Frontiers of Oral and Maxillofacial Medicine, 2020
Synovial plicae are common findings in most knees and extremity joints. However, plicae of the te... more Synovial plicae are common findings in most knees and extremity joints. However, plicae of the temporomandibular joint (TMJ) have not been adequately addressed. In the cadaver study, various plicae were observed with histologic findings in the research base, and clinically plica were detected in patients with internal derangement, recurrent luxation and other operative diseases in recent years. Although the incidence of a synovial plica varies between 24% with 62%, the prevalence is unknown because of not detectable by MRI. Plicae in recurrent dislocation cases are relatively thick, wide and pliable with histology of dense fibrous/hyalinized tissues with scattered chondroid cells. In cases with internal derangement, plicae were thin pliable, and finger-or band-like with histology of fibrous tissues and/or inflamed synovium with vascular proliferation suggesting in pathogenesis. Although plicae may or may not be causing symptoms, when detected during surgery should be removed with other intraarticular pathologies for restoring the biological function of TMJ. In development of TMJ lateral impingement, the lateral capsular prolapse may play an important role. The soft tissues of the capsule become fibrotic and constricted with inflammation restricting mandibular movement. Early adhesive capsulitis appears as an adherent finger-like plica vascularized from the lateral capsule restricting movement of the attached disc. Plica lined with synovium combined with a deformed disc induce mechanical abrasion resulting synovitis, which may induce chondromalacia leading to deterioration of bone and joint. The release of adhesions along the lateral aspect of the capsule is performed, then lateral capsular stretching and repositioning of prolapsed synovial plica is favorable to obtain good outcomes. The term "entrapment" generally refers to a compression of a peripheral nerve or artery usually between ligamentous and bony structures. Whereas symptomatic synovial impingement and intra-articular synovial entrapment syndromes have been well documented in patient undergone total arthroplasty and joint replacements of the hip and knee. There is strong evidence that the TMJ is susceptible to the same symptomatic impingement and intra-articular synovial entrapment as other synovial joints. This review of our current state of knowledge will accelerate and update the evolution of further understanding of TMJ pathologies, diagnosis and treatment.
Total joint replacement is the recommended treatment for end-stage temporomandibular joint (TMJ) ... more Total joint replacement is the recommended treatment for end-stage temporomandibular joint (TMJ) disease. The goal of treatment is to help the return to acceptable function with improvement of the maximum incisal opening (MIO) and a reduction of pain. When a prosthetic joint shows late complications, surgical management includes an open approach, with debridement, cultures, and prosthetic replacement as options. The purpose of the present study was to evaluate the early outcomes of arthroscopic management of failing prosthetic TMJs (PTMJs). Patients and Methods: The inclusion criteria were patients with custom or stock joints with complaints of limitation of mouth opening and pain, who had undergone arthroscopy. The exclusion criteria were patients with radiographic heterotopic bone formation, improvement with antibiotic treatment, and failed hardware found on imaging studies. Results: A total of 9 patients were included in the present study (all women), with 5 unilateral and 4 bilateral PTMJs, for a total of 13 sides that underwent arthroscopy. Their mean age was 40 years (range, 23 to 65 years). The mean preoperative MIO was 25 mm, and the mean preoperative visual analog scale for pain and functional limitation scores were both 8 of 10. The corresponding scores were 4 of 10 and 3 of 10 at 3 months postoperatively. Conclusions: Arthroscopic management of prosthetic joints has been reported in orthopedic studies, with benefits shown in the diagnosis and management of synovial impingement and arthrofibrosis. The results from the present study demonstrated that the early clinical outcomes of arthroscopic management of PTMJs is promising for decreasing pain and increasing the MIO. Larger studies with longer follow-up are needed to further classify the different causes of prosthetic failure and advance the approaches to management.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2016
This is a case report regarding the postoperative complication of pseudoaneurysm of the facial ar... more This is a case report regarding the postoperative complication of pseudoaneurysm of the facial artery likely due to mechanical injury after a bilateral sagittal split osteotomy (BSSO). This article will discuss diagnosis, management, embolization therapy using Onyx (ethylene vinyl alcohol copolymer in dimethyl sulfoxide -DMSO) and review the literature on pseudoaneurysm formed after bilateral sagittal split osteotomy. We will also discuss the common embolic agents and apparent adverse reaction of local infection that may be due to the presence of residual Onyx in the soft tissues.
