magnetic resonance imaging assessment of acute soft tissue injuries to the temporomandibular joint [J]. J Oral Maxillofac Surg, 1995, 53(7): 763-766.
[6] Jones JK, Van Sickels JE. A preliminary report of arthroscopic findings following acute condylar trauma [J]. J Oral Maxillofac Surg, 1991, 49(1): 55-60.
[7] Emshoff R, Rudisch A, Ennemoser T, et al. Magnetic resonance imaging findings of temporomandibular joint soft tissue changes in type V and VI condylar injuries[J]. J Oral Maxillofac Surg, 2007, 65(8): 1550-1554.
[8] He D, Yang C, Chen M, et al. Effects of soft tissue injury to the temporomandibular joint: report of 8 cases[J]. Br J Oral Maxillofac Surg, 2013, 51(1): 58-62.
[9] 王靖虎, 邓勇, 方一鸣, 等. 颞下颌关节损伤的早期MRI表现 [J]. 口腔医学研究, 2008, 24(4): 443-517.
[10] Yang C, Cai XY, Chen MJ, et al. New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I-technique introduction[J]. Int J Oral Maxillofac Surg, 2012, 41(9): 1058-1063.
[11] He D, Yang C, Zhang S, et al. Modified temporomandibular joint disc repositioning with mini screw anchor: part I-surgical technique [J]. J Oral Maxillofac Surg, 2015, 73(1): 47. e1-e9.
[12] Qiu YT, Yang C, Chen MJ. Endoscopically assisted reconstruction of the mandibular condyle with a costochondral graft through a modified preauricular approach[J]. Br J Oral Maxillofac Surg, 2010, 48(6):443-447.
[13] Cai XY, Jin JM, Yang C. Changes in disc position, disc length, and condylar height in the temporomandibular joint with anterior disc displacement: a longitudinal retrospective magnetic resonance imaging study[J]. J Oral Maxillofac Surg, 2011, 69(11): e340-346.
[14] Li H, Cai X, Wang S, et al. Disc positions and condylar changes induced by different stretching forces in the model for anterior disc displacement of temporomandibular joint[J]. J Craniofac Surg, 2014, 25(6): 2112-2116.
[15] Li L, Wang L, Yang C, et al. Establishment and histological evaluation of a goat traumatic temporomandibular joint model [J]. J Oral Maxillofac Surg, 2015, 73(5): 943-950.
[16] Abramowicz S, Dolwick MF. 20-year follow-up study of disc repositioning surgery for temporomandibular joint internal derangement [J]. J Oral Maxillofac Surg, 2010, 68(2): 239-242.
[17] Dolwick MF, Nitzan DW. The role of disc repositioning surgery for internal derangements of the temporomandibular joint [J]. Oral Maxillofac Surg Clin North Am, 1994, 6: 271.
[18] Kondoh T, Hamada Y, Kamei K, et al. Simple disc reshaping surgery for internal derangement of the temporomandibular joint: 5-years follow up results [J]. J Oral Maxillofac Surg, 2003, 61(1): 41-48.
[19] Gonçalves JR, Cassano DS, Rezende L, et al. Disc repositioning: does it really work?[J]. Oral Maxillofac Surg Clin North Am, 2015, 27(1):85-107.