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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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Rahajoe PS, Rismanto PH, Lutfianto MB. Reankylosis of temporomandibular joint 5 years after interpositional arthroplasty using gold foil: management and follow up (a case report). Int J Surg Case Rep 2024; 115:109311. [PMID: 38290354 PMCID: PMC10844817 DOI: 10.1016/j.ijscr.2024.109311] [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: 12/22/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Temporomandibular Joint (TMJ) reankylosis is one of TMJ arthroplasty complications that can interfere masticatory function and aesthetics. This case report aimed to describe a TMJ reankylosis in growing age patient that occurred 5 years after interpositional arthroplasty using gold foil. Interpositional arthroplasty using temporalis fascia and costochondral graft followed by unilateral coronoidectomy could be a treatment option. CASE PRESENTATION A 17-year-old female came with inability to open her mouth 5 years after first interpositional arthroplasty using gold foil due to traumatic TMJ ankylosis. Patient was diagnosed type IV left TMJ reankylosis with left coronoid process hyperplasia. Patient was treated with interpositional arthroplasty using temporalis fascia as an interposition material for articular disc substitution, costochondral graft for ramus condyle unit (RCU) reconstruction and followed by unilateral coronoidectomy. Postoperative mouth opening was ±26 mm. One year evaluation showed stable mouth opening and no recurrency occured. DISCUSSION Age at growing period, insufficient gap width, surgical technique and the effects of previous surgery may generate TMJ reankylosis. Temporalis fascia widely used for interposision material and act as a lubricant that makes movement frictionless. Costochondral graft can be used for RCU reconstruction to prevent decreasing mandibular ramus height and openbite. CONCLUSION Growing age increases the risk of TMJ reankylosis. Interpositional arthroplasty, which used temporalis fascia and a costochondral graft, has resulted in a sufficient mouth opening and an improvement in masticatory function. Recurrence was not found in the 1-year postoperative evaluation.
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Affiliation(s)
- Poerwati Soetji Rahajoe
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Panji Hendar Rismanto
- Resident of Oral and Maxillofacial Surgery Study Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - M Bakhrul Lutfianto
- Oral and Maxillofacial Surgery Staff, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Mommaerts M. Rationale for patient-fitted alloplastic temporomandibular joint replacement in childhood ankylosis. Ann Maxillofac Surg 2022; 12:2-4. [PMID: 36199455 PMCID: PMC9527849 DOI: 10.4103/ams.ams_250_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
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Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery. J Maxillofac Oral Surg 2021; 20:527-533. [PMID: 34776680 DOI: 10.1007/s12663-021-01648-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022] Open
Abstract
Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor.
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Acquired Facial, Maxillofacial, and Oral Asymmetries—A Review Highlighting Diagnosis and Management. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Facial asymmetry refers to the absence of, or the deviation from the regular mirror image of facial structures, relative to a referenced midline axis. It can be attributed to a wide spectrum of deformities, including congenital, developmental, or acquired conditions, which can originate either prenatally or postnatally. Though highly prevalent, asymmetry commonly goes undiagnosed due to its subtle or relative nature. Among the spectrum of conditions, acquired cases are triggered postnatally, in previously normal individuals, thus subjecting them to sudden, eventful psychological and psychosocial disharmony. When detected early, timely management may help intervene progressive growth of these conditions. This, therefore, emphasizes the need for a thorough diagnostic workup including medical/dental history, clinical examinations, study models, photographic and radiographic records for a case-by-case basis to prevent severe functional and aesthetic complications. Recently, advanced diagnostic procedures, such as stereophotogrammetry, 3D stereolithographic models, skeletal scintigraphy (radionucleotide scans), 3D computed tomographic scans, cone-beam computed tomography, and magnetic resonance imaging, have provided innovative diagnostic instruments for numerous craniofacial defects. This descriptive review aims at focusing on the factors leading to frequently encountered conditions of acquired facial asymmetry and highlights their clinical evaluation, conservative and surgical interventions by a multi-disciplinary team of clinicians.
