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Background/Objectives: Hemimandibular hyperplasia (HH) associated with osteochondroma presents complex challenges in maxillofacial surgery, including facial asymmetry, occlusal instability, and temporomandibular joint (TMJ) dysfunction. Surgical interventions vary widely in approach and outcomes, underscoring the need for a systematic evaluation of effectiveness. This systematic review assesses the effectiveness of surgical approaches for managing HH associated with osteochondroma, focusing on techniques including condylectomy, orthognathic surgery, distraction osteogenesis, total joint replacement (TJR), and genioplasty. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published from 2000 to 2023. Eligibility criteria were based on the PICO framework, with primary outcomes evaluated for facial symmetry, occlusal correction, mandibular function, and recurrence rates. The Cochrane Risk of Bias Tool assessed study quality, while the GRADE framework evaluated the certainty of evidence. This review was not registered due to exclusion criteria for certain dental topics in PROSPERO. Results: Of 145 studies identified, 18 met inclusion criteria, totaling 214 patients. High and low condylectomy both effectively corrected asymmetry, with high condylectomy reducing recurrence risk but often requiring reconstruction. Orthognathic surgery, combined with condylectomy, significantly enhanced facial symmetry and occlusal function. Distraction osteogenesis proved valuable for mandibular lengthening in cases of severe deformities, while TJR offered definitive solutions for extensive joint involvement. Genioplasty corrected chin asymmetry, contributing to improved facial balance. Limitations included small sample sizes and variable follow-up durations. Conclusions: Surgical approaches tailored to individual patient needs show effectiveness in treating HH associated with osteochondroma, achieving functional and esthetic outcomes. Future studies should prioritize larger cohorts and standardized follow-up protocols to better assess long-term efficacy. Advances in 3D surgical planning and individualized treatment strategies show promise for optimized patient-specific care. [ABSTRACT FROM AUTHOR]

Objective: Postoperative patients with temporomandibular joint internal derangement (ID) often have problems such as limited mouth opening and pain. Exercise therapy can be advantageous for improving the recovery of patients following surgery. However, there is continuing discussion on the precise aspects of the exercise program, including the optimal timing, length, intensity, and use of assistive equipment. Hence, this study aimed to incorporate pre‐existing exercise treatment regimens and investigate their impact. Methods: Publications that detailed the clinical treatment of patients with temporomandibular joint ID who received postoperative exercise therapy interventions were included. Nine databases were searched until October 1st, 2023. The JBI critical appraisal tools were used to assess the methodological quality of the included studies. Results: Five studies were finally included for subsequent analysis; two were randomised controlled studies, and three were quasi‐experimental. Exercises suitable for such patients encompass vertical, transverse, and horizontal stretching, among which vertical stretch can be divided into active and passive movements. The start time ranged from the first to the fifth week after surgery, with a duration of 1–6 months. Although the data in the studies could not be integrated and further analysed, preliminary results showed that maximum mouth opening and pain in patients improved significantly. The therapeutic effect of combining three exercise methods was best and was related to patient compliance. Conclusion: Exercise therapy positively affects postoperative rehabilitation in patients with temporomandibular joint ID. It is proposed that targeted, comprehensive studies be conducted to provide a basis for designing more sophisticated exercise therapy regimens and further confirm its curative effect. [ABSTRACT FROM AUTHOR]

Background: Current clinical approaches to regenerate temporomandibular joint (TMJ) articulating cartilage defects only treat the symptoms (i.e. pain and dysfunction) and do not seek to restore joint integrity for long‐term relief. Therefore, we investigated a novel self‐assembling tissue‐engineered cartilage to overcome this significant clinical issue for TMJ regenerative purposes. Objectives: Examine the maturation of dynamic self‐regenerating cartilage (dSRC) using auricular chondrocytes and evaluate a novel combinatorial approach with fractional laser treatment and dSRC implantation for TMJ cartilage repair. Materials and Methods: A suspension of 107 freshly harvested rabbit ear chondrocytes was cultured under a continuous reciprocating motion to form the dSRC. After 2, 4 and 8 weeks of culture, dSRC samples were stained with H&E, Safranin‐O and Toluidine Blue. Immunohistochemistry (IHC) was performed for collagens type I and II. Channels (300–500 μm diameter and 1.2–1.5 mm depth) were created in six freshly harvested condyles using a fractional Erbium laser. Two groups were tested: dSRC in a laser‐ablated lesion (experimental) and an empty laser‐ablated channel (control). TMJ condyles were cultured for up to 8 weeks and analysed as described above. Results: H&E staining showed a high cell density in dSRC compared to native cartilage. All dSRC groups demonstrated intense Safranin‐O staining, indicating high glycosaminoglycan (GAG) production and intense Toluidine Blue staining showed high proteoglycan content. IHC confirmed that dSRC consisted predominantly of collagen type II. The experimental group showed improved cartilage repair at both time points compared to the empty channels. Conclusion: dSRC viability and successful matrix formation were demonstrated in vitro. The combination of fractional laser ablation and dSRC implantation enhanced cartilage repair. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Pathology is the property of Canadian Association of Pathologists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first‐line surgical treatment since there are no evidence on best surgical practice yet. Objective: The aim was to perform a complex systematic review (SR) on the topic—is there evidence for surgical treatment of TMJ DD? Methods: The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. Results: The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta‐analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p <.0001, I2 = 22%; TMJ pain: p =.0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p =.04, I2 = 0%; TMJ pain: p =.28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta‐analyses only included 2–4 studies each, which might indicate a low grade of evidence. Conclusion: Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non‐invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains. [ABSTRACT FROM AUTHOR]

Temporomandibular disorders include a wide spectrum of extra-articular and intra-articular conditions affecting the temporomandibular joint (TMJ). In salvage cases involving intra-articular end-stage disease, alloplastic temporomandibular joint replacement (TMJR) is a management option which can be utilised to rehabilitate a disabled joint's function and form. Whilst post-TMJR infection is rare, it is one of the most serious complications. The principles governing TMJR surgery antibiotic prophylaxis have been based on those established in orthopaedic surgery literature. Antibiotic resistance due to antibiotic over-use is a significant concern, therefore antibiotic stewardship has been developed to deal with this world-wide public health concern. The TMJ's anatomical proximity to the external auditory canal and oral cavity creates the potential for bacterial contamination. The aim of this study was to explore the views of 39 sub-specialist TMJ surgeons across nine nations usual approach to antibiotic prophylaxis and their management of TMJR infection. To accomplish this, an international survey was developed and conducted using Google Forms. The results demonstrated that 97.4% of the respondents employ prophylactic antibiotics at TMJR surgery, 83.8% on discharge. Variability in antibiotic choice with additional antimicrobial perioperative practices were also reported. Opinions on the management of a TMJR infection also varied. This survey establishes there is an agreement on the use of antibiotic prophylaxis, However the variability in choice, timing, course, duration of antibiotic use as well as the management of a postoperative TMJR infection demonstrates the need for further study leading to development of standardised antibiotic prophylaxis and infection management protocols for TMJR surgery. [ABSTRACT FROM AUTHOR]

