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Rikhotso RE, Sekhoto MG. Surgical Treatment of Temporomandibular Joint Ankylosis: our experience with 36 cases. J Craniofac Surg 2024:00001665-990000000-01583. [PMID: 38743036 DOI: 10.1097/scs.0000000000010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024] Open
Abstract
AIM To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction. METHODOLOGY A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant. RESULTS The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28 mm. Reankylosis was the most common complication (n=5). CONCLUSIONS All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.
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Affiliation(s)
- Risimati E Rikhotso
- Department of Maxillofacial and Oral Surgery, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Andrade NN, Kapoor P, Mathai P, Gupta V, Lakshmi V, Sharma S. Management of paediatric ankylosis. J Oral Biol Craniofac Res 2023; 13:191-201. [PMID: 36691651 PMCID: PMC9860352 DOI: 10.1016/j.jobcr.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Temporomandibular joint ankylosis (TMJa) is one of the most crippling craniomaxillofacial pathological conditions characterized by replacement of normal architecture of temporomandibular joint (TMJ) with fibrous or bony tissue. The incidence of TMJa is most common in the paediatric population [first and second decades of life] and is commonly associated with maxillofacial trauma. Comprehensive management entails a thorough evaluation of the associated anatomy of the ankylotic mass and other pertinent details like the presence or absence of obstructive sleep apnoea. Categorizing patients based on these variables helps in selecting an appropriate surgical intervention. Various resective and reconstructive surgical techniques are discussed; along with their merits and demerits. Long-term physiotherapy, long-term clinical follow-up and appropriate family counselling are the essential pillars for success. In this review, the authors present an algorithmic approach to evaluation and management of paediatric TMJa. Appropriate recommendations are made based on evidence to select optimum surgical intervention.
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Affiliation(s)
- Neelam Noel Andrade
- Head of Department of Oral & Maxillofacial Surgery and Dean of Nair Dental College & Hospital, Mumbai and Dean of NESCO Jumbo Covid Care Center, Mumbai, Dean's Office, Nair Dental College & Hospital, Dr Anandrao Nair Marg, Mumbai Central, Mumbai, Maharashtra, 400008, India
| | - Prathmesh Kapoor
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Paul Mathai
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
- The Center For Oral, Maxillofacial and Facial Plastic Surgery, Mumbai
| | - Varsha Gupta
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - V.K. Lakshmi
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Shelly Sharma
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
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Shakya S, Li KD, Huang D, Liu ZQ, Liu ZR, Liu L. Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture. Chin J Traumatol 2022; 25:49-53. [PMID: 34518064 PMCID: PMC8787230 DOI: 10.1016/j.cjtee.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture. METHODS From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0. RESULTS All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement. CONCLUSION Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
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Affiliation(s)
- Shubhechha Shakya
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Kai-De Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Dou Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Zuo-Qiang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Zhi-Ru Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Viability and Volumetric Analysis of Free Autogenous Dermis Fat Graft as Interpositional Material in TMJ Ankylosis: A Long-Term MRI Study. J Maxillofac Oral Surg 2020; 20:304-309. [PMID: 33927501 DOI: 10.1007/s12663-020-01413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Abstract
Aims and Objectives Dermis fat graft has shown good clinical results as an interpositional material in temporomandibular joint (TMJ) ankylosis and prevents heterogeneous calcification following gap arthroplasty. However, survival of the graft and volume retention is still debatable. The main purpose of our study was to assess the viability of the graft, tissues changes associated with the graft and volume retention using magnetic resonance imaging (MRI). Materials and Methods Fifteen patients with TMJ ankylosis underwent gap arthroplasty followed by placement of abdominal dermis fat graft and were randomly divided into two groups. Group 1 was subjected to MRI analysis of the graft at 3-6 months and Group 2 was analyzed at 1-2 years post-operatively. The graft was evaluated using T1- and T2-weighed images along with fat suppression (FS) sequences in all the three planes and the volume was also calculated. Results Both Group 1 (7 patients and 11 joints) and Group 2 (8 patients and 13 joints) showed the presence of viable fat on T1 and T2 images, confirmed by FS images. Minor tissue changes were observed at the center of the graft in 5 patients of Group 1 and 3 patients of Group 2. Average volume of the graft was 4.154 cm3 at 3-6 months and 4.269 cm3 at 1-2 years, respectively, and when compared to the original volume of the graft (4.583 cm3 in Group 1 and 4.712 cm3 in Group 2), the difference was statistically insignificant (p > 0.005). Conclusion MRI shows long-term survival of autogenous dermis fat graft without significant volumetric reduction. This along with positive clinical results make dermis fat an excellent choice as an interpositional material for TMJ ankylosis.
