1
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Lu C, Zhu Y, Zhang W, Xu B. A New Method in Dealing With Children's Condylar Fracture by Botulinum Toxin A Injection in Lateral Pterygoid Muscle. J Craniofac Surg 2024:00001665-990000000-01745. [PMID: 38953580 DOI: 10.1097/scs.0000000000010450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024] Open
Abstract
Condylar is one of the most vulnerable sites to be traumatized in pediatric mandible fracture, while temporomandibular joint ankylosis might be the most severe complication of condylar fracture in children. There exists a long-time controversy on the treatment of condylar fractures in children. Considering the risk of facial nerve injury and a certain probability of absorption or even ankylosis after open reduction and internal fixation (ORIF) of condylar fractures, a series of nonsurgical approaches are preferred in cases without severe malocclusion or shortening of the ramus. Our treatment plan was carried out through combining procedures of Botulinum toxin A injection in lateral pterygoid muscle with ORIF of para symphyseal fracture; subsequently, a conservative way of the occlusal splint with elastic traction was performed. Three patients of bilateral or unilateral condylar fractures, aged between 2 y and 6 y, were involved in this treatment. After more than 1 year's follow-up, the occlusion was satisfactory in all patients. Condylar remodeling was approximately complete in 3 months, and no unwanted complications were observed. We may expect this method to offer a new idea when dealing with children's condylar fracture.
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Affiliation(s)
- Chenpei Lu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yanfei Zhu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wenbin Zhang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Bing Xu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Al-Moraissi EA, Neff A, Kaur A, Falci SGM, Maria de Souza G, Ellis E. Treatment for Adult Mandibular Condylar Process Fractures: A Network Meta-Analysis of Randomized Clinical Trials. J Oral Maxillofac Surg 2023; 81:1252-1269. [PMID: 37423262 DOI: 10.1016/j.joms.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Using network meta-analyses (NMA) has become increasingly valuable as it enables the comparison of interventions that have not been directly compared in a clinical trial. To date, there has not been a NMA of randomized clinical trials (RCT) that compares all types of treatments for mandibular condylar process fractures (MCPFs). The aim of this NMA was to compare and rank all the available methods used in the treatment of MCPFs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in 3 major databases up to January 2023 to retrieve RCTs that compared various closed and open treatment methods for MCPFs. The predictor variable is treatment techniques: arch bars (ABs) + wire maxillomandibular fixation (MMF), rigid MMF with intermaxillary fixation screws, AB + functional therapy with elastic guidance (AB functional treatment), AB rigid MMF/functional treatment, single miniplate, double miniplate, lambda miniplate, rhomboid plate, and trapezoidal miniplate. Postoperative complications were the outcome variables and included occlusion, mobility, and pain, among other things. Risk ratio (RR) and standardized mean difference were calculated. Version 2 of the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluations system were used to determine the certainty of the results. RESULTS The NMA included a total of 10,259 patients from 29 RCTs. At ≤6 months, the NMA revealed that the use of 2-miniplates significantly reduced malocclusion compared to rigid MMF (RR = 2.93; confidence interval [CI]: 1.79 to 4.81; very low quality) and functional treatment (RR = 2.36; CI: 1.07 to 5.23; low quality).Further, at ≥6 months, 2-miniplates resulted in significantly lower malocclusion compared to rigid MMF with functional treatment (RR = 3.67; CI: 1.93 to 6.99; very low quality).Trapezoidal plate and AB functional treatment were ranked as the best options in 3-dimensional (3D) plates and closed groups, respectively.3D-miniplates (very low-quality evidence) were ranked as the most effective treatment for reducing postoperative malocclusion and improving mandibular functions after MCPFs, followed closely by double miniplates (moderate quality evidence). CONCLUSIONS This NMA found no substantial difference in functional outcomes between using 2-miniplates versus 3D-miniplates to treat MCPFs (low evidence).However, 2-miniplates led to better outcomes than closed treatment (moderate evidence).Additionally, 3D-miniplates produced better outcomes for lateral excursions, protrusive movements, and occlusion than closed treatment at ≤6 months (very low evidence).
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Thamar University, Yemen.
| | - Andreas Neff
- Professor, Chairman and Medical Director, Department of Oral and Craniomaxillofacial Plastic Surgery, Oral Surgery and Implantology, University Hospital Marburg, Marburg, Hesse, Germany
| | - Amanjot Kaur
- Assistant Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India
| | - Saulo Gabriel Moreira Falci
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio
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Ma Z, Wang Y, Xue Y, Zhang W, Li D, Li Y, Li G, Zhou H, Hu X, Deng T, Hu K. Traumatic temporomandibular joint bony ankylosis in growing rats. BMC Oral Health 2022; 22:585. [PMID: 36494653 PMCID: PMC9733295 DOI: 10.1186/s12903-022-02560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis remains unknown. This study aimed to explore the pathogenesis of traumatic TMJ bony ankylosis in a rat model. METHODS Twenty-four 3-week-old male Sprague-Dawley rats were used in this study. Excision of the whole disc, the fibrocartilage damage of the condyle and glenoid fossa, and narrowed joint space were performed in the left TMJ of the operation group to induce TMJ bony ankylosis (experimental side). The right TMJ underwent a sham operation (sham side). The control group did not undergo any operations. At 1, 4, and 8 weeks postoperatively, rats of the operation group were sacrificed and TMJ complexes were evaluated by gross observation, Micro-CT, histological examinations, and immunofluorescence microscopy. Total RNA of TMJ complexes in the operation group were analyzed using RNA-seq. RESULTS Gross observations revealed TMJ bony ankylosis on the experimental side. Micro-CT analysis demonstrated that compared to the sham side, the experimental side showed a larger volume of growth, and a considerable calcified bone callus formation in the narrowed joint space and on the rougher articular surfaces. Histological examinations indicated that endochondral ossification was observed on the experimental side, but not on the sham side. RNA-seq analysis and immunofluorescence revealed that Matrix metallopeptidase 13 (MMP13) and Runt-related transcription factor 2 (RUNX2) genes of endochondral ossification were significantly more downregulated on the experimental side than on the sham side. The primary pathways related to endochondral ossification were Parathyroid hormone synthesis, secretion and action, Relaxin signaling pathway, and IL-17 signaling pathway. CONCLUSIONS The present study provided an innovative and reliable rat model of TMJ bony ankylosis by compound trauma and narrowed joint space. Furthermore, we demonstrated the downregulation of MMP13 and RUNX2 in the process of endochondral ossification in TMJ bony ankylosis.
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Affiliation(s)
- Zhen Ma
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Yiming Wang
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Yang Xue
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Wuyang Zhang
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Dengke Li
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Yuan Li
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Guowei Li
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Hongzhi Zhou
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Xiangxiang Hu
- grid.410711.20000 0001 1034 1720Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, NC 27514 USA
| | - Tiange Deng
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
| | - Kaijin Hu
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology, National Clinical Research and Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases and Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an, 710032 China
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Lateral Pterygoid Muscle Ossification After Intraoral Condylectomy. J Craniofac Surg 2022; 33:2122-2127. [PMID: 35765131 DOI: 10.1097/scs.0000000000008666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Lateral pterygoid muscle ossification has not been reported in condylectomy patients. This study aimed to explore the incidence, risk factors, and imaging characteristics of 38 cases with lateral pterygoid muscle ossification among 54 patients after condylectomy via intraoral approach. METHODS This retrospective study included 54 patients following simultaneous orthognathic surgery and condylectomy with coronoid process resection via intraoral approach. The authors evaluated the preoperative, 1 week, 6 months, and 1 year or more postoperative computed tomographic (CT) scans for the presence of lateral pterygoid muscle ossification and its characteristics. Sex, age at the time of surgery, disease course, affected side, preoperative alkaline phosphatase, pathology diagnosis, the height of the removed condyle, condylar shape, operator, preoperative temporomandibular joint movement, and clinical symptoms were assessed as risk factors for ossification. RESULTS No incidence of lateral pterygoid muscle ossification was found on preoperative CT images. Various small-size osseous masses were observed in the lateral pterygoid muscles on postoperative 6 months CT images in 38/54 patients (70.37%) after condylectomy. But no apparent enlargement of the osseous masses was found. No patients complained of clinical discomfort or functional disorder during the follow-up period (23.11 ± 13.16 months). No significant risk factors for ossification were found. CONCLUSIONS Lateral pterygoid muscle ossification is relatively common in patients after condylectomy via intraoral approach. However, its enlargement is self-limited and remains stable 6 months after surgery. it has no adverse effects on the temporomandibular joint functional movement.
