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Biomedical subjects

A N Goss

Publications and source records attributed to A N Goss.

At least 55 records · Page 3Linked to original sources
PubMed1999

Arthroscopic surgery of the temporomandibular joint: comparison of two successful techniques.

We have compared two techniques of arthroscopic surgery for advanced internal derangement of the temporomandibular joint (TMJ). Patients with stage III or above TMJ internal derangement, who had not responded to three months of non-surgical treatment, were prospectively and randomly assigned to one of two types of treatment. One group had arthroscopic lysis and lavage (ALL) and the other had ALL plus arthroscopic anterolateral capsular release (AALCR). All patients were assessed preoperatively, and at 1, 3, 6, and 12 months postoperatively. Thirty-five patients (41 joints) had ALL and 66 patients (73 joints) had AALCR. The only significant difference was at 1 month, when the ALL group could not open their mouths as far as the AALCR group (P < 0.01). Both groups had significantly less pain in the joint and better jaw opening one year postoperatively. The stage of disease did not affect the outcome. Both ALL and AALCR gave good results in the management of advanced internal derangement of the TMJ. Unless early wide mouth-opening is required, the less invasive procedure of lysis and lavage should be chosen.

Analysis of Variance↗
PubMed1999

Effect of unilateral condylectomy on the sheep temporomandibular joint.

Unilateral condylectomy was performed on five young adult sheep. The animals were killed at three months and both joints and the excised condyles were examined macroscopically and histologically. All five showed pronounced regeneration of the condylar head on the operated side. The articular surface was fibrous and fused to the disc. Four of the five opposite joints showed medial remodelling. Young sheep have a higher regenerative capability than human adults of equivalent age, and similar reactions to those of children.

Animals↗
PubMed1999

The outcome of arthroscopic treatment of temporomandibular joint arthropathy.

Ninety patients underwent arthroscopic temporomandibular joint surgery to 124 joints for arthropathy which had failed to respond to at least six months of non-surgical treatment. They were surveyed at between 6 months and 5 years (mean 2.5 years) after surgery and 63 per cent responded to the survey. They reported an 82 per cent improvement for pain (50 to 100 per cent better), 80 per cent for clicking and 82 per cent for locking. There was no morbidity following the treatment. Arthroscopic surgery should be considered for advanced temporomandibular joint arthropathy which is refractory to non-surgical treatment.

Adolescent↗
PubMed1999

Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws.

Patients who have had their jaws irradiated as part of management of head and neck malignancy are at risk of osteoradionecrosis (ORN) following tooth extraction. Thirty-seven patients with a history of irradiation to the jaws were managed during a four year period. Twenty-nine patients received hyperbaric oxygen therapy (HBO) consisting of 20 treatments before surgery and ten treatments after. Only one (4 per cent) developed ORN. Seven patients who did not have HBO and one who did (15 per cent) developed ORN. The need for prophylactic treatment with HBO is discussed. It is recommended that prophylactic HBO is used prior to surgery for irradiated facial bones.

Adult↗
PubMed1999

Short-term effect of deep-frozen stored auricular cartilage allograft repair on the osteoarthritic sheep temporomandibular joint.

The initial effect of deep-frozen stored auricular cartilage replacement was tested on the progression of experimentally induced osteoarthritis in sheep. Bilateral osteoarthritis was induced in the sheep temporomandibular joint. Three months later, discectomy and deep-frozen auricular cartilage allograft repair were performed unilaterally, with the other side being left as a control. Six months post induction of osteoarthritis, 3 months post repair, the sheep were killed. The stored auricular cartilage allografts were not firmly attached to the surrounding tissue and tended to be markedly thinned and perforated. The effect of storage detrimentally affected the properties of the graft.

Animals↗
PubMed1998

Correlation between preoperative mouth opening and surgical outcome after arthroscopic lysis and lavage in patients with disc displacement without reduction.