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Zhao Y, Ouyang N, Chen L, Zhao H, Shen G, Dai J. Stimulating Factors and Origins of Precursor Cells in Traumatic Heterotopic Ossification Around the Temporomandibular Joint in Mice. Front Cell Dev Biol 2020; 8:445. [PMID: 32626707 PMCID: PMC7314999 DOI: 10.3389/fcell.2020.00445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
The contributing factors and the origins of precursor cells in traumatic heterotopic ossification around the temporomandibular joint (THO-TMJ), which causes obvious restriction of mouth opening and maxillofacial malformation, remain unclear. In this study, our findings demonstrated that injured chondrocytes in the condylar cartilage, but not osteoblasts in the injured subchondral bone, played definite roles in the development of THO-TMJ in mice. Injured condylar chondrocytes without articular disc reserves might secrete growth factors, such as IGF1 and TGFβ2, that stimulate precursor cells, such as endothelial cells and muscle-derived cells, to differentiate into chondrocytes or osteoblasts and induce THO-TMJ. Preserved articular discs can alleviate the pressure on the injured cartilage and inhibit the development of THO-TMJ by inhibiting the secretion of these growth factors from injured chondrocytes. However, the exact molecular relationships among trauma, the injured condylar cartilage, growth factors such as TGFβ2, and pressure need to be explored in detail in the future.
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Affiliation(s)
- Yan Zhao
- Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China
| | - Ningjuan Ouyang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Chen
- Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China
| | - Hanjiang Zhao
- Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China
| | - Guofang Shen
- Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China
| | - Jiewen Dai
- Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China
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Retrospective analysis of a TMJ ankylosis protocol with a 9 year follow up. J Craniomaxillofac Surg 2019; 47:1903-1912. [DOI: 10.1016/j.jcms.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
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Abstract
One of the indications of the surgical approach of the temporomandibular joint is the presence of foreign body in its interior. However, joint handling offers risks, especially bleeding. In these cases, angiography and embolization of the arteries involved with the projectile play an important role in the prevention of complications. In this report, the authors describe a case of a 23-year-old male victim of firearm attack with comminuted fracture of the right mandibular condyle. The patient underwent angiography and prophylactic embolization of the arteries adjacent to the foreign body. A surgical procedure was performed to remove the projectile and bone fragments with the aid of the X-ray image intensifier, which resulted in the restoration of mandibular function, absence of joint pain, and satisfactory dental occlusion. This case shows the importance of auxiliary imaging methods for performing a safe surgical procedure for removal of ballistic and bony fragments from the interior of the temporomandibular joint.
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Frietman SK, van Proosdij ER, Veraa S, de Heer N, Ter Braake F. A minimally invasive partial condylectomy and temporal bone resection for the treatment of a suspected chronic synovial sepsis of the temporomandibular joint in a 3.5-year-old paint horse gelding. Vet Q 2019; 38:118-124. [PMID: 30773124 PMCID: PMC6830993 DOI: 10.1080/01652176.2018.1535216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- S K Frietman
- a Equine Department , Equine Veterinary Clinic Emmeloord , Espelerlaan 77 , Emmeloord 8302 DC , the Netherlands
| | - E R van Proosdij
- b Equine Department , DAP VUG , Evertsenlaan 18 , Voorthuizen 3781 TB , the Netherlands
| | - S Veraa
- c Division of Diagnostic Imaging , Utrecht University , Yalelaan 108 , Utrecht 3584 CM , the Netherlands
| | - N de Heer
- a Equine Department , Equine Veterinary Clinic Emmeloord , Espelerlaan 77 , Emmeloord 8302 DC , the Netherlands
| | - F Ter Braake
- a Equine Department , Equine Veterinary Clinic Emmeloord , Espelerlaan 77 , Emmeloord 8302 DC , the Netherlands
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Bedi RS, Khemka U, Singh J, Yadav M, Singh P. Use of T.M.J. Disc as a Soft Tissue Interpositional Graft Material for Functional Rehabilitation of Ankylosed T.M. Joint. J Maxillofac Oral Surg 2017; 16:219-225. [PMID: 28439164 DOI: 10.1007/s12663-016-0942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/07/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Many surgical techniques have been described for the treatment of TMJ ankylosis, but no strategy has been uniformly agreed upon underscoring the difficulty of the problem. Despite new guidelines and updated methods, treating patients with TMJ Ankylosis remains a challenge as the incidence of recurrence after treatment is soaring. This study exemplifies our experience in using an unsullied method to treat TMJ Ankylosis to restore the structure of TMJ in conjunction with convalescing secondary maxillofacial deformity. MATERIALS AND METHODS A total of 56 cases of unilateral bony TMJ ankylosis were included in the study, and postoperative results of T.M.J disc as a soft tissue interposition graft was evaluated. The operative protocol comprised of (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy or contralateral coronoidectomy when needed, (4) interpositioning disc as soft tissue graft, (5) interposing and fixing sternoclavicular or costocondral graft with lag screws and (6) early mobilization, aggressive physiotherapy. RESULTS The study assessed patients with regular follow-up checks for a period of 3 years. The average preoperative mouth opening was found to be 5.46 mm (range 2-10 mm). Mean post-operative mouth opening was 33.05 mm (range 24-43 mm), while 3 years post operative mouth opening (mean) was 39.75 mm. No cases of reankylosis were reported during this period suggesting it as a viable and satisfactory approach. CONCLUSION The use of TMJ disc as a soft tissue interpositional graft material is an effectual method for functional rehabilitation of ankylosis cases and serves as an effective means of preventing recurrence.
