In this study, we evaluated the short-term clinical effect of pumping lavage and arthrocentesis for 31 closed lock cases of the temporomandibular joint that had no improvement with conservative treatment. The analysis of the interincisal range of mouth opening and VAS (visual analogue scale) was measured preoperatively and at one month and two months after pumping lavage or arthrocentesis. On the interincisal range of mouth opening, both procedures showed appropriate improvement postoperatively. Arthrocentesis of VAS at two months postoperatively was reduced significantly compared with preoperatively and at one month postoperatively. VAS of pumping lavage at two months postoperatively was reduced significantly compared with preoperatively but it was not reduced significantly compared with one month postoperatively. To improve the interincisal range of mouth opening and reduce pain, it was also indicated that irrigation of the joint space should be done with a sufficient amount of saline solution and under adequate fluid pressure.

View full abstract

We performed a postoperative functional evaluation using electromyography of the lateral pterygoid muscle in a patient with temporomandibular joint disorders who underwent open TMJ surgery. The patient was a 44-year-old male with chief complaints of trismus and pain of the left temporomandibular joint.
Temporomandibular joint disorders (classification of JSTMJ: osteoarthritis), closed lock, and a stuck disc were noted on MRI. Exploratory pumping manipulation was performed, but was ineffective. Double contrast CT of the temporomandibular joint detected marked bilateral fibrous adhered lesions. Open TMJ surgery on removal of adhesions and pseudowalls assisted by arthroscopy was performed. We observed characteristic activities of the lateral pterygoid muscle (I-Lpt). Before surgery, muscular activity of I-Lpt was noted even when the mouth was closed, and no coordinated activity with the digastric muscle posterior belly of the mouth-opening muscles was noted.
After surgery, I-Lpt acted in coordination with the mouth-opening muscles, and reciprocal activity with the mouth-closing muscles was noted.
Regarding the jaw movement, limitation of right lateral movement was noted in the track of incisal point movement before surgery, but the range of protrusive and lateral movements increased after surgery. As for the movement of the heads of the mandible, the bilateral mandibular heads mainly showed hinge movement before surgery, but the range of movement of the left mandibular head increased in opening the mouth after surgery. This study revealed that pre-and post-operative functional evaluation using I-Lpt is useful.

View full abstract

The methods of treating recurrent temporomandibular joint dislocation in patients of advanced age or with cerebrovascular disease are not easily applied. We present here four cases with such recurrent dislocation who were treated with autologous blood injection into the upper temporomandibular joint cavity.
Case 1: A 74-year-old man with left hemiplegia for a cerebral infarction underwent autologous blood injection into the upper temporomandibular joint cavity and suture of the capsule, because he had frequent temporomandibular joint dislocations.
Cases 2 and 3: Two men in their fifties, who were admitted for subarachnoid hemorrhages, underwent autologous blood injection into the temporomandibular joint cavity and pericapsular tissue for recurrent temporomandibular joint dislocations.
Case 4: A 80-year-old woman, who was recognized as having recurrent dislocation of the right temporomandibular joint during hospitalization for ileus, underwent autologous blood injection into the right temporomandibular joint cavity and pericapsular tissue.
All patients received intermaxillary fixation or qualification of mouth opening with a chin cap for a few days. All cases achieved satisfactory results.

View full abstract