Альманах клинической медицины. 2017; 45: 471-477
Оценка артроскопической репозиции диска височно-нижнечелюстного сустава: проспективное исследование
https://doi.org/10.18786/2072-0505-2017-45-6-471-477Аннотация
Цель – оценить клинические результаты и эффективность нашей методики артроскопической репозиции диска височно-нижнечелюстного сустава с прошиванием. Материал и методы. Проведено проспективное исследование у больных, отобранных по определенным критериям. Исходно собирали информацию об их возрасте, поле, длительности заболевания и состоянии височно-нижнечелюстного сустава, на котором предстояла операция. До и после операции регистрировали такие параметры, как боли в суставе, суставной шум, максимальное межрезцовое расстояние, протрузия нижней челюсти и латеральная экскурсия (боковые движения). После операции проводили обследование, включавшее магнитно-резонансную томографию, оценку онемения, состояния рубца, затруднений жевания и качества жизни. Всех пациентов обследовали исходно и через 1, 3, 6 и 12 месяцев после артроскопического вмешательства. Количественные данные анализировали с помощью t-теста для несвязанных выборок, качественные – с помощью теста хи-квадрат. Результаты. Исследование выполнено на 224 суставах у 179 больных. Средний возраст пациентов составил 21,35 ± 8,71 года. Через месяц динамического наблюдения отмечалось существенное уменьшение болей и улучшение качества жизни, а через 3 месяца наблюдения боли практически прошли. Частота суставного шума через месяц динамического наблюдения значительно снизилась, но через 3 месяца существенно выросла. Заметное уменьшение онемения произошло через 12 месяцев после операции. Уменьшение затруднений при жевании и улучшение состояния рубца наблюдались через 3 месяца после операции. Объем движений нижней челюсти значимо увеличился через 12 месяцев после операции. Процент успешной репозиции диска, по данным магнитно-резонансной томографии, несколько снизился с 99,6% через 1 месяц до 97,8% через 12 месяцев динамического наблюдения. Заключение. Предложенная нами методика артроскопической репозиции диска – эффективный хирургический подход, который не только улучшает функционирование сустава, но и позволяет довольно долго удерживать диск в правильном положении. Ее можно считать перспективной методикой лечения переднего вывиха височно-нижнечелюстного сустава.
Список литературы
1. Israel HA. Internal derangement of the temporomandibular joint: new perspectives on an old problem. Oral Maxillofac Surg Clin North Am. 2016;28(3): 313–33. doi: 10.1016/j.coms.2016.03.009.
2. Al-Moraissi EA. Arthroscopy versus arthrocentesis in the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2015;44(1): 104–12. doi: 10.1016/j.ijom.2014.07.008.
3. McCarty WL, Farrar WB. Surgery for internal derangements of the temporomandibular joint. J Prosthet Dent. 1979;42(2): 191–6. doi: http://dx.doi.org/10.1016/0022-3913(79)90174-4.
4. Ohnishi M. Arthroscopy and arthroscopic surgery of the temporomandibular joint (T.M.J.). Rev Stomatol Chir Maxillofac. 1990;91(2): 143–50.
5. Murakami KI, Lizuka T, Matsuki M, Ono T. Diagnostic arthroscopy of the TMJ: differential diagnoses in patients with limited jaw opening. Cranio. 1986;4(2): 117–26.
6. Koslin MG, Martin JC. The use of the holmium laser for temporomandibular joint arthroscopic surgery. J Oral Maxillofac Surg. 1993;51(2): 122–3.
7. McCain JP, Podrasky AE, Zabiegalski NA. Arthroscopic disc repositioning and suturing: a preliminary report. J Oral Maxillofac Surg. 1992;50(6): 568–79. doi: https://doi.org/10.1016/0278-2391(92)90435-3.
8. Politi M, Sembronio S, Robiony M, Costa F, Toro C, Undt G. High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(1): 27–33. doi: https:// doi.org/10.1016/j.tripleo.2006.01.008.
