ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Eminectomy for Chronic Dislocation of the Mandible Results in Improved Outcomes Compared with Mini-Plates: Low Level Evidence
Clinical Question In patients with chronic mandibular dislocation does treatment with eminectomy compared with mini-plates provide improved results including recurrent dislocation?
Clinical Bottom Line Eminectomy reduces the recurrence of dislocation of the mandible compared with the use of mini-plates: low level evidence.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19925978Vasconcelos/2009n =10 patients: 20 eminectomies mean age 31.4 (and n = 8 patients): 16 mini platesRetrospective case series
Key resultsGroup 1: 20 eminectomies were performed in 10 patients with a mean age 31.4 years and mean duration of follow up 37.4 months. The mean preoperative and postoperative maximal mouth opening (MMO) was 48.4±8.5 mm and 41.3±5.0 mm, respectively. No nerve paralysis or recurrence of mandibular dislocation was observed in any patient in group 1. Group 2: 16 bilateral mini-plates were placed in 8 patients with a mean age of 29.3 years and a mean duration of post-operative follow-up of 59.75 months. The mean preoperative and postoperative MMO was 42.75±11.53 mm and 45.62+ 8.52 mm respectively. Mini-plates mechanically restrict the anterior movement of the condyles. There were no failures in the eminectomy group while 2 mini-plates failures occurred. The major complication was unilateral mini-plate fracture in 2 patients and recurrence of the mandibular dislocation in one case. Both patients received eminectomy with no recurrence.
Evidence Search Bone Plates"[Mesh] AND "Dislocations"[Mesh] AND eminectomy[All Fields]
Comments on
The Evidence
Even though it is based on a retrospective case series, this article emphasizes the benefits of the eminectomy over the placement of mini-plates. A major limitation of this study is the small sample size. A future randomized clinical trial would produce a higher level of evidence.
Applicability This study is applicable to patients suffering chronic mandibular dislocation when surgery is indicated.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Oral Surgery)
Keywords Eminectomy, Dislocation, Mini-plates
ID# 2074
Date of submission: 10/26/2011spacer
E-mail faddoul@uthscsa.edu
Author Taoufik Faddoul, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Stephen Matteson, DDS
Faculty mentor/Co-author e-mail matteson@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Nicole Conlee and Surina Odhav (San Antonio, TX) on 11/28/2017
PubMed and TRIP database searches were conducted in November 2017 in order to seek updated evidence on this CAT topic. As a result, de Ameida’s 2016 systematic review (PMID: 26616027) was found. Just as stated in the retrospective case study from 2009 which was cited in support of the original bottom line for this CAT, de Ameida’s review concludes that an eminectomy is the “gold standard” for oral surgeons when treating recurrent temporomandibular joint dislocations. However, all sources that were included in de Ameida’s review, upon further analysis, show some form of bias. Reviewers concluded that further research should be conducted in order to clarify eminectomy as the standard in lieu of mini-plates, screws and other interventions.
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