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Affiliation(s)
- Ravinder Singh Bedi
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College, Tiwariganj, Chinhat, Lucknow, India
| | - Upasana Khemka
- Opposite Moinul Haq Stadium Gate, Saidpur Extension, Rajendra Nagar, Patna, Bihar 800016 India
| | - Jaipal Singh
- 108 J- Block, Silver Line Apartmet, Near BBD University, Chinhat, Lucknow, India
| | - Manoj Yadav
- 36- B, Shivam Dento-Maxillofacial Centre, Laxmanpuri, Lucknow, India
| | - Pratibha Singh
- 108 J- Block, Silver Line Apartmet, Near BBD University, Chinhat, Lucknow, India
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Quantifying the outcome of surgical treatment of temporomandibular joint ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44:6-15. [DOI: 10.1016/j.jcms.2015.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/13/2015] [Accepted: 08/19/2015] [Indexed: 11/21/2022] Open
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Aggarwal SK, Ankur B, Jain RK. Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques. Indian J Otolaryngol Head Neck Surg 2015; 67:242-7. [PMID: 26405658 DOI: 10.1007/s12070-014-0806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/21/2014] [Indexed: 11/26/2022] Open
Abstract
We have described a new technique of using ultra-thin silicon sheet (0.2 mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15 years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2 years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5 mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2 cm. The mouth opening was about more than 2.7 cm in all our cases at 2 years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.
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Affiliation(s)
| | - Bhatnagar Ankur
- Department of Plastic Surgery, SGPGIMS, Lucknow, 226014 India
| | - R K Jain
- Department of ENT, IMS, BHU, Varanasi, 221005 India
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Bansal V, Bansal A, Mowar A, Gupta S. Ultrasonography for the volumetric analysis of the buccal fat pad as an interposition material for the management of ankylosis of the temporomandibular joint in adolescent patients. Br J Oral Maxillofac Surg 2015; 53:820-5. [PMID: 26169502 DOI: 10.1016/j.bjoms.2015.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 06/16/2015] [Indexed: 12/01/2022]
Abstract
The aim of this study was to analyse preoperatively with ultrasound the minimum volume of buccal fat that would be required for interposition of a pad after gap arthroplasty, and to emphasise the value of such a pad in the management of ankylosis of the temporomandibular joint (TMJ) during a short term follow up. Nineteen patients with ankylosis of the TMJ (22 joints) were selected, whose mean (SD) mouth opening was 4.9 (3.7) mm. In 10 joints in which the mean (SD) volume of the buccal fat pad was 0.7 (0.2) ml, the harvested buccal fat was inadequate for interposition, so they were treated with other materials. The remaining 12 joints had a mean (SD) volume of 1.1 (0.3) ml, which gave enough fat for interposition after gap arthroplasty. Investigation with ultrasound at 15 days and 6 months postoperatively showed that the fat pad was viable and the volume had shrunk by 28%. The 6-month postoperative computed tomographic (CT) scan showed little or no heterotopic calcification. We conclude that a buccal fat pad with a preoperative mean (SD) volume of 1.1 (0.3) ml is easy to harvest as interposition material. At a mean follow up of the 12 joints after 31 (range 24-36) months there was progressive improvement in mouth opening with a mean (SD) of 32.5 (5.0) mm, which established that a pedicled buccal fat pad is a stable, efficient, viable soft tissue barrier in the management of ankylosis of the TMJ.
