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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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Parrino D, Val M, Lovato A, de Filippis C, Nardini LG. Pediatric temporomandibular joint ankylosis and arthritis: Forgotten complications of acute otitis media. Am J Otolaryngol 2022; 43:103599. [PMID: 35988366 DOI: 10.1016/j.amjoto.2022.103599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Temporomandibular joint (TMJ) arthritis and ankylosis represent unusual but potential complications of ear suppuration, especially in children. We performed a review of the literature of pediatric otogenic TMJ arthritis and ankylosis, discussing their clinical and radiological features, their mechanism of infection spread, and the importance of a prompt diagnosis and treatment. We additionally describe a case of TMJ ankylosis following acute mastoiditis in a 4-year-old female patient. METHODS A search of English literature from January 1, 1980 to December 31, 2021 was performed on the electronic databases (PubMed, Web of Science and Scopus) in order to identify studies concerning TMJ complication after ear suppuration. RESULTS Seventeen articles were considered eligible for the review. Eight and nine studies described otogenic TMJ ankylosis and arthritis, respectively. A total of 17 children affected by ankylosis consequent to ear infection and a total of 31 cases of TMJ arthritis concurrent to otomastoiditis were identified. Mean time elapsed between ear infection and diagnosis of TMJ ankylosis was 4.8 years (range 0.5-13). CONCLUSION TMJ involvement during complicated otitis media should be kept in mind. Its prompt recognition is mandatory to set up appropriate treatment and follow-up and reduce the risk of ankylosis with its functional and psychological complications.
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Affiliation(s)
- Daniela Parrino
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Matteo Val
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
| | - Andrea Lovato
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
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Farley ES, Amirtharajah M, Winters RD, Taiwo AO, Oyemakinde MJ, Fotso A, Torhee LA, Mehta UC, Bil KA, Lenglet AD. Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria. Trans R Soc Trop Med Hyg 2021; 114:812-819. [PMID: 32785671 PMCID: PMC7645286 DOI: 10.1093/trstmh/traa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0–20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.
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Affiliation(s)
- Elise S Farley
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria.,Department of Public Health Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | | | - Ryan D Winters
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, LA, USA
| | - Abdurrazaq O Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.,Faculty of Dental Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | - Linda A Torhee
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | - Ushma C Mehta
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Karla A Bil
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Annick D Lenglet
- Médecins Sans Frontières, Amsterdam, the Netherlands.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Temporomandibular Joint Ankylosis among Patients at Saint Paul's Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study. Int J Dent 2021; 2021:6695664. [PMID: 33679982 PMCID: PMC7906814 DOI: 10.1155/2021/6695664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study aimed to determine the pattern of TMJA at St. Paul's Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia. Methods A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program. Results A total of 130 patients' medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20-29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty. Conclusions TMJA was predominant among females than their male counterparts. Of note, 20-29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients' quality of life.
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Surgical correction of ankylosed TMJ in a child: case report. Oral Maxillofac Surg 2020; 24:509-514. [PMID: 32572708 DOI: 10.1007/s10006-020-00864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
The temporomandibular joint (TMJ) ankylosis describes the bone or fibrous adhesion of the TMJ components, with functional impairment. The present report shows the surgical correction the TMJ ankylosis due to a condyle fracture in a child. A 12-year-old patient, female, attended to the Oral and Maxillofacial Surgery Department of the Clinical Hospital/Federal University of Uberlândia, showing severe mouth opening limitation (9 mm) and history of bilateral condyle fracture and symphysis fracture. The right TMJ ankylosis was diagnosed, removed, reshaped, and repositioned to form the reshaped condyle, by the sliding reconstruction of the condyle using posterior border of mandibular ramus and myofascial interposition of the temporal fascia. Five months of follow-up showed mouth opening of 44 mm maintained after 2 years, without complaints. The surgical treatment of the TMJ ankylosis is needed for the reestablishment of the immediate function; however, the patient must be watched until the end of development.
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Fivez S, Politis C, Dormaar JT, Cadenas de Llano-Pérula M. Surgical and Orthodontic Approach to Temporomandibular Joint Ankylosis After Ear Infection: A Case Series. J Oral Maxillofac Surg 2020; 78:2235-2246. [PMID: 32649895 DOI: 10.1016/j.joms.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022]
Abstract
Ankylosis of the temporomandibular joint (TMJ) is defined as the emergence of a bony or fibrous compound between the condyle and the cranial base. It can result in divergent craniofacial characteristics. The aim of this study was to present an orthodontic-surgical approach in a case series of 4 patients with a diagnosis of TMJ ankylosis as a complication of otomastoiditis. The patient characteristics of 4 patients in whom TMJ ankylosis was diagnosed as a complication of otomastoiditis were described. All patients were treated with gap arthroplasty with costochondral graft, physiotherapy, and orthodontic therapy to achieve acceptable mouth opening and function. All reacted differently to this therapy, and additional interventions were required during childhood. In early-onset ankylosis, however, guiding the mandibular growth orthodontically can prevent increasing facial asymmetry and canting of the occlusal plane. After the pubertal growth spurt is finished, orthodontic treatment combined with surgical intervention may be considered to correct facial asymmetry and provide good dental occlusion. Orthodontic and surgical treatments showed themselves to be fundamental for patients with TMJ ankylosis as a complication of otomastoiditis, although continual monitoring until the end of growth is necessary to achieve the most functional recovery possible.
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Affiliation(s)
- Sofie Fivez
- Private Orthodontist, Department of Oral Health Sciences-Orthodontics, KU Leuven, Leuven, Belgium; and Service of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department Head, OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine University, Leuven, Belgium; and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Clinical Staff Member, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Assistant Professor, Department of Oral Health Sciences-Orthodontics, KU Leuven, Leuven, Belgium; and Service of Dentistry, University Hospitals Leuven, Leuven, Belgium.
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Evaluating the remodeling of condyles reconstructed by transport distraction osteogenesis in the treatment of temporomandibular joint ankylosis. J Craniomaxillofac Surg 2020; 48:494-500. [DOI: 10.1016/j.jcms.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/05/2020] [Accepted: 03/08/2020] [Indexed: 11/20/2022] Open
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Khanna JN, Ramaswami R. Protocol for the management of ankylosis of the temporomandibular joint. Br J Oral Maxillofac Surg 2019; 57:1113-1118. [PMID: 31732273 DOI: 10.1016/j.bjoms.2019.10.298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Ankylosis of the temporomandibular joint (TMJ) is a severely deforming, disabling condition as a result of craniomandibular fusion caused mainly by condylar fractures with displacement of the meniscus. Ankylosis may be fibrous, fibro-osseous, or bony, and unilateral or bilateral. The severity of the deformity is based on the onset, duration, and type of ankylosis. Various surgical techniques have been described for treatment, but no single treatment is recommended because of inconsistent results and the high rate of failure. While our total experience extends to 300 cases, we have developed a protocol using the most recent 193 patients to address our earlier high failure rate. The onset was during childhood in 168 patients, and 25 were adults. We describe the protocol that we developed for these two groups. Our management included gap arthroplasty, costochondral grafting, temporalis flaps, ramus osteotomies, and transport distraction.
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Affiliation(s)
- J N Khanna
- Saifee Hospital, Mumbai, Maharashtra, India
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9
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Hassan SAEH, Mohamed FI. Distraction osteogenesis in the management of mandibular hypoplasia secondary to temporomandibular joint ankylosis. Long term follow up. J Craniomaxillofac Surg 2019; 47:1510-1520. [DOI: 10.1016/j.jcms.2019.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/08/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
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Association between the clinical features of and types of temporomandibular joint ankylosis based on a modified classification system. Sci Rep 2019; 9:10493. [PMID: 31324825 PMCID: PMC6642162 DOI: 10.1038/s41598-019-46519-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/21/2019] [Indexed: 01/13/2023] Open
Abstract
This study aimed to describe the clinical features of different types of traumatic temporomandibular joint (TMJ) ankylosis. Seventy-one patients with 102 ankylosed joints were retrospectively reviewed and categorized into four groups according to the grades of severity: type I, non-bony ankylosis of the joint with almost-normal joint space; type II, lateral bony ankylosis marked by a normal joint space that coexists with a radiolucent line; type III, complete bony ankylosis of the joint characterized by only a radiolucent line; and type IV, extensive bony ankylosis without any radiolucent line. The period of ankylosis, maximal mouth opening (MMO), rate of complications, and histopathological changes were compared among groups. Intergroup comparison showed significant differences in the clinical features of MMO and the incidence of complications (p < 0.05). Younger trauma patients tended to develop more severe types of ankylosis than older patients. Additionally, long post-trauma periods were related to the development of severe ankylosis. MMO was highly negatively correlated with the severity of ankylosis. Significant differences were noted among the four types of ankylosis. Younger trauma patients with long post-trauma periods tended to develop more severe TMJ ankylosis, experience more complications, and face more challenges in treatment than older patients.
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Abstract
INTRODUCTION While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction. METHODS A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications. RESULTS Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions. CONCLUSIONS Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.
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Xia L, He Y, An J, Chen S, Zhang Y. Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: a retrospective investigation. Int J Oral Maxillofac Surg 2019; 48:526-533. [DOI: 10.1016/j.ijom.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/13/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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Ghorui T, Ray A. Release of Extra Articular Ankylosis of Jaws as a Sequelae of Cancrum Oris with Extensive Gingival Myasis in a Scoliosis Patient: A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2018; 71:734-736. [PMID: 31742053 DOI: 10.1007/s12070-018-1526-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/01/2018] [Indexed: 11/29/2022] Open
Abstract
'Noma' is an allusion to the rapidly destructive course of gangrene (Emmanuel et al. in J Maxillofac Surg 11:160-170, 1983). The pathogenicity is related to the high bacterial load of microorganisms resulting in gangrene that rapidly invades the facial tissues. The infection causes perforating wounds of the lips, cheek, nose, palate and bony fusion of the maxilla and mandible.
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Affiliation(s)
- Tanmoy Ghorui
- Department of Oral & Maxillofacial Surgery, Guru Nanak Institute of Dental Sciences & Research, Kolkata, India
| | - Amit Ray
- Department of Oral & Maxillofacial Surgery, Guru Nanak Institute of Dental Sciences & Research, Kolkata, India
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Ibikunle AA, Taiwo AO, Braimah RO. A 5-year audit of major maxillofacial surgeries at Usmanu Danfodiyo university teaching hospital, Nigeria. BMC Health Serv Res 2018; 18:416. [PMID: 29879975 PMCID: PMC5992770 DOI: 10.1186/s12913-018-3236-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a paucity of data on the pattern of oral and maxillofacial surgeries done in Nigeria. Despite the rising prominence of oral and maxillofacial surgery as a specialty in our immediate environment, no published audit of the surgeries performed exist. This study aims to present the pattern and types of major surgeries done by oral and maxillofacial surgeons in our hospital as well as the indications for such surgeries. It is hoped that the findings will assist in formulating informed policies and improving healthcare delivery. Methods A review of hospital records of all patients who had major oral and maxillofacial surgeries at Usmanu Danfodiyo University Teaching Hospital from January, 2013 to August, 2017 was done. Descriptive statistics such biodata, indication for surgery and type of surgery were recorded and analyzed using the IBM SPSS statistics for windows version 20 (Armonk, NY: IBM Corp) software. Results One hundred and forty six individuals who underwent 158 major surgeries under general anaesthesia were included. There were 82 males and 64 females, giving a male/female ratio of 1.3: 1. The ages ranged from 3 months to 81 years [median of 33 years]. Tumours and tumour-like lesions were the major indications for surgery [85 (58.2%)]. The most commonly performed surgery was mandibulectomy [31 (19.6%)], followed by Open Reduction and Internal Fixation (ORIF) [29 (18.4%)]. Conclusion Major oral and maxillofacial surgeries are common in our environment. The frequencies of these surgeries can increase with better healthcare financing and universal availability of health insurance schemes. Efforts aimed at reducing the incidence of tumours should be instituted.
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Affiliation(s)
- Adebayo Aremu Ibikunle
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, PMB, Sokoto, 12003, Nigeria.
| | - Abdurrazaq Olanrewaju Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, PMB, Sokoto, 12003, Nigeria
| | - Ramat Oyebunmi Braimah
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, PMB, Sokoto, 12003, Nigeria
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Vadepally AK, Sinha R, Kumar AVSSS. Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery. J Oral Biol Craniofac Res 2018; 8:30-34. [PMID: 29556460 DOI: 10.1016/j.jobcr.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022] Open
Abstract
Background Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2 cm. Materials and methods The procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n = 6), oral submucous fibrosis (OSMF; n = 6), temporomandibular joint (TMJ) ankylosis (n = 4) and internal derangement of TMJ (n = 2). All patients were assessed for preoperative interincisal opening; during intubation through specific parameters and; also postoperative findings were observed. Results Mean time taken for successful intubation was 5.6 min ± 1.66. One patient had subcutaneous emphysema which was managed conservatively. Postoperatively, four patients had sore throat which resolved in few days. No other complications were encountered. Conclusion In conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.
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Affiliation(s)
- Ashwant Kumar Vadepally
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Management of recurrent heterotopic ossification around total alloplastic temporomandibular joint replacement. Int J Oral Maxillofac Surg 2016; 45:1234-6. [DOI: 10.1016/j.ijom.2016.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/12/2016] [Indexed: 11/19/2022]
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17
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Wang WH, Xu B, Zhang BJ, Lou HQ. Temporomandibular joint ankylosis contributing to coronoid process hyperplasia. Int J Oral Maxillofac Surg 2016; 45:1229-33. [PMID: 27173825 DOI: 10.1016/j.ijom.2016.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/13/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate the association between coronoid process hyperplasia and temporomandibular joint (TMJ) ankylosis and to analyze the pathological mechanism and clinical significance of coronoid process hyperplasia. Forty-four patients treated for TMJ ankylosis between January 2007 and December 2014 were studied retrospectively; 176 patients with normal TMJs served as controls. The original DICOM data were used to reconstruct the jaw, and a three-dimensional cephalometric analysis (SimPlant Pro software version 11.04) was performed to assess the association between the severity of TMJ ankylosis and the height of the coronoid process. The height of the coronoid process was 20.41±5.00mm in the case group and 14.86±2.67mm in the control group; there was a significant difference between the two groups (P<0.001). Long-standing TMJ ankylosis contributes to coronoid process hyperplasia. Therefore, attention should be drawn to the coronoid process in patients with TMJ ankylosis. A coronoidectomy together with arthroplasty is recommended in patients with TMJ ankylosis.
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Affiliation(s)
- W H Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China.
| | - B Xu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - B J Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - H Q Lou
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
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Recent advances in the management of oral and maxillofacial trauma. Br J Oral Maxillofac Surg 2015; 53:913-21. [DOI: 10.1016/j.bjoms.2015.08.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022]
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Bagewadi SB, Awasthi UR, Mody BM, Suma GN, Garg S. Bony fusion of the maxilla and mandible as a sequelae of noma: A rare case report. Imaging Sci Dent 2015; 45:193-8. [PMID: 26389063 PMCID: PMC4574058 DOI: 10.5624/isd.2015.45.3.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 11/18/2022] Open
Abstract
Noma is a gangrenous disease of the orofacial region that leads to severe facial tissue destruction and is a significant cause of death among children. With the advent of modern antibiotics and improved nutrition, children with noma may survive into adulthood, but must face the challenge of undergoing repair of the sequelae of noma. This report describes a case of bony fusion of the maxilla and mandible in a 28-year-old female patient, which was a sequelae of a childhood case of noma.
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Affiliation(s)
- Shivanand B Bagewadi
- Department of Oral Medicine and Radiology, ITS Center for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Ujjwala Rastogi Awasthi
- Department of Oral Medicine and Radiology, ITS Center for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Bharat M Mody
- Department of Oral Medicine and Radiology, ITS Center for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Gundareddy N Suma
- Department of Oral Medicine and Radiology, ITS Center for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Shruti Garg
- Department of Oral Medicine and Radiology, ITS Center for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
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Anyanechi CE. Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria. Int J Oral Maxillofac Surg 2015; 44:1027-33. [PMID: 26008733 DOI: 10.1016/j.ijom.2015.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.
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Affiliation(s)
- C E Anyanechi
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
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21
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Al-Moraissi E, El-Sharkawy T, Mounair R, El-Ghareeb T. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2015; 44:470-82. [DOI: 10.1016/j.ijom.2014.10.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
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Anyanechi C, Osunde O, Bassey G. Use of oral mucoperiosteal and pterygo-masseteric muscle flaps as interposition material in surgery of temporomandibular joint ankylosis: a comparative study. Ann Med Health Sci Res 2015; 5:30-5. [PMID: 25745573 PMCID: PMC4350059 DOI: 10.4103/2141-9248.149782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0.18). Conclusion: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis.
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Affiliation(s)
- Ce Anyanechi
- Department of Dental Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Od Osunde
- Department of Dental Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Go Bassey
- Department of Dental Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
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Tahim A, Goodson A, Payne K, Brennan P. A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012. Br J Oral Maxillofac Surg 2015; 53:e9-e12. [DOI: 10.1016/j.bjoms.2013.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/11/2013] [Indexed: 11/24/2022]
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Yan YB, Liang SX, Shen J, Zhang JC, Zhang Y. Current concepts in the pathogenesis of traumatic temporomandibular joint ankylosis. Head Face Med 2014; 10:35. [PMID: 25189735 PMCID: PMC4158390 DOI: 10.1186/1746-160x-10-35] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 08/25/2014] [Indexed: 01/10/2023] Open
Abstract
Traumatic temporomandibular joint (TMJ) ankylosis can be classified into fibrous, fibro-osseous and bony ankylosis. It is still a huge challenge for oral and maxillofacial surgeons due to the technical difficulty and high incidence of recurrence. The poor outcome of disease may be partially attributed to the limited understanding of its pathogenesis. The purpose of this article was to comprehensively review the literature and summarise results from both human and animal studies related to the genesis of TMJ ankylosis.
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Affiliation(s)
- Ying-Bin Yan
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Su-Xia Liang
- Department of Operative Dentistry and Endodontics, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Jun Shen
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Jian-Cheng Zhang
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun Nandajie, Haidian District, Beijing 100081, PR China
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Baur D, Jannuzzi J, Mercan U, Quereshy FA. Treatment of long term anterior dislocation of the TMJ. Int J Oral Maxillofac Surg 2013; 42:1030-3. [DOI: 10.1016/j.ijom.2012.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/03/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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Bello SA. Gillies fan flap for the reconstruction of an upper lip defect caused by noma: case presentation. Clin Cosmet Investig Dent 2012; 4:17-20. [PMID: 23674921 PMCID: PMC3652365 DOI: 10.2147/cciden.s31190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The case of a 65-year-old noma patient with a defect involving her upper lip is presented. The defect also included missing teeth numbers eleven, twelve, 21, and 22 and the adjoining alveolus. One-stage lip reconstruction was carried out with Gillies fan flap followed by vestibuloplasty and commissuroplasty. An acrylic partial denture was subsequently fabricated to replace the missing teeth and thereby restore function. Even though the incidence of cancrum oris has reduced worldwide, cases are still being reported in Africa and can leave behind a significant facial defect. Whereas most cases of lip defects reported from the Western world are due to cancer, cancrum oris could be the cause of lip defects in sub-Saharan Africa. Gillies fan flap could be employed for the reconstruction of a relatively large defect of the lip and the disadvantage of microstomia could be minimized for the restoration of articulation, speech, and masticatory functions of the lip.
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Affiliation(s)
- Seidu Adebayo Bello
- Department of Dental and Maxillofacial Surgery, State House Medical Center, Asokoro, Abuja, Nigeria
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TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement-A Case Report. Case Rep Dent 2011; 2011:187580. [PMID: 22567429 PMCID: PMC3335446 DOI: 10.1155/2011/187580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/08/2011] [Indexed: 11/18/2022] Open
Abstract
This report describes the multidisciplinary phasewise treatment of a 20-year-old female patient having unilateral right TMJ bony (true) ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism; additionally, she was also suffering from speech problems, snoring, difficulty in breathing, and low level of self-esteem and self-confidence. Bilateral gap arthroplasty and temporalis myofascial graft interpositioning through preauricular approach were done in surgical phase followed by the aggressive jaw physiotherapy in postsurgical period. Oral prophylaxis and restorations were followed by the fixed orthodontic therapy to resolve bimaxillary protrusion. Advancement sliding genioplasty was performed to enhance the chin button. Speech therapy and psychological counseling were also performed from time to time to boost up the self-esteem and self-confidence. At the end of treatment, facial esthetics was improved considerably and patient got over the impact of disfigurement, impaired functions, and psychosocial stigma. Rationale to use the multidisciplinary team approach in treatment of such cases is discussed.
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