Maxillofacial Plastic and Reconstructive Surgery

  • Volume 42
  • /
  • Pages.14.1-14.11
  • /
  • 2020
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Temporomandibular joint disc plication with MITEK mini anchors: surgical outcome of 65 consecutive joint cases using a minimally invasive approach

  • Lee, Bu-Kyu (Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Hong, Jun Hee (Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan)
  • Received : 2020.04.03
  • Accepted : 2020.04.15
  • Published : 2020.12.31
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Abstract

Background: The purpose of this study is to introduce our modified disc plication technique using MITEK mini anchors and to evaluate the clinical outcome for patients with internal derangement (ID) of the temporomandibular joint (TMJ). Patients and methods: We evaluated 65 joints in 46 patients, comprised 32 women and 14 men, who first visited the Asan Medical Center from December 2012 to December 2016. The age of the patients ranged from 14 to 79 years, with a mean age of 36.6 years. The patients presented with joint problems including pain, joint noise, and mouth opening limitation (MOL). Patients who met our inclusion criteria underwent unilateral or bilateral disc repositioning surgery with our minimally invasive disc plication technique using MITEK mini anchors and No. 2-0 Ethibond® braided polyester sutures. The variables taken into account in this study were the range of maximum mouth opening (MMO), painful symptoms (evaluated with the visual analog scale, VAS), and the type of noise (click, popping, crepitus) in the TMJ. Results: Preoperative examination revealed painful symptoms in 50.7% (n = 35) of the operated joints (n = 69) and the presence of clicks in 56.5% (n = 39). Postoperative examination revealed that 4.3% (n = 3) of the operated joints had painful symptoms with lower intensity than that in the preoperative condition. Additionally, 17.4% (n = 12) had residual noise in the TMJ, among which two were clicking and the other 10 had mild crepitus. The intensity of the postoperative residual noise was significantly decreased in all cases compared to that in the preoperative condition. Among patients with MOL below 38 mm (n = 18), the mean MMO was 31.4 mm preoperatively and 44.2 mm at 6 months postoperatively, with a mean increase of 13.8 mm. A barely visible scar at the operation site was noted during the postoperative observation period, with no significant complications such as facial palsy or permanent occlusal disharmony. Conclusion: Subjective symptoms in all patients improved following the surgery. TMJ disc plication using MITEK mini anchors with our minimally invasive approach may be a feasible and effective surgical option for treating TMJ ID patients who are not responsive to conservative treatment.

Keywords

Acknowledgement

This study was supported by the Korean Temporomandibular Joint Cooperation.

