Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation

Objectives

Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function.

Materials and Methods

This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics.

Results

Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with mean±standard deviation (13.8±6.6 years). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis.

Conclusion

Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

Intraocular Foreign Bodies: Myths and Truths

Over the centuries, the management of eyes with intraocular foreign bodies (IOFB) has posed a special challenge to the physician, and the anxiety created by such injuries has never abated. During the past few decades, several new diagnostic tests, IOFB removal techniques, and methods to treat the complications of the injury have been introduced. Nevertheless, old habits die hard: many of the management options that used to be standard are not appropriate any more but have proved difficult to change. This article reviews over forty of these die-hard myths and confronts them with factual statements published in the peer-review international literature.

Diagnostic imaging modalities in head and neck disease

BACKGROUND

Because of the complex anatomy of the head and neck region, conventional projection radiography alone is unreliable and carries a high risk of misdiagnosis. The poor risk-benefit ratio of conventional radiography has led to their replacement by tomographic imaging for nearly all studies in this region.

METHOD

This review is based on pertinent articles retrieved by a selective search in the PubMed database (January 1980 to May 2013) as well as on the relevant guidelines from Germany and abroad.

RESULTS

The indication for diagnostic imaging in the anatomically complex head and neck region should be established for a specific type of imaging study on the basis of a thorough clinical examination. Conventional films, though easy to obtain, often cannot answer the diagnostic question and may yield confusing information leading to misdiagnosis. Computed tomography (CT) has the best risk-benefit profile and a high diagnostic value, but low-dose protocols have not yet been put into use in all centers. Magnetic resonance imaging (MRI) is best for bone and soft-tissue diagnosis, but consumes more resources. Digital volume tomography (DVT) is another type of three-dimensional, sectional imaging with high local resolution; the associated radiation exposure and image quality are generally both low, but may vary depending on the apparatus used. DVT cannot be used to evaluate the soft tissues. Ultrasonography can be used to evaluate superficial structures in the head and neck region; nuclear imaging can be used to evaluate thyroid disease and cancer.

CONCLUSION

Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.

Acquired palsy of the oculomotor, trochlear and abducens nerves

There have been few studies primarily concerned with the relative frequencies, aetiologies and prognoses of ocular motor palsies. Those published have emanated largely from neurological tertiary referral centres rather than primary ophthalmology departments. We have performed a retrospective study of all patients with acquired III, IV or VI cranial nerve palsy who were seen in the orthoptic department at Ninewells Hospital, Dundee, over the 9 year period from 1984 to 1992. A total of 165 cases were identified. VI nerve palsies accounted for the majority of patients (57%), with IV nerve palsies (21%) occurring more frequently than III nerve palsies (17%) and multiple palsies (5%). Thirty-five per cent of cases were of unknown aetiology and 32% of vascular aetiology. The incidence of sinister pathology-neoplasia (2%) and aneurysm (1%)-was surprisingly low. Fifty-seven per cent of all patients made a total recovery (in a median time of 3 months) and 80% made at least a partial recovery. The results are contrasted with those of previous studies and the value of associated symptoms and of further investigation in the assessment of these patients is discussed.