Arthroscopic disc fixation to the condylar head. Use of resorbable pins for internal derangement of the temporomandibular joint (stage II-IV). Preliminary report of 34 joints

Carlos C Goizueta-Adame, Daniel Pastor-Zuazaga, Juan E Orts Bañón
Journal of Cranio-maxillo-facial Surgery 2014, 42 (4): 340-6

AIM: The study describes the arthoscopic use of resorbable pins for the internal derangement of the temporomandibular joint with McCain's technique. Clinical and image features are reported retrospectively.

METHODS: Twenty-seven consecutive patients (34 joints) were included. Symptomatic internal derangement and anterior-medial disc displacement with or without reduction in magnetic resonance images (MRI) were diagnosed in all cases. Two resorbable pins (SmartNail) were placed in each joint employing arthroscopic surgery with a third portal for disc recapture and fixation to condylar head. Clinical data 24 months after surgery are reported (movements, pain score, clicking, laterodeviation, occlusal changes). In eight joints a MRI control was required between 1 and 2 years after surgery.

RESULTS: Visual analogue scale values (0-100) decreased from 70.8 to 11.9 (p < 0.001) in the first control (week) and kept down after 24 months of follow-up (VAS: 4.8). Movements began to recover in 3 months and mouth opening increased from 34 mm to 43.2 mm 1 year after surgery (p < 0.001). Clicking, laterodeviation and contralateral excursions improvement were statistically significant (p < 0.001). MRI showed disc fixation to condyle head in closed and opened mouth.

CONCLUSION: Disc fixation to condylar head with resorbable pins is a safe and satisfactory procedure. Pain becomes drastically reduced and mandibular function recovers normal parameters in patients with internal derangement.

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