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Bazsefidpay N, Ulmner M, Lund B. Did temporomandibular gap arthroplasty with temporalis interpositional flap improve function and pain in patients with end-stage joint disease? A 5-year retrospective follow-up. J Craniomaxillofac Surg 2024; 52:578-584. [PMID: 38368213 DOI: 10.1016/j.jcms.2024.02.013] [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: 04/14/2023] [Revised: 11/07/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
The primary aim of this study was to investigate whether patients with end-stage temporomandibular joint (TMJ) disease treated with gap arthroplasty with temporalis interpositional flap (GAT) had improved maximal interincisal opening (MIO) and TMJ pain in a long-term perspective. All patients with severe osteoarthritis, or fibrous or bony ankyloses, and subjected to GAT between 2008 and 2015 were included. The criteria of treatment success were TMJ pain VAS score ≤4 and MIO ≥30 mm. Reoperation was considered as a failure. Forty-four patients (mean age 47 years) were included in this retrospective descriptive case series and followed up for up to 7 years (mean 4.5). Comorbidities were frequent (n = 34) and most commonly rheumatic disease (n = 17). The indications for surgery were ankylosis (n = 32) or severe osteoarthritis (n = 12). Of the 44 included patients, 84% (n = 37) had a history of earlier TMJ surgery. The preoperative mean values for TMJ pain and MIO (VAS 7 and 23 mm, respectively) changed significantly (p < 0.001) to postoperative means of VAS 3 and 34 mm, respecitvely. The success rate was 59% (n = 26). When compared with a previous 2-year follow-up, the success rate was found to have decreased over time (p = 0.0097). The rate of successful treatment outcome in terms of MIO alone was 82% (n = 36). The most common reason for treatment failure was residual pain. In conclusion, the success-rate after GAT did not show long-term stability and continued to drop over time in this patient cohort. TMJ pain seems to be the main reason for failure.
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Affiliation(s)
- Nikoo Bazsefidpay
- Head-Neck and Plastic Surgery Clinic, Department of Oral and Maxillofacial Surgery, Örebro University Hospital, Örebro, Sweden; School of Medical Sciences, Örebro University, Sweden.
| | - Mattias Ulmner
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Bodil Lund
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Dolwick MF, Widmer CG. Temporomandibular joint surgery: the past, present, and future. Int J Oral Maxillofac Surg 2024; 53:301-310. [PMID: 38135637 DOI: 10.1016/j.ijom.2023.12.004] [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: 11/09/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Temporomandibular joint surgery for various pathological conditions and diseases affecting the integrity, mobility, and function of the joint has a long history. However, the greatest explosion of knowledge regarding the diagnosis and management of temporomandibular joint pain, pathology, and rehabilitation has occurred in the last 50 years. This review focuses on the incremental expansion of knowledge over time that led to the development of concepts that support our current surgical decisions and techniques, with the aim of identifying gaps in knowledge that require well-designed studies to move the field forward. Using this approach will allow an enhancement of our understanding of temporomandibular joint form and function, and enable focus to be placed on the evaluation, diagnosis, and non-surgical and surgical management strategies that are the most efficacious for our patients.
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Affiliation(s)
- M F Dolwick
- Department of Oral and Maxillofacial Surgery, University of Florida, Gainesville, Florida, USA
| | - C G Widmer
- Division of Facial Pain, Department of Orthodontics, University of Florida, Gainesville, Florida, USA.
