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Biomedical subjects

W S Kirk

Publications and source records attributed to W S Kirk.

17 recordsLinked to original sources
PubMed1998

Risk factors and initial surgical failures of TMJ arthrotomy and arthroplasty: a four to nine year evaluation of 303 surgical procedures.

Studies exist which support the efficacy of TM joint arthrotomy, arthroplasty and arthroscopic surgery. Few, if any, studies have evaluated failures of arthroplasty and/or diskectomy and specific risk factors that might invite initial surgical failure. This paper is a retrospective review of 210 patients operated with arthrotomy/arthroplasty for painful and dysfunctional TM joint derangement. There were 303 surgical procedures evaluated over a follow-up period of 4-9 years. Patient ages ranged from 16-72 years. There was no age correlation seen with degree of joint derangement. All cases were operated by one surgeon. There were no cases of alloplastic materials in this group of patients. There were no cases of autograph such as auricular cartilage for dermal grafting or other disc substitution materials. Operations consisted of capsular arthroplasty in Wilkes' stage II, III, and IV. Diskectomy was performed in Wilkes' stages IV and V. Comparisons are made among staged groups and operation performed. Two hundred seventy-three of 303 operated joints met the criteria for surgical success for a technical success rate of 90.1%. Potential risk factors of missing molar teeth, preoperative joint collapse, and skeletal malocclusion were evaluated. The frequency of their presence in successful and non-successful surgical outcomes is noted. Patients with imaging confirmed osteoporosis were evaluated as group with potential systemic disease or a result of systemic disease that may influence long term surgical outcome. Predictable preoperative risk factors that may influence initial surgical outcome do appear to be significant in long term success. There were 30 cases of failure to evaluate. It is concluded that reconstructive arthroplasty is a stage specific operation with excellent results in Wilkes' stage II and good results in stage III derangement. Attempted arthroplasty failed significantly (50%) in a small number of attempts in stage IV cases. However, diskectomy was successful in stage IV and V cases. Osteoporosis may be the most significant risk factor and the presence of risk factors studied may jeopardize initial surgical outcomes. Preoperative staging of joint derangement is strongly suggested and evaluation of risk factors may necessitate selection of specific initial surgical procedures that minimize the influence of concomitant risk factors to long term success.

Adolescent↗
PubMed1997

Guide to evaluation of permanent impairment of the temporomandibular joint. American Academy of Head, Neck and Facial Pain; American Academy of Orofacial Pain; American Academy of Pain Management; American College of Prosthodontists; American Equilibration Society and Society of Occlusal Studies; American Society of Maxillofacial Surgeons; American Society of Temporomandibular Joint Surgeons; International College of Cranio-mandibular Orthopedics; Society for Occlusal Studies.

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Ankylosis↗
PubMed1993

Early surgical correction of unilateral TMJ ankylosis and improvement in mandibular symmetry with use of an orthodontic functional appliance--a case report.

Early ankylosis of the temporomandibular joint (TMJ) can be a deterrent to normal mandibular growth. The frequency of occurrence is rare in the population of young patients who undergo orthodontic treatment. Early diagnosis of TMJ ankylosis is important and early surgical intervention is now an accepted mode of treatment. Ankylosis infers minimal, if any joint function. Caldwell argues that restoration of joint function at an early age is necessary to activate as much growth potential as possible. Laboratory and clinical studies have supported the theory that the mandibular condyle is adaptable under function and perhaps even the most deformed condylar head may exhibit growth when released and placed in function. The purpose of this article is to present a case report of surgical release of TMJ ankylosis followed by radiographic and clinical evidence of unilateral condylar growth. The surgical procedure involved maintenance of the condyle, the disk and majority of fibrocartilage covering the mandibular condyle. Aggressive postoperative physical therapy and the employment of a functional orthodontic appliance appeared to have assisted in a more symmetric growth pattern and maintenance of appropriate function.

Ankylosis↗
PubMed1991

Magnetic resonance imaging and tomographic evaluation of occlusal appliance treatment for advanced internal derangement of the temporomandibular joint.