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Viability and Volumetric Analysis of Free Autogenous Dermis Fat Graft as Interpositional Material in TMJ Ankylosis: A Long-Term MRI Study. J Maxillofac Oral Surg 2020; 20:304-309. [PMID: 33927501 DOI: 10.1007/s12663-020-01413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Abstract
Aims and Objectives Dermis fat graft has shown good clinical results as an interpositional material in temporomandibular joint (TMJ) ankylosis and prevents heterogeneous calcification following gap arthroplasty. However, survival of the graft and volume retention is still debatable. The main purpose of our study was to assess the viability of the graft, tissues changes associated with the graft and volume retention using magnetic resonance imaging (MRI). Materials and Methods Fifteen patients with TMJ ankylosis underwent gap arthroplasty followed by placement of abdominal dermis fat graft and were randomly divided into two groups. Group 1 was subjected to MRI analysis of the graft at 3-6 months and Group 2 was analyzed at 1-2 years post-operatively. The graft was evaluated using T1- and T2-weighed images along with fat suppression (FS) sequences in all the three planes and the volume was also calculated. Results Both Group 1 (7 patients and 11 joints) and Group 2 (8 patients and 13 joints) showed the presence of viable fat on T1 and T2 images, confirmed by FS images. Minor tissue changes were observed at the center of the graft in 5 patients of Group 1 and 3 patients of Group 2. Average volume of the graft was 4.154 cm3 at 3-6 months and 4.269 cm3 at 1-2 years, respectively, and when compared to the original volume of the graft (4.583 cm3 in Group 1 and 4.712 cm3 in Group 2), the difference was statistically insignificant (p > 0.005). Conclusion MRI shows long-term survival of autogenous dermis fat graft without significant volumetric reduction. This along with positive clinical results make dermis fat an excellent choice as an interpositional material for TMJ ankylosis.
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Shakya S, Zhang X, Liu L. Key points in surgical management of mandibular condylar fractures. Chin J Traumatol 2020; 23:63-70. [PMID: 31744656 PMCID: PMC7156880 DOI: 10.1016/j.cjtee.2019.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023] Open
Abstract
Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons' preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.
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Affiliation(s)
- Shubhechha Shakya
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Chen S, He Y, An JG, Zhang Y. Recurrence-Related Factors of Temporomandibular Joint Ankylosis: A 10-Year Experience. J Oral Maxillofac Surg 2019; 77:2512-2521. [DOI: 10.1016/j.joms.2019.06.172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
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Hassan SAEH, Mohamed FI. Distraction osteogenesis in the management of mandibular hypoplasia secondary to temporomandibular joint ankylosis. Long term follow up. J Craniomaxillofac Surg 2019; 47:1510-1520. [DOI: 10.1016/j.jcms.2019.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/08/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
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Shivakotee S, Menon CS, Sham ME, Kumar V, Archana S. TMJ Ankylosis Management: Our Experience. J Maxillofac Oral Surg 2019; 19:579-584. [PMID: 33071506 DOI: 10.1007/s12663-019-01293-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022] Open
Abstract
Aim Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Temporomandibular joint ankylosis is very common among young children. The aim of treatment is not only to treat the movement of the joint but also to prevent relapse. Materials and Method In this series, 18 cases of temporomandibular joint ankylosis were treated at our institute from January 2012 to January 2017 with osteoarthrectomy and interpositional arthroplasty. Patients were in the age range of 5-57 years, with 11 males and 7 females and including 8 unilateral and 10 bilateral cases. Duration of ankylosis ranged from less than 2 years to more than 6 years. Seven of the patients were secondarily taken up for correction of their deformities with either orthognathic surgery or distraction osteogenesis. Results Good mouth opening was achieved in all the patients with a mean follow-up period of 12 months. The early post-operative mouth opening ranged from 24 to 37 mm. The late post-operative mouth opening ranged from 20 to 33 mm. There was a stress on aggressive physiotherapy for a minimum of 6 months in all our patients. Conclusion Interpositional arthroplasty using vascularized temporalis fascia flap is a very reliable method to prevent recurrence of ankylosis, and it also avoids the disadvantages of alloplastic materials as well as nonvascularized autogenous tissues.
