1
|
Schneider R, Burton R. Coordinated reconstruction with bilateral condylar replacement and dental implant rehabilitation: a clinical report. J Prosthet Dent 2013; 111:101-6. [PMID: 24189116 DOI: 10.1016/j.prosdent.2013.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The evaluation of complex facial-cranial trauma and subsequent restoration requires multidisciplinary treatment planning for optimal success and patient satisfaction. Patients with bilateral subcondylar fractures and facial-dental trauma are invariably challenging. Consideration of total joint replacement, along with the comprehensive evaluation of facial-dental esthetics and occlusion is critical for an optimal long-term outcome and for patient comfort. This patient treatment illustrates team cooperation and an optimal patient treatment outcome with long-term follow-up in the reconstruction of a complex cranial-facial injury from an unrestrained motor vehicle accident. The treatment included bilateral temporomandibular joint replacement with computer-aided design and computer-aided manufacturing fitted total temporomandibular joint reconstruction, grafting of a deficient anterior maxillary alveolar ridge, and dental implant placement and subsequent restoration with a partial fixed dental prosthesis.
Collapse
Affiliation(s)
- Robert Schneider
- Professor, Division Director Maxillofacial Prosthodontics, University of Iowa Hospitals and Clinics, Hospital Dentistry Institute, Iowa City, Iowa.
| | - Richard Burton
- Professor, Vice Chair, Oral and Maxillofacial Surgery, University of Iowa Hospitals and Clinics, Hospital Dentistry Institute, Iowa City, Iowa
| |
Collapse
|
2
|
Wan DC, Taub PJ, Allam KA, Perry A, Tabit CJ, Kawamoto HK, Bradley JP. Distraction Osteogenesis of Costocartilaginous Rib Grafts and Treatment Algorithm for Severely Hypoplastic Mandibles. Plast Reconstr Surg 2011; 127:2005-2013. [DOI: 10.1097/prs.0b013e31820cf4d6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Shimizu M, Kurita K, Matsuura H, Ishimaru JI, Goss AN. The role of muscle grafts in temporomandibular joint ankylosis: short-term experimental study in sheep. Int J Oral Maxillofac Surg 2006; 35:842-9. [PMID: 16730161 DOI: 10.1016/j.ijom.2006.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 01/19/2006] [Accepted: 03/02/2006] [Indexed: 10/24/2022]
Abstract
The temporalis muscle flap can be used as an inter-positional graft placed into a gap arthroplasty site in temporomandibular joint (TMJ) ankylosis. The purpose of this study was to investigate the role of the muscle graft in sheep. Five pure-bred adult Merino sheep were used and ankylosis was induced in all right TMJs. At 3 months, the ankylosis was released by gap arthroplasty and reconstructed with a masseter muscle graft, because the temporalis muscle is short and poorly vasculized in sheep. The sheep were killed at 3 months after muscle grafting. The maximal mouth opening was recorded before and after operation and at death. The joints were examined radiologically and histologically. In 4 sheep mouth opening remained at the pre-operative level. A clear radiolucent space remained between the smooth temporal and ramus stumps. Histologically, the muscle graft remained vital but with some fibrous tissue formation between the bone ends. One sheep developed an infection at the operative site following the muscle graft; this partly resolved with antibiotics, but the TMJ developed a fibrous reankylosis that was demonstrated clinically, radiologically and histologically. These results indicate that an uncomplicated temporalis muscle graft reconstruction with gap arthroplasty is a successful and stable procedure in human TMJ ankylosis.
