TMD (temporomandibular joint disorder) is a collective term used to describe a number of related disorders affecting the temporo-mandibular joint (TMJ), masticatory muscles and associated structures, all of which have common symptoms such as pain and limited mouth opening. In the present study the authors perform a retrospective analysis of all patients affected by internal derangement, according to Wilkes’ criteria, who underwent surgery of condilar shaving and disc reposition. From 1982 to 2005, at the Department of Maxillo-Facial Surgery, ‘Sapienza’ Università di Roma, 352 patients were treated throughout open joint surgery for a total number of 696 treated joints. Long term follow up was accomplished in every patient from the smallest value of 3 years to the highest of 26 with a mean value of 12.5 years. A post surgical evaluation of the local pain was performed according to same classes of pre-surgical evaluation supplying the following results: in 543 joints there was no local pain corresponding to class I (78%), in 70 joints a class II pain range was present (10%), in 42 joints a class III was reported (6%), 28 joints presented a class IV (4%) and 13 joints class V (2%). Post surgical headache and cervical pain varied significantly: Class I counted 190 patients (54%), class II counted 77 patients 22%, class III counted 39 patients (11%), class IV counted 21 patients (6%) and class V counted 25 patients being the 7% of the whole sample. Maximum wide opening has been evaluated both before and after surgery. Surgical treatment in our opinion should be a consistent part of the therapeutic protocol. Our protocol aims for the most part to the restoration of morphofunctional recovery. The results we had widely confirm the viability of our surgical approach for internal derangement.
Functional TMJ arthroplasty: 30 years experience
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