Abstracts

Rationale: We prospectively evaluated (pre and postoperatively) the signs and symptoms of temporomandibular disorders (TMD) in patients who underwent craniotomy for refractory mesial temporal lobe epilepsy (MTLE). Methods: We investigated 24 patients (mean age 37.3 10 years; 17 women) who underwent surgery for MTLE. We used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to investigate pre- and post-operatory signs and symptoms of TMD, mandibular function and masticatory muscles pain. Maximal mouth opening (MMO), protrusion and laterality were also obtained. We obtained the ratio (pos-op value/pre-op value) to evaluate the relationship with preoperatory conditions. We performed paired and unpaired T-test and Fisher s exact test for statistical analyses. Results: Presurgery, nine patients had TMJ disc displacement (DD); 15% subjects had TMJ pain; 20% patients presented masticatory muscle complaints. MMO significantly reduced after surgery ([pre-op 44.6 6.68mm],[post-op 33.4 9.47mm], p< 0.0001); as well as protrusion ([pre-op 6.8 1.6mm],[post-op 1.2 0.74mm], p< 0.05). The MMO ratio was reduced in patients with preoperatory disc displacement ([DD positive ratio 0.7 0.2],[DD negative ratio 0.86 0.08], p=0.036). Conclusions: Patients with preexisting TMJ dysfunction signs undergoing craniotomy are likely to present significant worsening of the TMJ and masticatory muscles dysfunction postsurgery and neurologists should be aware of this risk.