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Radiologic outcomes of temporomandibular joint disk repositioning by suturing through an open incision in adolescent patients with anterior disk displacement

  • Xuehong Wang
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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  • Yi Mao
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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  • Xuzhuo Chen
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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  • Jinze Zhen
    Correspondence
    Corresponding authors
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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  • Shanyong Zhang
    Correspondence
    Corresponding authors
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Published:August 30, 2022DOI:https://doi.org/10.1016/j.oooo.2022.08.012

      Purpose

      To investigate the efficacy and stability of temporomandibular joint disk repositioning by suturing through an open incision in adolescents with anterior disk displacement (ADD).

      Methods

      Patients (aged 10-18 years) diagnosed with ADD and operated for disc repositioning between June 2019 and January 2021 were included in this study. Magnetic resonance imaging (MRI) and cephalometric films before and 1 year after surgery were collected from all patients. The surgical success rate was defined as the primary outcome variable. Changes of condylar height, mandibular asymmetry, and retrognathia were defined as the secondary outcome variables.

      Results

      One hundred and four patients (167 joints) with a mean age of 14.6 ± 1.81 years were included in this study. Postoperative MRIs showed that all disks had been repositioned with an overall success rate of 94%. Statistically significant differences were found in the improvement of condylar height (P < .001), mandibular asymmetry (P < .001), and retrognathia (P < .001) after 1 year of follow-up. The relapse rate in patients <15 years (8.57%) was higher than that of patients older than 15 years (4.12%), although this was not statistically significant (P = .387).

      Conclusions

      For juvenile patients, disk repositioning by suturing through an open incision was an effective treatment. Early surgery can promote condylar regeneration and alleviate maxillofacial deformity in juvenile patients.
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      References

