1.
Prospective multicenter comparison of 4 temporomandibular joint operations.
Hall, HD, Indresano, AT, Kirk, WS, Dietrich, MS
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2005;(8):1174-9
Abstract
PURPOSE This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. PATIENTS AND METHODS A prospective, controlled study of arthroscopy, condylotomy, discectomy, and disc repositioning was conducted at 3 sites. All sites used the same inclusion and exclusion criteria. Trained, independent examiners assessed pain, diet, and range of motion before operation and 1 month and 1 year after operation. RESULTS There were statistically significant reductions in the amount of pain ( P < .001) and daily time in pain ( P < .001) that were similar for all 4 operations 1 month and 1 year after the procedures. The degrees of change after each of the 4 procedures were not statistically different from each other (amount: P = .453 and time: P = .416). Ability to chew, as measured by diet visual analog scale, was substantially improved 1 year after operation ( P < .001). The degrees of change for diet at 1 year also were not different from each other ( P = .314). There were, however, statistically significant differences ( P < .05) in range of motion that varied with procedure. CONCLUSIONS All 4 operations were followed by marked improvements in pain and diet. The amounts of improvement varied slightly by operation, but these differences were not statistically significant. There were small but statistically significant differences between procedures for range of motion. If these findings are confirmed, they have an important implication for procedure selection.
2.
Total prosthetic replacement of the TMJ: experience with two systems 1988-1997.
Speculand, B, Hensher, R, Powell, D
The British journal of oral & maxillofacial surgery. 2000;(4):360-9
Abstract
We report our experience with the Vitek VK II and the Christensen systems for total prosthetic replacement of the temporomandibular joint, in 62 patients treated between 1988 and 1997. Thirteen were treated in Birmingham and 49 in Gloucester. A total of 86 joints were replaced, of which 27 (31%) were Vitek VK II and 59 (69%) were Christensen prostheses. Just over half of the patients were treated for degenerative arthropathy or osteoarthritis, and the second most common diagnosis was rheumatoid arthritis. Twenty-five patients had had previous operations. The median follow-up was 14.5 months (range 1-120). Preoperatively only 14 patients (23%) could eat all types of food - and postoperatively this increased to 48 (77%). Thirty-nine patients (63%) reported severe pain preoperatively compared with three (5%) postoperatively. No prostheses were rejected, but four patients required replacement of Vitek VK II by Christensen prostheses; all four showed histological evidence of a foreign body giant cell reaction. The overall success rate was 58/62 patients and 81/86 joints replaced (94% in each case). However, for the Vitek VK II system alone the success rate was 14/17 patients (82%) and 24/27 joints replaced (89%).