Temporomandibular disorders: clinical and laboratory analyses for risk assessment of criteria for surgical therapy, a pilot study.
Temporomandibular disorder (TMD) is a broad category involving dysfunction of the skeletomuscular structures of the head and neck, and the temporomandibular joint (TMJ). A total of 66 patients, 54 with TMD, participated in this study. Group 1 (G1) had 31 patients suffering from early to intermediate stage disease, and no prior surgeries. G1 patients had arthrotomy/meniscectomy performed on the diseased joint(s). Group 2 (G2) consisted of 23 patients with late stage disease. All G2 patients had previously had unsuccessful TMJ surgery and were treated with either a partial or total joint prosthesis. Group 3 (G3) consisted of 12 patients who were clinically and radiographically asymptomatic. Medical histories including inflammatory bowel disease, headaches, vertigo, tinnitus and anemia, as well as surgical tonsillectomies, appendectomies and cholecystectomies, were significantly greater in G1 and G2 when compared to G3. Serological testing included HLA subtype, positive (ANA) antinuclear antibody, erythrocyte sedimentation rate (ESR), anemia profile, hormonal levels of prolactin and estradiol, and rheumatoid factor (RF). HLA frequencies, as well as some serological analyses, were significantly different among the three groups. These findings suggest that surgical failure may be secondary to autoimmune dysfunction with a predisposition to multisystem disease. The utilization of genetic markers, serological testing, and thorough medical and surgical histories should allow the clinician to determine which patients are potentially better surgical risk candidates for treatment of TMD.
Halpern
L R
LR
University of Tennessee Medical Center, Knoxville, Department of Oral & Maxillofacial Surgery, USA.
Chase
D C
DC
Gerard
D A
DA
Behr
M M
MM
Jacobs
W
W
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000974:Antibodies, Antinuclear / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006680:HLA Antigens / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012086:Reoperation; D018570:Risk Assessment; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000601:surgery; D017211:Treatment Failure
D000974:Antibodies, Antinuclear; D006680:HLA Antigens