Collapse
Affiliation(s)
- M Shimizu
- The First Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
| | | | | | | | | |
Collapse
|
4
|
Abstract
Mandibular hypoplasia is a frequently encountered craniofacial difference and can be classified into three groups: congenital, developmental, and acquired. The focus of this article is on the congenital group, the majority of which is associated with syndromes. There have been numerous publications on patients with syndromic congenital mandibular hypoplasia; however, there has been no investigation and differentiation of the "nonsyndromic" patients. The purpose of this study was to analyze this subgroup of patients with nonsyndromic congenital mandibular hypoplasia to determine incidence, clinical presentation, and treatment.A retrospective analysis of all children treated for congenital mandibular hypoplasia at the Children's Hospital of Philadelphia between 1975 and 2003 was performed. Two hundred sixty-six patients were identified during this 27-year period. Of these 266 patients, 148 presented with oculo-auriculo-vertebral (OAV) spectrum, 52 with mandibulofacial dysostosis, 31 with Pierre Robin sequence, and 17 with miscellaneous syndromes. The remaining 18 patients were identified as having congenital mandibular hypoplasia without any known syndrome. Of the 18 patients with nonsyndromic congenital mandibular hypoplasia, 17 had primary bilateral growth anomalies and 1 had a primary unilateral growth disturbance resulting in bilateral deformity. Seven patients were products of a complicated pregnancy, 10 patients required tracheotomy or prolonged intubations, and 7 required gastric tube feedings. Associated anomalies included temporomandibular joint ankylosis in five patients, aglossia/microglossia in three patients, and rare craniofacial clefts in three patients. The average number of procedures required to treat the mandibular deformity for each patient was six. Although mandibular hypoplasia is a common craniofacial anomaly, patients manifesting nonsyndromic congenital mandibular hypoplasia are a rare subgroup. Case reports illustrating the range of mandibular deformities are presented.
Collapse
Affiliation(s)
- Davinder J Singh
- Division of Plastic Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
5
|
Unlü RE, Uysal AC, Alagöz MS, Tekin F, Sensöz O. An Unusual Complication of Condylectomy: Fracture of the Temporal Bone and Intratemporal Facial Paralysis. J Craniofac Surg 2005; 16:185-9. [PMID: 15699674 DOI: 10.1097/00001665-200501000-00040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The incidence of temporomandibular joint (TMJ) ankylosis appears to be decreasing with the increased socioeconomic status of society. The intraoperative complications were reported to be few, the most dangerous of which are facial nerve injury during the extended preauricular incision and maxillary artery injury during condylectomy. The authors report a case of fracture of the temporal bone tearing the intratemporal portion of the facial nerve, resulting in a total facial nerve paralysis.
Collapse
Affiliation(s)
- Ramazan Erkin Unlü
- Department of Plastic and Reconstructive Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | | | | | | |
Collapse
|
6
|
Raustia A, Pernu H, Pyhtinen J, Oikarinen K. Clinical and computed tomographic findings in costochondral grafts replacing the mandibular condyle. J Oral Maxillofac Surg 1996; 54:1393-400; discussion 1400-1. [PMID: 8957117 DOI: 10.1016/s0278-2391(96)90251-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to evaluate by computed tomography (CT) and clinically the structure and function of costochondral grafts (CCG) used to replace the mandibular condyles. MATERIAL AND METHODS CT and clinical examination were performed in 11 patients with CCGs (9 female, 2 male; mean age at surgery, 25 years; range, 9 to 44 years) approximately 4.5 years after surgery (range, 5 months to 10.5 years). One mandibular condyle was replaced in six patients and two in five patients. RESULTS Facial asymmetry was observed in two cases and palpation tenderness of the TMJs or clicking and crepitation were found in 10 of 16 operated TMJs. In three cases coronal CT scans showed the graft to be situated laterally in the mandibular fossa, and lateral overgrowth of the graft was seen in three cases. In two cases, coronal CT slices showed that a new fossa had developed. In most cases translatory movement of the graft was minimal. The graft was either partially or almost completely mineralized, especially in cases with longer follow-up. CONCLUSIONS Most of the patients in this study seemed to have benefitted from replacement of the deformed mandibular condyle with a CCG as estimated by improved range of mandibular movements and decreased symptoms. There were some problems related to unpredictable growth and location of the graft, as well as restricted movement of the replaced condyle. In the future, care should be taken to ensure proper postoperative functional therapy and to examine the role of cartilage thickness on future growth in young patients.