EDS (Ehlers-Danlos Syndrome) is a heterogenous group of inheritable connective tissue disorders that commonly precludes patients from being elective surgical candidates. Patients with EDS are at a higher risk of increased bleeding, delayed wound healing, and temporomandibular joint pain refractory to treatment. Historically, patients with EDS and TMJ disorders are considered inappropriate surgical candidates due to a higher risk of delayed wound healing, increased risk for uncontrolled post-surgical bleeding, and unsubstantiated outcomes in regards to elective orthognathic surgery. A review of the literature demonstrates a paucity of data accounting the use of orthognathic surgery and maxillary-mandibular advancement in patients with EDS. The present study reports on the use of orthognathic double jaw surgery in a patient with a known diagnosis of hypermobile EDS, history of TMJ subluxation and pain. This case describes a 47-year-old woman with a history of hypermobile EDS who presented with Angle Class II malocclusion, Class II skeletal pattern, and clockwise rotation of the occlusal plane associated with pain at the bilateral TMJs. She underwent maxillary-mandibular advancement with counterclockwise rotation of the occlusal plane and genioplasty. The surgery was without complications, and at 22 months follow up, the patient healed uneventfully with improvement of pain and range of motion. This case report demonstrates that with diligent patient selection, orthognathic surgery in patients with EDS can be safe and effective and should not be an absolute contraindication. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint arthroscopy (TMJA) is often performed under general anaesthesia (GA) worldwide on an inpatient basis, whereas local anaesthesia (LA) is not equally considered as the standard procedure. Objectives: To compare the efficacy between LA and GA when performing TMJA. Methods: This study retrospectively reviewed a total of 182 patients in LA group and 91 patients in GA group who underwent TMJA for the management of disc displacement. Patients were divided into two groups based on type of anaesthesia used for surgery; LA group and GA group. Comparisons were made based on operative time, intubation and extubation time (for GA only), hospital stay duration, total cost and post‐operative clinical and radiological outcomes. Results: The demographics and pre‐operative clinical assessments were matched in both groups. No post‐operative significant difference was found in outcomes when performing TMJA under LA compared to GA in terms of pain reduction (p =.016) and improvement in mouth opening (p =.866). The median operative time and hospital stay duration for LA group were significantly less compared to GA group (p <.001). GA group required an additional intubation and extubation time, whereas LA group patients were waived from it. TMJA for LA group was performed in the minor procedure setup, which reduced the costs for surgery (p <.001). Post‐operative disc position was excellent and good with an overall success rate of 95%. Conclusion: The use of LA performing TMJA reduces operating time, costs, hospital stay and recovery room time than GA group. Furthermore, TMJA performed under LA shared similar post‐operative clinical and radiological outcomes with those performed under GA. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the prevalence of radiographic changes in the mandibular angle (bone apposition) and osseous alterations in the temporomandibular joints (TMJs) in the adult population of Switzerland. In addition, the study intended to investigate possible correlations between the two sites of contour bone changes (mandibular angle and TMJ) and to analyze various patient-related factors, including sex, age, dental status, and medical history. Methods: Panoramic radiographs of 600 patients distributed into six age groups (283 females, 317 males, aged 20 to 79 years) were included to evaluate radiographic changes. The bone in the mandibular angle region and the shape of the condylar heads were examined for contour changes (bone apposition at the jaw angles and osseous changes of the TMJs). General estimating equations, binormal tests, and chi-squared tests were used for statistical analysis. Results: Approximately half of the mandibular angles (47.8%) showed bone apposition, mostly bilateral. TMJ alterations were less common (27%), often unilateral, with flattening being the most frequent finding. No significant correlation was found between the two sites. Bone apposition at the mandibular angle showed a significant male predominance, whereas TMJ changes did not differ by sex. Alterations in both sites increased with age, and were not related to dental status or analgesic use. Conclusions: Bone apposition at the mandibular angle should be interpreted as part of the natural functional adaptation of the bone associated with aging. Assuming that parafunctional habits may influence the development and progression of alterations in the mandibular angle or TMJs, the presence of radiographic changes in these areas should prompt dental clinicians to investigate further in this direction. Trial registration: The study was approved by the Swiss Association of Research Ethics Committees (swissethics), BASEC reference number: 2020–00963 (25.05.2020). [ABSTRACT FROM AUTHOR]

Background: In the last decade, tissue‐engineering strategies for regenerating the temporomandibular joint (TMJ) have been investigated. This may be a promising strategy for the minimally invasive restoration of joint integrity. Objectives: To evaluate whether dental pulp stem cells (DPSCs) loaded in a light‐occured hydrogel made of gelatin methacryloyl (GelMA) enhance the regeneration of osteochondral defects in the rabbit TMJ. Materials and Methods: Defects were filled with GelMA alone (control group; n = 4) or filled with GelMA loaded with rabbit DPSCs (experimental group; n = 4), In one group, the TMJ capsule was opened without creating a defect (sham group; n = 2). The following micro‐CT parameters were analysed: bone volume to total volume ratio (BV/TV%) and bone mineral density (BMD). Histological evaluation was performed to assess cartilage regeneration features. A semi‐quantitative scoring system was also used to evaluate the defects. Results: All groups had no statistical difference regarding the micro‐CT parameters. The highest mean healing score was found for the experimental group. After 4 weeks, there were no signs of hydrogel in either group or no signs of inflammation in the adjacent tissues. The tissue formed in the defect was dense fibrous connective tissue. Conclusion: Adding DPSCs to GelMA did not provide a regenerative enhancement in TMJ osteochondral defects. This resulted in similar micro‐CT parameters after 4 weeks of healing, with improved signs of subchondral bone regeneration but no cartilage regeneration. [ABSTRACT FROM AUTHOR]

Temporomandibular joint (TMJ) surgery accounts for a significant number of patient episodes in oral and maxillofacial surgery, and treatment effectiveness is commonly assessed using measures of pain and mouth opening. Patient-reported outcome measures (PROMs) enable assessment of the patient's perspective and perception of the diseases and treatment outcomes. The purpose of this review was to assess the use of PROMs in TMJ surgery. A review of 3 databases (PubMed, OVID, Trip) was carried out to assess the use of PROMs when reporting on TMJ surgical interventions. Studies were limited to the English language, involving humans and at least one surgical intervention of the TMJ. A total of 214 articles met the inclusion and exclusion criteria, of which only 28 used 18 PROMs among them. Half of these PROMs were single-question visual analogue scales or Likert scales on quality of life and disability. The Oral Health Impact Profile and the Helkimo Clinical Dysfunction Index were the second most used (n = 3). PROMs were used most in studies on internal derangement (n = 9) and in cohort study designs (n = 26), but this was not statistically significant. In the majority of research on TMJ surgery, no PROMs are used, and when one is, there is a tendency to use weaker single-question PROMs as opposed to multi-question PROMs to assess outcomes. With the increasing importance of PROMs for assessing patients' perception of treatment outcomes, further research is needed to establish valid and reproducible PROMs for TMJ surgery. [ABSTRACT FROM AUTHOR]

