Search PubMed⌕ Search

Biomedical subjects

H D Hall

Publications and source records attributed to H D Hall.

At least 19 recordsLinked to original sources
PubMed2000

One- and three-year prospective outcome study of modified condylotomy for treatment of reducing disc displacement.

PURPOSE: This outcomes study was designed to provide a comprehensive evaluation of modified condylotomy for the treatment of the painful temporomandibular joint with reducing disc displacement (Wilkes stage II, early III). PATIENTS AND METHODS: A prospective study of 48 consecutive patients (79 joints) was conducted. All reducing disc displacements were verified by disc imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease before modified condylotomy and at intervals up to 1 year after operation. Thirty-one patients (50 joints) completed the examination before the operation and 1 year later. Patient-based assessments were made for pain and diet in 22 patients (35 joints) 3 years after operation. RESULTS: The mean (+/- SE) visual analog scale (VAS) score for pain improved from 6.9+/-0.4 before modified condylotomy to 2.0+/-0.4 1 year later (P < .001). Serious pain (VAS score greater than 4) after operation was 7 times more likely (P < .04) when there was persistent disc displacement. The mean frequency of pain each day decreased from 14.6+/-1.4 hours to 4.8+/-1.3 hours (P < .001). Dietary restrictions improved from a mean VAS score of 6.1+/-0.5 before operation to 8.8+/-0.3 at 1 year (P < .001). Small differences between mean VAS scores for pain at 1 (2.0+/-0.5) and 3 (2.7+/-0.5) years and diet at 1 (8.6+/-0.4) and 3 (8.4+/-0.5) years after operation were not significant. Mean maximal incisal opening was 41.7+/-1.2 mm before operation and 43.5+/-1.1 mm 1 year later, but the difference was not statistically significant. Mean contralateral movement improved from 8.1+/-0.3 mm to 8.9+/-0.3 mm 1 year after operation (P < .05). Clicking was reduced from 64% of joints to 16% 1 year after operation (P < .001). The disc was reduced in 72% of joints, healing of an incipient degenerative lesion occurred in 1 joint, and there was no evidence of progression to nonreducing disc displacement (Wilkes late III, IV, V) or DJD (Wilkes IV, V) in any joint 1 year after modified condylotomy. The rate for reoperation was 4%. Complications occurred in 4 patients after operation and were resolved 1 year later. When these outcomes were judged by 7 AAOMS assessment indices for internal derangement, the mean rate of favorable outcome was 94%. CONCLUSION: Modified condylotomy is an effective operation for treating pain and diminished function of temporomandibular joints with reducing disc displacement. It is also an effective treatment for slowing and, in some cases, reversing the progression of internal derangement.

Adolescent↗
PubMed2000

Prospective study of modified condylotomy for treatment of nonreducing disk displacement.

OBJECTIVE: This study was performed to provide an objective assessment of the outcome of modified condylotomy for treatment of the painful temporomandibular joint with nonreducing disk displacement (Wilkes late stage III, IV, V). STUDY DESIGN: A prospective study of 31 consecutive patients (43 joints) was conducted. All patients had nonreducing disk displacement verified by means of disk imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease. The examinations were performed before modified condylotomy and at intervals up to 1 year after the operation. Eighteen patients (26 joints) completed the required examinations. Patient-based assessments were completed for pain and diet on 15 of these 18 patients (23 joints) 3 years after the operation. RESULTS: Visual analog scale (VAS) scores (mean +/- SE) for pain improved from 7.4 +/- 0.4 before modified condylotomy to 2.4 +/- 0.5 1 year later (P <. 001). Joints with degenerative joint disease (Wilkes stage IV, V) had less satisfactory pain relief compared with stage III joints (3. 6 +/- 0.9 vs 1.1 +/- 0.4, P =.05) and an 11-fold higher risk (P <. 04) for serious residual pain (VAS score >4). Dietary restrictions improved from a mean VAS score of 5.3 +/- 0.7 before the operation to 7.7 +/- 0.5 1 year later (P =.02). Minor differences between mean VAS scores at 1 (2.1 +/- 0.5) and 3 (2.1 +/- 0.5) years for pain, and 1 (7.4 +/- 0.6) and 3 (8.1 +/- 0.6) years for diet, were not significant. Mean maximal interincisal opening was 36.7 +/- 2.0 mm before the operation, and this improved to 40.1 +/- 2.0 mm 1 year later (P <.02). Mean contralateral movement was 8.3 +/- 0.5 mm before the operation and 8.4 +/- 0.6 mm 1 year after the operation (P >.05). None of the 12 Wilkes late III joints progressed to Wilkes IV or V, and none of the 14 Wilkes IV, V joints showed evidence of further bone resorption. The rate for reoperation was 4%. Minor complications occurred in 5 patients and were resolved in all but 1 a year later. When these outcomes were judged by 7 American Association of Oral and Maxillofacial Surgeons assessment indices for internal derangement, the mean rate of favorable outcome was 87%. CONCLUSION: Modified condylotomy is a safe and effective operation for treating pain and diminished function of temporomandibular joints with nonreducing disk displacement. It also seems to be an effective treatment for slowing further progression of the internal derangement and associated pathologic conditions.