9. Undt G, Murakami K, Rasse M, Ewers R. Open versus arthroscopic surgery for internal derangement of the temporomandibular joint: a retrospective study comparing two centres' results using the Jaw Pain and Function Questionnaire. J Craniomaxillofac Surg. 2006;34(4): 234–41. doi: 10.1016/j.jcms.2005.12.002.
10. Smolka W, Iizuka T. Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: correlation of preoperative staging to arthroscopic findings and treatment outcome. J Oral Maxillofac Surg. 2005;63(4): 471–8. doi: 10.1016/j.joms.2004.07.021.
11. Yang C, Cai XY, Chen MJ, Zhang SY. New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I – technique introduction. Int J Oral Maxillofac Surg. 2012;41(9): 1058–63. doi: 10.1016/j.ijom.2012.05.025.
12. Zhang SY, Liu XM, Yang C, Cai XY, Chen MJ, Haddad MS, Yun B, Chen ZZ. New arthroscopic disc repositioning and suturing technique for treating internal derangement of the temporomandibular joint: part II – magnetic resonance imaging evaluation. J Oral Maxillofac Surg. 2010;68(8): 1813–7. doi: 10.1016/j.joms.2009.08.012.
13. Indresano AT. Surgical arthroscopy as the preferred treatment for internal derangements of the temporomandibular joint. J Oral Maxillofac Surg. 2001;59(3): 308–12. doi: 10.1053/joms.2001.21001.
14. Mancha de la Plata M, Munoz-Guerra M, Escorial Hernandez V, Martos Diaz P, Gil-Diez Usandizaga JL, Rodriguez-Campo FJ. Unsuccessful temporomandibular joint arthroscopy: is a second arthroscopy an acceptable alternative? J Oral Maxillofac Surg. 2008;66(10): 2086–92. doi: 10.1016/j.joms.2008.06.043.
15. Moses JJ, Poker ID. TMJ arthroscopic surgery: an analysis of 237 patients. J Oral Maxillofac Surg. 1989;47(8): 790–4.
16. Ulmner M, Kruger-Weiner C, Lund B. Patientspecific factors predicting outcome of temporomandibular joint arthroscopy: a 6-year retrospective study. J Oral Maxillofac Surg. 2017;75(8): 1643.e1–7. doi: 10.1016/j.joms.2017.04.005.
17. Holmlund A, Gynther G, Axelsson S. Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the temporomandibular joint. Int J Oral Maxillofac Surg. 1994;23(5): 262–5.
18. Machoň V, Sedy J, Klima K, Hirjak D, Foltan R. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction. Int J Oral Maxillofac Surg. 2012;41(1): 109–13. doi: 10.1016/j.ijom.2011.07.907.
19. 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 Oral Maxillofac Surg. 2011;69(11):e340–6. doi: 10.1016/j.joms.2011.02.038.
20. Hu YK, Yang C, Xie QY. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study. Sci Rep. 2016;6:34253. doi: 10.1038/srep34253.
21. Hu YK, Yang C, Cai XY, Xie QY. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: A magnetic resonance imaging retrospective study. Medicine (Baltimore). 2016;95(35):e4715. doi: 10.1097/MD.0000000000004715.
22. Mehra P, Wolford LM. The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int J Oral Maxillofac Surg. 2001;30(6): 497–503. doi: 10.1054/ijom.2001.0163.
23. Conway WF, Hayes CW, Campbell RL, Laskin DM, Swanson KS. Temporomandibular joint after meniscoplasty: appearance at MR imaging. Radiology. 1991;180(3): 749–53. doi: 10.1148/radiology.180.3.1871289.
24. Sembronio S, Robiony M, Politi M. Disc-repositioning surgery of the temporomandibular joint using bioresorbable screws. Int J Oral Maxillofac Surg. 2006;35(12): 1149–52. doi: 10.1016/j.ijom.2006.06.010.