This paper considers the current situation regarding medicolegal risks in temporomandibular joint surgery from three perspectives: the law, the patient, and the surgeon. The law relating to successful claims of clinical negligence requires that a cause-and-effect relationship is demonstrated by the claimant. Complications are considered in the light of recent research on their stratification in other fields of surgery. Surgeons become repeat offenders rarely. They display certain common characteristics which are discussed in this paper. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied. Objective: This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion. Methods: A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups. Results: After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001). Conclusion: These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS. Trial registration: This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019 [ABSTRACT FROM AUTHOR]

Background: Reconstruction of the temporomandibular joint (TMJ) is a significant challenge in maxillofacial surgery. A vascularized medial femoral condyle (MFC) osteocartilaginous flap is a good choice for TMJ reconstruction. In this study, we evaluated the radiographic and histological changes of MFC after TMJ reconstruction. Methods: A ramus-condyle unit (RCU) defect was created unilaterally in five adult male Bama miniature pigs. The ipsilateral vascularized MFC osteocartilaginous flap was used to reconstruct the TMJ, and the non-operative sides served as controls. Multislice spiral computed tomography (CT) was performed preoperatively, immediately postoperatively, and at two weeks, three months, and six months postoperatively. Three animals were euthanized at 6 months postoperatively. Their reconstructed condyles, natural condyles and the MFCs on the opposite side were collected and subjected to µCT and histological evaluation. Results: In the miniature pigs, the vascularized MFC osteocartilaginous flap was fused to the mandible, thus restoring the structure and function of the RCU. The postoperative radiographic changes and histological results showed that the reconstructed condyle was remodeled toward the natural condyle, forming a similar structure, which was significantly different from the MFC. Conclusions: In miniature pigs, the RCU can be successfully reconstructed by vascularized osteocartilaginous MFC flap. The reconstructed condyle had almost the same appearance and histological characteristics as the natural condyle. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol. Methods: This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ—H&N35) during those perioperative visits. Results: Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027). Conclusions: This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis. [ABSTRACT FROM AUTHOR]

The objective of this case report is to describe the treatment of a dentofacial and temporomandibular joint (TMJ) deformity by means of reconstruction with a customized TMJ prosthesis and orthognathic surgery. The article discusses the therapeutic approach and the importance of functional and esthetic rehabilitation of the patient. A 22-year-old man displayed sequelae of osteomyelitis diagnosed at 6 years of age, including facial asymmetry, laterognathism, unsatisfactory occlusion, and mandibular retrognathism. Computed tomography revealed a deformity of the left mandibular condyle, ramus, and fossa. The patient underwent 1-stage surgery that involved bimaxillary orthognathic surgery and mentoplasty in conjunction with reconstruction of the left TMJ with a customized prosthesis. Postoperatively, substantial improvement was observed in the patient's facial pattern and masticatory function, and the beneficial changes have been maintained through 2 years of follow-up. The positive outcome in this patient suggests that TMJ reconstruction using a customized prosthesis in combination with computer-guided orthognathic surgery can be a satisfactory approach to correct a mandibular defect. The advantages of 1-stage surgery for the surgeon include shorter treatment time and more predictable results, while the benefits for the patient are good esthetic and functional results and improved quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This retrospective study aimed to evaluate patient satisfaction with different temporomandibular joint (TMJ) treatments. Patients were included in the study according to the following inclusion criteria: 1) arthrogenous and/or myogenous temporomandibular disorders (TMD); 2) Dimitroulis classification category between 1-4; 3) conservative treatment without any improvement at least for 3 months; 4) indication for one of the following TMD treatments: injection of botulinum toxin; arthrocentesis; arthroscopy, and open surgery without alloplastic material; and 5) age ≥16 years. An independent satisfaction questionnaire with 11 queries was applied via phone call to all patients, which included 6 questions using a 10-point Likert scale and 5 yes-or-no questions. The principal outcome was the overall satisfaction with the clinical result of the treatment, and the secondary outcomes were specific satisfaction with the following: 1) pain reduction; 2) range of mouth opening; 3) chewing ability; 4) postoperative recovery; 5) the fulfillment of expectations; 6) treatment choice; 7) treatment recommendation to a friend; and 8) the need for another intervention. Anxiety and depression were also included as variables. Data were analyzed using descriptive statistics, non-parametric Kruskal-Wallis and Spearman rank correlation coefficient tests. A total of 120 patients (mean age 41.20 ± 17.78 years) were enrolled, comprising 109 women (90%) and 11 men (10%). The overall clinical satisfaction of all patients was 8.24 ± 2.23 (mean ± SD), and 97 patients (80.8%) stated that they would repeat the treatment. Patients submitted to TMJ arthrocentesis and arthroscopy had higher overall clinical satisfaction (9.09 ± 0.971 and 9.03 ± 1.13, p = 0.021) followed by open surgery (8.38 ± 1.84). The authors observed three statistically significant correlations: 1) overall clinical satisfaction and patient expectations (r = 0.803; p < 0.0001); 2) overall clinical satisfaction and post-treatment pain (r = −0.299; p = 0.003); and (3) the presence of depression and the need for further TMJ treatment (r = 0.186; p = 0.043). Within the limitations of the study it seems that patient expectations should be addressed ad initium, and the presence of a diagnosis of depression with concomitant TMD must alert the clinical team and patient for the possible need of additional treatment. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic injuries of internal maxillary artery (IMA) and external carotid artery (ECA) during temporomandibular and retromandibular region surgeries are serious surgical complications with high mortality and morbidity. In order to avoid this complication, it is important for surgeons to know these vascular structures' course and their relationship with the mandibular condyle and ramus. The aim of this study was to reveal the relationship of the IMA and ECA with the mandible by head and neck computed tomography (CT) angiography. Materials and methods: Bilateral head and neck CT angiography data in 26 patients (52 region) were evaluated retrospectively. The spatial distance of IMA and ECA to the mandible was calculated in all three planes (IMAx, ECAx, IMAy, ECAy, IMAz, ECAz planes). The presence of vascular tortuosity and contact were also evaluated. Results: We have found that the nearest distance to the ramus of the ECA before giving a branch to IMA was 32.5±7.7 mm above the line drawn tangent to the lower border of corpus mandible. The internal maxillary artery was measured to be in contact with the medial cortical surface of the mandibular condyle in 39 of the 52 angiographies. This contact point was found to be 1.74 mm in front of the posterior margin of the ramus. Conclusion: In this study, we radiologically confirmed that the internal maxillary artery is in close association with the mandibular condyle. It is important for surgeons to be aware of this neighborhood in order to prevent intraoperative vascular injuries. [ABSTRACT FROM AUTHOR]

