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- Hearing changes after temporomandibular joint arthroscopy: a prospective studyPublication . DF, AngeloTemporomandibular Joint (TMJ) arthroscopy is considered an effective and safe minimally invasive surgical approach. While the long-term outcomes of arthroscopy tend to be positive and free of secondary effects, patients occasionally complain about their hearing following the treatment. The aim of this prospective study was to investigate possible hearing changes associated with TMJ arthroscopy. Pure-tone audiograms were performed in patients two weeks before TMJ arthroscopy and repeated six weeks after intervention. A total of 15 patients (mean age of 41.73 +- 16.36) were enrolled; 25 TMJ arthroscopies were performed (five unilateral and ten bilateral). Statistically significant differences were found between preoperative and postoperative audiograms in the frequencies 256 Hz (P = 0.011) and 8 kHz (P = 0.058, borderline). For the frequency 256 Hz the difference was favourable, but not superior to 5 dB. For the frequency 8 kHz, in three patients the TMJ arthroscopy resulted in a decrease of 10 dB. However, no clinical hearing changes or complaints were observed in the involved patients. No differences in audiograms between level 1 or 2 arthroscopy were observed. The study reinforces the safety of the TMJ arthroscopy level 1 and 2 with the reported protocol. The authors recommend larger studies to validate the results, specially for frequency 8 kHz
- Unilateral temporomandibular joint discectomy without interposal material in patients with disc perforation or fragmentation: a prospective studyPublication . Ângelo, David Faustino; Sanz, David; Cardoso, Henrique JoséObjective: Temporomandibular joint (TMJ) discectomy is one of the most popular surgical techniques for patients with an unsalvageable disc. Previous studies have demonstrated predictable results of dis-cectomy with optimal results in pain reduction and maximum mouth opening (MMO) improvement.However, those studies had most of the times wide-ranging inclusion criteria. This study was thereforeconducted to assess the role of unilateral TMJ discectomy in a well defined diagnosis.Methods: A 6-year prospective study was designed including patients treated with unilateral TMJ dis-cectomy without interposal material, preserving condyle and temporal fibrocartilage, for two specificintra-articular diagnosis: disc perforation and disc fragmentation.Results: A total of 19 patients were enrolled, with a mean age of 51.05 ± 13.71 (mean ± SD) years.Preoperative pain was 7.63 ± 1.89 (mean ± SD), MMO was 25.95 ± 10.27 mm (mean ± SD) and muscletenderness (MT) was 2.53 ± 0.77 (mean ± SD). The most common diagnosis was disc perforation. Afteran average of 37.9 months of follow-up time (range from 10 to 71 months), a statistically significant improvement of pain (P < 0.0001), MMO (P < 0.0001) and MT (P = 0.00011) was observed. Postoperatively,16 of 18 patients (89 %) showed a reduction in pain and improvement in MMO, fulfilling the criteria fora successful outcome of TMJ surgery. No second surgery was necessary. Conclusion: Unilateral TMJ discectomy without interposal material in patients with disc perforation or fragmentation seems to be an adequate technique. However, we encourage rigorous long-term studiesand new preclinical trials to pursuit a disc substitute, as relevant preclinical trials have demonstrated significant degenerative changes after TMJ discectomy.
- Comment on: a modified technique of temporomandibular joint arthroscopic operative surgery of the superior and Inferior joint spacesPublication . DF, Angelo; González-García, Raúl; Monje, F
- Synovial entrapment in alloplastic temporomandibular joint replacementPublication . DF, AngeloComplications of alloplastic temporomandibular joint (TMJ) prostheses can lead to stress and anxiety for the patient and the surgical team, and prosthesis substitution is sometimes required. The aim of this case report is to describe the surgical finding of synovial entrapment with interposed fibrosis in a postoperative alloplastic TMJ revision, managed effectively with adequate surgical debridement. The authors believe that synovial entrapment needs to be considered as a possible postoperative complication of total joint replacement when no clear symptoms of infection, metal hypersensitivity, osteolysis, or heterotopic bone formation are present. The implications of synovial entrapment in TMJ alloplastic replacement remains relatively unpredictable and poorly understood.