25. McKenna SJ, Cornella F, Gibbs SJ. Long-term follow-up of modified condylotomy for internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(5): 509–15. doi: https://doi.org/10.1016/S1079-2104(96)80038-2.
Almanac of Clinical Medicine. 2017; 45: 471-477
Evaluation of arthroscopic disc repositioning: a prospective study
https://doi.org/10.18786/2072-0505-2017-45-6-471-477Abstract
Aim: To evaluate clinical outcomes and success rates of our arthroscopic disc repositioning and suturing technique in patients with internal derangements of the temporomandibular joint (TMJ). Materials and methods: This was a prospective study in selected patients who met certain criteria. At baseline, we collected the information on their age, gender, disease duration, and the operated TMJ. Preoperative and postoperative variables included joint pain, joint clicking, maximal inter-incisal opening, mandibular protrusion, and lateral movements. Postoperative assessments were also performed, including magnetic resonance imaging (MRI) scans, assessment of numbness, scar, diet, and quality of life. All patients were assessed preoperatively and at 1, 3, 6, 12 months after the arthroscopic surgery. An independent t-test was used to assess the quantitative data and chi-square test was applied to the binary data. Results: The study was completed in 224 joints from 179 patients. Their mean age was 21.35 ± 8.71 years. Joint pain and quality of life improved significantly at 1 month of the follow-up, and almost vanished at 3 months of the follow-up. Frequency of joint clicking was significantly lower at 1 month of the follow-up, but increased significantly at 3 months of the follow-up. Numbness was significantly reduced at 12 months after surgery. Dietary and scar improvements were obvious at 3 months after surgery. Jaw movements were significantly improved at 12 months after the surgery. The success rate of the disc position evaluated by MRI decreased slightly from 99.6% to 97.8% at 1 month and 12 months of the follow-up. Conclusion: Our arthroscopic disc repositioning technique is an effective surgical method not only to improve the joint functioning, but also to correct the disc displacement for a relatively long time. It can be regarded as an appealing technique for the treatment of TMJ internal derangements.
References
1. Israel HA. Internal derangement of the temporomandibular joint: new perspectives on an old problem. Oral Maxillofac Surg Clin North Am. 2016;28(3): 313–33. doi: 10.1016/j.coms.2016.03.009.
2. Al-Moraissi EA. Arthroscopy versus arthrocentesis in the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2015;44(1): 104–12. doi: 10.1016/j.ijom.2014.07.008.
3. McCarty WL, Farrar WB. Surgery for internal derangements of the temporomandibular joint. J Prosthet Dent. 1979;42(2): 191–6. doi: http://dx.doi.org/10.1016/0022-3913(79)90174-4.
4. Ohnishi M. Arthroscopy and arthroscopic surgery of the temporomandibular joint (T.M.J.). Rev Stomatol Chir Maxillofac. 1990;91(2): 143–50.
5. Murakami KI, Lizuka T, Matsuki M, Ono T. Diagnostic arthroscopy of the TMJ: differential diagnoses in patients with limited jaw opening. Cranio. 1986;4(2): 117–26.
6. Koslin MG, Martin JC. The use of the holmium laser for temporomandibular joint arthroscopic surgery. J Oral Maxillofac Surg. 1993;51(2): 122–3.
7. McCain JP, Podrasky AE, Zabiegalski NA. Arthroscopic disc repositioning and suturing: a preliminary report. J Oral Maxillofac Surg. 1992;50(6): 568–79. doi: https://doi.org/10.1016/0278-2391(92)90435-3.
8. Politi M, Sembronio S, Robiony M, Costa F, Toro C, Undt G. High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(1): 27–33. doi: https:// doi.org/10.1016/j.tripleo.2006.01.008.
9. Undt G, Murakami K, Rasse M, Ewers R. Open versus arthroscopic surgery for internal derangement of the temporomandibular joint: a retrospective study comparing two centres' results using the Jaw Pain and Function Questionnaire. J Craniomaxillofac Surg. 2006;34(4): 234–41. doi: 10.1016/j.jcms.2005.12.002.