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Xin X, Zhao Y, Cheng G, Diarra D, Li ZB, Li Z. Treatment of sagittal fracture of the mandibular condyle using resorbable-screw osteosynthesis. J Oral Maxillofac Surg 2022; 80:1207-1214. [DOI: 10.1016/j.joms.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
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Yu Y, Soh HY, Bai S, Zhang WB, Wang Y, Peng X. Three-dimensional morphological analysis of neocondyle bone growth after fibula free flap reconstruction. Int J Oral Maxillofac Surg 2021; 50:1429-1434. [PMID: 33752937 DOI: 10.1016/j.ijom.2021.03.005] [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: 09/21/2020] [Revised: 01/26/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
The aim of this retrospective study was to verify the three-dimensional morphological change in neocondyle bone growth after fibula free flap (FFF) reconstruction. The independent variables were age, sex, and diagnosis. Outcome variables included the direction and volume of neocondyle bone growth, and the time to a stable neocondyle following bone growth. The outcome variables were measured on postoperative computed tomography scans using iPlan 3.0. Of the 35 patients included, 25 showed neocondyle bone growth. The direction of neocondyle bone growth included the direction of lateral pterygoid traction (DLPT) and the direction towards the glenoid fossa (DGF). The bone growth of the neocondyle showed three patterns: only DLPT (eight patients), only DGF (two patients), and a combination of DLPT and DGF (15 patients). The average volume of bone growth in the 25 patients was 0.479 ± 0.380 cm3. The average volume of neocondyle bone growth was significantly greater in patients aged <18 years (0.746 ± 0.346 cm3) than in patients aged >18 years (0.219 ± 0.191 cm3) (P < 0.001). The time to a stable neocondyle following bone growth was 5.6 months postoperatively. In conclusion, neocondyle bone growth after FFF reconstruction occurred in two different directions, DLPT and DGF. Osteogenesis of the lateral pterygoid muscle affects neocondyle growth with DLPT. Neocondyle bone growth is more marked in paediatric patients than in adults.
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Affiliation(s)
- Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - H Y Soh
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - S Bai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - W-B Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Y Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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He L, Zhang Z, Xiao E, He Y, Zhang Y. Pathogenesis of traumatic temporomandibular joint ankylosis: a narrative review. J Int Med Res 2020; 48:300060520972073. [PMID: 33213251 PMCID: PMC7686630 DOI: 10.1177/0300060520972073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To comprehensively review the literature and summarize the results from human and animal studies related to the possible causes and pathogenesis of traumatic temporomandibular joint ankylosis (TMJA). MATERIALS AND METHODS The Google Scholar, Embase, and Web of Science databases were used to search for articles related to traumatic TMJA from 2011 to 2020. All articles were screened according to the inclusion and exclusion criteria, collected, and analyzed. RESULTS Nineteen relevant articles were collected. These articles were classified into three groups: predisposing and etiological factors, cellular studies, and molecular studies. CONCLUSION The pathological mechanisms are similar between TMJA and nonunion hypertrophy. Aberrant structural and etiological factors as well as disordered cellular and molecular mechanisms might contribute to TMJA formation. Although preclinical and clinical data have provided new evidence on the pathogenesis of traumatic TMJA, the molecular mechanisms and biological events require further exploration.
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Affiliation(s)
- Linhai He
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhiyong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - E Xiao
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,Laboratory of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Exclusive Functional Treatment for Mandibular Condylar Fractures. J Oral Maxillofac Surg 2019; 77:2523.e1-2523.e8. [DOI: 10.1016/j.joms.2019.06.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/20/2022]
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9
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Deng TG, Liu CK, Wu LG, Liu P, Wang JJ, Sun XZ, Zhang LL, Ma Y, Chen CS, Ding YX, Hu KJ. Association between maximum mouth opening and area of bony fusion in simulated temporomandibular joint bony ankylosis. Int J Oral Maxillofac Surg 2019; 49:369-376. [PMID: 31320176 DOI: 10.1016/j.ijom.2019.06.030] [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: 12/05/2018] [Revised: 04/12/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the quantitative association between active/passive maximum mouth opening (AMMO/PMMO) and the severity of simulated temporomandibular joint (TMJ) bony ankylosis. Twenty-eight male sheep were divided randomly and equally into surgical and control groups. Surgical group animals underwent bilateral TMJ osteotomy during which left lateral pterygoid muscle function was blocked. Control animals did not undergo surgery. Body weight, AMMO/PMMO, and TMJ morphological features were evaluated preoperatively and at 12 and 24 weeks post-surgery. In the surgical group, only the right TMJ complexes with maintained lateral pterygoid muscle function developed TMJ bony ankylosis. The AMMO/PMMO and end-feel distance in the surgical group were significantly lower than those in the control group (P < 0.001, both) at 12 and 24 weeks post-surgery. Moreover, AMMO (r = -0.940 and -0.952, P < 0.001, both) and PMMO (r = -0.944 and -0.953, P < 0.001, both) were negatively correlated with the area (mm2) of bony fusion post-surgery. These findings may be useful for the clinical treatment of early mandibular condyle fracture, with the use of occlusal pads/open-mouth plates to relax the lateral pterygoid muscle and block its function. When bony ankylosis developed in the TMJ, the greater the area of bony fusion, the more limited were AMMO/PMMO.
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Affiliation(s)
- T-G Deng
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - C-K Liu
- Department of Stomatology, Xi'an Medical University, Xi'an, China
| | - L-G Wu
- Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - P Liu
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - J-J Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - X-Z Sun
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - L-L Zhang
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Y Ma
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - C-S Chen
- Department of Health Statistics, School of Preventive Medicine, The Fourth Military, Medical University, Xi'an, China
| | - Y-X Ding
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
| | - K-J Hu
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
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Zhang J, Sun X, Jia S, Jiang X, Deng T, Liu P, Hu K. The role of lateral pterygoid muscle in the traumatic temporomandibular joint ankylosis: A gene chip based analysis. Mol Med Rep 2019; 19:4297-4305. [PMID: 30942403 PMCID: PMC6471772 DOI: 10.3892/mmr.2019.10078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
Traumatic temporomandibular joint ankylosis (TMJA) is a common disease and disorder of the temporomandibular joint (TMJ); however, its pathogenesis has yet to be completely elucidated. In the authors' previous studies, the lateral pterygoid muscle (LPM) was confirmed to exert a function in distraction osteogenesis (DO) during the healing of a condylar fracture, which resulted in the formation of excess bone. The aim of the present study was to investigate alterations in the expression of any associated genes via an Affymetrix GeneChip method. The traumatic TMJA model was fabricated by a condylar fracture in the TMJ area of sheep with either a dissected LPM (LPD) or normal (LPN). The untreated sheep served as a control. At 4- and 12 weeks post-surgery, the condylar zone was isolated to perform the gene chip analysis, which was performed according to a standard Affymetrix protocol. The validated genes were further evaluated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The gene chip analysis indicated that the LPN gene expression pattern was similar compared with the DO process, while LPD was similar to that of normal bone fracture healing. The validated genes were collagen type II α1 chain, C-type lectin domain family 3 member A, interleukin 1A, cartilage oligomeric matrix protein, chondromodulin (LECT1), calcitonin receptor (CALCR), transforming growth factor (TGF)-β1, Fos proto-oncogene (FOS), bone γ-carboxyglutamate protein and bone morphogenic protein (BMP)7, among which, BMP7, LECT1, CALCR and FOS were confirmed by RT-qPCR. In conclusion, the present study demonstrated that LPM exerts a DO effect during the pathogenesis of traumatic TMJA, which may provide a novel target for preventing TMJA.
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Affiliation(s)
- Jianying Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiangzhao Sun
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Sen Jia
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xin Jiang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Tiange Deng
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Ping Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Kaijin Hu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle. Plast Reconstr Surg 2018; 141:718e-725e. [DOI: 10.1097/prs.0000000000004295] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Jeong YK, Park WJ, Park IK, Kim GT, Choi EJ. Protrusive maxillomandibular fixation for intracapsular condylar fracture: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2017; 43:331-335. [PMID: 29142868 PMCID: PMC5685863 DOI: 10.5125/jkaoms.2017.43.5.331] [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: 05/21/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022] Open
Abstract
Clinical limitations following closed reduction of an intracapsular condylar fracture include a decrease in maximum mouth opening, reduced range of mandibular movements such as protrusion/lateral excursion, and reduced occlusal stability. Anteromedial and inferior displacement of the medial condyle fragment by traction of the lateral pterygoid muscle can induce bone overgrowth due to distraction osteogenesis between the medial and lateral condylar fragments, causing structural changes in the condyle. In addition, when conventional maxillomandibular fixation (MMF) is performed, persistent interdental contact sustains masticatory muscle hyperactivity, leading to a decreased vertical dimension and premature contact of the posterior teeth. To resolve the functional problems of conventional closed reduction, we designed a novel method for closed reduction through protrusive MMF for two weeks. Two patients diagnosed with intracapsular condylar fracture had favorable occlusion after protrusive MMF without premature contact of the posterior teeth. This particular method has two main advantages. First, in the protrusive position, the lateral condylar fragment is moved in the anterior-inferior direction closer to the medial fragment, minimizing bone formation between the two fragments and preventing structural changes. Second, in the protrusive position, posterior disclusion occurs, preventing masticatory muscle hyperactivity and the subsequent gradual decrease in ramus height.
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Affiliation(s)
- Yeong Kon Jeong
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Won-Jong Park
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Il Kyung Park
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Gi Tae Kim
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Eun Joo Choi
- Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
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Retromandibular reduction of medially dislocated condylar process fractures. Arch Plast Surg 2017; 45:23-28. [PMID: 29076315 PMCID: PMC5784372 DOI: 10.5999/aps.2017.00962] [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: 05/31/2017] [Revised: 09/01/2017] [Accepted: 10/24/2017] [Indexed: 11/08/2022] Open
Abstract
Background Condylar process fractures account for one-third of all mandibular fractures, and the distal fragment is prone to dislocate to the medial side due to the pulling of the lateral pterygoid muscle. Retromandibular approaches are commonly used, but the intraoperative view becomes limited in medially dislocated fractures. This study summarized a series of cases of retromandibular reduction for medially dislocated condylar process fractures and described our supplementary procedure to realign the dislocated condylar process. Methods Nine patients with medially dislocated condylar process fractures underwent surgical correction from January 2012 to December 2016. In 6 of them, it was possible to realign the fractures with a conventional retromandibular approach, but for 3 cases of severe dislocation to the middle cranial fossa, a supplementary transoral procedure was carried out. The angle difference between the ramus and condyle, ramus height, and maximal mouth opening (MMO) were evaluated. Results All 9 cases were restored to the proper anatomical alignment without any major complications, and postoperative images revealed successful union. The angle difference was 8.94°±4.11° preoperatively, and 0.99±0.49° at the 6-month follow-up. The pretreatment ramus height difference was 6.12±6.09 mm, and the postoperative difference was 0.18±0.10 mm. These changes after surgery were statistically significant. The MMO before surgery was 11.44±3.0 mm, and the postoperative MMO was 37.2±2.9 mm, reflecting a significant increase after reduction. Conclusions Retromandibular reduction is a useful method in medially dislocated condylar process fractures, and additional transoral assistance should be considered to realign condylar processes that severely dislocate to the middle cranial fossa.
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Chuanjun C, Xiaoyang C, Jing C. [Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:474-477. [PMID: 28326704 DOI: 10.7518/hxkq.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. METHODS Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. RESULTS Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. CONCLUSIONS Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.
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Affiliation(s)
- Chen Chuanjun
- Stomatological School, Wannan Medical College, Wuhu 241002, China
| | - Chen Xiaoyang
- Dept. of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Chen Jing
- Dept. of Stomatology, Anhui Jimin Tumor Hospital, Hefei 230011, China
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Deng TG, Liu CK, Liu P, Zhang LL, Wu LG, Zhou HZ, Ding YX, Hu KJ. Influence of the lateral pterygoid muscle on traumatic temporomandibular joint bony ankylosis. BMC Oral Health 2016; 16:62. [PMID: 27234304 PMCID: PMC4884350 DOI: 10.1186/s12903-016-0220-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathogenesis of traumatic TMJ ankylosis remains unclear. This study aimed to verify the role of the lateral pterygoid muscle in the pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis. METHODS Eight 6-month-old male sheep were used in this study. Bilateral TMJ osteotomies were performed to induce sagittal fractures of the mandibular condyle. The lateral one-fourth segment of the disc was removed to establish a model of TMJ bony ankylosis. Subsequently, the function of the left and right lateral pterygoid muscles was blocked (experimental group) or maintained (control group), respectively. At 12 weeks postoperatively, animals were sacrificed and TMJ complex samples were evaluated by gross observation, spiral computed tomography (CT), micro-CT, and histological examinations. RESULTS Gross observation revealed bony ankylosis in the control TMJs and fibrous adhesions in the experimental TMJs. Spiral CT and micro-CT demonstrated that, compared to the experimental group, the control group showed calcified callus formation in the joint space and roughened articular surfaces after new bone formation, which protruded into the joint space. Maximum mediolateral and anteroposterior condylar diameters were significantly larger in the control group than in the experimental group. Micro-CT also showed that the primary growth orientation of new trabeculae was consistent with the direction of lateral pterygoid traction in the control group, but not in the experimental group. Histological examination showed fibro-osseous ankylosis in the control group, but not in the experimental group. CONCLUSIONS The lateral pterygoid simulates the effects of distraction osteogenesis, which is an important factor in the pathogenesis of TMJ bony ankylosis during the healing of sagittal condylar fractures.
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Affiliation(s)
- Tian-Ge Deng
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China
| | - Chang-Kui Liu
- Department of Stomatology, 451th Hospital of the People's Liberation Army, 269 East Youyi Road, Xi'an, 710049, China
| | - Ping Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China
| | - Lin-Lin Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China
| | - Li-Geng Wu
- Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Hong-Zhi Zhou
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China
| | - Yu-Xiang Ding
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China.
| | - Kai-Jin Hu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi'an, 710032, China.
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Guo SS, Zhou WN, Wan LZ, Yuan H, Yuan Y, Du YF, Jiang HB. Computer-aided design-based preoperative planning of screw osteosynthesis for type B condylar head fractures: A preliminary study. J Craniomaxillofac Surg 2016; 44:167-76. [DOI: 10.1016/j.jcms.2015.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 10/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
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17
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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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18
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He LH, Xiao E, Duan DH, Gan YH, Zhang Y. Osteoclast Deficiency Contributes to Temporomandibular Joint Ankylosed Bone Mass Formation. J Dent Res 2015; 94:1392-400. [PMID: 26250572 DOI: 10.1177/0022034515599149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ankylosed bone mass in temporomandibular joint ankylosis (TMJA) is an important factor affecting mouth-opening limitation. However, the mechanism underlying the occurrence of ankylosed bone mass remains unknown. Research has shown that osteoblasts and osteoclasts maintain balance in bone remodeling. Thus, we hypothesized that aberrant osteoclastogenesis and osteogenesis may be involved in the occurrence of ankylosed bone mass in TMJA. In this study, we characterized the osteogenesis of bone marrow stem cells and the osteoclastogenesis of myelomonocyte in clinical specimens of TMJA and normal controls. Results showed that, compared with control bone marrow stem cells, TMJA bone marrow stem cells had lower proliferative and osteogenic capacities. The number of osteoclasts in the ankylosed bone mass group dramatically decreased, and myelomonocyte osteoclastogenic potential was impaired. The RANKL/OPG ratio of the ankylosed bone mass group was lower than that of the control group. Thus, our study suggests that osteoclast deficiency may be an important factor affecting bone mass ankylosis.
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Affiliation(s)
- L H He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - E Xiao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - D H Duan
- Department of General Dentistry, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Y H Gan
- Central Laboratory and Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Y Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
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Wu D, Yang XJ, Cheng P, Deng TG, Jiang X, Liu P, Liu CK, Meng FW, Hu KJ. The lateral pterygoid muscle affects reconstruction of the condyle in the sagittal fracture healing process: a histological study. Int J Oral Maxillofac Surg 2015; 44:1010-5. [DOI: 10.1016/j.ijom.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/16/2014] [Accepted: 02/03/2015] [Indexed: 11/28/2022]
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20
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Jiang X, Xue Y, Zhou H, Li S, Zhang Z, Hou R, Ding Y, Hu K. Evaluation of reference gene suitability for quantitative expression analysis by quantitative polymerase chain reaction in the mandibular condyle of sheep. Mol Med Rep 2015; 12:5633-40. [PMID: 26238421 PMCID: PMC4581798 DOI: 10.3892/mmr.2015.4128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 05/08/2015] [Indexed: 11/29/2022] Open
Abstract
Reference genes are commonly used as a reliable approach to normalize the results of quantitative polymerase chain reaction (qPCR), and to reduce errors in the relative quantification of gene expression. Suitable reference genes belonging to numerous functional classes have been identified for various types of species and tissue. However, little is currently known regarding the most suitable reference genes for bone, specifically for the sheep mandibular condyle. Sheep are important for the study of human bone diseases, particularly for temporomandibular diseases. The present study aimed to identify a set of reference genes suitable for the normalization of qPCR data from the mandibular condyle of sheep. A total of 12 reference genes belonging to various functional classes were selected, and the expression stability of the reference genes was determined in both the normal and fractured area of the sheep mandibular condyle. RefFinder, which integrates the following currently available computational algorithms: geNorm, NormFinder, BestKeeper, and the comparative ΔCt method, was used to compare and rank the candidate reference genes. The results obtained from the four methods demonstrated a similar trend: RPL19, ACTB, and PGK1 were the most stably expressed reference genes in the sheep mandibular condyle. As determined by RefFinder comprehensive analysis, the results of the present study suggested that RPL19 is the most suitable reference gene for studies associated with the sheep mandibular condyle. In addition, ACTB and PGK1 may be considered suitable alternatives.
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Affiliation(s)
- Xin Jiang
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yang Xue
- State Key Laboratory of Military Stomatology, Department of Oral Biology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hongzhi Zhou
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Shouhong Li
- Department of Oral and Maxillofacial Surgery, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, P.R. China
| | - Zongmin Zhang
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Rui Hou
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yuxiang Ding
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Kaijin Hu
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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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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22
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Koolstra JH, Kommers SC, Forouzanfar T. Biomechanical analysis of fractures in the mandibular neck (collum mandibulae). J Craniomaxillofac Surg 2014; 42:1789-94. [PMID: 25028068 DOI: 10.1016/j.jcms.2014.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/16/2014] [Accepted: 06/06/2014] [Indexed: 11/16/2022] Open
Abstract
After treatment of fractures in the neck of the mandible by means of immobilization of the dentition, often more or less severe manifestations of malocclusion remain. It was hypothesized that this is caused by an altered articulation in the jaw joint on the affected side. Furthermore, it was hypothesized that an anteriorly displaced condyle, as observed frequently as a side effect of the treatment, is caused by pull of the lateral pterygoid muscle, despite maxillomandibular fixation. Intervention experiments were performed in silico to test these hypotheses. With a biomechanical model of the human masticatory system alterations were applied mimicking a fractured mandibular neck and configurations that had been observed after healing. It was predicted that the altered articulation in the jaw joint caused asymmetrical jaw movements despite symmetrical muscle activation. The jaw was predicted to close with an open bite similar to clinical observations. The predicted laterodeviations, however, were not in accordance with clinical observations. Despite maxillo-mandibular fixation the lateral pterygoid muscle was able to pull the mandibular condyle out of its fossa in anterior direction. Consequently, despite some methodological limitations, in general the predictions corroborated the hypotheses.