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Lima FGGP, Rios LGC, Paranhos LR, Vieira WA, Zanetta-Barbosa D. Survival of temporomandibular total joint replacement: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:775-784. [PMID: 38071499 DOI: 10.1111/joor.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Prosthetic total joint replacement has been incorporated as a treatment for complex temporomandibular disorder; however, the survival of those devices is unknown. OBJECTIVE To assess the survival rate of the total temporomandibular joint (TMJ) prothesis and their main causes of failure. METHODS An electronic search was conducted in eight databases until March 2023. Prospective studies reporting the survival rate of total TMJ prothesis with a minimum follow-up of 12 months were included. Studies with partial TMJ prostheses or those no longer available on the market were excluded. Two reviewers assessed the individual risk of bias using the JBI Systematic Reviews for Quasi-experimental studies tool. Meta-analysis of proportions was conducted to summarise the survival rate, using 95% confidence intervals (CI). The GRADE approach assessed the certainty of the body of evidence. RESULTS Data from 320 patients were collected from six prospective studies. The number of prothesis losses varied from none to four. All studies presented sources of bias related to follow-up description of the patients. The follow-up time varied from 12 months to 21 years. In most of the studies, prosthesis failure occurred within the first 6 months after surgery due to infection. The overall survival of total TMJ protheses was 97% (95% CI: 95%; 99%), with low heterogeneity (I2 = 29%) and a very low certainty of evidence. CONCLUSION TMJ total prosthesis apparently is a safe procedure with a high survival rate and the evidence is very uncertain and presents important sources of bias.
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Affiliation(s)
| | | | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Walbert A Vieira
- Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Darceny Zanetta-Barbosa
- Division of Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Resnick CM. Pediatric Temporomandibular Joint Pathology. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00008-6. [PMID: 38462395 DOI: 10.1016/j.coms.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Pediatric temporomandibular joint (TMJ) disorders represent a broad range of congenital and acquired diagnoses. Dentofacial deformities, including facial asymmetry, retrognathism, and malocclusion, commonly develop. Compared with adult TMJ conditions, pain and articular disc pathology are less common. Accurate diagnosis is paramount in planning and prognostication. Several specific considerations apply in preparation for skeletal correction, including timing in relation to disease progression and growth trajectory, expectation for postcorrection stability, reconstructive technique as it applies to expected durability and need for future revision, management of occlusion, and need for ancillary procedures to optimize correction. This article reviews common conditions and treatment considerations.
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Affiliation(s)
- Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Chechang SK, Miloro M, Mercuri LG. Does surgical volume correlate with outcomes in TMJ replacement surgery? Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00087-7. [PMID: 38692960 DOI: 10.1016/j.oooo.2024.02.026] [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: 02/22/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To survey oral and maxillofacial surgeons (OMS) who perform temporomandibular joint replacement (TMJR) to determine whether length of surgery, specific TMJR protocols, or the incidence of complications are related to experience and case volume. STUDY DESIGN An anonymous electronic survey was emailed to 407 surgeon members of the American Association of Oral and Maxillofacial Surgeons, American Society of Temporomandibular Joint Surgeons, and European Society of Temporomandibular Joint Surgeons known to have TMJR experience via publications or reputation. The descriptive survey contained multiple choice and open-ended questions. Descriptive statistics were computed for each variable for data analysis. RESULTS Forty-nine surgeons completed the survey. The average stock TMJR cases included 54.6% unilateral and 50.5% bilateral cases. The average custom TMJR cases included 50.5% unilateral and 49.5% bilateral cases. Average procedure time for stock TMJR was 2.86 hours for unilateral, and 5.30 hours for bilateral cases. The average procedure time for a custom TMJR was 2.75 hours for unilateral, and 4.87 hours for bilateral cases. Average duration of hospital stay for stock and custom TMJR cases was 1.49 and 1.41 days (unilateral), and 1.98 and 1.95 days (bilateral). CONCLUSIONS This study provides some pilot data that demonstrates that the length of surgery, specific TMJR surgical protocols, and the incidence of complications may be related to surgeon TMJR experience and case volume.
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Affiliation(s)
- Shaina K Chechang
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA.
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Louis G Mercuri
- Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL, USA
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Keith DA, Handa S, Mercuri LG. Peri-articular bone formation involving the temporomandibular joint: a narrative summary and Delphi consensus of a new classification system. Int J Oral Maxillofac Surg 2024; 53:212-218. [PMID: 37777385 DOI: 10.1016/j.ijom.2023.09.003] [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: 03/21/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/02/2023]
Abstract
Heterotopic ossification (HO) is defined as 'bone where it does not belong'. Given the historical variety of nomenclature and eponyms, there is significant confusion about the etiology, pathogenesis, classification, and treatment of HO related to the temporomandibular joint (TMJ). The existing classifications for TMJ HO have shortcomings: they relate to specific populations, use differing imaging studies and demographic data, do not universally include alloplastic/autologous replacements, are based variously on radiological and/or clinical presentations that cannot always be combined, and were largely developed to assist oral and maxillofacial surgeons in surgical management. These deficiencies make it problematic to compare studies, draw valid conclusions, and pursue research. The aim of this study was to develop a new, more inclusive classification for TMJ HO. Currently available classifications were evaluated and a Delphi-type system used to build consensus from clinicians and researchers to develop a new system. Fourteen unique classifications for TMJ ankylosis/HO were identified. In light of the biological specifics related to heterotopic calcification of extracellular matrix versus heterotopic formation of actual bone, the group recommends a more unambiguous term - peri-articular bone formation - and proposes a new classification. This will help clinicians and researchers to study, describe, and manage various types of ectopic bone associated with the TMJ.
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Affiliation(s)
- D A Keith
- Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
| | - S Handa
- Orofacial Pain Division, Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Orofacial Pain Division, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Yang X, Li Q, Zhu S, Bi R. Comparison of Class II open bite correction by temporomandibular joint prostheses or bimaxillary orthognathic surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101630. [PMID: 37689138 DOI: 10.1016/j.jormas.2023.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the outcome of skeletal Class II and anterior open bite patients who received simultaneous Le fort I osteotomies with temporomandibular joint (TMJ) prostheses or bimaxillary orthognathic surgery. MATERIALS AND METHODS Patients with condylar resorption (CR) were treated by TMJ prostheses and orthognathic surgery and divided into two groups. Cephalometric radiographs were obtained before and after operation to find out the surgical alteration by comparing measures at different time points. RESULTS 23 patients were included. Mean overbite of the patients was increased by 3.39 mm in TMJ prostheses group and 3.24 mm in orthognathic group. Occlusal plane angle was averagely rotated -6.06° and 1.31°; mandibular plane counterclockwise rotated 12.23° and 5.81°, respectively. The increase of ramus height in TMJ prostheses group were significantly greater than orthognathic surgery group (8.02 ± 1.96 mm vs. -0.09 ± 1.29 mm). The overall treatment effect was stable in both groups during the 1-year follow up. DISCUSSION Two surgical plans seem to be reliable treatments of anterior open bite and mandibular retrognathism caused by temporomandibular disease. TMJ prostheses with simultaneous Le fort I osteotomies close open bite by lengthening the height of ramus and rotating maxillo-mandibular complex counterclockwise, while bimaxillary orthognathic surgery by rotating maxilla clockwise and mandible counterclockwise without rebuilding ramus.
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Affiliation(s)
- Xianni Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qianli Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
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Shen Z, Zhang P, Cheng B, Liu F, He D. Computational modelling of the fossa component fixation associated with alloplastic total temporomandibular joint replacements. J Mech Behav Biomed Mater 2023; 147:106104. [PMID: 37729840 DOI: 10.1016/j.jmbbm.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
The alloplastic total temporomandibular joint (TMJ) replacement is a complex surgical approach to end-stage TMJ disorders. The fixation of TMJ prostheses remains a critical issue for implant design and performance. For the fossa component, it is generally considered to use fixation screws to achieve tripod stability. However, the fossa may still come loose, and the mechanism remains unknown. A computational framework, consisting of a musculoskeletal model for calculating muscle and TMJ forces, and a finite element model for the fossa fixation simulation, was developed. A polyethylene (PE) fossa with stock prosthesis design was analyzed to predict contact pressures at the fixation interfaces, and stresses/strains in the fossa implant and bone during the static loading of normal chewing bite and maximum-force bite. The predicted maximum von Mises stresses were 33 MPa and 44 MPa for the bone, 13 MPa and 28 MPa for the PE fossa, and 131 MPa and 244 MPa for the screws, for the normal and maximum bites, respectively; the peak minimum principal strain was in the range of -2514 ∼ -3545 με for the bone. The results show that the sufficient initial mechanical strength of the fossa component fixation can be established using the screws in combination with bone support. The functional loads applied through the prosthetic TMJ bearing can be largely transferred to supporting bone without causing high level stresses. Tightening fixation screws with a pretension of 100 N can reduce transverse load to the screws and help prevent screw loosening. Further research is recommended to accurately quantify the transverse load and its influence on screw loosening during dynamic loading, and the frictional properties at the bone-implant interface.
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Affiliation(s)
- Zhenhao Shen
- School of Mechanical Engineering, North University of China, PR China
| | - Pengyu Zhang
- School of Mechanical Engineering, North University of China, PR China
| | - Bo Cheng
- School of Mechanical Engineering, North University of China, PR China
| | - Feng Liu
- School of Mechanical Engineering, North University of China, PR China.
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, PR China.
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Khattak YR, Arif H, Gull H, Ahmad I. Extended total temporomandibular joint reconstruction prosthesis: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101404. [PMID: 36720364 DOI: 10.1016/j.jormas.2023.101404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.
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Affiliation(s)
| | | | - Hanan Gull
- Farooq Hospital Lahore, Pakistan; Akhtar Saeed Trust Hospital Lahore, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Olate S, Ravelo V, Huentequeo C, Parra M, Unibazo A. An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement. J Pers Med 2023; 13:jpm13030533. [PMID: 36983715 PMCID: PMC10053320 DOI: 10.3390/jpm13030533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023] Open
Abstract
The temporomandibular joint (TMJ) is a complex structure in the cranio-maxillomandibular region. The pathological changes of the joint cause deficiencies at different levels, making its replacement necessary in some cases. The aim of this article is to analyze the current indications, treatment and criteria, and follow-up using a systematic review and case series. A systematic review was carried out, identifying the indications for the use of a customized TMJ prosthesis and evaluating criteria and validation in the international literature. After review and exclusion, 8 articles were included with a minimum follow-up of 12 months. The age of the subjects was between 18 and 47 years old. In 226 patients, 310 TMJ prostheses were installed, 168 bilaterally and 142 unilaterally. In most of the articles, a good condition in the follow-up was observed, with a reduction in pain and better conditions of mandibular movement and function. TMJ prosthesis and replacement is a protocolized, defined, stable, and predictable procedure. Indications and criteria must be evaluated by specialists and patients related to the pathology involved in TMJ deformity or degeneration. Randomized research with an accurate diagnosis and follow-up is necessary to obtain the best indication for this treatment.
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Affiliation(s)
- Sergio Olate
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
- Correspondence: ; Tel.: +56-954187768
| | - Víctor Ravelo
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
| | - Marcelo Parra
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
| | - Alejandro Unibazo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
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Zhou Y, Lin S, Huang Z, Zhang C, Wang H, Li B, Li H. Receptor-interacting protein 1 inhibition prevents mechanical stress-induced temporomandibular joint osteoarthritis by regulating apoptosis and later-stage necroptosis of chondrocytes. Arch Oral Biol 2023; 147:105612. [PMID: 36603515 DOI: 10.1016/j.archoralbio.2022.105612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Temporomandibular joint osteoarthritis (TMJ OA) is a common degenerative joint disease that has multiple causes. The abnormal stress distribution is known to be an important trigger of TMJ OA. This article explored the pathological changes of the condylar cartilage under 60 g mechanical force and whether the inhibition of Receptor-interacting protein 1 (RIP1) can protect stress-induced TMJ OA. MATERIAL AND METHODS We used a compressive mechanical force-induced-TMJ OA model and Lenti-virus targeting RIP1 to perform this study. A total of 72 male rats were used in the animal experiment. Each rat was injected with a negative control Lenti-shRNA in the right TMJ and Lenti-siRIP1 in the left TMJ and euthanized after 4 and 7 days, respectively. Quantitative real-time PCR, immunohistochemistry, Tunnel staining and Micro-CT were used to detect cartilage pathological changes and one way ANOVA with LSD analysis was used to determine statistical significance between groups. RESULTS The results identified the characteristics of the spatio-temporal changes in stress-induced TMJ OA. Under mechanical force, inflammation and apoptosis, which occur in the whole layer of mandibular cartilage, appear on the 4th day and persist till the 7th day. Necroptosis arises in the later stage of mechanical force and is mainly located in the transition layer. RIP1 inhibition through Lenti-virus could protect stress-induced mandibular cartilage thinning by inhibiting persisted apoptosis and later-stage necroptosis in the transition layer. CONCLUSIONS RIP1 plays an essential role in the destruction of mandibular cartilage under mechanical force. RIP1 inhibition through Lenti-virus could protect mechanical stress-induced TMJ OA.
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Affiliation(s)
- Yiwen Zhou
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Shuang Lin
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ziwei Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Caixia Zhang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Huijuan Wang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Baochao Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China.
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Navaneetham A, Nagaraj V, Kumaran PS, Channabasappa B, Loyola D, Navaneetham R. Temporomandibular Joint Replacement Using Stock Alloplastic Graft in the Treatment of Ankylosis: A Case Report. J Contemp Dent Pract 2023; 24:113-119. [PMID: 37272143 DOI: 10.5005/jp-journals-10024-3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION This paper aims to assess the suitability and effectiveness of temporomandibular joint replacement (TMJR) devices to treat a case of re-ankylosis and association of tuberculosis (TB) with reduced mouth opening. Traditional protocols for the treatment of temporomandibular joint (TMJ) ankylosis have preferred autologous grafts for reconstruction. Usage of TMJR devices have been reserved for very specific conditions. CASE DESCRIPTION We present a case of a patient previously treated for ankylosis using a sternoclavicular graft, who came with a chief complaint of progressive decrease in mouth opening. She also gave a history of pulmonary TB a year back. Investigations revealed no active TB. Images and clinical presentation were consistent with bilateral ankylosis. The treatment plan consisted of resection of ankylotic mass on the left side and removal of the failed graft and reconstruction with Biomet stock TMJR prosthesis on the left side. DISCUSSION Stock device has proven to be reliable option in planned TMJR procedures. Osteoarticular TB should be ruled out in patients with a history and features of TB. CONCLUSION Stock TMJR devices are an effective and viable option for the treatment of re-ankylosis. This ensures almost immediate possibility of physiotherapy and long-term results including maintenance of mouth opening and function. Osteoarticular TB can cause trismus and painful joints which may be misdiagnosed. Any patient with reduced mouth opening with a history of TB should be investigated for possible extrapulmonary TB.
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Affiliation(s)
- Anuradha Navaneetham
- Department of Oral and Maxillofacial Surgery, MR Ambedkar Dental College, Bengaluru, Karnataka, India
| | - Vaibhav Nagaraj
- Department of Oral and Maxillofacial Surgery, MR Ambedkar Dental College, Bengaluru, Karnataka, India, Phone: +91 9844258076, e-mail:
| | - P Satish Kumaran
- Department of Oral and Maxillofacial Surgery, MR Ambedkar Dental College, Bengaluru, Karnataka, India
| | - Bindu Channabasappa
- Department of Oral and Maxillofacial Surgery, MR Ambedkar Dental College, Bengaluru, Karnataka, India
| | - Daisy Loyola
- Consultant Oral and Maxillofacial Surgeon, Spreading Smiles Dental Hospital, Puducherry, India
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Cantanhede ALC, Olate S, de Assis AF, de Moraes M. Central Giant Cell Granuloma in the Mandibular Condyle in a Teenager. A Case Report with Literature Review. J Clin Med 2022; 11:jcm11144239. [PMID: 35888004 PMCID: PMC9318563 DOI: 10.3390/jcm11144239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy.
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Affiliation(s)
- André Luís Costa Cantanhede
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba 13414-903, SP, Brazil; (A.L.C.C.); (M.d.M.)
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
- Correspondence: ; Tel.: +56-45-2325000
| | - Adriano Freitas de Assis
- Department of Oral and Maxillofacial Surgery, Bahiana School of Medicine and Public Health, Salvador 40290-000, BA, Brazil;
| | - Márcio de Moraes
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba 13414-903, SP, Brazil; (A.L.C.C.); (M.d.M.)
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