Implication of general anaesthetic and sedation techniques in temporomandibular joint disorders – a systematic review

Talaván-Serna, J.; Montiel-Company, José María; Bellot-Arcís, Carlos; Almerich‐Silla, José Manuel

doi:10.1016/j.jormas.2016.12.002

Cited by 4 publications

(7 citation statements)

References 23 publications

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“…In the previous case reports reviewed, authors describe TMJ dislocation after the use of neuromuscular blocking drugs with a SAD [7–8]. Reduced muscle tone associated with general anaesthesia can contribute to greater joint mobility at the TMJ [16]. It may be valuable to study in detail how the use of analgesic agents and neuromuscular blocking drugs affect jaw function.…”

Section: Discussionmentioning

confidence: 99%

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study

et al. 2021

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Summary Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre‐operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter‐incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter‐incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter‐incisor distance in the pre‐ and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (−0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre‐ and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre‐ and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre‐ and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre‐ and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7–17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.

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Section: Discussionmentioning

confidence: 99%

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study

et al. 2021

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“…Damage to the TMJ may be due to excessive forces being applied to achieve a maximum opening of the patient’s mouth in an attempt to complete an intubation or other procedures such as bronchoscopy. In addition, the loss of muscle tone due to the unconsciousness and muscular relaxation of a patient under general anesthetic can predispose to greater joint mobilization [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Difficulties with intubation are especially common in patients with limited mouth opening such as those with TMJ ankyloses [ 8 , 9 , 10 , 11 ]. However, proper TMJ assessment is required both before and after anesthesia in order to avoid or minimize temporomandibular complications [ 6 , 12 ]. TMJ evaluation should be a component of the preoperative airway physical examination as suggested by The American Society of Anesthesiologist practice guidelines [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Even though some studies show that general anesthesia with intubation can influence the onset and worsening of TMD [ 6 ], the literature is still very limited on this topic. Moreover, in a recent longitudinal study, no difference was found in the incidence of signs and symptoms of TMD in patients who underwent orotracheal intubation compared with the patients who underwent surgery without intubation [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the study presented some limitations: only TMD of muscular origin was evaluated, and the TMD pre-assessment was self-reported by the patients after the surgery with no measurements of mouth opening, the 3 months’ follow-up was performed by phone, and only older patients were included (mean of 66 years for study group, and 54 years for the control group). According to a systematic review of the literature, more studies of higher evidence quality need to be conducted on TMJ issues in relation to general anesthetic and sedation procedures [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

Gadotti

Geronimo

Rodríguez

et al. 2020

JCM

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Background: Orotracheal intubation has been considered a risk factor for the development or exacerbation of disorders related to the temporomandibular joint (TMJ). The objective of this pilot study was to evaluate TMJ assessment performed by anesthetists in Florida when conducting orotracheal intubation. Methods: An online questionnaire was created using Qualtrics. The survey included 22 questions related to demographics, TMJ related to anesthesia procedures, and education/awareness regarding TMJ related to intubation. Descriptive statistics and cross-tabulation analysis were performed. Results: One hundred and eight providers participated (mean 46 years-old ± 12; 59% female). About 50% reported to always evaluate TMJ prior non-emergency intubation. Of those, 56% used an alternative intubation technique based on the TMJ status and 60% never/rarely evaluated TMJ post-intubation. Twenty-five percent reported they did not know of possible intubation effects on TMJ and 47% reported that they did not receive adequate information/education on TMJ management related to intubation in school. After participation, 81% reported to be more aware of the importance of evaluating TMJ. Conclusions: Only half of the providers who frequently performed intubation in Florida evaluated TMJ prior to intubation. This survey increased the awareness regarding the importance of evaluating TMJ when conducting intubation. This may contribute to reducing TMJ issues associated with non-emergency intubations.

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A novel rat model of temporomandibular disorder with improved face and construct validities

2021

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Implication of general anaesthetic and sedation techniques in temporomandibular joint disorders – a systematic review

Cited by 4 publications

References 23 publications

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study

Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

A novel rat model of temporomandibular disorder with improved face and construct validities

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