A case of severe mandibular hypomobility due to fibrosis of the left temporalis tendon, combined ... more A case of severe mandibular hypomobility due to fibrosis of the left temporalis tendon, combined with ankylosis of the temporomandibular joint, is presented. This case emphasizes the importance of reconstructing the historical timeline to establish a correct diagnosis, ultimately leading to appropriate treatment. The use of minimally invasive surgical techniques and the importance of postoperative rehabilitation are emphasized.
A case of aspiration of an endodontic instrument is presented. Aspiration of a foreign body is a ... more A case of aspiration of an endodontic instrument is presented. Aspiration of a foreign body is a major complication which may arise from dental instrumentation in the oral cavity. Serious complications involving the respiratory system may result. The basic principles of prevention, diagnosis, and early treatment are emphasized in reducing the morbidity resulting from foreign body aspiration.
Summary The atrocities produced by Nazi doctors during the Holocaust have left a lasting imprint ... more Summary The atrocities produced by Nazi doctors during the Holocaust have left a lasting imprint on contemporary society and, in particular, the health professions. The discovery of the Nazi origins of a classic anatomy atlas is just one of many examples of scientific information obtained by doctors who violated the Hippocratic Oath and abused their power in the name of science. The focus of this paper is on how the origins of the Pernkopf anatomy atlas became known over 50 years after its creation. The ethical dilemmas that doctors and medical centers face as a result of this and other potentially tainted data is reviewed.
Temporomandibular disorders are a complex group of conditions which are common causes of orofacia... more Temporomandibular disorders are a complex group of conditions which are common causes of orofacial pain and are frequently associated with headaches. Because a wide variety of diseases can ultimately cause symptoms that result in dysfunction of the masticatory system, it is important for the clinician to establish an accurate diagnosis and rule out any serious neurologic pathology. Serious extra-articular conditions often can simulate the nonspecific symptoms of a temporomandibular joint disorder. A careful history and clinical examination of the head, neck, and cranial nerves are important in establishing a differential diagnosis. Diagnostic imaging and consultation with specialists in several disciplines are often necessary to establish an accurate diagnosis and develop an appropriate therapeutic regimen.
The defining characteristic of a profession - and especially a health-care profession - is that t... more The defining characteristic of a profession - and especially a health-care profession - is that the behaviour of its members is proscribed by a formal code of ethics. The main purpose of such codes is to guide practitioners' interactions with patients, assuring that patient interests are protected. In other words, the ethical code requires practitioners to place their patients' needs for proper diagnosis and appropriate treatment ahead of their own needs for income and advancement. The dental profession has a code of ethics that was developed by the American Dental Association many years ago; in most clinical situations, determination of proper behaviour is self-evident. However, the field of temporoman-dibular disorders (TMDs) has been the subject of considerable controversy for over half a century, and many people have argued that this makes it impossible to evaluate various approaches to treatment of TMDs within an ethical framework. In this article, the authors argue that the large volume of scientific evidence in the contemporary TMD literature provides an ethical framework for the diagnosis and treatment of patients with TMDs within a biopsychosocial medical model. They present a summary of the research with contemporary scientific integrity, which has produced that information over a period of many years. Based on that research, they conclude that dentists may provide conservative and reversible treatments that will be successful for most TMDs and in doing so will comply with the profession's code of ethics. Conversely, the authors claim that those dentists who continue to follow the older mechanistic models of TMD aetiology and treatment are not only out of step scientifically, but are placing their patients' welfare at risk by providing unnecessary irreversible bite-changing and jaw-repositioning interventions. Therefore, debate of these issues should not be solely focused on scientific merit, but also upon the compelling ethical obligations that dentists have as a result of the contemporary scientific literature regarding TMDs.
