TMJ - Dislocation of Temporomandibular Joint, TMJ Internal Derangement, TMJ - Oral &Maxillofacial Surgery
Conditions
Keywords
TMJ, TMJ derangement, extracapsular surgery, supradiscal subperiosteal technique, facial plastic surgery
Brief summary
This study aims to evaluate the efficacy of the ESS technique in correcting TMJ internal derangement, with a focus on functional outcomes and patient satisfaction.
Detailed description
Background: Internal derangement (ID) of the temporomandibular joint (TMJ) is a prevalent condition characterized by disc displacement, leading to pain, restricted mandibular mobility, and reduced quality of life. While non-surgical treatments are often the first line of management, surgical intervention becomes necessary in refractory cases. Traditional surgical methods, such as arthrocentesis and disc repositioning, have shown variable success rates, particularly in advanced stages of disc damage. This study introduces the Extracapsular Supradiscal Subperiosteal (ESS) surgical procedure, a novel technique designed to address these limitations. Therefore, current study aims to evaluate the efficacy of the ESS technique in correcting TMJ internal derangement, with a focus on functional outcomes and patient satisfaction. Patients and Methods: A prospective study was conducted on 50 patients (47 females, 3 males; age range: 11-50 years) with TMJ ID refractory to non-surgical management. The ESS procedure was performed to reposition the displaced disc and stabilize retrodiscal tissues without violating the joint capsule. Preoperative and postoperative assessments included pain levels, maximum mouth opening (MMO), and subjective patient feedback.
Interventions
PROCEDUREExtracapsular Supradiscal Subperiosteal Surgical Procedure for Temporomandibular Joint Internal Derangement Correction
Patients in a supine extended position with nasotracheal intubation; oral intubation in such cases is not suitable as it makes dissection and disc repositioning difficult and compromises the surgery results. Periauricular incision with postauricular extension; after infiltration with noradrenaline 1/200000 solution with or without zylocaine which gives better exposure and better aesthetic results. Dissection down the wound till reach the temporal fascia starting posteriorlay till the fascia blended with the zygomatic arch anteriorly; identification of temporal root of zygomatic arch using fine dissector followed by subperiosteal dissection of zygomatic arch till five mm anterior to the articular eminence of TMJ. Accurate identification of TMJ followed by meticulous subperiosteal dissection of superior margin of TMJ capsule then the dissection continued posteriorly till posterior margin; no need to dissect the bilaminar zone, and the dissection continued anteriorly down the skull base t
Sponsors
Menoufia University
Sinai University
Mohamed Moawed Ibrahim Ghoneim, PhD
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A prospective study was conducted on 50 patients (47 females, 3 males; age range: 11-50 years) with TMJ ID refractory to non-surgical management. The ESS procedure was performed to reposition the displaced disc and stabilize retrodiscal tissues without violating the joint capsule. Preoperative and postoperative assessments included pain levels, maximum mouth opening (MMO), and subjective patient feedback
Eligibility
Sex/Gender
ALL
Age
11 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Patients with stage 3 or stage 4 internal derangements of TMJ radiological and clinical findings should coincide to set up the diagnosis and predict the treatment plan.
Exclusion criteria
* Age less than 11 years old * Age more than 50 years are excluded
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| TMJ Pain | 3 months | change of pain on a visual analogue scale (VAS) from 0 to 10 with decreased number means less pain |
| Interincisal Distance Score | pre- and post operative (3 days) | Interincisal Distance Scores from score-0 to score-3 to be identified |
| Jaw deviation during Mouth Opening | 3 days | A 13-score evaluating the jaw deviation during mouth opening from score-0 to score-12 |
| Clicking | 3 months | The clicking during mouth opening scores among study participants, both pre- and postoperative |
| HIT-6 | 3 days | the Headache impact test (HIT-6) both pre- and postoperatively among study participants |
Countries
Egypt
Outcome results
None listed