Collapse
Affiliation(s)
- A Raustia
- Department of Prosthetic Dentistry and Stomatognathic Physiology, University of Oulu, Finland
| | | | | | | |
Collapse
|
7
|
Perrott DH, Umeda H, Kaban LB. Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up. Int J Oral Maxillofac Surg 1994; 23:321-8. [PMID: 7699266 DOI: 10.1016/s0901-5027(05)80046-3] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This is a retrospective study of 26 patients (seven growing and 19 non-growing) who received costochondral grafts (n = 33) for construction or reconstruction of the ramus/condyle unit (RCU). Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long-term (> 1 year). Average follow-up was 48.6 months for growing and 46.4 months for nongrowing patients. Facial asymmetry and malocclusion were successfully corrected in all patients except for those with hemifacial microsomia, where partial correction was most common. For the growing patients mean change in RCU length (n = 8) during the observation period was +3.1 mm on the constructed/reconstructed side and +3.2 mm on the unoperated side. For nongrowing patients, mean change in the RCU length (n = 25) was -5.7 mm for the reconstructed side. Three patients developed lateral contour overgrowth of the articulating surface; no patients developed clinically significant linear overgrowth with malocclusion. The results of this study indicate that a costochondral graft may be used successfully to construct/reconstruct the RCU and that linear overgrowth of the graft does not appear to be a clinical problem with the method described in this paper.
Collapse
Affiliation(s)
- D H Perrott
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, USA
| | | | | |
Collapse
|
8
|
Condylar growth arrest—early versus late treatment. J Craniomaxillofac Surg 1994. [DOI: 10.1016/s1010-5182(05)80242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
9
|
Alonso del Hoyo J, Fernandez Sanroman J, Gil-Diez JL, Diaz Gonzalez FJ. The temporalis muscle flap: an evaluation and review of 38 cases. J Oral Maxillofac Surg 1994; 52:143-7; discussion 147-8. [PMID: 8295048 DOI: 10.1016/0278-2391(94)90396-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article analyzes the authors' experience with the temporal myofascial flap in orbital, maxillary, floor of the mouth, tongue, retromolar trigone, and buccal mucosa reconstruction after oncologic surgery. Thirty-eight patients were treated and evaluated after using this technique. Four of the patients received the flap to restore orbital defects; the other 34 flaps were used in oral reconstruction. The flap remained viable in all instances. Most of the patients experienced no perioperative complications. Ten patients (29.4%) with flaps transposed to the oral cavity showed partial wound dehiscence. Two patients experienced temporomandibular joint dysfunction, two severe reduction in the oral aperture, 22 had mild depression of the temporal fossa, and four had mild to severe alteration in the facial aesthetics secondary to bone resection. All flaps transposed to the oral cavity showed good epithelialization and adaptation to the recipient site.
Collapse
Affiliation(s)
- J Alonso del Hoyo
- Department of Maxillofacial Surgery, La Princesa Hospital, Madrid, Spain
| | | | | | | |
Collapse
|
10
|
Ferguson JW, Luyk NH, Parr NC. A potential role for costo-chondral grafting in adults with mandibular condylar destruction secondary to rheumatoid arthritis--a case report. J Craniomaxillofac Surg 1993; 21:15-8. [PMID: 8445047 DOI: 10.1016/s1010-5182(05)80525-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Little attention has been directed towards reconstruction of the mandibular condyles in adult patients with rheumatoid arthritis, other than with allogenic implants which are now known to cause serious complications. There is a relatively high incidence of condylar erosion and breakdown in rheumatoid arthritis, often leading to anterior open bite and retrognathia. Costochondral grafting does not appear to have been considered as a logical option for reconstruction, despite its high success rate in many other situations. A case is described of rapid bilateral condylar destruction occurring in a young woman with rheumatoid arthritis, leading to anterior open bite. Reconstruction was undertaken using bilateral costochondral grafts, giving an excellent clinical result which has been maintained over the follow-up period of two-and-a-half years. Radiologically complete healing of severe glenoid fossa erosion has taken place.