Objective: To identify factors affecting condylar bone changes following surgical-orthodontic treatment., Methods: A total of 200 patients with dentofacial deformities were classified into skeletal Classes I, II, and skeletal Class III groups consisting of 61 and 139 subjects, respectively. Temporomandibular joints (TMJs) were evaluated using clinical findings and computed tomography images before treatment, immediately before surgery, and 6 months after surgery., Results: Condylar bone changes occurred at a significantly higher rate after surgery in both groups. Factors related to condylar bone changes following surgical-orthodontic treatment included skeletal Class I or II, disc displacement, and condylar bone changes before treatment. There were three cases with condylar bone changes after surgery that were diagnosed with condylar resorption and skeletal Class II and anterior disc displacement before surgery., Conclusion: Condylar resorption could occur when the load on the condyle increases after orthognathic surgery and exceeds the permissible limit.

Background: Arthroscopy is regarded as a minimally invasive surgical procedure, with complication rates ranging from 1.7 to 4.4%. It remains unclear whether the complexity of the arthroscopic procedure is associated with the frequency of complications., Purpose: The study purpose was to measure the association between the level of arthroscopic complexity and short-term postoperative complications., Study Design, Setting, Sample: The researchers implemented a prospective cohort study. Subjects presenting to Clinica Bupa Santiago, a tertiary care hospital in Chile between 2022 and 2023 who requires arthroscopy were enrolled. Inclusion criteria required subjects to have a history of joint disorder and a preoperative magnetic resonance imaging (MRI) to be scheduled for an arthroscopic surgery with a 6-month follow-up. Subjects lacking 6-month follow-up were excluded., Predictor Variable: The predictor variable was the arthroscopy complexity level: level I (single puncture diagnostic sweep), level II (double puncture with instrumentation or shaver), and level III (discopexy or discectomy)., Main Outcome Variable: The main outcome variable was intraoperative and postoperative complications, which were defined as any unwanted development resulting in lasting consequences, additional surgeries, or unresolved issues, and these were coded as either present or absent., Covariates: The covariates included age, sex, duration of symptoms, prior conservative therapies, history of previous open joint surgery, and Wilkes stage., Analyses: Data were analyzed using descriptive statistics with statistical significance set at P value <.05. χ 2 or Fisher's exact test was used depending on the variable type., Results: A total of 165 subjects (285 joints) with a mean age of 28.9 years (SD 13.0) were included. Of these, 149 (90.3%) were female and 16 (9.7%) were male. Level I procedures were performed on 37 joints (13.0%) in 23 subjects (16.3%), level II on 53 joints (18.6%) in 27 subjects (16.3%), and level III on 195 joints (68.4%) in 116 subjects (69.9%). Complications occurred only in level III (7 procedures, 2.5%, P = .33), affecting 5 subjects (3.0%). Observed complications included transient frontal facial paresis, mouth floor edema, transient neuropathic pain, suture rejection, and emphysema., Conclusion and Relevance: The postoperative complication rate after arthroscopy was 2.5%, with no statistically significant association with operative complexity. Although more complications were observed in advanced arthroscopies, this increase was not significant., (Copyright © 2025 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Dislocation of the temporomandibular joint (TMJ) may be due to various reasons. Long-standing dislocation is a rare condition as it is a sequela of unrecognised dislocation, which can lead to ankylosis of TMJ, a rare clinical representation. A male patient in his late 30s reported with a deviated mandible to the left side, occlusal derangement and reduced mouth opening of 1 cm. The radiological investigation showed a bony mass above the normal condylar appearance within the glenoid fossa and extending medially to the base of the skull. Ankylosis release was done with right condylotomy, and removal of the bony mass and right coronoidectomy was done and reconstructed with prosthetic condyle., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: This study developed and evaluated a computer-based method for automating the registration of scanned dental models with 3D reconstructed skulls and segmentation of the temporomandibular joint (TMJ)., Methods: A dataset comprising 1274 skull models and corresponding scanned dental models was collected. In total, 1066 cases were used for the development of the computer-based method, while 208 cases were used for validation. Performance was evaluated by comparing the automated results with manual registration and segmentation performed by clinicians, using accuracy and completeness metrics (e.g. intersection of union [IoU] and Dice similarity coefficient [DSC])., Results: The automated registration achieved a mean absolute error of 0.35 mm for the maxilla and 0.38 mm for the mandible, and a root mean squared error of 0.46 mm and 0.39 mm, respectively. The automatic TMJ segmentation exhibited an accuracy of 97.48 %, a precision of 97.06 %, a IoU of 95.72 %, DSC of 97.3 %, and a Hausdorff value of 1.87 mm, which were sufficient for clinical application., Conclusion: The proposed method significantly improved the efficiency of orthognathic surgical planning by automating the registration and segmentation processes. The accuracy and precision of the automated results were sufficient for clinical use, reducing the workload on clinicians and facilitating faster and more reliable surgical planning., Clinical Significance: The computer-based method streamlines orthognathic surgical planning, enhancing precision and efficiency without compromising clinical accuracy, ultimately improving patient outcomes and reducing the workload of surgeons., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

This retrospective study aimed to evaluate the difference in the temporomandibular joint (TMJ) space volume between the deviated (Dev) and non-deviated (NDev) side following transoral vertical ramus osteotomy (TOVRO) in patients with mandibular prognathism combined with asymmetry using reconstructed 3-dimensional images. Sixty joints from 30 patients who underwent TOVRO between January 2018 and December 2021 were included. Computed tomography (CT) or cone-beam CT was performed before surgery (T0), and 6 (T1) and 12 months postoperatively (T2). The volume of the overall joint space (Vjs) and its compartments (i.e., the anterior, posterior, medial, and lateral joint spaces) were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used. Vjs increased at T1 compared to T0 and decreased at T2 compared to T1 (p < 0.0001). Furthermore, the volume changes over time were statistically significant in all compartments (p < 0.05); however, there was no significant difference in the Vjs and its compartments between the Dev and NDev side over time (p > 0.05). Adjustments for sex and mandibular movements did not affect the results. This study can provide the basis in TMJ spatial change and predicting the prognosis after TOVRO in facial asymmetry., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The study was approved by the institutional review board of Yonsei University Gangnam Severance Hospital approved this retrospective study (IRB No. 3-2024-0125), and waiver of written informed consent for this retrospective study. This study was also conducted according to the principles of the Declaration of Helsinki for research on humans., (© 2025. The Author(s).)

