Treatment of recurrent TMJ dislocation by arthroscopic disc suturing and fixation
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概要
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Various surgical procedure have been reported for the treatment of recurrent dislocation of the temporomandibular joint (TMJ). However, we thought that a treatment involving the least possible surgical insult would be the most desirable procedure. Starting from this therapeutic principle and considering the pathologic features of this disease, we have developed an arthroscopic surgical procedure for this disease and evaluated its clinical utility. This paper describes the outline of our treatment for recurrent dislocation of the TMJ by arthroscopic disc suturing and fixation.The upper joint cavity was the target of our procedure.After arthroscopy, a fresh wound was formed by arthroscopic laser surgery starting from the area posterior to the disc to the posterior wall of the upper joint cavity and advancing to the mandibular fossa, articular tubercle and synovial membrane of the medial wall. The disc was then pulled backward to be fixed in place with arthroscopic suture needle using our procedure of arthroscopic disc suturing and fixation. This was concurrently supplemented with a manipulative procedure involving interior and exterior stitching of the lateral fibrous capsule for posteior traction and sew-up. Disc adhesion and fixation to the mandibular fossa and articular tubercle were done by pressure-welding of the mandibular head from beneath the disc by postoperative intermaxillar traction and fixation of the maxillary and mandibular dentitions. This manipulation succeeded in pulling and fixing the articular disc to the posterior wall and making the disc adhere to the mandibular fossa and articular tubercle, resulting in subsidence of the upper joint cavity and marked reduction of the mandibular head movement owing to the sew-up of the fibrous capsule. The procedural objective was to gain contracture of the soft tissue of TMJ through suturing and fixing of the articular disc and fibrous capsule and it could also be functionally categorized as a mobility-restricting procedure. As a new treatment for recurrent TMJ dislocation, it proved more useful than any other conventional treatment in fulfilling the primary objective with less surgical insult since it could be carried out without opening the joint. This procedure was conducted on 21 TMJs from 12 patients from November 1988 to January 1993. Although one patient suffered a recurrent TMJ dislocation requiring another operation, all patients including this one have since remained well and free from recurrence.
- 一般社団法人 日本顎関節学会の論文
一般社団法人 日本顎関節学会 | 論文
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