The purposes of this investigation were to determine how common osteoarthritis and synovitis are ... more The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity. and Methods: Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. All joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic mo~hologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis. A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%). Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity c.977); however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only ,707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.92O); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214). ~thou~ there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.
The specific aim of this investigation was to assess dtierences between primary and secondary ost... more The specific aim of this investigation was to assess dtierences between primary and secondary osteoarthritis (OA) of the temperomandibular joint (TMJ) using clinical evaluation and synovial fluid analysis for proteoglycans. and Methods: Arthroscopic surgery was performed on 101 TMJs from patients with significant pain or dysfunction and who had failed to respond to treatment. Joints were assessed for primary and secondary osteoarthritis. Synovial fluid aspirates were obtained and analyzed to determine the levels of keratan sulfate (KS) epitope and a novel 3B3( -> epitope by enzyme-linked immunosorbent assay (PLEA). Fifty-four patients and 67 joints had OA diagnosed by both clinical examination and arthroscopy. Primary OA was diagnosed in 14 joints (20%) and the remaining 53 joints were regarded as having secondary OA. No differences were detected in the levels of KS in the synovial fluid from the primary and secondary OA joints. Furthermore, the 3B3(-) epitope was not detectable in the synovial fluid aspirates of any TMJ. Secondary OA is a common disorder of the TMJ. However, there is no apparent difference in the metabolism of the joints with primary and secondary OA as assessed by proteoglycans in the synovial fluid. The apparent absence of the 3b3(-) epitope, in contrast to its presence in OA of other major synovial joints, suggests that there are some differences between the cartilage metabolism of the TMJ and these other joints during OA. A major problem in clinical research on temporomandibular disorders (TMDs) is that there are no uniform classification criteria. Classification criteria are neces-
The purpose of this investigation was to determine the relationship between arthroscopically diag... more The purpose of this investigation was to determine the relationship between arthroscopically diagnosed synovitis and adhesions in a population of patients with significant limitation of mandibular opening and temporomandibular joint pain. Temporomandibular joint arthroscopy was performed on 126 joints in 80 patients (female:male = 5.7:1; mean age = 35.5 years; mean duration of symptoms = 50 months). All patients were diagnosed with severe temporomandibular joint disease recalcitrant to conservative therapy. Each joint was evaluated arthroscopically for the presence of synovitis and adhesions. Chi-squared analysis was performed to determine if there was a significant relationship between the presence of synovitis and adhesions. Diagnostic arthroscopic examination showed the following: no synovitis and no adhesions in 18/126 joints (14%), no synovitis with adhesions present in 33/126 joints (26%), synovitis with no adhesions in 13/126 joints (10%), and synovitis and adhesions present in 62/126 joints (49%). Statistical analysis showed a significant relationship between arthroscopically diagnosed synovitis and adhesions. Synovitis and adhesions are commonly present in the temporomandibular joints of patients requiring arthroscopic surgery due to painful limitation of mandibular movement. Excessive mechanical stress on the temporomandibular joint leads to maladaptive responses in the articular and synovial tissues, ultimately leading to synovitis, osteoarthritis and the formation of adhesions. An understanding of the pathogenic mechanisms that lead to synovitis, osteoarthritis and adhesions has important clinical implications for the nonsurgical as well as surgical management of patients suffering from these disorders.
Abstract A case is reported in which an interpositional graft is used to augment a cortical defic... more Abstract A case is reported in which an interpositional graft is used to augment a cortical deficiency of the maxillary alveolar ridge. The procedure is based on sound biologic principles and may offer technique that minimizes the amount of resorption of the graft and therefore yields more predictable results.