PURPOSE: This study was designed to evaluate the efficacy of arthroscopic lysis and lavage for patients with limited mouth opening. The relationship between preoperative mouth opening and the surgical outcome was determined. METHOD: Fourteen patients with 16 internally deranged joints were treated by arthroscopic lysis and lavage. All had received 10.4 (7 to 19) months of nonsurgical treatment before arthroscopy. The preoperative magnetic resonance images showed anterior disc displacement without reduction in all treated joints. RESULTS: Twelve of the 14 patients (86%) showed good reduction in pain and improved range of jaw movement on average follow-up of 28.5 (13 to 66) months. Two patients showed no improvement after arthroscopy and required open surgical procedures. The preoperative mouth opening of the successful group averaged 29.4 (22 to 35) mm, whereas the two failed cases had 10- and 19-mm openings, respectively (P < .05). CONCLUSION: Persistent limitation of mouth opening of more than 22 mm after nonsurgical treatment has a good prognosis when treated by arthroscopic lysis and lavage. However, those with greater limitation should probably have earlier surgical intervention.

Adult↗
PubMed1998

Arthroscopic management of temporomandibular closed lock.

Sixty-three consecutive patients with painful closed lock involving 83 temporomandibular joints were treated by surgery and followed up for at least 24 months. Prior to surgical treatment all had imaging to demonstrate that the cause of their painful jaw locking was an anterior displaced disc without reduction. All patients had received at least three months non-surgical treatment without response. The arthroscopic surgery consisted of release of adhesions, manipulation and placement of 25 mg hyaluronic acid into the joint space. No significant surgical complications occurred. Postoperative treatment involved physical therapy and stabilization splints. At 24 months after surgery 57 patients (90.5 per cent) had no pain and month opening had improved from preoperative 27.2 +/- 5.4 mm to 44.4 +/- 4.1 mm (p < 0.001). This study shows that arthroscopic surgery with continuing non-surgical therapy is a highly effective treatment for painful closed lock.

Adolescent↗
PubMed1997

The effect of hyaluronic acid on experimental temporomandibular joint osteoarthrosis in the sheep.

PURPOSE: The purpose of this study was to test the effect of repeated injections of hyaluronic acid (HA) on the sheep model of osteoarthrotic temporomandibular joint (TMJ) disease. MATERIALS AND METHODS: Bilateral osteoarthrosis (OA) was induced in the TMJs of six sheep. HA was injected into one joint on 7, 10, 14, 17, and 21 days postoperatively. Normal saline was injected into the contralateral joint. Three sheep were killed at 1 month and 3 at 3 months. The joints were removed and examined macroscopically and histologically. A special scoring system was applied following the modified Mankin's score to evaluate the histologic changes. RESULTS: The control group showed severe osteoarthrotic changes in the condyle, deviation in form from normal morphology, and marked marrow fibrosis. The HA-treated group showed less deviation from normal condylar morphology. The histologic scores at 1 month were HA 12.6, control 24.2 (P < .001), and at 3 months were HA 6.9, control 18.9 (P < .001). There was a significant difference in osteoarthrotic changes between HA-treated and control TMJs, with the HA-treated TMJs having less severe changes. CONCLUSION: Repeated intraarticular injections of HA into a sheep TMJ with experimentally induced OA minimizes the extent of osteoarthrotic change when compared with the control joint. Thus, HA may have a role in preventing the progression of TMJ OA.

Animals↗
PubMed1997

The short-term effect of autogenous auricular cartilage graft following discectomy on the osteoarthrotic temporomandibular joint in sheep.

The aim of this experimental study was to determine the effect of auricular cartilage graft replacement on the progression of experimentally induced osteoarthrosis in sheep. Bilateral osteoarthrosis was induced in the sheep temporomandibular joint (TMJ). Three months later, discectomy and autogenous auricular cartilage grafting were performed unilaterally. At sacrifice, three months postrepair and six months postinduction of osteoarthrosis, it was found that the untreated side had extensive condylar osteoarthrosis and the grafted side showed evidence of fibrous repair. The graft prevented intra-articular adhesions and reduced degenerative changes, but there was a tendency towards graft perforation. Auricular cartilage grafting was effective in minimizing osteoarthrotic effects on the TMJ in the early stages after grafting.

Animals↗
PubMed1997

Short-term effect of fresh disk allograft on the osteoarthrotic sheep temporomandibular joint.

