Shadamarshan R Arunkumar, Sharma Rohit, Agrawal Nitesh, Patrikar Seema
Dept of Oral and Maxillofacial Surgery, Indo-Bhutan Friendship Hospital, Thimphu, 11001, Bhutan.
Dept of Oral and Maxillofacial Surgery, Command Military Dental Centre (Western Command), Chandimandir, India.
J Craniomaxillofac Surg. 2023 Feb;51(2):117-122. doi: 10.1016/j.jcms.2023.01.010. Epub 2023 Jan 31.
The aim of this study was to evaluate the efficacy of suprafoveal condylar arthroplasty (SFCA) in the management of patients with unilateral temporomandibular joint (TMJ) disc displacement without reduction (DDWoR). A retrospective study comprising patients who underwent unilateral SFCA for clinically and radiologically confirmed unilateral DDWoR from 2008 to 2020 was conducted. Patients older than 18 years at the time of diagnosis with a minimum of 6 months of unsuccessful non-surgical and minimally invasive management (including diet and life style modification, physiotherapy, appliance therapy, pharmacotherapy, arthrocentesis and arthroscopic lysis and lavage) before undergoing surgery with a minimum of 1 year follow-up post-surgery were included in the study. Patients with other articular and extra-articular causes of restricted mouth opening, prior history of mandibular surgery and/or trauma, growth abnormalities, systemic, metabolic, infective, neoplastic conditions affecting TMJ, including gross occlusal disharmony, untreated existing para-functional habits and bilateral DDWoR, were excluded from the study. Patients were assessed in terms pain on a visual analog scale (VAS), interincisal mouth opening (MO) and subjective assessment of mandibular range of movements including deviation of mouth opening, protrusion and ability for contralateral laterotrusion. 23 patients (10 males and 13 female) were included in the study, with a mean age of 35.09 years and mean follow up period of 37.7 months (range = 12-58; SD = 15.3). The mean pain scores on the VAS reduced from 6.35 preoperatively to 1.13 postoperatively and were found to be statistically significant (p < 0.0001). The improvement of the mean pre-operative mouth opening of 21.83 mm to a mean post-operative mouth opening of 42.09 mm was also found to be statistically significant (p < 0.0001). The subjective improvement in protrusive (p = 0.0003), laterotrusive (p = 0.0005) and opening movements (p = 0.0001) after 1 year were also found to be statistically significant. No patient developed any significant changes in occlusion post-operatively. Four of 23 (17.3%) patients developed transient neuromotor deficit of the temporal branch of the facial nerve. Within the limitations of the study, it seems that SFCA (without addressing the disc) might be an alternative to less invasive treatment approaches, if the latter turned out not to be successful.
本研究的目的是评估中央凹上髁关节成形术（SFCA）治疗单侧颞下颌关节（TMJ）不可复性盘移位（DDWoR）患者的疗效。进行了一项回顾性研究，纳入2008年至2020年因临床和影像学确诊为单侧DDWoR而接受单侧SFCA的患者。研究纳入诊断时年龄超过18岁、手术前至少6个月非手术和微创治疗（包括饮食和生活方式调整、物理治疗、矫治器治疗、药物治疗、关节穿刺及关节镜下松解和灌洗）失败且手术后至少随访1年的患者。排除有其他关节内和关节外原因导致张口受限、既往有下颌骨手术和/或创伤史、生长异常、影响TMJ的全身、代谢、感染、肿瘤性疾病（包括严重咬合不协调、未治疗的现有副功能习惯和双侧DDWoR）的患者。根据视觉模拟量表（VAS）评估疼痛情况、测量切牙间开口度（MO），并对下颌运动范围进行主观评估，包括开口偏斜、前伸和对侧侧方运动能力。本研究纳入23例患者（10例男性和13例女性），平均年龄35.09岁，平均随访时间37.7个月（范围=12 - 58个月；标准差=15.3）。VAS平均疼痛评分从术前的6.35降至术后的1.13，差异有统计学意义（p < 0.0001）。术前平均开口度21.83mm改善至术后平均开口度42.09mm，差异也有统计学意义（p < 0.0001）。术后1年时，前伸（p = 0.0003）、侧方运动（p = 0.0005）和开口运动（p = 0.0001）的主观改善也有统计学意义。术后无患者出现咬合明显改变。23例患者中有4例（17.3%）出现面神经颞支短暂性神经运动功能缺损。在本研究的局限性范围内，如果侵入性较小的治疗方法未成功，SFCA（不处理关节盘）似乎可能是一种替代方法。
