Temporomandibular Joint Discectomy Followed by Disc Replacement Using Viable Osteochondral and Umbilical Cord Allografts Results in Improved Patient Outcomes
| Autor: | Alla Danilkovitch, Rishi Gupta, S. Thaddeus Connelly, Molly O'Hare, Gianluca M. Tartaglia, Rebeka G. Silva |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Visual analogue scale medicine.medical_treatment Umbilical Cord 03 medical and health sciences 0302 clinical medicine Interquartile range Discectomy medicine Humans Prospective Studies Range of Motion Articular Prospective cohort study Retrospective Studies Temporomandibular Joint business.industry Retrospective cohort study 030206 dentistry Allografts Temporomandibular joint Surgery Treatment Outcome medicine.anatomical_structure Otorhinolaryngology 030220 oncology & carcinogenesis Quality of Life Female Oral Surgery business Range of motion Diskectomy Case series |
| Zdroj: | Journal of Oral and Maxillofacial Surgery. 78:63-74 |
| ISSN: | 0278-2391 |
| DOI: | 10.1016/j.joms.2019.05.024 |
| Popis: | Purpose The ideal surgical solution to reconstruct the temporomandibular joint (TMJ) disc after it has been removed has remained elusive. The major obstacle has been identifying a durable biocompatible material that will provide for restoration of TMJ function. The present study evaluated the outcomes of the interpositional implantation of a cryopreserved viable osteochondral allograft (CVOCA) combined with a viable cryopreserved umbilical cord tissue (vCUT) allograft after TMJ discectomy in patients with internal derangement and/or degenerative joint disease (DJD). Patients and Methods We implemented a retrospective case series study and enrolled patients with DJD or disc displacement diagnosed using the Diagnostic Criteria of Temporomandibular Disorders, who had undergone interpositional CVOCA and vCUT implantation after TMJ discectomy. The primary outcome variable was pain, measured using a visual analog scale (VAS). The secondary outcomes variables included maximal incisal opening (MIO) and Glasgow Benefit Inventory (GBI) general subscale scores. The primary analysis compared the preoperative measures with those at the last follow-up visit. Descriptive and analytic statistics were computed to summarize the sample's characteristics and assess the pre- and postoperative differences. Results The study sample included 9 patients with a mean age of 36 years, and 44% were men. The VAS scores had decreased significantly from 9.0 ± 2.0 to 3.0 ± 3.0 postoperatively (P = .001). The MIO had increased from 31 ± 5 to 36 ± 5 mm (P = .178). The average GBI general subscale score of 13 ± 46 for the 9 patients showed a trend toward improved quality of life and patient satisfaction with the surgery. The median postoperative follow-up at the time of our report was 15 months (interquartile range, 10; range, 2 to 27) without treatment-related complications. Conclusions The reported outcomes suggest that the interpositional implantation of CVOCA and vCUT after TMJ discectomy could be a solution for reducing TMJ-related pain and restoring TMJ function. Longer follow-up and prospective multicenter studies are warranted. |
| Databáze: | OpenAIRE |
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