Clinical evaluation of the temporomandibular joint and masticatory muscles 10-15 years after mandibular setback surgery and six weeks of inter-maxillary fixation

Objectives. The purpose of this study was to clinically evaluate the TMJs and masticatory muscles 10-15 years after orthodontic-surgical treatment of mandibular prognathism. Material and methods. Thirty-six patients where included in this study. All patients had been operated with the intraoral vertical ramus osteotomy (IVRO) technique and subsequent inter-maxillary fixation (IMF) for six weeks. Mean follow-up period after surgery was 12.5 years, and mean age at the long-term follow-up examination was 34.1 years (range 27.2 – 59.8 years). At the long-term follow-up consultation, the masticatory muscles and TMJs were examined according to the Helkimo clinical dysfunction index. The participants also completed a questionnaire. Results. Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2). Statistically significantly greater in males compared to females (p=0.004). Mean Helkimo Dysfunction group was 1.5. None of the patients reported to have pain while chewing or opening the mouth on a weekly or daily basis. However, eight patients reported weekly (n=6) or daily (n=2) difficulties with maximum opening of the mouth. Conclusion. The results of the present study show that 10-15 years after IVRO setback surgery and subsequent IMF for six weeks, mandibular range of movement is satisfactory and the patients report few functional limitations or symptoms related to the TMJs and/or masticatory musculature.Prosjektoppgave / Integrert masteroppgaveOD3PROS

Surgical vs conservative treatment of medication-related osteonecrosis of the jaw—A complex systematic review and meta-analysis

Objective The objective of this study was to compare the outcome of surgical and conservative treatment approaches for medication-related osteonecrosis of the jaw. Study Design Publications in Medline, The Cochrane Library, EMBASE, and PubMed (non-indexed articles) and by Health Technology Assessment organizations were searched. Quality of evidence in primary studies were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the level of bias in systematic reviews by a measurement tool to assess systematic reviews (AMSTAR). Results Quality assessment identified 3 primary studies with moderate GRADE score. Moderate risk of bias was found in 7 systematic reviews and low risk of bias in 3. Nine studies were included in the meta-analysis, where 62.1% healing was reported after surgical treatment (144 of 232 included patients) and 28.8% healing was reported after conservative treatment (38 of 132 included patients). Moderate heterogeneity was found among the included studies (P = .02). The overall odds ratio for resolution of osteonecrosis after surgical versus conservative treatment was 1.25 (95% confidence interval, 0.24-2.26) and was not statistically significant. Conclusion Slightly better outcomes are reported after surgical treatment, in particular for advanced disease stages, but there is a lack of standardized treatment protocols and outcome measures. Overall, the quality of evidence is poor, and the majority of studies have a low evidence certainty rating and high risk of bias.publishedVersio

Clinical evaluation of the temporomandibular joint and masticatory muscles 10-15 years after mandibular setback surgery and six weeks of inter-maxillary fixation

Objectives. The purpose of this study was to clinically evaluate the TMJs and masticatory muscles 10-15 years after orthodontic-surgical treatment of mandibular prognathism. Material and methods. Thirty-six patients where included in this study. All patients had been operated with the intraoral vertical ramus osteotomy (IVRO) technique and subsequent inter-maxillary fixation (IMF) for six weeks. Mean follow-up period after surgery was 12.5 years, and mean age at the long-term follow-up examination was 34.1 years (range 27.2 – 59.8 years). At the long-term follow-up consultation, the masticatory muscles and TMJs were examined according to the Helkimo clinical dysfunction index. The participants also completed a questionnaire. Results. Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2). Statistically significantly greater in males compared to females (p=0.004). Mean Helkimo Dysfunction group was 1.5. None of the patients reported to have pain while chewing or opening the mouth on a weekly or daily basis. However, eight patients reported weekly (n=6) or daily (n=2) difficulties with maximum opening of the mouth. Conclusion. The results of the present study show that 10-15 years after IVRO setback surgery and subsequent IMF for six weeks, mandibular range of movement is satisfactory and the patients report few functional limitations or symptoms related to the TMJs and/or masticatory musculature

Hemangioma of the hard palate with invasive growth into the maxillary sinus

Abstract A 55 year‐old woman presented with an invasive hemangioma of the hard palate. One year after partial surgical excision there was no sign of recurrency or oroantral fistulation. No malignant cells could be identified

Surgical vs conservative treatment of medication-related osteonecrosis of the jaw—A complex systematic review and meta-analysis

Objective The objective of this study was to compare the outcome of surgical and conservative treatment approaches for medication-related osteonecrosis of the jaw. Study Design Publications in Medline, The Cochrane Library, EMBASE, and PubMed (non-indexed articles) and by Health Technology Assessment organizations were searched. Quality of evidence in primary studies were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the level of bias in systematic reviews by a measurement tool to assess systematic reviews (AMSTAR). Results Quality assessment identified 3 primary studies with moderate GRADE score. Moderate risk of bias was found in 7 systematic reviews and low risk of bias in 3. Nine studies were included in the meta-analysis, where 62.1% healing was reported after surgical treatment (144 of 232 included patients) and 28.8% healing was reported after conservative treatment (38 of 132 included patients). Moderate heterogeneity was found among the included studies (P = .02). The overall odds ratio for resolution of osteonecrosis after surgical versus conservative treatment was 1.25 (95% confidence interval, 0.24-2.26) and was not statistically significant. Conclusion Slightly better outcomes are reported after surgical treatment, in particular for advanced disease stages, but there is a lack of standardized treatment protocols and outcome measures. Overall, the quality of evidence is poor, and the majority of studies have a low evidence certainty rating and high risk of bias

Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation

Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. Objective: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. Methodology: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2–59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. Results: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. Conclusion: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life

Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation

Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. Objective: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. Methodology: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2–59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. Results: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. Conclusion: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life