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Affiliation(s)
- Vishal Bansal
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India.
| | - Avi Bansal
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India
| | - Apoorva Mowar
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India
| | - Sanjay Gupta
- Healthcare & Imaging Centre. 43, Shivaji Road, Near N.A.S. College, Meerut (Uttar Pradesh), India
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Sanders RE, Schumacher J, Brama PAJ, Zarelli M, Kearney CM. Mandibular condylectomy in a standing horse for treatment for osteoarthritis of the temporomandibular joint. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. E. Sanders
- Veterinary Clinical Sciences; School of Veterinary Medicine; University College Dublin; Ireland
| | - J. Schumacher
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville USA
| | - P. A. J. Brama
- Veterinary Clinical Sciences; School of Veterinary Medicine; University College Dublin; Ireland
| | - M. Zarelli
- Veterinary Clinical Sciences; School of Veterinary Medicine; University College Dublin; Ireland
| | - C. M. Kearney
- Veterinary Clinical Sciences; School of Veterinary Medicine; University College Dublin; Ireland
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Gui H, Wu J, Shen SG, Bautista JS, Voss P, Zhang S. Navigation-Guided Lateral Gap Arthroplasty as the Treatment of Temporomandibular Joint Ankylosis. J Oral Maxillofac Surg 2014; 72:128-38. [DOI: 10.1016/j.joms.2013.07.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Jakhar SK, Agarwal M, Gupta DK, Tiwari AD. Preservation of condyle and disc in the surgical treatment of type III temporomandibular joint ankylosis: a long-term follow-up clinical study of 111 joints. Int J Oral Maxillofac Surg 2013; 42:746-51. [PMID: 23490475 DOI: 10.1016/j.ijom.2013.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/10/2013] [Accepted: 02/07/2013] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to establish the role of retaining the condyle and disc in the treatment of type III ankylosis, by clinical and computed tomography (CT) evaluation. A total of 90 patients with type III ankylosis met the inclusion criteria; 42 patients had left temporomandibular joint (TMJ) ankylosis, 27 patients had right TMJ ankylosis, and 21 had bilateral TMJ ankylosis, thus a total 111 joints were treated. Considerable improvements in mandibular movement and maximum mouth opening were noted in all patients. At the end of a minimum follow-up of 2 years, the mean inter-incisal mouth opening was 30.7 mm. Postoperative occlusion was normal in all patients, and open bite did not occur in any case because the ramus height was maintained through preservation of the pseudo-joint. Only three patients had recurrence of ankylosis, which was due to a lack of postoperative physiotherapy. The advantages of condyle and disc preservation in type III ankylosis are: (1) surgery is relatively safe; (2) the disc helps to prevent recurrence of ankylosis; (3) the existing ramus height is maintained; (4) the growth site is preserved; and (5) there is no need to reconstruct the joint with autogenous or alloplastic material. It is recommended that the disc and condyle are preserved in type III TMJ ankylosis.
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Affiliation(s)
- S K Jakhar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Jaipur, Rajasthan, India
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Babu L, Jain MK, Ramesh C, Vinayaka N. Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases. Br J Oral Maxillofac Surg 2012; 51:473-8. [PMID: 23219020 DOI: 10.1016/j.bjoms.2012.11.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.
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Affiliation(s)
- Lokesh Babu
- Department of Oral and Maxillofacial Surgery, KGF College of Dental Sciences and Hospital, BEML Nagar, K.G.F, Karnataka, India.