References

  1. Mehra P, Wolford LM (2001) The Mitek mini anchor for TMJ disc repositioning: surgical technique and results. Int J Oral Maxillofac Surg 30: 497-503
  2. Wilkes CH (1978) Structural and functional alterations of the temporomandibular joint. Northwest Dent 57:287-294
  3. McCarty WL, Farrar WB (1979) Surgery for internal derangements of the temporomandibular joint. J Prosthet Dent 42:191-196
  4. Hall MB (1984) Meniscoplasty of the displaced temporomandibular joint meniscus without violating the inferior joint space. J Oral Maxillofac Surg 42:788-792
  5. Abramowicz S, Dolwick MF (2010) 20-year follow-up study of disc repositioning surgery for temporomandibular joint internal derangement. J Oral Maxillofac Surg 68:239-242
  6. Kerstens HC, Tuinzing DB, van der Kwast WA (1989) Eminectomy and discoplasty for correction of the displaced temporomandibular joint disc. J Oral Maxillofac Surg 47:150-154
  7. Anderson DM, Sinclair PM, McBride KM (1991) A clinical evaluation of temporomandibular joint disk plication surgery. Am J Orthod Dentofacial Orthop 100:156-162
  8. Dolwick MF (2007) Temporomandibular joint surgery for internal derangement. Dent Clin North Am 51:195-208 vii-viii
  9. Walker RV, Kalamchi S (1987) A surgical technique for management of internal derangement of the temporomandibular joint. J Oral Maxillofac Surg 45:299-305
  10. Rehak DC, Sotereanos DG, Bowman MW, Herndon JH (1994) The Mitek bone anchor: application to the hand, wrist and elbow. J Hand Surg Am 19: 853-860
  11. Pederson B, Tesoro D, Wertheimer SJ, Coraci M (1991) Mitek Anchor System: a new technique for tenodesis and ligamentous repair of the foot and ankle. J Foot Surg 30:48-51
  12. Ruiz Valero CA, Marroquin Morales CA, Jimenez Alvarez JA, Gomez Sarmiento JE, Vallejo A (2011) Temporomandibular joint meniscopexy with Mitek mini anchors. J Oral Maxillofac Surg 69:2739-2745
  13. Fields RT Jr, Cardenas LE, Wolford LM (1997) The pullout force for Mitek mini and micro suture anchor systems in human mandibular condyles. J Oral Maxillofac Surg 55:483-487 discussion 487-488
  14. Goncalves JR, Cassano DS, Rezende L, Wolford LM (2015) Disc repositioning: does it really work? Oral Maxillofac Surg Clin North Am 27:85-107
  15. Moon SY, Chung H (2015) Ultra-thin Rigid diagnostic and therapeutic arthroscopy during arthrocentesis: development and preliminary clinical findings. Maxillofac Plast Reconstr Surg 37:17
  16. Sharma A, Paeng JY, Yamada T, Kwon TG (2016) Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis. Maxillofac Plast Reconstr Surg 38:12
  17. Williamson RA, McNamara D, McAuliffe W (2000) True eminectomy for internal derangement of the temporomandibular joint. Br J Oral Maxillofac Surg 38:554-560
  18. Dergin G, Kilic C, Gozneli R, Yildirim D, Garip H, Moroglu S (2012) Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings. J Craniomaxillofac Surg 40:459-463
  19. Dolwick MF, Dimitroulis G (1994) Is there a role for temporomandibular joint surgery? Br J Oral Maxillofac Surg 32:307-313
  20. Sidebottom AJ (2009) Current thinking in temporomandibular joint management. Br J Oral Maxillofac Surg 47:91-94
  21. Obrist J, Genelin F, Neureiter H (1991) Bankart operation with the Mitek anchor system. Unfallchirurgie 17:208-212
  22. Wolford LM (1997) Temporomandibular joint devices: treatment factors and outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:143-149
  23. Fields RT Jr, Wolford LM (2001) The osseointegration of Mitek mini anchors in the mandibular condyle. J Oral Maxillofac Surg 59:1402-1406 discussion 1407
  24. Gocmen G, Varol A, Karatas B, Basa S (2013) Evaluation of temporomandibular joint disc-repositioning surgery with Mitek mini anchors. Natl J Maxillofac Surg 4:188-192
  25. Sheikh O, Logan G, Komath D, Grossman P, Ayliffe P (2016) Splint-assisted disc plication surgery. Ann Stomatol (Roma) 7:73-78
  26. Miloro M, Henriksen B (2010) Discectomy as the primary surgical option for internal derangement of the temporomandibular joint. J Oral Maxillofac Surg 68:782-789
  27. Roh HS, Kim W, Kim YK, Lee JY (2012) Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg 40:283-286
  28. Provenzano Mde M, Chilvarquer I, Fenyo-Pereira M (2012) How should the articular disk position be analyzed? J Oral Maxillofac Surg 70:1534-1539
  29. Ruiz CA, Guerrero JS (2001) A new modified endaural approach for access to the temporomandibular joint. Br J Oral Maxillofac Surg 39:371-373
  30. Sato S, Goto S, Nasu F, Motegi K (2003) Natural course of disc displacement with reduction of the temporomandibular joint: changes in clinical signs and symptoms. J Oral Maxillofac Surg 61:32-34
  31. Fernandez Sanroman J, Sandoval Gutierrez J, Goizueta Adame C (2000) Discoplasty with mitek anchors for the treatment of the anteror disk displacement without reduction of the TMJ : a prospective clinical study with MRI. Rev Espanola Cirugia Oral Maxilofacial 22:252