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Affiliation(s)
- Jan Harm Koolstra
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
| | - Sofie C Kommers
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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Boffano P, Benech R, Gallesio C, Arcuri F, Benech A. Current opinions on surgical treatment of fractures of the condylar head. Craniomaxillofac Trauma Reconstr 2014; 7:92-100. [PMID: 25050145 PMCID: PMC4078111 DOI: 10.1055/s-0034-1371772] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 05/01/2013] [Indexed: 10/25/2022] Open
Abstract
Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the temporomandibular joint induced by the trauma. Several techniques have been proposed to reduce and fix fractures of the condylar head, such as standard bone screws, resorbable screws, resorbable pins, and cannulated lag screws. Therefore, the aim of this article is to review the literature about the surgical treatment of fractures of the condylar head to resume the current knowledge about open treatment of such fractures.
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Affiliation(s)
- Paolo Boffano
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Rodolfo Benech
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Cesare Gallesio
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Francesco Arcuri
- Department of Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Arnaldo Benech
- Department of Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
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de Aguiar Soares Carneiro SC, do Egito Vasconcelos BC, Castro C, Andrade ESS, Porto GG, Melo AR. Effect of surgical repair of the joint capsule in mandibular condyle fractures in adult rats. J Oral Maxillofac Surg 2014; 72:950-7. [PMID: 24560172 DOI: 10.1016/j.joms.2013.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the present study was to assess histologic changes in the temporomandibular joint (TMJ) of adult rats subjected to unilateral fracture of the mandibular condyle and soft tissue injury. MATERIALS AND METHODS The animals were divided into 2 groups: one had surgical treatment for soft tissue repair and the other had no soft tissue treatment. All histologic evaluations were performed according to the presence or absence of synovitis, vascularity, presence or absence of joint inflammation, and presence or absence of the articular disc. The contralateral TMJs also were evaluated. RESULTS The results showed few histologic changes in the synovial membrane and joint disc for the 2 groups and in the synovial membrane and disc of the contralateral side, where indirect trauma occurred in the unoperated joint. CONCLUSION This study showed that treating or not treating soft tissues does not change the treatment results of condyle fracture or interfere with TMJ pathosis.
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Affiliation(s)
| | | | - Célia Castro
- Senior Lecturer, Department of Microbiology, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Gabriela Granja Porto
- Professor, Department of Forensic Science, University of Pernambuco, Recife, PE, Brazil
| | - Auremir Rocha Melo
- Postgraduate Student in Doctoral Degree Program, Department of Oral and Maxillofacial Surgery, University of Pernambuco, Recife, PE, Brazil
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Liang SX, Yan YB. Fibroblast growth factor-21 may be a potential novel drug for preventing the development of traumatic TMJ bony ankylosis. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2014. [DOI: 10.1016/j.jmhi.2013.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liu CK, Meng FW, Tan XY, Xu J, Liu HW, Liu SX, Huang HT, Yan RZ, Hu M, Hu KJ. Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children. Br J Oral Maxillofac Surg 2013; 52:144-8. [PMID: 24262674 DOI: 10.1016/j.bjoms.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/23/2013] [Indexed: 11/17/2022]
Abstract
This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.
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Affiliation(s)
- Chang-Kui Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Fan-Wen Meng
- Department of Stomatology, 359th Hospital of the People's Libration Army, Zhenjiang 212001, China
| | - Xin-Ying Tan
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Juan Xu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Hua-Wei Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - San-Xia Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Hai-Tao Huang
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Rong-Zeng Yan
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Min Hu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China.
| | - Kai-Jin Hu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China.
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