This study evaluates the positional relationship of the disc and mandibular condyle in patients with late opening clicks treated with appliance therapy. A total of 30 joints (18 patients) were studied. Twenty-seven of these 30 joints were treated with the appliance until the joints were silent to auscultation. The patients were then evaluated with axial corrected tomography and magnetic resonance imaging (MRI) in the centric occlusion position and with their bite appliance (Sved-type) in place. Comparisons were made between condyle position in centric occlusion and with the appliance in place. Magnetic resonance imaging was then used to evaluate disc positional changes. Each imaging procedure was made in the same sagittal plane. Only changes in condyle positioning could be identified. Evidence of disc repositioning with the appliance in place was seen in only three MRI examinations. The remaining 27 joints continued to exhibit disc displacement with various changes in disc morphology. It is concluded that the concept of "disc capture" is a clinical term only, and that such perceived clinical success should not lead to the assumption that an actual change in intra-articular anatomic relationships has occurred. Joint noises may decrease because joint space is increased, allowing smoother condylar translation beyond disc surface irregularities and positional abnormalities.

Cartilage, Articular↗
PubMed1990

Morphologic differences between superior and inferior disc surfaces in chronic internal derangement of the temporomandibular joint.

This study examines the morphologic differences between the superior and inferior disc surfaces in patients with chronic internal derangement of the temporomandibular joint. Forty-two discs were removed in 33 patients when morphologic or qualitative tissue changes made a reparative procedure impossible. Eighty-three percent of the joints operated in this series showed late opening (grade III) clicking or were considered clinically locked. Specific differences between superior and inferior disc surface anatomy were demonstrated in these cases of long-standing internal derangement.

Adolescent↗
PubMed1989

A comparative study of axial corrected tomography with magnetic resonance imagery in 35 joints.

Axially corrected tomographic examination of 35 temporomandibular joints was compared with respective MRI images. The criteria of joint space measurements, condylar positioning, and degenerative osseous changes were correlated with the MRI image of disk positioning. Joints with disk displacements that reduced with condylar translation and joints with disk dislocation without reduction of the articular disk were compared with normal examinations. The mean measured joint space on tomographic examination decreased with MRI evidence of disk displacement and dislocation. Fourteen of twenty-five joints with MRI documentation of disk displacement or dislocation did show a tendency for some condylar displacement from a centric position. Only the joints with MRI evidence of total disk dislocation showed bony evidence of degenerative changes with tomography. The clinical cross-sectional study suggests that there can be changes seen in axially corrected tomographic examinations that may suggest the presence of disk displacement or significant internal derangement.

Cartilage, Articular↗
PubMed1989

Diagnosing disk dysfunction and tissue changes in the temporomandibular joint with magnetic resonance imaging.

Magnetic resonance imaging (MRI) is a noninvasive technique that clearly documents disk positioning abnormalities and tissue structure changes not previously discovered except by surgical intervention and biopsy. The MRI also shows hyperplasias, disk folds, displaced disks, and disk thinning-important information to have before surgical intervention is begun. Overall, MRI provides a basis for complex dental treatment planning and prognostic evaluation.

Adult↗
PubMed1989

Clinical evaluation of physical therapy in the management of internal derangement of the temporomandibular joint.

This clinical cross-sectional study examines the favorable functional improvement in patients undergoing physical therapy for mild to moderate internal disc derangements of the temporomandibular joint. Sixty-eight patients with internal derangements were treated with physical therapeutic modalities as described by Rocabado. A success rate of 86% was achieved in patients with early- to mid-opening and late- to mid-closing clicks of the temporomandibular joint. Approximately one third of these patients required short-term occlusal bite appliances to assist in their management. A success rate of 7% was achieved in patients with late-opening and late-closing clicks. No patient with clicking on mediolateral movement was successfully managed with physical therapy. Likewise, patients with nonreducing anteriorly displaced discs of the temporomandibular joint did not respond well to physical therapy. Pain management was evaluated separately and showed subjective improvement in 82% of patients with mild to moderate disc dysfunction and pain. Only 29% of patients with late-opening clicking or locked joints experienced pain relief. When patients were classified according to occurrence of the clicking phenomenon, interesting trends relating to duration of symptoms were found. Twenty-two patients who did not respond favorably to physical therapy underwent surgical procedures. Findings in these patients offer suggestions about why nonsurgical therapy is not successful in certain cases.

Cartilage, Articular↗