The Aim of the Study: To study the possibilities of using digital dental techniques in the rehabilitation of a patient after surgical treatment of unilateral ankylosis of the temporomandibular joint (TMJ) using the condylotomy method., Material and Methods: Digital dental techniques, the method of electronic axiography, cone-beam computed tomography, intraoral scanning, programs that allow compiling the obtained data into a general functional-dynamic model were used., Results: The use of digital dental techniques in the rehabilitation of people after surgical treatment of unilateral TMJ ankylosis using condylotomy is advisable, since they are painless and safe for the patient. Standardization of the procedure allows obtaining reliable information, including during dynamic observation. Thanks to the use of a digital approach, it becomes possible to combine the results of individual digital methods into one functional model, which allows for a comprehensive analysis of the rehabilitation process., Conclusion: The use of digital dental techniques is becoming a necessary step in dental rehabilitation and carries the prospects for further digital development of dentistry and MSF.

Background: Temporomandibular joint (TMJ) replacement may be indicated for various pathological conditions, and the type of condition can affect the surgical procedure and outcomes. The causes of limited range of motion after alloplastic TMJ replacement have not been extensively studied., Objectives: The present study aimed to evaluate the impact of preoperative jaw anatomy and functional status on the immediate and long-term outcomes of total TMJ replacement using a two-component patient-specific TMJ endoprosthesis., Material and Methods: This retrospective study included 31 patients who underwent total TMJ replacement surgery between 2016 and 2020. The main outcome variable was the maximal incisal opening (MIO) after treatment. Secondary outcome variables included MIO improvement and the presence and type of postoperative complications. The primary predictive variable was the preoperative initial MIO. Secondary predictive variables included sex, age, indications for TMJ replacement, preoperative occlusion, condition of the glenoid fossa and/or condyle, shortening of the mandibular ramus, sagittal mandible position, lateral chin deviation, shape of the coronoid process, and type of surgery., Results: The mean preoperative MIO was 13.0 ±8.0 mm, while the mean MIO 1 month after surgery was 20.6 ±5.5 mm, which was not statistically significant. However, at a later follow-up, functional parameters showed a significant improvement (p = 0.003), with a mean MIO of 32.5 ±5.0 mm 3 years after surgery. Statistical analysis indicated that the initial mouth opening is the strongest predictor of long-term functional recovery after TMJ replacement. Postoperative complications occurred in 4 cases (12.9%) following patient-specific endoprosthesis (PSE) placement., Conclusions: The use of PSEs for TMJ replacement has enabled the restoration of anatomical relationships in complex clinical cases and an improvement in mouth opening. The preoperative MIO was the only factor that significantly influenced long-term functional outcomes.

Temporomandibular joint (TMJ) prostheses are considered an important alternative for the treatment of severe end-stage TMJ disorders. However, unilateral TMJ replacement may affect the healthy contralateral TMJ. The purpose of this study was to systematically review the literature on the effects of unilateral total TMJ prosthesis placement on the contralateral healthy TMJ. The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched for English-language articles published up to December 2023. Inclusion criteria encompassed clinical studies (randomized, prospective, retrospective, observational) that evaluated clinical and patient-reported outcomes after total unilateral TMJ prosthesis placement (both glenoid and mandibular components). The initial search identified 141 non-duplicate studies, of which eight remained after title and abstract reading. Four studies included only unilateral prostheses; the other four included bilateral interventions and/or control groups without any TMJ intervention. The studies reported on stock and custom prostheses, with custom prostheses being the most used. As the studies had different specific objectives, no pattern of data reporting was found and the research question could not be answered. Randomized clinical trials with standardized variables are required to achieve reliable conclusions. Furthermore, long-term follow-up is necessary to determine whether the function of the healthy TMJ is compromised., Competing Interests: Competing interests None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study aims to evaluate a temporomandibular joint (TMJ) arthroscopy simulator using construct and face analyses., Methods: Thirty participants attending a TMJ training course were divided into novice and expert surgeons (more than 100 procedures) and performed two arthroscopic tasks (cavity access/cavity exploration) during which the surgical tool movements were tracked. Five objective metrics were used to measure surgeon ability and construct validity was assessed by comparing novel and expert performance. Face validity was assessed by subjective questionnaires rating simulator realism and utility (1-5 scale) and tissue consistency (1-4 scale)., Results: Expert surgeons spent less total time (76.58 ± 47.40 vs. 27.60 ± 5.52; novices vs. experts) with higher average speed (7.40 ± 5.32 vs. 12.65 ± 5.37) and average acceleration (198.33 ± 2.42 vs. 325.93 ± 87.36). Movement smoothness revealed lower values in novice surgeons (3638.33 ± 1083.95 mm/s 3 ; 2553.70 ± 768.01 mm/s 3 ) than in expert surgeons (4655.63 ± 837.05 mm/s 3 ; 4172.08 ± 1098.61 mm/s 3 ). All these outcomes reached statistical significance (p ≤ 0.05) but in contrast total path of the instruments did not. Face validity scores averaged 4.75/5 for utility and over 4/5 for realism except for watertightness. Tissue consistency was regarded as lower than human tissue but without impact on the training experience. There were no statistically significant differences between the two groups., Conclusions: Both the construct and face validity analyses confirmed the TMJ simulator can be regarded as a valuable, safe, economic adjunctive tool to train TMJ arthroscopy., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. All rights reserved.)

