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Goss, A., Bosanquet, A.: TMJ Arthroscopy. J. Oral Max. Surg. 44:614-617, 1986.

The Use of a CoUagen Sheet as a Disc Replacement io TMJ Surgery. Edward J. McDonnell, DDS, (Feinberg, S.E., Pruitt, J.) The Ohio State University College of Dentistry, Dept. of OMS, 305 W. 12th Ave., Columbus, OH 43210 Merck Sharp & Dohme Resident Award Winner

Alloplastic interpositional materials used for TMJ disc replacement have been shown to cause a significant amount of foreign body reaction and articular destruc- tion. Autogenous dermal grafts are presently the most acceptable materials used for disc replacement. The ma- jor disadvantages of dermis are the morbidity associated with a second surgical site, adhesion of the graft to the condyle or fossa preventing return to maximum function, and cystic degeneration secondary to epithelial elements remaining in the graft. The objective of this study was to evaluate a biocompatible preformed allogeneic collagen sheet as a disc replacement in TMJ surgery. The collagen sheet is composed of a Type I Bovine Collagen that has been highly crosslinked with glutaraldehyde and is of .5 mm thickness when hydrated. Its advantages as a disc replacement are attributed to: its availability, low antige- nicity, its ability to be preformed, and that its strength can be altered by cross-linking.

Adult New Zealand White Rabbits were randomly di- vided into four groups: (Group I) non-operated control group, (Group II) discectomy with collagen replacement, (Group III) discectomy with dermal replacement, (Group IV) discectomy with no replacement. One rabbit from each group was then sacrificed at 2, 4, 8, 18, and 36 weeks. The glenoid fossa and condyle and either the disc, dermal implants or collagen sheet were resected enbloc bilaterally, decalcified and processed for routine histol- ogy.

Results indicated that:

1. There was significant articular destruction in the discectomy with no replacement group.

2. Both the dermal and collagen replacement were re- sorbed by the eighth week. The articular surfaces exhibited cartilaginous hyperplasia which eventu- ally returned to near normal thickness by the 18th week.

3. There was a fibrous connective tissue pseudodisc formed in the 36 week collagen replacement speci- men.

Conclusions were drawn:

1. Performance of the collagen replacement was simi- lar to the dermal replacement.

2. The collagen and dermal replacements may act in protective capacity helping to retard early degener- ative changes.

References:

Sprinz, R.: Arch Oral Biol 5:195, l%l. Eriksson, L., Westesson, P.L.: J Oral Maxillofac Surg 43:263,

1985.

Signs and Symptoms, Patient Satisfaction and Meniscal Po- sition Following Arthroscopic TMJ Surgery. Michael T. Montgomery, (Van Sickels, J.E., Thrash, W.J., Harms, S.E.) University of Texas Health Science Center, Dept. of OMS, 7703 Floyd Curl Dr., San Antonio, TX 78284

Reports on arthroscopic TMJ surgery indicate that pa- tients improve following this therapy. The purpose of this investigation was to assess the impact of TMJ arthros- copy on patient satisfaction, signs and symptoms, and meniscal position. Twenty-eight female and four male pa- tients, with clinically diagnosed and radiographically con- firmed intra-articular disorders were involved. Subjects were considered surgical candidates when conservative therapy failed, there was inability to live with residual symptomatology, and documented intra-articular pathol- ogy. Mean age was 28 years. Radiographically, meniscal dislocation was diagnosed in 29 joints and meniscal sub- luxation in 25 joints. Arthroscopic TMJ surgery was per- formed bilaterally on 20 subjects and unilaterally on 12. Postsurgical management included combinations of phar- macotherapy, splint therapy and physical therapy. The presence of TMJ pain and joint sounds, the need for an- algesic medication, dietary limitations, and mandibular range of motion were recorded at 1, 2, 4, 8, 24 and 52 weeks following surgery. Subjects’ perspectives were evaluated via a post-surgical questionnaire, given at 8 weeks and repeated at 52 weeks. Changes in meniscal position were evaluated on 21 subjects foIlowing surgery by magnetic resonance imaging. Friedman two way ANOVA was used for all statistical comparisons with the exception of mandibular movement, which was evaluated with a one factor ANOVA. The incidence of pain and the need for analgesic medication were significantly reduced at all post-surgical evaluation periods (p < .05). The in- cidence of joint sounds was significantly reduced at weeks 1, 2, 4 (p < .05). Diet was significantly less re- stricted after 4 weeks (p < .05). Vertical opening was significantly improved postsurgically (p < .05) with a mean of 10.7 mm at 52 weeks. Right and left lateral move- ments were significantly improved at weeks 24 and 52 (p < .05, mean 1.5, 2.3 mm, respectively). Patients felt that pain intensity, pain frequency, the need for analgesic medication, diet and the functions of eating, kissing and yawning were significantly improved by surgery (p < .Ol ) . Comparing the two month and one year questionnaires, subjects reported a significant reduction in the incidence and intensity of pain (p < .05) at one year. Regarding post-surgical meniscal position, 78.4% of the joints were unchanged, 16.2% of the joints were improved and 5.4% had a worsening of men&al position. Following arthro- scopic TMJ surgery (52 weeks or less), pain, mandibular movement and function, and diet were significantly im- proved. The incidence of joint sounds was not sign@ cantty improved beyond the 4 week evaluation and me- niscal position was unchanged by surgery in 78% of the subjects.

References:

Sanders, B.: Arthroscopic surgery of the temporomandibular joint: Treatment of internal derangement with persistent closed lock. Oral Surg, Oral Med, Oral Path 62:361, 1986.

Nuelle, D.G., Alpem, M.C., Ufema, J. W. : An arthroscopic per- spective of the temporomandibular joint. J Clin Ortho 21:llO. 1987.

Five Year Follow-up of the Polymer Glenoid Fossa Prosthe- sis for Partial aud Total TMJ Recmstruction. John N. Kent, DDS, (Block, M.S.) Louisiana State University School of Dentistry, Dept. of OMS, 1100 Florida Ave., New Orleans, LA 70119

The FEP (fluorinated ethylene propylene) polymer gle-