Frontiers of Oral and Maxillofacial Medicine, 2020
Synovial plicae are common findings in most knees and extremity joints. However, plicae of the te... more Synovial plicae are common findings in most knees and extremity joints. However, plicae of the temporomandibular joint (TMJ) have not been adequately addressed. In the cadaver study, various plicae were observed with histologic findings in the research base, and clinically plica were detected in patients with internal derangement, recurrent luxation and other operative diseases in recent years. Although the incidence of a synovial plica varies between 24% with 62%, the prevalence is unknown because of not detectable by MRI. Plicae in recurrent dislocation cases are relatively thick, wide and pliable with histology of dense fibrous/hyalinized tissues with scattered chondroid cells. In cases with internal derangement, plicae were thin pliable, and finger-or band-like with histology of fibrous tissues and/or inflamed synovium with vascular proliferation suggesting in pathogenesis. Although plicae may or may not be causing symptoms, when detected during surgery should be removed with other intraarticular pathologies for restoring the biological function of TMJ. In development of TMJ lateral impingement, the lateral capsular prolapse may play an important role. The soft tissues of the capsule become fibrotic and constricted with inflammation restricting mandibular movement. Early adhesive capsulitis appears as an adherent finger-like plica vascularized from the lateral capsule restricting movement of the attached disc. Plica lined with synovium combined with a deformed disc induce mechanical abrasion resulting synovitis, which may induce chondromalacia leading to deterioration of bone and joint. The release of adhesions along the lateral aspect of the capsule is performed, then lateral capsular stretching and repositioning of prolapsed synovial plica is favorable to obtain good outcomes. The term "entrapment" generally refers to a compression of a peripheral nerve or artery usually between ligamentous and bony structures. Whereas symptomatic synovial impingement and intra-articular synovial entrapment syndromes have been well documented in patient undergone total arthroplasty and joint replacements of the hip and knee. There is strong evidence that the TMJ is susceptible to the same symptomatic impingement and intra-articular synovial entrapment as other synovial joints. This review of our current state of knowledge will accelerate and update the evolution of further understanding of TMJ pathologies, diagnosis and treatment.
Total joint replacement is the recommended treatment for end-stage temporomandibular joint (TMJ) ... more Total joint replacement is the recommended treatment for end-stage temporomandibular joint (TMJ) disease. The goal of treatment is to help the return to acceptable function with improvement of the maximum incisal opening (MIO) and a reduction of pain. When a prosthetic joint shows late complications, surgical management includes an open approach, with debridement, cultures, and prosthetic replacement as options. The purpose of the present study was to evaluate the early outcomes of arthroscopic management of failing prosthetic TMJs (PTMJs). Patients and Methods: The inclusion criteria were patients with custom or stock joints with complaints of limitation of mouth opening and pain, who had undergone arthroscopy. The exclusion criteria were patients with radiographic heterotopic bone formation, improvement with antibiotic treatment, and failed hardware found on imaging studies. Results: A total of 9 patients were included in the present study (all women), with 5 unilateral and 4 bilateral PTMJs, for a total of 13 sides that underwent arthroscopy. Their mean age was 40 years (range, 23 to 65 years). The mean preoperative MIO was 25 mm, and the mean preoperative visual analog scale for pain and functional limitation scores were both 8 of 10. The corresponding scores were 4 of 10 and 3 of 10 at 3 months postoperatively. Conclusions: Arthroscopic management of prosthetic joints has been reported in orthopedic studies, with benefits shown in the diagnosis and management of synovial impingement and arthrofibrosis. The results from the present study demonstrated that the early clinical outcomes of arthroscopic management of PTMJs is promising for decreasing pain and increasing the MIO. Larger studies with longer follow-up are needed to further classify the different causes of prosthetic failure and advance the approaches to management.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2016
This is a case report regarding the postoperative complication of pseudoaneurysm of the facial ar... more This is a case report regarding the postoperative complication of pseudoaneurysm of the facial artery likely due to mechanical injury after a bilateral sagittal split osteotomy (BSSO). This article will discuss diagnosis, management, embolization therapy using Onyx (ethylene vinyl alcohol copolymer in dimethyl sulfoxide -DMSO) and review the literature on pseudoaneurysm formed after bilateral sagittal split osteotomy. We will also discuss the common embolic agents and apparent adverse reaction of local infection that may be due to the presence of residual Onyx in the soft tissues.