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Affiliation(s)
| | | | - M E Sham
- Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, India
| | - Veerendra Kumar
- Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, India
| | - S Archana
- Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, India
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Connelly ST, Silva R, Gupta R, O'Hare M, Danilkovitch A, Tartaglia G. Temporomandibular Joint Discectomy Followed by Disc Replacement Using Viable Osteochondral and Umbilical Cord Allografts Results in Improved Patient Outcomes. J Oral Maxillofac Surg 2019; 78:63-74. [PMID: 31278938 DOI: 10.1016/j.joms.2019.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The ideal surgical solution to reconstruct the temporomandibular joint (TMJ) disc after it has been removed has remained elusive. The major obstacle has been identifying a durable biocompatible material that will provide for restoration of TMJ function. The present study evaluated the outcomes of the interpositional implantation of a cryopreserved viable osteochondral allograft (CVOCA) combined with a viable cryopreserved umbilical cord tissue (vCUT) allograft after TMJ discectomy in patients with internal derangement and/or degenerative joint disease (DJD). PATIENTS AND METHODS We implemented a retrospective case series study and enrolled patients with DJD or disc displacement diagnosed using the Diagnostic Criteria of Temporomandibular Disorders, who had undergone interpositional CVOCA and vCUT implantation after TMJ discectomy. The primary outcome variable was pain, measured using a visual analog scale (VAS). The secondary outcomes variables included maximal incisal opening (MIO) and Glasgow Benefit Inventory (GBI) general subscale scores. The primary analysis compared the preoperative measures with those at the last follow-up visit. Descriptive and analytic statistics were computed to summarize the sample's characteristics and assess the pre- and postoperative differences. RESULTS The study sample included 9 patients with a mean age of 36 years, and 44% were men. The VAS scores had decreased significantly from 9.0 ± 2.0 to 3.0 ± 3.0 postoperatively (P = .001). The MIO had increased from 31 ± 5 to 36 ± 5 mm (P = .178). The average GBI general subscale score of 13 ± 46 for the 9 patients showed a trend toward improved quality of life and patient satisfaction with the surgery. The median postoperative follow-up at the time of our report was 15 months (interquartile range, 10; range, 2 to 27) without treatment-related complications. CONCLUSIONS The reported outcomes suggest that the interpositional implantation of CVOCA and vCUT after TMJ discectomy could be a solution for reducing TMJ-related pain and restoring TMJ function. Longer follow-up and prospective multicenter studies are warranted.
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Affiliation(s)
- S Thaddeus Connelly
- Assistant Professor, Department of Oral and Maxillofacial Surgery, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA.
| | - Rebeka Silva
- Associate Professor, Department of Oral and Maxillofacial Surgery, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA
| | - Rishi Gupta
- Assistant Professor, Department of Oral and Maxillofacial Surgery, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA
| | - Molly O'Hare
- Dental Student and DDS Candidate, United States Air Force; and Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Gianluca Tartaglia
- Professor, Department of Biomedical Sciences for Health, Functional Anatomy Research Center, Università degli Studi di Milano, Milan, Italy
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Abstract
INTRODUCTION While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction. METHODS A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications. RESULTS Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions. CONCLUSIONS Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.
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Abstract
The aim of the study is to discuss the current management options for intra- and extra-cranial communication giant cell tumor of the lateral skull base and perform a review of the literature. A total of 6 patients with giant cell tumor of the lateral skull base were retrospectively enrolled in the study. The principal complaints, imaging manifestations, surgical resection and reconstruction of intra- and extra-cranial communication defects for the diseases were discussed. There were 2 males and 4 females. The most of principal complaints were discomfort or pain in the temporomandibular joint in 5 cases (83.3%). Imaging examination showed invasion of the temporal bone alone in 3 cases (50.0%) and both temporal bone and sphenoid bone involvement in 3 cases (50.0%). C-shaped preauricular infratemporal fossa approach was used for tumour removal and gross total resection was done in all 6 cases. The pedicled temporal muscle fascial flap was used to reconstruct the intra- and extra-cranial communication defect of the lateral skull base. The conclusion is that giant cell tumor is a benign tumor but is also locally aggressive. Gross total resection is the most commonly recommended treatment choice for giant cell tumor of the skull and can achieve good treatment outcomes. The temporalis muscle flap is a good alternative choice for reconstruction of the defect.