Adult↗
PubMed1997

Results of reoperation after failed modified condylotomy.

PURPOSE: This retrospective study reports the reoperation rate for failure after modified condylotomy. MATERIALS AND METHODS: A consecutive series from each of two surgeons constituted the study group of 361 joints in 235 patients. Reoperation rates were calculated for all joints and by type of disc displacement. RESULTS: A second operation occurred in 4.2% of all joints. However, the cumulative rate of reoperation was 4.4%, because one of the joints required a third operation. Although the rate of reoperation varied (0% to 6.5%) according to the type of disc displacement, the differences were not statistically significant. All joints requiring reoperation had a displaced disc, and more than half had lost nearly all the joint space gained by the primary operation. CONCLUSION: The rate of reoperation for modified condylotomy is low. Risk factors for reoperation appear to be recurrent or residual disc displacement and loss of joint space after the first operation. Bilateral operation was not a risk factor.

Adolescent↗
PubMed1996

Modification of the modified condylotomy.

PURPOSE: This article describes the results of modification of the condylotomy procedure for treating painful internal derangements of the temporomandibular joint. MATERIALS AND METHODS: Data on postoperative disc position, joint space, and pain were evaluated in patients who underwent either the original modified condylotomy or the newly modified procedure. RESULTS: Less anterior and inferior sag of the condyle was produced by the new technique. Pain relief and disc reduction were about the same with both procedures. CONCLUSIONS: The new modifications make the operation quicker and easier, while producing outcomes similar to those obtained with the original modified procedure.

Cartilage, Articular↗
PubMed1995

Disk position before and after modified condylotomy in 80 symptomatic temporomandibular joints.

OBJECTIVE: Our primary objective was to determine the frequency of disk reduction after modified condylotomy and whether the type of displacement affected outcome. DESIGN: We classified reducing disk displacements from magnetic resonance images of 80 symptomatic temporomandibular joints before modified condylotomy. Disk position was reassessed after surgery. RESULTS: The disk and condyle typically move in reciprocal directions. The disk was reduced by surgery in 79% of the joints. The rate of reduction varied by the type of displacement, but the differences between the groups were not statistically significant. CONCLUSION: This finding reaffirms that modified condylotomy has a high rate of disk reduction. The unexpected observation that the increase in joint space resulting from the surgery typically permitted a variable degree of spontaneous movement of the disk has implications for the nature of osteoarthrosis and internal derangement and for surgical treatments intended to reduce the risk.

Adolescent↗
PubMed1994

Is it time to pay more attention to disc position?

Most surgical and nonsurgical treatments of painful temporomandibular joint internal derangements are primarily directed toward relief of pain and dysfunction; correction of disc displacement is increasingly of lesser or no concern. However, internal derangements are variably progressive and, in some patients, cause condylar deformity with secondary deficiency of the mandible. If data support the hypothesis that condylar deformity and growth retardation can result from a displaced disc, and, conversely, that a normally positioned disc permits normal growth and maintains condylar mass, a goal of any treatment for reducing disc displacement should include reestablishment of a normal disc/condyle relationship. Functional appliance therapy for the deficient mandible may be most effective in those patients that present with a normal disc/condyle relationship; if a reducing disc is present, such therapy may be most effective only when the appliance advances the condyle to a position beneath the disc.

Facial Pain↗
PubMed1993

Modified condylotomy for treatment of the painful temporomandibular joint with a reducing disc.

Data from a pool of approximately 400 patients operated on with modified condylotomy during a 9-year period are presented. The chief findings were good relief of pain and dysfunction, and reversal of the internal derangement in a high percentage of patients. There was low morbidity and remarkably few complications. Comparison of these findings with published results of alternative surgical and nonsurgical procedures seems to favor modified condylotomy.

Bone Remodeling↗