Desai Harsh, Pande Nivedita, Jawdekar Ashwin
Assistant Professor, Department of Dentistry, MAEER MIT Pune's MIMER Medical College and Dr. BSTR Hospital, Yashwant Nagar Approach Rd, Yashwant Nagar, Talegaon Dabhade, Maharashtra 410507, India.
Consultant Pediatric and Preventive Dentist, Department of Dentistry, KEM Hospital, 489, Mudaliar Rd, Rasta Peth, Pune - 411011, Maharashtra, India..
Br J Oral Maxillofac Surg. 2022 Oct;60(8):1023-1034. doi: 10.1016/j.bjoms.2022.05.005. Epub 2022 May 30.
Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques from which interpositional arthroplasty (IPA) involves using several materials. The objectives of this study were to assess and compare post arthroplasty maximum mouth opening (MMO), symptoms like pain and discomfort in jaw opening and movements, failures such as reankylosis, neurosensory disturbances, and the effect of confounding variables such as age, gender, physiotherapy, etc. The search (conducted in September, 2021) included studies published in English on otherwise healthy individuals (11 months to 88 years) having undergone arthroplasty with a minimum of six months' follow up. We used search engines such as Cochrane database, PubMed, Embase, Scopus, EBSCO host, Pro quest, J gate, Google Scholar, and manual search to include books and grey literature. Randomised clinical (RCT) and non-randomised clinical trials, observational studies, case series and reports meeting the inclusion criteria were selected. Two reviewers (HD and NP) independently extracted the data. Risk of bias was assessed using the Cochrane tool, Rangel checklist, and Joanna Briggs Institute. Data were analysed using RevMan (Version 5.4). Fifty studies with 1524 participants (442 bilateral and 891 unilateral joints) were included; six RCTs, 31 retrospective, 10 prospective, and three case series and reports. Amongst all interpositional materials, the highest increase in mouth opening was seen with dermis fat graft with a mean difference (Pooled MD) being 35.29mm (95% CI [32.36 to 38.22]). Comparison of temporalis myofascial with gap arthroplasty (GA) showed significant increase in MMO (Pooled MD in mm 1.30 95% CI [0.14 to 2.45]). Recurrence was significantly reduced when (IPA) was used, compared with GA (Risk difference 0.08mm 95% CI [-0.15 to -0.02]) and for Temporalis Myofascial Flap (TMF) when compared with GA (Risk difference -0.07mm 95% CI [-0.15 to 0]). Higher odds for developing neurosensory disturbances were seen with Al-Kayat Bramley incision (Pooled OR 0.11 95% CI [0.04 to 0.34]) compared to pre-auricular incision (Pooled OR 0.03 95% CI [0.01 to 0.09]). IPA was superior to GA with respect to maximum mouth opening (MMO) (Pooled MD in mm 1.21 95% CI [0.41 to 2.07]). Dermis fat graft offers the highest MMO. The overall quality of evidence for RCTs is poor while that of observational studies is moderate as per the relevant assessment of quality of evidence. More research with appropriate study designs is needed. Similar to the findings from the previous reviews, outcomes with IPA were superior when compared to GA in terms of mouth opening and less recurrence.
颞下颌关节（TMJ）强直的手术治疗涉及多种技术，其中间置物关节成形术（IPA）使用多种材料。本研究的目的是评估和比较关节成形术后的最大开口度（MMO）、张口和运动时的疼痛与不适等症状、再强直、神经感觉障碍等失败情况，以及年龄、性别、物理治疗等混杂变量的影响。检索（于2021年9月进行）包括以英文发表的关于其他方面健康的个体（11个月至88岁）接受关节成形术且随访至少6个月的研究。我们使用了Cochrane数据库、PubMed、Embase、Scopus、EBSCO主机、ProQuest、J门、谷歌学术等搜索引擎，并进行手动检索以纳入书籍和灰色文献。选择符合纳入标准的随机临床（RCT）和非随机临床试验、观察性研究、病例系列和报告。两名评审员（HD和NP）独立提取数据。使用Cochrane工具、兰赫尔检查表和乔安娜·布里格斯研究所评估偏倚风险。使用RevMan（5.4版）分析数据。纳入了50项研究，共1524名参与者（442个双侧关节和891个单侧关节）；6项RCT、31项回顾性研究、10项前瞻性研究以及3项病例系列和报告。在所有间置物材料中，真皮脂肪移植后的开口度增加最大，平均差值（合并MD）为35.29mm（95%CI[32.36至38.22]）。颞肌筋膜与间隙关节成形术（GA）的比较显示MMO有显著增加（合并MD，单位为mm 1.30，95%CI[0.14至2.45]）。与GA相比，使用（IPA）时复发率显著降低（风险差值0.08mm，95%CI[-0.15至-0.02]），与GA相比，颞肌筋膜瓣（TMF）的复发率也显著降低（风险差值-0.07mm，95%CI[-0.15至0]）。与耳前切口相比，Al-Kayat Bramley切口发生神经感觉障碍的几率更高（合并OR 0.11，95%CI[0.04至0.34]），耳前切口的合并OR为0.03，95%CI[0.01至0.09]。在最大开口度（MMO）方面，IPA优于GA（合并MD，单位为mm 1.21，95%CI[0.41至2.07]）。真皮脂肪移植提供了最大的MMO。根据相关证据质量评估，RCT的总体证据质量较差，而观察性研究的证据质量为中等。需要更多采用适当研究设计的研究。与先前综述的结果相似，在开口度和较少复发方面，IPA的结果优于GA。