Background: Custom-designed and patient-fitted temporomandibular joint replacement (TMJR) devices are used to manage end-stage temporomandibular joint (TMJ) pathology, distorted bony TMJ architecture, or in patients who have undergone multiple prior failed TMJ surgeries., Purpose: This study aimed to measure the frequency of revision or replacement over time, estimate the 1-, 2-, and 3-year survival rate of implants, and determine what demographic, anatomical, or operative variables may be associated with a device adverse event (AE)., Study Design, Setting, Sample: A prospective cohort study was conducted on consenting adults who could read English, implanted with the TMJ Concepts TMJR prostheses between 2013 and 2015 by private or academic surgeons. Patients under the age of 18 and those who were incapable, unwilling, or unable to complete the perioperative forms were excluded., Main Outcome Variable: The primary outcome variable was the frequency of AEs, which is defined as device revision or replacement. The secondary outcome variable was the survival rate for the TMJ Concepts devices., Analyses: Device survival at 1, 2, and 3 years was estimated using the Kaplan-Meier methodology. Cox proportional hazards regression was used to analyze the effects of the predictor variables for the device survival rate. A P value of <.05 was considered significant., Results: A total of 738 subjects (1,098 joints) were enrolled in the study with 102 (14%) males and 636 (86%) females. The mean age was 45.4 (+14.8) years. The median follow-up period was 36.2 months (95% CI: 36.1 to 36.2 months). A total of 187 subjects (25.3%) were lost to follow-up during; the study period. Forty-nine devices (4.46%) were associated with an AE at 3 years. The; 3-year device survival was 95.1% (95% CI: 93.6 to 96.3%). The only significant risk factor for an AE was the asymmetry of the mandible (hazard rate ratio = 1.989, P = .03). The primary diagnosis was not associated with the time to an AE (P value = .8685). Infection (44.7%, 21 joints) and material sensitivity (12.8%, 6 joints) were the most common reasons specifically for device removal/replacement in the study cohort., Conclusion and Relevance: Infection was the primary reason reported for device revision or replacement followed by material sensitivity. In the study cohort, the device survival following implantation of the TMJ Concepts prosthesis was not significantly different than reported by the TMJR stock device., (Copyright © 2025 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA)., Material and Methods: 5 and 10 mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated., Results: The stresses on the cartilage were 1.150 MPa on the 5 mm advancement model and 1.506 MPa on the 10 mm advancement model. The stresses on the disc were 11.56 MPa on the 5 mm advancement model, 7.94 MPa on the 10 mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback., Conclusion: SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: To compare the effect of plasma rich in growth factors (PRGF), hyaluronic acid (HA), and saline intra-articular injections following temporomandibular joint arthroscopy on decreasing pain and increasing maximal mouth opening., Methods: Included patients were randomized into three groups: PRGF group, hyaluronic acid group, and control group. Intra-articular injections were done at the end of the arthroscopy. Pain was measured using the VAS scale preoperatively, 7 days, 1 month, and 6 months postoperatively. Maximal mouth opening was measured preoperatively and 7 days postoperatively., Results: There was a statistically significant decrease in pain in all groups, although, the decrease was significantly greater in the HA group following surgery., Conclusion: A hyaluronic acid injection following temporomandibular joint arthroscopy can decrease pain better than saline and platelet-rich plasma during the first postoperative week. However, the results do not differ in later postoperative periods.

Temporomandibular joint ankylosis (TMJ ankylosis) manifests itself as a locked jaw and reduced mouth opening. We hypothesized that the efficacy of TMJ ankylosis surgery in a child may largely depend on physiotherapeutic management. In this case report, we present the treatment of a girl between 1 and 4 years of age, who was unable to open her jaws immediately after birth. Congenital ankylosis was diagnosed. Two models of therapeutic management were presented, with a surgical procedure to release bone fusion adopted as a starting point. In the first model, the rehabilitation procedure started 21 days after surgery. Despite rehabilitation, no clinical improvement was achieved (i.e. the child was still unable to open her jaws). In the second model, rehabilitation started from the day after surgery and management according to the second model allowed for obtaining therapeutic benefits. After therapy, the girl was able to abduct the mandible to a degree allowing for improved speech and the ability to crush food. This clinical case shows that the efficacy of surgical procedures may depend on the type of postoperative management. It was demonstrated that physiotherapy started immediately after the procedure to release the ankylosis improved the mandible mobility outcomes for this child. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify potential clinical and radiological predictors associated with the outcome of discectomies. Methods: In this retrospective observational study, the material comprised preoperative CBCT images and medical records of 62 patients with disc derangement disorders, who had undergone discectomy because of disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR), systemic arthritis (SA), or joint hypermobility. Clinical and radiographic variables were analysed in relation to success rate determined by subjective, objective and combined outcomes. Results: The success odds ratio was 11 times higher in patients with painful DDwR versus that of SA (p = 0.03), and even 25.9 times higher when considering solely objective outcome (p = 0.03). In the absence of subchondral pseudocyst, there were 5.2 times higher odds to have a successful subjective outcome (p = 0.04). Extensive bone apposition on the temporal joint component indicated a 9.3 times higher likelihood of a failed objective outcome (p = 0.04). Conclusions: There is a significant higher risk for combined outcome failure for the diagnosis SA involving the TMJ compared with DDwR. Predictors of importance based on CBCT findings related to the objective outcome failure were extensive bone apposition on the temporal joint component and condylar subchondral pseudocysts for the subjective outcome failure. [ABSTRACT FROM AUTHOR]

Roxanne Bavarian,1,2 Michael E Schatman,3,4 David A Keith1,2 1Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; 2Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Ma, USA; 3Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU School of Medicine, New York, NY, USA; 4School of Social Work, North Carolina State University, Raleigh, NC, USACorrespondence: David A KeithDepartment of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USATel +1 617 643-1425Fax +1 617 726-2814Email dkeith@mgh.harvard.eduAbstract: Over three decades ago, hundreds of predominantly young women with temporomandibular joint pain and other symptoms were implanted with a prosthetic device composed of Proplast-Teflon that subsequently caused considerable harm, with patients developing chronic pain, dysfunction, and disability. This perspective review presents such a patient who suffered for decades with severe pain despite extensive pharmacotherapy, injection therapy, multiple surgeries, and behavioral health interventions. The details of the origin and subsequent events regarding the use of Proplast-Teflon interpositional implants in the temporomandibular joint are described with resources from several different perspectives. The lessons learned demonstrate failures at the federal, professional, and individual level.Keywords: Proplast-Teflon, implants, temporomandibular joint surgery, temporomandibular joint replacement, risk management, medicolegal, chronic pain

Background: Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients.Objective: The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction.Methods: A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus.Results: The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process.Conclusions: A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The. [ABSTRACT FROM AUTHOR]