- A randomized controlled preclinical trial on 3 interposal temporomandibular joint disc implants: TEMPOJIMS-Phase 2Publication . Ângelo, David Faustino; Wang, Yadong; Morouço, Pedro; Monje, Florencio; Mónico, Lisete; González-Garcia, Raúl; Moura, Carla; Alves, Nuno; Sanz, David; Gao, Jin; Sousa, Rita; Neto, Lia; Faísca, Pedro; Salgado, Francisco; López Peña, Monica; Permuy, Maria; Munñoz, FernandoThe effort to develop an effective and safe temporomandibular joint (TMJ) disc substitute has been one of the mainstreams of tissue engineering. Biodegradable customized scaffolds could approach safety and effectiveness to regenerate a new autologous disc, rather than using non‐biodegradable materials. However, it is still technically challenging to mimic the biomechanical properties of the native disc with biodegradable polymers. In this study, new 3D tailored TMJ disc implants were developed: (1) Poly(glycerol sebacate) (PGS) scaffold reinforced with electrospun Poly(εcaprolactone) (PCL) fibers on the outer surface (PGS+PCL); (2) PCL and polyethylene glycol diacrylate (PEGDA) (PCL+PEGDA); and (3) PCL. The TMJ implants were tested in a randomized preclinical trial, conducted in 24 black Merino sheep TMJ, perfoming bilateral interventions. Histologic, imaging, and kinematics analysis was performed. No statistical changes were observed between the PGS+PCL disc and the control group. The PCL+PEGDA and PCL groups were associated with statistical changes in histology (p = 0.004 for articular cartilage mid‐layer; p = 0.019 for structure changes and p = 0.017 for cell shape changes), imaging (p = 0.027 for global appreciation) and dangerous material fragmentation was observed. No biomaterial particles were observed in the multi‐organ analysis in the different groups. The sheep confirmed to be a relevant animal model for TMJ disc surgery and regenerative approaches. The PCL and PCL+PEGDA discs presented a higher risk to increase degenerative changes, due to material fragmentation. None of the tested discs regenerate a new autologous disc, however, PGS+PCL was safe, demonstrated rapid resorption, and was capable to prevent condyle degenerative changes.
- The ESTMJS (European Society of Temporomandibular Joint Surgeons) consensus and evidence-based recommendations on management of condylar dislocationPublication . Neff, Andreas; McLeod, Niall; Spijkervet, Frederik; Riechmann, Merle; Vieth, Ulla; Kolk, Andreas; Sidebottom, Andrew; Bonte, Bernard; Speculand, Bernard; Saridin, Carrol; Wilms, Christian; Politis, Constantus; Ângelo, David Faustino
- Biological treatments for temporomandibular joint disc disorders: strategies in tissue engineeringPublication . Trindade, Daniela; Cordeiro, Rachel; Cardoso, Henrique José; DF, Angelo; Alves, Nuno; Moura, CarlaThe temporomandibular joint (TMJ) is an important structure for the masticatory systemand the pathologies associated with it affect a large part of the population and impair people’slifestyle. It comprises an articular disc, that presents low regeneration capacities and the existingclinical options for repairing it are not effective. This way, it is imperative to achieve a permanentsolution to guarantee a good quality of life for people who suffer from these pathologies. Completeknowledge of the unique characteristics of the disc will make it easier to achieve a successful tissueengineering (TE) construct. Thus, the search for an effective, safe and lasting solution has alreadystarted, including materials that replace the disc, is currently growing. The search for a solutionbased on TE approaches, which involve regenerating the disc. The present work revises the TMJ disccharacteristics and its associated diseases. The different materials used for a total disc replacementare presented, highlighting the TE area. A special focus on future trends in the field and part of thesolution for the TMJ problems described in this review will involve the development of a promisingengineered disc approach through the use of decellularized extracellular matrices.