A case of severe mandibular hypomobility due to fibrosis of the left temporalis tendon, combined ... more A case of severe mandibular hypomobility due to fibrosis of the left temporalis tendon, combined with ankylosis of the temporomandibular joint, is presented. This case emphasizes the importance of reconstructing the historical timeline to establish a correct diagnosis, ultimately leading to appropriate treatment. The use of minimally invasive surgical techniques and the importance of postoperative rehabilitation are emphasized.
A case of aspiration of an endodontic instrument is presented. Aspiration of a foreign body is a ... more A case of aspiration of an endodontic instrument is presented. Aspiration of a foreign body is a major complication which may arise from dental instrumentation in the oral cavity. Serious complications involving the respiratory system may result. The basic principles of prevention, diagnosis, and early treatment are emphasized in reducing the morbidity resulting from foreign body aspiration.
Summary The atrocities produced by Nazi doctors during the Holocaust have left a lasting imprint ... more Summary The atrocities produced by Nazi doctors during the Holocaust have left a lasting imprint on contemporary society and, in particular, the health professions. The discovery of the Nazi origins of a classic anatomy atlas is just one of many examples of scientific information obtained by doctors who violated the Hippocratic Oath and abused their power in the name of science. The focus of this paper is on how the origins of the Pernkopf anatomy atlas became known over 50 years after its creation. The ethical dilemmas that doctors and medical centers face as a result of this and other potentially tainted data is reviewed.
Temporomandibular disorders are a complex group of conditions which are common causes of orofacia... more Temporomandibular disorders are a complex group of conditions which are common causes of orofacial pain and are frequently associated with headaches. Because a wide variety of diseases can ultimately cause symptoms that result in dysfunction of the masticatory system, it is important for the clinician to establish an accurate diagnosis and rule out any serious neurologic pathology. Serious extra-articular conditions often can simulate the nonspecific symptoms of a temporomandibular joint disorder. A careful history and clinical examination of the head, neck, and cranial nerves are important in establishing a differential diagnosis. Diagnostic imaging and consultation with specialists in several disciplines are often necessary to establish an accurate diagnosis and develop an appropriate therapeutic regimen.
The defining characteristic of a profession - and especially a health-care profession - is that t... more The defining characteristic of a profession - and especially a health-care profession - is that the behaviour of its members is proscribed by a formal code of ethics. The main purpose of such codes is to guide practitioners' interactions with patients, assuring that patient interests are protected. In other words, the ethical code requires practitioners to place their patients' needs for proper diagnosis and appropriate treatment ahead of their own needs for income and advancement. The dental profession has a code of ethics that was developed by the American Dental Association many years ago; in most clinical situations, determination of proper behaviour is self-evident. However, the field of temporoman-dibular disorders (TMDs) has been the subject of considerable controversy for over half a century, and many people have argued that this makes it impossible to evaluate various approaches to treatment of TMDs within an ethical framework. In this article, the authors argue that the large volume of scientific evidence in the contemporary TMD literature provides an ethical framework for the diagnosis and treatment of patients with TMDs within a biopsychosocial medical model. They present a summary of the research with contemporary scientific integrity, which has produced that information over a period of many years. Based on that research, they conclude that dentists may provide conservative and reversible treatments that will be successful for most TMDs and in doing so will comply with the profession's code of ethics. Conversely, the authors claim that those dentists who continue to follow the older mechanistic models of TMD aetiology and treatment are not only out of step scientifically, but are placing their patients' welfare at risk by providing unnecessary irreversible bite-changing and jaw-repositioning interventions. Therefore, debate of these issues should not be solely focused on scientific merit, but also upon the compelling ethical obligations that dentists have as a result of the contemporary scientific literature regarding TMDs.