The management of infected temporomandibular joint prostheses presents a surgical challenge. In certain instances, an intermediate approach involving biofilm debridement and local antibiotic instillation may obviate the need for prosthesis removal. This technical note describes an update of the technique outlined by Wolford for managing infections, in which improved materials are used to implement the technique., Competing Interests: Conflict of Interest None., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. Previously, we utilized the medial femoral condyle (MFC) flap for TMJ reconstruction. However, the optimal fixation method remains uncertain. In this study, finite element analysis was used to study the effects of three different fixation types of bone graft: overlap type, bevel type, and flush type. Models of different fixation types of MFC flap were reconstructed from CT images. A standard internal fixation model for extracapsular condylar fracture was also included as a control. Displacement of bone graft, deformation of plates and screws, and stress distribution of plates, screws, and cortical and cancellous of the bone graft were analyzed by finite element analysis to investigate their biomechanical features. The displacement of the bone graft and deformation of plates and screws in three different fixation types showed no significant difference. The overlap type and flush type of fixation displayed the lowest and highest stress respectively. All three fixation types could satisfy the mechanical requirement and face no risk of breakage and the major displacement of the MFC bone graft. These results provide insights into the optimal fixation approach for MFC bone grafts, offering valuable guidance and reference for clinical application., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Pain intensity after temporomandibular joint (TMJ) surgery is often underestimated, and inadequate pain control may relate to poor recovery quality, increased opioid consumption, and longer hospital stay. This trial aims to evaluate whether non-opiate anesthesia provides a promising option of pain management for patients undergoing TMJ surgery., Methods: Sixty patients receiving TMJ surgery were randomly assigned to either the control group or the non-opiate group. Non-opiate anesthesia used lidocaine, dexmedetomidine, and ketamine infusion therapy for pain management. The primary outcome was the highest documented pain score while in the post-anesthesia care unit (PACU). Secondary outcomes included perioperative opioid consumption, utilization, dosage, and timing of rescue analgesia in the PACU, incidence of postoperative nausea and vomiting in the PACU and at home, pain satisfaction levels, occurrence of opioid-related adverse effects, duration of PACU and hospital stays, and total consumption of oxycodone-acetaminophen tablets at 24 and 48 hours post-surgery., Results: Patients were predominantly female (88.3%) and had a median age of 37.5 [IQR 26.0, 52.5] years. There were no significant differences observed in the highest documented pain scores (mean difference [MD] -0.36 points, 95% CI: -1.84, 1.12, p = 0.63), postoperative oxycodone-acetaminophen consumption (MD 6.68 mg, 95% CI: -2.48, 15.84, p = 0.15), pain satisfaction (odds ratio [OR] 0.81, 95% CI: 0.23, 2.81, p = 0.74), time to PACU discharge (hazard ratio [HR] 1.24, 95% CI: 0.67, 2.30, p = 0.49) or time to hospital discharge (HR 1.48, 95% CI: 0.80, 2.75, p = 0.21) between the two groups. Similarly, no significant difference was observed in time to rescue analgesia, calculated in minutes from the end of surgery (HR 1.69, 95% CI: 0.79, 3.61, p = 0.18)., Conclusion: Non-opiate anesthesia for pain management shows a similar postoperative analgesia effect, compared to opioid-based anesthesia, in patients undergoing arthroscopic TMJ surgery., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Ma et al.)

Temporomandibular joint (TMJ) and infratemporal fossa (ITF) tumors, even though rare, present diagnostic complexities due to their nonspecific symptoms. Synovial sarcoma comprises 5-10% of adult soft-tissue sarcomas and is uncommon in the head and neck and exceptionally rare in the TMJ/ITF region. We presented a case of monophasic synovial sarcoma affecting the left TMJ/ITF in a 24-year-old man with severe preauricular pain who was misdiagnosed with temporomandibular disorder for 3 years. When in-depth evaluations uncovered a 40 mm tumor adjacent to the TMJ, extensive resection and immediate reconstruction were conducted, followed by postoperative radiotherapy and adjuvant chemotherapy. Magnetic resonance imaging photos of the early stage and after 3 years of tumor progression, initial signs and symptoms, and intraoperative images allowed tumor evolution assessment., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The repair of hemimandibulectomy defects involving the temporomandibular joint (TMJ) is challenging. This study compared the functional outcomes and reconstruction accuracy using a deep circumflex iliac artery (DCIA) flap with and without a virtually planned stock TMJ prosthesis (TMJP) after hemimandibulectomy. Ten patients were assessed: five with a TMJP (TMJP group) and five without (control group). A three-dimensional comparison revealed a mean deviation of 0.11 ± 0.04 mm between the planned and actual DCIA flap with TMJP. The planned and actual TMJP positions differed by 0.56 ± 0.57 mm in height, 0.33 ± 0.24 mm ventrally/dorsally, and 1.18 ± 0.42 mm medially/laterally. Mouth opening, laterotrusion, and midline deviation were significantly greater in the control group than in the TMJP group (P = 0.024, P = 0.008, P = 0.024). The deviation in ventral to dorsal translation for the DCIA flap was slightly higher than reported values in the literature, while height deviation was comparable. Lower deviations in the literature were due to the DCIA flap being used where both TMJs were intact. The in-house virtually planned DCIA flap with stock TMJP yielded results comparable to more expensive patient-specific prostheses., Competing Interests: Competing Interests No competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

There are few animal models for heterotopic ossification of the temporomandibular joint (TMJ-HO). This scoping review provides an overview of current knowledge on the induction methods and specific conditions required to produce TMJ-HO in various animal models. Two independent reviewers selected papers from the PubMed, Web of Science, and Cochrane Library databases. The inclusion criteria were articles in English, in vivo studies, and a TMJ-HO induction method. Observational, in vitro, human studies, reviews, and book chapters were excluded. Twenty-four publications were included. HO was surgically, genetically, or chemically induced through single or combined defects in the condyle, articular disc, and temporal bone in animal models (sheep=9 studies, mouse=5, rat=4, rabbit=2, pig=2, goat=1, dog=1, monkey=1) specific for traumatic TMJ-HO (n=4), ankylosis (n=9), osteoarthritis (n=8), experimental disc perforation (n=1), status post-TMJ replacement (n=1), and status post bilateral sagittal split osteotomy (n=1). TMJ-HO remains challenging to study due to its multifactorial etiology and largely unknown pathogenesis, which varies between species. There is a need for more accurate, reproducible animal models that can be extrapolated to human TMJ-HO and a consolidated clinical classification system to allow for meaningful future research., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to evaluate the efficacy of bilateral TMJ arthroscopy in patients with different Wilkes stages, comparing the results obtained in different arthroscopic levels on a larger scale, unifying similar populations., Methods: A multicentric prospective clinical study was conducted in three TMJ departments performing temporomandibular joint surgery in Portugal and Brazil, with an enrolling window active from January 1, 2019, to December 1, 2022. The primary clinical outcome was TMJ pain evaluated through a visual analogue scale. The secondary clinical outcome was the maximum mouth opening (MMO). TMJ arthroscopy was performed with a 1.9-mm arthroscope, including a video system with a 2.8-mm outer protective cannula., Results: 262 patients, representing a total of 524 operated joints were enrolled. The mean age was 35.3 years. A significant decrease postoperatively in VAS pain was observed for all Wilkes stages. The lowest value of VAS pain was observed in Wilkes II compared to Wilkes III and IV. In the secondary outcome, MMO was observed to have a significant improvement in all Wilkes stages., Conclusion: In this multicentric study, bilateral TMJ arthroscopy was shown to be an effective procedure to reduce pain and increase maximum mouth opening in patients with different Wilkes stages, representing a valid minimally invasive solution., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: With the capacity to provide maximal lesion exposure, the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy is highly utilized in radical resection of skull base tumors. While this approach requires disruption of the temporomandibular joint (TMJ) for access, the effects of this maneuver are poorly appreciated in neurosurgery. The aim of this study was to assess the morbidity of condylar fossa osteotomies by comparing oral health quality of life (OHQOL) and general health quality of life (GHQOL) outcomes after TMJ-involving and TMJ-sparing skull base approaches., Methods: A retrospective review of the medical records of patients who underwent surgery with the SPI approach (TMJ-involving approach) for skull base chondrosarcoma (CS) by a single senior surgeon at Vancouver General Hospital between 2002 and 2022 was performed. Patients undergoing TMJ-sparing anterolateral approaches for trigeminal schwannoma (TS) during the same study period by the same surgeon were included as controls. GHQOL was evaluated using the 36-item Short Form Health Survey from preoperative and postoperative periods. Postoperative OHQOL was evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I/II screening instrument., Results: Data regarding quality of life were available for 13 of 19 CS patients and 12 of 15 TS patients surgically managed between 2002 and 2022. CS patients demonstrated less jaw dysfunction in all parameters of the DC/TMD Axis I/II components when specifically assessing OHQOL. CS patients had a lower likelihood of temporomandibular disorder (TMD) presence on the TMD pain screener than TS patients (25% vs 45%, p = 0.40). Chronic pain scores were higher in the TS group, with significantly more patients with grade 2 or higher pain (36.4% vs 0%, p = 0.01). The mean Jaw Functional Limitation Scale (JFLS) scores were lower in CS patients than in TS patients. Both CS and TS patients demonstrated lower mean JLFS scores (0.50 and 0.81, respectively) than patients with chronic TMD (1.76), but higher mean JLFS scores than patients without TMD (0.16)., Conclusions: The authors report novel findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQOL and GHQOL among skull base tumor patients. Anatomical disruption of the TMJ was not associated with significant clinical TMJ dysfunction. Compared with TS patients, CS patients had even lower mean scores in TMJ-related morbidity, and both groups had lower TMJ morbidity than patients diagnosed with chronic TMJ dysfunction. Condylar fossa osteotomies can therefore be considered without concern of significant additional morbidity.