UNLABELLED: The aim of this experimental study is to evaluate the effect of fresh disk allograft on the osteoarthrotic temporomandibular joints in four sheep. STUDY DESIGN: Bilateral osteoarthrosis was induced in the sheep's temporomandibular joint. Three months later, unilateral diskectomy and fresh disk allograft repair were performed, with the contralateral joint being left as a control. At 6 months after the initial procedure, 3 months after the repair, the four sheep were sacrificed. RESULTS: It was found that the operated joint was fibrously repaired without ankylosis, whereas the control joint showed progressive disease. One grafted disk survived, but the other three were perforated and displaced. CONCLUSION: Fresh disk allograft does temper progression of the disease in the early stages.

Animals↗
PubMed1997

Distribution and coexistence of neuropeptides in nerve fibres in the temporomandibular joint of late gestation fetal sheep.

The density and distribution of nerve fibres immunoreactive to antisera for PGP 9.5 (general neuronal marker), calcitonin gene related peptide (CGRP) and substance P (SP) (markers for sensory neurons), as well as neuropeptide Y (NPY), vasoactive intestinal peptide (VIP) and tyrosine hydroxylase (TH) (markers for autonomic fibres), were examined in the temporomandibular joint (TMJ) of late gestation fetal sheep. This work formed part of a project investigating the influence of age and osteoarthritis on the innervation of the TMJ, and was undertaken to determine whether the innervation of the joint at 140 d gestation (17 d before birth) differed from that in the mature adult. Immunofluorescence microscopy was applied to serial sections of the capsule, disc and synovial membrane of 10 joints from 5 fetuses and image analysis was used for the quantitative assessment. The capsule, synovial membrane and the disc contained fibres immunoreactive (IR) to antisera for PGP 9.5, SP and CGRP. NPY-IR fibres were only visible in the loose connective tissue of the capsule. No VIP- or TH-IR nerve fibres were detected in the fetal TMJ. There was no statistically detectable difference between the density of nerve fibres immunoreactive to CGRP or PGP 9.5 antisera in the capsule or disc. Substance P-immunoreactivity (IR) was relatively weak in all samples examined. Scattered branches of CGRP-IR fibres were found deep in the disc proper. The lack of receptor endings, other than free nerve endings in the TMJ of the late fetal sheep, might be a reflection of the functional and anatomical immaturity of the TMJ, as reflected in the immature, gross and microscopic appearance of the disc, the inferior joint compartment and articular surface of the condyle at this stage. These results demonstrate that the capsule, synovial membrane and disc in the TMJ of fetal sheep at 140 d gestation age are innervated with sensory fibres, while autonomic fibres are located in the capsule only. The findings also support the view that the disc is innervated at an early stage of life but at a later stage the density of innervation in the central part of the disc regresses and the innervation remains only peripherally in the adult TMJ disc. Further work is required to determine (1) at what stage sympathetic fibres innervate the disc and the synovium, and (2) when the mechanoreceptive nerve endings develop.

Animals↗
PubMed1997

Comparison of different methods of temporomandibular joint disc reconstruction--an animal model.

The optimum method of temporomandibular joint (TMJ) reconstruction has not been defined despite numerous surgical treatments and several well controlled clinical trials. Animal models offer an experimental method allowing direct comparison of standardized surgical techniques. Advanced osteoarthrosis was induced bilaterally in 12 mature merino sheep. Three months alter unilateral surgical reconstruction was performed. Four sheep had discectomy alone, four discectomy with fresh TMJ disc grafts, and four discectomy with fresh auricular grafts. All three surgical methods resulted in some reversal and repair of the osteoarthritic process, with the best result being from the auricular graft, next discectomy alone, next the disc graft, with the untreated osteoarthritic joint showing the most advanced pathosis. This study supports the role of surgical reconstruction in advanced degenerative disease of the temporomandibular joint, in particular, auricular graft reconstruction.

Animals↗
PubMed1996

The short-term effect of discectomy on the osteoarthrotic temporomandibular joint in sheep.

