Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study

Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar’s test was used to evaluate CBCT and MRI changes (P < 0.05). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512 [http://clinicaltrials.gov/show/NCT01903512]

Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study

Among healthcare workers, oral and maxillofacial surgeons are some of the most exposed to coronavirus disease (COVID-19). The aim of this retrospective study was to develop suggestions for continuing the work of oral and maxillofacial surgeons using a safe protocol for elective and urgent aerosol-generating procedures that could prevent the onset of new clusters. Based on the results obtained and a guidelines review of those Asian countries that had promptly managed the current pandemic, the following safety protocol was developed

Subciliary versus swinging eyelid approach to the orbital floor

In this retrospective study, the authors compare the outcomes of two different approaches to the orbital floor: the classic subciliary versus the transconjunctival plus lateral canthotomy (swinging eyelid). Forty-five patients who underwent orbital surgery (47 approaches) for different indications (orbital fractures, correction of Grave’s exophthalmos, tumours of the internal orbit and correction of enophthalmos in secondary trauma) were placed in two groups, depending on the approach. The long-term effects of the incisions, the outcome of the approach and the complications were recorded and compared. The minimum follow-up for inclusion in the study was 1 year. Twenty-three orbits underwent subciliary incision, and 24 underwent swinging eyelid. No ectropion or entropion was seen in any patient. For the swinging eyelid approach, complications included three cases (12.5%) of canthal malposition; for the subciliary approach, five cases (21.14%) of lagophthalmos and 10 visible scars were observed. Our findings show the advantages of the swinging eyelid: better aesthetic results, the same or greater exposure of the orbital floor and the caudal part of the lateral and medial walls, shorter surgical time (sutureless) and a less extended scar. Although in our experience this approach is preferable in orbital surgery, some indications for the subciliary still remain

Cheek mucosa: a versatile donor site of Myomucosal flaps: technical and functional considerations

Background. Reconstruction of moderate-sized mucosal defects of the oral cavity/oropharynx represents a surgical challenge. The most widely used reconstructive techniques are skin grafts, local or regional pedicled flaps, and free flaps, but they do not provide mucosal sensitivity, mobility, volume, or texture similar to that of native tissue. The cheek myomucosal flaps seem to provide ‘‘ideal reconstruction’’ because they carry a thin, mobile, well-vascularized, and sensitive tissue, like those excised or lost. The purpose of this retrospective analysis was to evaluate the indications for the advantages and disadvantages of 6 types of buccinator myomucosal flaps which are possible to raise from the cheek mucosa. Methods. Sixty-nine buccinator myomucosal flaps were performed on 66 patients with moderate-sized postoncologic and posttraumatic oral and oropharyngeal defects. Results. In all cases except 1, flaps were successfully used with excellent oncological and functional results. Conclusion. Buccinator myomucosal flaps can be considered ‘‘ideal flaps’’ for three-dimensional oral and oropharyngeal reconstructions.</br

Evaluation of discriminative sensibility recovery in patients with buccinator myomucosal flap oral cavity reconstructions

Background: Sensitive restoration is the primary aim of oral reconstructive surgery. Discriminative sensibility is an important index of innervation density of a tissue. Instruments normally used to assess this type of skin sensibility are bulky and difficult to introduce in the oral cavity, even in healthy patients with a normal mouth opening. This study was intended to evaluate the recovery of static and dynamic two-point discrimination sensitivity of the reconstructed areas of the oral cavity. Methods: Surgical staples, calibrated in predetermined width (from 1 to 30 mm) and introduced in the oral cavity with a Mayo needle holder, were used to evaluate two-point discrimination recovery in 57 patients who underwent reconstructive surgery with buccinator myomucosal flaps. Tests were conducted both on the reconstructive flap and on the non-operated contralateral side. The latter also included the non-operated cheek. Results: All of the considered flaps showed a recovery of tactile sensitivity. The overall average discriminative threshold value assessed on this sample was 9.11 ± 2.46 mm for the static and 6.56 ± 2.46 mm for the dynamic. Conclusions: The use of surgical staples allows easy assessment of tactile sensitivity in all oral cavity areas, even in operated patients who often present lockjaw or microstomia. In our series, buccinator myomucosal flaps demonstrate a much greater recovery of the sensation compared to results found in the literature on fasciocutaneous free flaps, even those reinnervated. Level of Evidence: Level III, prognostic study

Complications and post-operative sequelae of temporomandibular joint arthrocentesis

Objective: To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate. Methods: This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period. Results: Temporary swelling of the periarticular tissues (95.1%) or the external auditory canal (23.5%), ipsilateral temporary open bite (68.8%), frontalis and orbicularis oculis paresis (65.1%), preauricular hematoma (0.4%), and a case of vertigo (0.2%) were the complications detected. Conclusions: TMJ arthrocentesis remains a procedure with a minimum number of important complications. If present, complications are generally temporary, caused by the anesthetic effect or by the soft tissue edema created by the fluid extravasation created by the irrigation procedure, and can be managed on an outpatient basis

Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study

Objectives: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. Subjects and Methods: Retrospective analysis of data from 22 secondary care centres in seven countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. Results: The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in patients with cancer treated with zoledronate. Conclusions: The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate and intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk-reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP