Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents

doi:10.3969/j.issn.1674-8115.2022.02.006

Abstract

Abstract: Objective

·Based on magnetic resonance imaging (MRI), adolescents with anterior disc displacement (ADD) of temporomandibular joint treated by temporomandibular joint disc repositioning surgery with miniscrew anchor were studied retrospectively to analyze the difference of postoperative recurrence rate among adolescents at different developmental stages.

Methods

·Adolescent patients (12 years old≤age≤18 years old ) who received disc repositioning from January 2015 to January 2020 in the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected and the patients were divided into 2 groups defined by the age of 15. MRIs during at least 6 months follow-up were used to evaluate changes in the disc position and condylar bone. During follow-up, ADD without reduction was considered relapse. The position, length of disc and height of condylar were analyzed quantitatively by modified three-circle method on MRI images and compared by statistical analysis via Software SPSS 25.0. Difference of recurrence rates between the 2 groups was compared by using chi-square test. T test was performed for the difference of condylar growth height between the 2 groups.

Results

·Totally 90 cases were included, including 64 females and 26 males, with the average age of (14.2±1.2) years and follow-up interval of (16.0±12.0) months. Postoperative MRIs showed that all the discs were repositioned. During follow-up, 96.4% (54/56) of the discs in group A (>15 years old) were still in position, whereas 3.6% (2/56) of the discs had relapsed anteriorly. In group B (≤15 years old), 85.2% (75/88) of the discs were still in position, whereas 14.8% (13/88) of the discs had relapsed anteriorly, which was higher than that in group A (P=0.032). The condylar height in group A increased by (1.33±1.29) mm compared with that in group B [(1.79±1.14) mm)]. The condylar height in group B increased more during follow-ups (P=0.036). The degree of anterior disc displacement in group B was greater than that in group A (P=0.002), but there was no significant difference in preoperative disc length between the 2 groups (P=0.585).

Conclusion

·For adolescent patients who received temporomandibular joint disc repositioning surgery with miniscrew anchor, experiencing rapid growth might be a factor affecting the effect of the operation. The postoperative effect of repositioning surgery with miniscrew anchor may be affected by the rapid growth and development of condyle.

Key words: adolescent, temporomandibular joint disc repositioning with miniscrew anchor, condylar height, magnetic resonance imaging (MRI), recurrence

CLC Number:

R782.6

Xuehong WANG, Xuzhuo CHEN, Yi MAO, Da SHEN, Shanyong ZHANG. Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(2): 173-177.

Figures/Tables 7

TrendMD

References 16

1	RAMMELSBERG P, POSPIECH P R, JAGER L, et al. Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology, 1997, 83(3): 393-399.
2	RIBEIRO R F, TALLENTS R H, KATZBERG R W, et al. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years[J]. J Orofac Pain, 1997, 11(1): 37-47.
3	HU Y K, YANG C, CAI X Y, et al. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?[J]. Medicine, 2016, 95(35): e4715.
4	XIE Q, YANG C, HE D M, et al. Is mandibular asymmetry more frequent and severe with unilateral disc displacement?[J]. J Craniomaxillofac Surg, 2015, 43(1): 81-86.
5	XIE Q Y, YANG C, HE D M, et al. Will unilateral temporomandibular joint anterior disc displacement in teenagers lead to asymmetry of condyle and mandible? A longitudinal study[J]. J Craniomaxillofac Surg, 2016, 44(5): 590-596.
6	HU Y K, ABDELREHEM A, YANG C, et al. Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study[J]. Sci Rep, 2017, 7: 45513.
7	LEI J, LIU M Q, YAP A U, et al. Condylar subchondral formation of cortical bone in adolescents and young adults[J]. Br J Oral Maxillofac Surg, 2013, 51(1): 63-68.
8	WOLFORD L M. Temporomandibular joint devices: treatment factors and outcomes[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997, 83(1): 143-149.
9	YANG C, ZHANG S Y, WANG X D, et al. Magnetic resonance arthrography applied to the diagnosis of intraarticular adhesions of the temporomandibular joint[J]. Int J Oral Maxillofac Surg, 2005, 34(7): 733-738.
10	LIU Z Y, XIE Q Y, CHEN M J, et al. Measurement of mandibular condylar height based on magnetic resonance imaging[J]. J Craniofacial Surg, 2020, 31(4): e415-e418.
11	LIU Z, XIE Q, YANG C, et al. The effect of arthroscopic disc repositioning on facial growth in juvenile patients with unilateral anterior disc displacement[J]. J Craniomaxillofac Surg, 2020, 48(8): 765-771.
12	WOLFORD L M, KARRAS S C, MEHRA P. Considerations for orthognathic surgery during growth, part 1: mandibular deformities[J]. Am J Orthod Dentofacial Orthop, 2001, 119(2): 95-101.
13	WOLFORD L M, KARRAS S C, MEHRA P. Considerations for orthognathic surgery during growth, part 2: maxillary deformities[J]. Am J Orthod Dentofacial Orthop, 2001, 119(2): 102-105.
14	朱慧敏, 周琴, 何冬梅, 等. 关节盘复位锚固术术后稳定性的影像学评价[J]. 中国实用口腔科杂志, 2018, 11(12): 731-734.
15	LIU X, SHEN P, WANG X, et al. A prognostic nomogram for postoperative bone remodeling in patients with ADDWoR[J]. Sci Rep, 2018, 8(1): 4361.
16	ZHU H, HE D, YANG Z, et al. The effect of disc repositioning and post-operative functional splint for the treatment of anterior disc displacement in juvenile patients with Class Ⅱ malocclusion[J]. J Craniomaxillofac Surg, 2019, 47(1): 66-72.

Group	Postoperative recurrence/n （%）	No recurrence after surgery/n （%）	Total/n	P value
A （>15 year）	2 （3.6）	54 （96.4）	56
B （≤15 year）	13 （14.8）	75 （85.2）	88
Total	15 （10.4）	129 （89.6）	144	0.032

Group	Postoperative recurrence/n （%）	No recurrence after surgery/n （%）	Total/n	P value
A （>15 year）	2 （3.6）	54 （96.4）	56
B （≤15 year）	13 （14.8）	75 （85.2）	88
Total	15 （10.4）	129 （89.6）	144	0.032

Group	Average follow up period/month	Condylar height increased/mm	P value
A （>15 year）	15.0±7.4	1.33±1.29
B （≤15 year）	17.0±14.0	1.79±1.14
Total	16.0±12.0	1.61±1.23	0.036

Group	Average follow up period/month	Condylar height increased/mm	P value
A （>15 year）	15.0±7.4	1.33±1.29
B （≤15 year）	17.0±14.0	1.79±1.14
Total	16.0±12.0	1.61±1.23	0.036

Group	TMJ disc displacement distance/mm	P value
A （>15 year）	4.52±1.80	0.002
B （≤15 year）	5.55±1.93	0.002