The short-term effect of discectomy on osteoarthrotic joints was tested experimentally in sheep. Bilateral temporomandibular joint (TMJ) osteoarthrosis was induced, and at 3 months discectomy was performed on one joint, with the other being left as a control. Neither masticatory nor mouth-opening disturbances had been found after discectomy. The animals were killed at 6 months, and the TMJs were removed, fixed, and assessed radiologically, macroscopically, and histologically. The control joints showed ongoing degenerative changes consistent with previous reports. The discectomy joints showed marked fibrous repair with joint surface remodelling rather than ongoing degeneration. This result is consistent with the clinical findings after discectomy for osteoarthrotic joints.

Animals↗
PubMed1996

The training and surgical scope of oral and maxillofacial surgeons: the International Survey 1994.

In 1992, the International Association of Oral and Maxillofacial Surgeons (IAOMS) published its training guidelines document. The following survey was conducted to determine the current status of the training and scope of practice of oral and maxillofacial surgeons (OMS) worldwide. Currently, 55% of OMS practice with a single degree, predominantly a dental degree (DDS), while only 16% of the responding countries require dual qualification (MD, DDS). There is a trend toward the dual degree (MD, DDS) in the remaining 29%. In general, in those countries where dual qualification is mandatory, the scope is broadest; however, the scope in a number of countries in which surgeons practice with only the DDS degree - for example, Japan - is equally broad. This baseline information will be used to monitor the growth and development of the speciality in the future.

Adult↗
PubMed1996

Oral conditions and their social impact among HIV dental patients.

This study aimed to assess oral health status and the social impact of oral conditions among dental patients with HIV infection in comparison with general dental patients receiving public-funded care in Adelaide, South Australia. DMFT and CPITN indices were recorded by one dentist at a clinic for HIV dental patients. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using the Oral Health Impact Profile questionnaire and responses from HIV dental patients were compared with responses from a telephone interview survey of Adelaide residents. HIV patients were aged 21 to 49 years (median = 34), 90.7 percent were male and 29.6 percent had stage 4 HIV infection. Oral candida was present among 32.0 percent, hairy leukoplakia among 24.1 percent, HIV gingivitis among 18.5 percent, and HIV periodontitis among 33.3 percent. The DMFT index and its components did not differ significantly between HIV and general dental patients, while CPITN scores were lower among HIV patients (p = 0.01). However social impact among HIV patients was frequent: 64.6 percent reported toothache, 43.7 percent avoided foods, and 16.7 percent avoided going out because of dental problems. HIV patients reported significantly greater levels of social impact than the Adelaide sample (p < 0.01). Patients to this clinic frequently presented with severe and disabling oral conditions which were not adequately captured using standard clinical indices.

Adult↗
PubMed1994

The effect of occlusal loss on normal and pathological temporomandibular joints: an animal study.

The effect of unilateral posterior malocclusion on temporomandibular joint intra-articular pathology was studied in sheep. In Group I, osteoarthritic changes were induced in the left temporomandibular joint by gentle scraping of the articular surface (Ishimaru and Goss, 1992). Group II had the same procedures as Group I, with concurrent extraction of all the left maxillary posterior teeth. Group III had a different osteoarthritic precondition in the left temporomandibular joint, allowing synovial fluid to contact the condylar marrow (Ishimaru et al., 1992). Group IV had the same procedure as Group III, with concurrent extraction of all the left maxillary posterior teeth. Group V had unilateral maxillary molar teeth extraction in the left side. At 3 months, the animals were sacrificed and the joints examined histologically. There were no significant differences between normal control joints and those with unilateral tooth extraction (Group V). Similarly the degree of osteoarthritic change was the same between Groups I and II. Significant differences (p < 0.05) were seen between Groups III and IV with tooth extraction increasing the osteoarthritic effects. Hence it was concluded that in sheep, malocclusion had no effect on the normal temporomandibular joint and on one type of experimental osteoarthritis, but accelerated osteoarthritic change in another model.

Alveolectomy↗
PubMed1994

Allergy to gloves. Case report.

The risk of contracting infectious diseases from patients with either serious or even fatal consequences has led to considerable changes in dental practice in the last few years. A key step in infection control is to prevent contact between the dentist's skin and the patient's blood and saliva by wearing gloves. The practice initially requires some patients and tolerance but then has few disadvantages. This paper reports a case where there were adverse effects to the patient from the dentist wearing gloves.

Aged↗