Collapse
Affiliation(s)
- J W Ferguson
- Department of Oral Medicine and Oral Surgery, University of Otago, Dunedin, New Zealand
| | | | | |
Collapse
|
11
|
Thyne GM, Yoon JH, Luyk NH, McMillan MD. Temporalis muscle as a disc replacement in the temporomandibular joint of sheep. J Oral Maxillofac Surg 1992; 50:979-87; discussion 987-8. [PMID: 1506974 DOI: 10.1016/0278-2391(92)90059-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Temporalis muscle flaps were evaluated in sheep. Flaps placed following discectomy were examined at 2, 4, 12, and 24 weeks. Histologic evaluation showed avascular necrosis and subsequent displacement and loss of tissue from the joint resulting in close contact between the condyle and fossa. Muscle flaps placed lateral to the joint in operative controls were examined at 4, 12, and 24 weeks. This muscle remained viable while undergoing fibrous replacement. Although the surface layers of the condyle and fossa were initially lost, the tissues were reformed with time. This experiment showed that in the sheep, temporalis muscle does not withstand functional loading within the joint. However, despite the lack of interpositional material, the condyle and fossa can remodel.
Collapse
Affiliation(s)
- G M Thyne
- School of Dentistry, University of Otago, Dunedin, New Zealand
| | | | | | | |
Collapse
|
12
|
Brusati R, Raffaini M, Sesenna E, Bozzetti A. The temporalis muscle flap in temporo-mandibular joint surgery. J Craniomaxillofac Surg 1990; 18:352-8. [PMID: 2283400 DOI: 10.1016/s1010-5182(05)80055-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the treatment of the severely damaged TMJ structural components (ankylosis, arthrosis, tumour, perforation or degeneration of the disc), it is advisable to insert a biological interposition between bony articular surfaces. The temporal muscle, due to its anatomical, topographical, and functional properties, can be successfully employed for this purpose. Based on the experience of Tessier, Delaire and Rowe, a temporalis muscle flap, inferiorly based, is rotated downwards and medially to the zygomatic arch, interposed and then fixed to condyle and capsule. Using this surgical technique, 12 patients and 13 temporo-mandibular joints were treated with good functional results and without any complication.
Collapse
Affiliation(s)
- R Brusati
- Dept. of Maxillo-Facial Surgery, University and Hospital of Parma, Italy
| | | | | | | |
Collapse
|
13
|
|
14
|
Feinberg SE, Larsen PE. The use of a pedicled temporalis muscle-pericranial flap for replacement of the TMJ disc: preliminary report. J Oral Maxillofac Surg 1989; 47:142-6. [PMID: 2913247 DOI: 10.1016/s0278-2391(89)80104-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Disc replacement in temporomandibular joint surgery has been troublesome. Problems such as migration, fragmentation, foreign body reactions, and unpredictable biodegradation have occurred. Autogenous tissue is presently the material of choice, but requires a second surgical site. In addition, it is a free graft, and thus its fate is unknown. A technique has been developed that uses a pedicled autogenous flap composed of a portion of the temporalis muscle and pericranium to act as an interpositional material in temporomandibular joint surgery. The flap, based on the deep temporal arteries, and pedicled off of the coronoid process, is rotated anterior to the articular eminence and then posteriorly into the temporomandibular joint where it is sutured to the retrodiscal tissue. This procedure allows maintenance of tissue viability and functional movement of the flap during mandibular excursions. The technique offers numerous advantages over the existing autogenous, allogeneic, and alloplastic materials presently used in temporomandibular joint surgery.
Collapse
Affiliation(s)
- S E Feinberg
- Department of Oral and Maxillofacial Surgery, Ohio State University College of Dentistry, Columbus 43210
| | | |
Collapse
|