        • Ribeiro RF
        • Tallents RH
        • Katzberg RW
        • et al.
        The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years.
        J Orofac Pain. 1997; 11: 37-47
        • Xie Q
        • Yang C
        • He D
        • Cai X
        • Ma Z.
        Is mandibular asymmetry more frequent and severe with unilateral disc displacement?.
        J Craniomaxillofac Surg. 2015; 43: 81-86
        • Choi HJ
        • Kim TW
        • Ahn SJ
        • Lee SJ
        • Donatelli RE.
        The relationship between temporomandibular joint disk displacement and mandibular asymmetry in skeletal class III patients.
        Angle Orthod. 2011; 81: 624-631
        • Sakar O
        • Calisir F
        • Oztas E
        • Marsan G.
        Evaluation of the effects of temporomandibular joint disk displacement and its progression on dentocraniofacial morphology in symptomatic patients using lateral cephalometric analysis.
        Cranio. 2011; 29: 211-218
        • Hosgor H.
        The relationship between temporomandibular joint effusion and pain in patients with internal derangement.
        J Craniomaxillofac Surg. 2019; 47 ([published correction appears in J Craniomaxillofac Surg. 2021 Aug;49(8):748]): 940-944
        • McCarty WL
        • Farrar WB.
        Surgery for internal derangements of the temporomandibular joint.
        J Prosthet Dent. 1979; 42: 191-196
        • Zhang S
        • Liu X
        • Yang X
        • et al.
        Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by magnetic resonance imaging.
        BMC Musculoskelet Disord. 2010; 11: 262
        • He D
        • Yang C
        • Zhu H
        • Ellis 3rd, E
        Temporomandibular joint disc repositioning by suturing through open incision: a technical note.
        J Oral Maxillofac Surg. 2018; 76: 948-954
        • Puthukkudiyil JS
        • Bhutia O
        • Roychoudhury A
        • Bhatt K
        • Yadav R
        • Bhalla AS.
        Does repositioning of temporomandibular joint disc with bone anchors provide better clinical outcomes than conventional disc plication procedures for anterior disc displacements without reduction in patients refractory to nonsurgical treatments?.
        J Oral Maxillofac Surg. 2020; 78: 2160-2168
        • Liu Z
        • Xie Q
        • Chen M
        • Yang C
        • Bai G.
        Measurement of mandibular condylar height based on magnetic resonance imaging.
        J Craniofac Surg. 2020; 31: e415-e418
        • Cai XY
        • Jin JM
        • Yang C.
        Changes in disc position, disc length, and condylar height in the temporomandibular joint with anterior disc displacement: a longitudinal retrospective magnetic resonance imaging study.
        J Oral Maxillofac Surg. 2011; 69: e340-e346
        • Masuoka N
        • Momoi Y
        • Ariji Y
        • et al.
        Can cephalometric indices and subjective evaluation be consistent for facial asymmetry?.
        Angle Orthod. 2005; 75: 651-655
        • Wilkes CH.
        Internal derangements of the temporomandibular joint. Pathological variations.
        Arch Otolaryngol Head Neck Surg. 1989; 115: 469-477
        • Lei J
        • Han J
        • Liu M
        • Zhang Y
        • Yap AU
        • Fu KY.
        Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults.
        J Craniomaxillofac Surg. 2017; 45: 408-413
        • Farronato G
        • Rosso G
        • Giannini L
        • Galbiati G
        • Maspero C.
        Correlation between skeletal Class II and temporomandibular joint disorders: a literature review.
        Minerva Stomatol. 2016; 65: 239-247
        • Zhou D
        • Hu M
        • Liang D
        • Zhao G
        • Liu A.
        Relationship between fossa-condylar position, meniscus position, and morphologic change in patients with Class II and III malocclusion.
        Chin J Dent Res. 1999; 2: 45-49
        • Goncalves JR
        • Wolford LM
        • Cassano DS
        • da Porciuncula G
        • Paniagua B
        • Cevidanes LH.
        Temporomandibular joint condylar changes following maxillomandibular advancement and articular disc repositioning.
        J Oral Maxillofac Surg. 2013; 71 (1759.e1-1759.e15)
        • Zhu H
        • He D
        • Yang Z
        • Song X
        • Ellis 3rd, E
        The effect of disc repositioning and post-operative functional splint for the treatment of anterior disc displacement in juvenile patients with Class II malocclusion.
        J Oral Maxillofac Surg. 2019; 47: 66-72
        • Zhou Q
        • Zhu H
        • He D
        • Yang C
        • Song X
        • Ellis 3rd, E
        Modified temporomandibular joint disc repositioning with mini-screw anchor: part II-stability evaluation by magnetic resonance imaging.
        J Oral Maxillofac Surg. 2019; 77: 273-279
        • Mao Y
        • Chen X
        • Xie X
        • Xu W
        • Zhang S
        • Zhang S.
        Evaluation of an improved anchoring nail in temporomandibular joint disc repositioning surgery: a prospective study of 25 patients.
        J Craniomaxillofac Surg. 2021; 49: 929-934
        • Liu X
        • Shen P
        • Wang X
        • Zhang S
        • Zheng J
        • Yang C.
        A prognostic nomogram for postoperative bone remodeling in patients with ADDWoR.
        Sci Rep. 2018; 8: 4361
        • Lei J
        • Liu MQ
        • Yap AU
        • Fu KY.
        Condylar subchondral formation of cortical bone in adolescents and young adults.
        Br J Oral Maxillofac Surg. 2013; 51: 63-68
        • Wolford LM
        • Karras SC
        • Mehra P.
        Considerations for orthognathic surgery during growth, part 1: mandibular deformities.
        Am J Orthod Dentofacial Orthop. 2001; 119: 95-101
        • Wolford LM
        • Karras SC
        • Mehra P.
        Considerations for orthognathic surgery during growth, part 2: maxillary deformities.
        Am J Orthod Dentofacial Orthop. 2001; 119: 102-105
        • Liu Z
        • Xie Q
        • Yang C
        • Chen M
        • Bai G
        • Abdelrehem A.
        The effect of arthroscopic disc repositioning on facial growth in juvenile patients with unilateral anterior disc displacement.
        J Craniomaxillofac Surg. 2020; 48: 765-771
        • Zhu H
        • He D
        • Yang Z
        • Lu C
        • Zhao J
        • Yang C.
        The effect of condylar regeneration after different disc repositioning surgeries in adolescents with skeletal class II malocclusion.
        J Oral Maxillofac Surg. 2021; 79: 1851-1861
        • Gonçalves JR
        • Cassano DS
        • Rezende L
        • Wolford LM.
        Disc repositioning: does it really work?.
        Oral Maxillofac Surg Clin North Am. 2015; 27: 85-107
        • Nitzan DW
        • Marmary Y.
        The “anchored disc phenomenon”: a proposed etiology for sudden-onset, severe, and persistent closed lock of the temporomandibular joint.
        J Oral Maxillofac Surg. 1997; 55: 797-803