The purposes of this investigation were to determine how common osteoarthritis and synovitis are ... more The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity. and Methods: Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. All joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic mo~hologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis. A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%). Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity c.977); however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only ,707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.92O); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214). ~thou~ there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.
The specific aim of this investigation was to assess dtierences between primary and secondary ost... more The specific aim of this investigation was to assess dtierences between primary and secondary osteoarthritis (OA) of the temperomandibular joint (TMJ) using clinical evaluation and synovial fluid analysis for proteoglycans. and Methods: Arthroscopic surgery was performed on 101 TMJs from patients with significant pain or dysfunction and who had failed to respond to treatment. Joints were assessed for primary and secondary osteoarthritis. Synovial fluid aspirates were obtained and analyzed to determine the levels of keratan sulfate (KS) epitope and a novel 3B3( -> epitope by enzyme-linked immunosorbent assay (PLEA). Fifty-four patients and 67 joints had OA diagnosed by both clinical examination and arthroscopy. Primary OA was diagnosed in 14 joints (20%) and the remaining 53 joints were regarded as having secondary OA. No differences were detected in the levels of KS in the synovial fluid from the primary and secondary OA joints. Furthermore, the 3B3(-) epitope was not detectable in the synovial fluid aspirates of any TMJ. Secondary OA is a common disorder of the TMJ. However, there is no apparent difference in the metabolism of the joints with primary and secondary OA as assessed by proteoglycans in the synovial fluid. The apparent absence of the 3b3(-) epitope, in contrast to its presence in OA of other major synovial joints, suggests that there are some differences between the cartilage metabolism of the TMJ and these other joints during OA. A major problem in clinical research on temporomandibular disorders (TMDs) is that there are no uniform classification criteria. Classification criteria are neces-
The purpose of this investigation was to determine the relationship between arthroscopically diag... more The purpose of this investigation was to determine the relationship between arthroscopically diagnosed synovitis and adhesions in a population of patients with significant limitation of mandibular opening and temporomandibular joint pain. Temporomandibular joint arthroscopy was performed on 126 joints in 80 patients (female:male = 5.7:1; mean age = 35.5 years; mean duration of symptoms = 50 months). All patients were diagnosed with severe temporomandibular joint disease recalcitrant to conservative therapy. Each joint was evaluated arthroscopically for the presence of synovitis and adhesions. Chi-squared analysis was performed to determine if there was a significant relationship between the presence of synovitis and adhesions. Diagnostic arthroscopic examination showed the following: no synovitis and no adhesions in 18/126 joints (14%), no synovitis with adhesions present in 33/126 joints (26%), synovitis with no adhesions in 13/126 joints (10%), and synovitis and adhesions present in 62/126 joints (49%). Statistical analysis showed a significant relationship between arthroscopically diagnosed synovitis and adhesions. Synovitis and adhesions are commonly present in the temporomandibular joints of patients requiring arthroscopic surgery due to painful limitation of mandibular movement. Excessive mechanical stress on the temporomandibular joint leads to maladaptive responses in the articular and synovial tissues, ultimately leading to synovitis, osteoarthritis and the formation of adhesions. An understanding of the pathogenic mechanisms that lead to synovitis, osteoarthritis and adhesions has important clinical implications for the nonsurgical as well as surgical management of patients suffering from these disorders.
Abstract A case is reported in which an interpositional graft is used to augment a cortical defic... more Abstract A case is reported in which an interpositional graft is used to augment a cortical deficiency of the maxillary alveolar ridge. The procedure is based on sound biologic principles and may offer technique that minimizes the amount of resorption of the graft and therefore yields more predictable results.
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Papers by Howard Israel