10. Smolka W, Iizuka T. Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: correlation of preoperative staging to arthroscopic findings and treatment outcome. J Oral Maxillofac Surg. 2005;63(4): 471–8. doi: 10.1016/j.joms.2004.07.021.
11. Yang C, Cai XY, Chen MJ, Zhang SY. New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I – technique introduction. Int J Oral Maxillofac Surg. 2012;41(9): 1058–63. doi: 10.1016/j.ijom.2012.05.025.
12. Zhang SY, Liu XM, Yang C, Cai XY, Chen MJ, Haddad MS, Yun B, Chen ZZ. New arthroscopic disc repositioning and suturing technique for treating internal derangement of the temporomandibular joint: part II – magnetic resonance imaging evaluation. J Oral Maxillofac Surg. 2010;68(8): 1813–7. doi: 10.1016/j.joms.2009.08.012.
13. Indresano AT. Surgical arthroscopy as the preferred treatment for internal derangements of the temporomandibular joint. J Oral Maxillofac Surg. 2001;59(3): 308–12. doi: 10.1053/joms.2001.21001.
14. Mancha de la Plata M, Munoz-Guerra M, Escorial Hernandez V, Martos Diaz P, Gil-Diez Usandizaga JL, Rodriguez-Campo FJ. Unsuccessful temporomandibular joint arthroscopy: is a second arthroscopy an acceptable alternative? J Oral Maxillofac Surg. 2008;66(10): 2086–92. doi: 10.1016/j.joms.2008.06.043.
15. Moses JJ, Poker ID. TMJ arthroscopic surgery: an analysis of 237 patients. J Oral Maxillofac Surg. 1989;47(8): 790–4.
16. Ulmner M, Kruger-Weiner C, Lund B. Patientspecific factors predicting outcome of temporomandibular joint arthroscopy: a 6-year retrospective study. J Oral Maxillofac Surg. 2017;75(8): 1643.e1–7. doi: 10.1016/j.joms.2017.04.005.
17. Holmlund A, Gynther G, Axelsson S. Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the temporomandibular joint. Int J Oral Maxillofac Surg. 1994;23(5): 262–5.
18. Machoň V, Sedy J, Klima K, Hirjak D, Foltan R. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction. Int J Oral Maxillofac Surg. 2012;41(1): 109–13. doi: 10.1016/j.ijom.2011.07.907.
19. 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 Oral Maxillofac Surg. 2011;69(11):e340–6. doi: 10.1016/j.joms.2011.02.038.
20. Hu YK, Yang C, Xie QY. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study. Sci Rep. 2016;6:34253. doi: 10.1038/srep34253.
21. Hu YK, Yang C, Cai XY, Xie QY. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: A magnetic resonance imaging retrospective study. Medicine (Baltimore). 2016;95(35):e4715. doi: 10.1097/MD.0000000000004715.
22. Mehra P, Wolford LM. The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int J Oral Maxillofac Surg. 2001;30(6): 497–503. doi: 10.1054/ijom.2001.0163.
23. Conway WF, Hayes CW, Campbell RL, Laskin DM, Swanson KS. Temporomandibular joint after meniscoplasty: appearance at MR imaging. Radiology. 1991;180(3): 749–53. doi: 10.1148/radiology.180.3.1871289.
24. Sembronio S, Robiony M, Politi M. Disc-repositioning surgery of the temporomandibular joint using bioresorbable screws. Int J Oral Maxillofac Surg. 2006;35(12): 1149–52. doi: 10.1016/j.ijom.2006.06.010.
25. McKenna SJ, Cornella F, Gibbs SJ. Long-term follow-up of modified condylotomy for internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(5): 509–15. doi: https://doi.org/10.1016/S1079-2104(96)80038-2.