Objective: To conduct a retrospective study on the treatment outcomes of patients who underwent artificial temporomandibular joint (TMJ) replacement surgery and to evaluate the effectiveness of artificial TMJ treatment. Methods: This study selected 62 patients who received standard Biomet artificial TMJ treatment at Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University from May 2010 to September 2023 as the study subjects. Among them, there were 15 male patients and 47 female patients. The average age was 33.5 years old(ranging from 18 to 67 years). This study statistically analyzed postoperative indicators, including maximum mouth opening, forward jaw movement, lateral movement, postoperative pain scores, and patient satisfaction. Results: This study included a total of 62 patients with 99 TMJ joints. No infections occurred postoperatively. The average follow-up period was 33.7 months (ranging from 7 to 170 months). At 6 months postoperatively, the mean mouth opening was (36.1±6.2) mm, lateral movement was (2.1±0.9) mm, and forward jaw movement was (1.0±0.9) mm. The pain visual analog scale score at 6 months postoperatively was (2.8±0.6), and patient satisfaction with the surgery was (8.8±1.1). Spiral CT scans conducted after surgery showed no joint dislocation or migration, and the artificial joint remained stable during the follow-up period. Conclusions: Artificial TMJ replacement is a valuable method for effectively restoring TMJ structure and essential functions related to mouth opening and chewing. It is worthy of promotion as a reconstructive approach for the temporomandibular joint.

Temporomandibular joint (TMJ) surgery in China, as an important part of oral and maxillofacial surgery, has made significant progress in the past 20 years. It is mainly reflected in the reduction of TMJ dislocated joint disc, prosthetic total TMJ reconstruction, and the treatment of adult condylar fracture. There are major controversies about the surgical methods and indications for the reduction of the dislocated/displacement joint disc of the temporomandibular disorders.

Replacement of the temporomandibular joint (RTJ) has undergone decades of technological improvements and is now an important treatment for end-stage temporomandibular joint (TMJ) disease. The main complications of RTJ include aseptic loosening, heterotopic ossification, postsurgical infection, hypersensitivity reaction, prosthesis loosening or malposition, nerve injury and severe bleeding. Improvement in clinical technique is now the key to resolving complications. In the future, improvements in prosthetic materials may be an important development for newer iterations. With the development and popularity of TMJ surgical techniques, prosthesis-related complications will increasingly come into clinical view. This article provides a systematic review of the complications of RTJ prosthesis replacement and the measures to deal with them, and looks forward to the direction of the development of this field from the perspective of reducing complications, so as to provide a reference for clinical work.

To search for the best available scientific evidence in relation to the reported overall and selective complication rates for arthroscopic surgery in patients presenting with internal derangement (ID) of the temporomandibular joint (TMJ). A comprehensive electronic search was conducted without data or language restrictions up to August 2023. Inclusion criteria were the following: study in humans, randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies and series of clinical cases. The proposed PICOS question was: "In clinical trials and retrospective clinical series of patients treated by arthroscopy, which were the overall and selective complication rates?" Exclusion criteria were animal studies, review papers, technical reports, and in vitro studies. The Cochrane Collaboration Tool was used to assess the risk of bias of the included studies in terms of their quality. The Strength of Recommendation Taxonomy (SORT) classification was used to determine the level of evidence of the selected studies. A total of 498 studies were identified. Of these, 16 studies fulfilled the inclusion criteria and were selected for qualitative assessment. Temporary 5th nerve deficit, ranging from 0.15% to 2.38%, was reported to occur in most larger series, comprising 7394 operated joints. Temporary 7th nerve paresis was reported to occur in 0.21%-0.7% in the largest series, comprising 6866 operated joints. Partial hearing loss was reported in 6 studies, ranging from 0.21% to 2.2% in 5845 operated joints. Edema of surrounding soft tissues, including parapharyngeal, soft palate and/or preauricular edema was reported in 8 studies, with complication rates ranging from 2% to 17.9% in 2274 operated joints. Laceration of the EAC was reported in 8 studies involving 2665 operated joints, with complication rates ranging from 0.3% to 6%. A total of 872 complicated events among 11,304 operated joints were reported, accounting for an overall complication rate of 7.71%. Complications from arthroscopic procedures have been inconsistently reported, but there are a small number of retrospective studies with well-reported complications rates. As overall complication rate accounts for less than 8% of the cases, arthroscopy seems to be a highly safe procedure for the treatment of internal derangement (ID) of the TMJ. Due to the absence of studies with high evidence, information for patients about complications should be based on clinical series of cases., Competing Interests: Declaration of competing interest There are no disclosures that might pose a potential, perceived or real conflict of interest., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The temporomandibular joint (TMJ) is the critical functional unit in the human stomatognathic system. Damage of the TMJ causes orofacial dysfunction and secondary jaw deformities, leading to seriously decreased quality of life in patients. The TMJ prosthetic replacement is an important treatment method for severe joint destruction because of its remarkable advantages compared with other methods. In recent years, this technique has gradually attracted wide attention in China, but it has not been popularized on a large scale in our country because of several limitations. Thus, in this study, the clinical experience of patients with TMJ prosthetic replacement in clinical units was summarized, and the treatment principles, treatment processes, and technical advantages were systematically discussed, aiming to promote the popularization and application of TMJ prosthetic replacement in China.