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Modified internal mandibular distraction osteogenesis in the treatment of micrognathia secondary to temporomandibular joint ankylosis: 4-Year follow-up of a case. J Craniomaxillofac Surg 2012; 40:373-8. [DOI: 10.1016/j.jcms.2011.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 06/01/2011] [Accepted: 06/07/2011] [Indexed: 11/16/2022] Open
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Effects of soft tissue injury to the temporomandibular joint: report of 8 cases. Br J Oral Maxillofac Surg 2012; 51:58-62. [PMID: 22465223 DOI: 10.1016/j.bjoms.2012.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/10/2012] [Indexed: 11/22/2022]
Abstract
Our aim was to describe the effects of soft tissue injury to the temporomandibular joint (TMJ), to analyse possible reasons for it, and to evaluate the results of treatment. Eight patients (12 joints) who developed disorders of the TMJ after trauma to the mandible without fracture of the condyle were treated in our department from 2009 to 2010. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to check the condition of the joint. Five patients had their joints explored to relieve pain and improve mouth opening. MRI showed all 12 joints had displaced discs. CT showed that the surface of the condylar bone was "intact" immediately after injury but destroyed later in 8 joints. Exploration showed fibrous ankylosis in 5, osteoarthritis with intra-articular adhesions in 2, and internal derangement in 1. Four were treated by costochondral graft (CCG) with 7 symptomatic joints. The disc was repositioned in 1 case with 1 affected joint. The mean maximal incision opening at follow-up were significantly better than the one before treatment (mean 34 compared with 23 mm, p=0.02). Pain in the TMJ was relieved by operation in all patients so treated. The other 3 patients (4 joints) had no treatment because their symptoms were minor and mouth opening was not restricted. Soft tissue injuries of the TMJ can potentially lead to internal derangement, osteoarthrosis, and possibly fibrous ankylosis, which should be considered during follow-up. Displacement of the disc and damage to the condylar cartilage seem to be the causes of these complications. Surgical management is effective in the short term.
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Singh V, Dhingra R, Sharma B, Bhagol A, Kumar P. Retrospective analysis of use of buccal fat pad as an interpositional graft in temporomandibular joint ankylosis: preliminary study. J Oral Maxillofac Surg 2011; 69:2530-6. [PMID: 21664741 DOI: 10.1016/j.joms.2011.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 01/02/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the feasibility and usefulness of buccal fat pad as an interpositional graft in the treatment of temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS A retrospective study of 10 patients with TMJ ankylosis (9 unilateral and 1 bilateral) was performed with follow-up of 6 months to 2 years. RESULTS In the present study, patients had a maximum interincisal opening of 32 to 41 mm (mean, 35.1 mm) at the latest follow-up. Mean deviation to the affected side on mouth opening was 1.6 mm (range, 0 to 4 mm), but chewing function was good and all the patients were satisfied. No major occlusal changes were observed and all the patients had satisfactory occlusion at the follow-up periods. No facial paresis of temporal and zygomatic branch of facial nerve was observed in any case. Periodic panoramic radiographs showed well-maintained intra-articular space because of the interposed tissue, with no signs of relapse. CONCLUSION The findings of this study showed the short-term successful management of TMJ ankylosis using buccal fat pad as an interpositional graft.
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Affiliation(s)
- Virendra Singh
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt BD Sharma University of Health Sciences, Rohtak, Haryana, India.
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Jagannathan M, Devale M, Kesari P, Karanth S. Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits. Indian J Plast Surg 2008; 41:110-5. [PMID: 19753248 PMCID: PMC2740506 DOI: 10.4103/0970-0358.44708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.
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Affiliation(s)
- Mukund Jagannathan
- Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Muncipal Medical College and Hospital, Sion, Mumbai-400 022, India
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Huang IY, Lai ST, Shen YH, Worthington P. Interpositional arthroplasty using autogenous costal cartilage graft for temporomandibular joint ankylosis in adults. Int J Oral Maxillofac Surg 2007; 36:909-15. [PMID: 17644342 DOI: 10.1016/j.ijom.2007.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 01/25/2007] [Accepted: 05/09/2007] [Indexed: 11/22/2022]
Abstract
This retrospective study evaluated 11 adult patients with TMJ ankylosis treated by interpositional arthroplasty using autogenous costal cartilage grafts between 1985 and 2003. Minimum follow-up was 2 years. Basic personal data, function of TMJ and complications of operation were recorded. Mouth opening increased during operation by a mean of 25.5mm and postoperatively by a mean of 26.2mm. The procedure failed in one case with recurrent ankylosis. The remaining 10 cases had final opening ranges in excess of 30mm. Complications included one numb lower lip. There were no instances of a facial nerve or internal maxillary artery injury. Consideration is given to the width and level of gap arthroplasty, fixation of the grafts, complications at both donor and recipient sites, postoperative physical therapy, occlusal change, and the need for coronoidectomy. This study demonstrated that autogenous costal cartilage is a suitable material for interpositional arthroplasty in adults. Complications were low. The intraoral approach and the role of postoperative physical therapy appear key elements in the success of this procedure.
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Affiliation(s)
- I-Y Huang
- Department of Oral and Maxillofacial Surgery, Chon-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, No.100, Tzyou 1st Rd., Kaohsiung, Taiwan 807, Taiwan
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