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Interpositional Arthroplasty by Temporalis Fascia Flap and Galea Aponeurotica Combined With Distraction Osteogenesis: a Modified Method in Treatment of Adult Patients With Temporomandibular Joint Ankylosis and Mandibular Dysplasia. J Craniofac Surg 2018; 29:e184-e190. [PMID: 29303852 DOI: 10.1097/scs.0000000000004242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Interpositional arthroplasty (IPA) with temporalis fascia flap has been one of the most frequently performed procedures to treat temporomandibular joint (TMJ) ankylosis. However, recurrence often occurs when the flap lacks bulk or atrophies. Whether to perform IPA or distraction osteogenesis (DO) first has long been a controversial issue when patients presented mandibular dysplasia (MD). This study provided IPA a new graft material sufficient to prevent recurrence, combined the modified protocol of performing DO 6 months after IPA, and evaluated its efficacy in treating TMJ ankylosis patients with MD. METHODS Six patients with unilateral TMJ ankylosis and MD were treated in the authors' study. The temporalis fascia flap and part of adjacent galea aponeurotica were filled the space after surgical release. Mouth-opening exercises started immediately post-IPA. Distraction osteogenesis was performed 6 months after IPA and had a 4-month consolidation. The maximum interincisal distance at preoperative, immediately post-IPA and the latest follow-up were recorded, as was the distraction length. The body mass index was measured at each patient's postoperative visit. RESULT All patients had significant improvements in facial aesthetic, mouth-opening, and occlusion. No major complication or recurrence was observed at 3 to 4 years' follow-up. The mean maximum interincisal distance was 4.83 ± 2.79 mm preoperative and 35.67 ± 3.39 mm at the latest follow-up. The mean distraction distance was 16.17 ± 5.98 mm. The body mass index improved from 17.33 ± 0.64 kg/m preoperative to 18.75 ± 0.60 kg/m before DO. CONCLUSIONS Temporalis fascia flap and adjacent galea aponeurotica as new graft materials are recommended for IPA. The modified staged treatment proved to be reliable and effective to prevent recurrence, improve mandibular length and final occlusion.
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Candirli C, Demirkol M, Yilmaz O. Interpositional Flap Reconstruction of Temporomandibular Joint Using a Novel Anterior-Based Mastoid Flap Technique. J Maxillofac Oral Surg 2018; 17:396-397. [PMID: 30034161 DOI: 10.1007/s12663-017-1027-6] [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: 02/20/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022] Open
Abstract
In this report, it was aimed to use the anterior-based mastoid fascia flap as an interpositional graft in TMJ surgery. This technical report, along with this characteristic, is the first in the literature.
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Affiliation(s)
- Celal Candirli
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Demirkol
- 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, 27310 Gaziantep, Turkey
| | - Onur Yilmaz
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
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Aneja V, Raval R, Bansal A, Kumawat V, Kaur J, Shaikh AA. Interpositional Gap Arthroplasty by Versatile Pedicled Temporalis Myofascial Flap in the Management of Temporomandibular Joint Ankylosis- A Case Series Study. J Clin Diagn Res 2016; 10:ZR01-ZR04. [PMID: 27891496 DOI: 10.7860/jcdr/2016/20157.8741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material.
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Affiliation(s)
- Vikas Aneja
- Reader, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre , Sriganganagar, Rajasthan, India
| | - Rushik Raval
- Junior Resident, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre , Sriganganagar, Rajasthan, India
| | - Anupam Bansal
- Consultant Oral and Maxillofacial Surgeon, Bansal Dental Clinic and Maxillofacial Hospital , Sri Ganganagar, Rajasthan India
| | - Vinod Kumawat
- Junior Resident, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre , Sriganganagar, Rajasthan, India
| | - Jasleen Kaur
- Junior Resident, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre , Sriganganagar, Rajasthan, India
| | - Ahemer Arif Shaikh
- Junior Resident, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Centre , Sriganganagar, Rajasthan, India
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Denadai R, Raposo-Amaral CE, Buzzo CL, Raposo-Amaral CA. Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis. J Plast Reconstr Aesthet Surg 2016; 69:1052-8. [PMID: 27236502 DOI: 10.1016/j.bjps.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/04/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty. METHODS A retrospective analysis of temporomandibular joint ankylosis patients (n = 15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared. RESULTS Significant (all p < 0.05) differences were recorded in temporomandibular joint ankylosis patients treated with interpositional arthroplasty with autogenous tissue (53.3%) versus Matthews device arthroplasty (46.7%) according to intermediate (25 ± 7 vs. 34 ± 5 mm) and late (19 ± 8 vs. 33 ± 5 mm) postoperative maximal incisal opening, intermediate (31% vs. 7%) and late (47% vs. 12%) postoperative relapse, and reoperation rate (38% vs. 0%). There was similarity (all p > 0.05) in preoperative (4.8 ± 2.9 vs. 4.9 ± 2.9 mm) and recent (35 ± 4 vs. 37 ± 4 mm) postoperative maximal incisal opening, hospital stay (3.5 ± 0.8 vs. 3.6 ± 0.8 days), and surgery-related complications (13% vs. 14%). CONCLUSION Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse.
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Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | | | - Celso Luiz Buzzo
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
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Quantifying the outcome of surgical treatment of temporomandibular joint ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44:6-15. [DOI: 10.1016/j.jcms.2015.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/13/2015] [Accepted: 08/19/2015] [Indexed: 11/21/2022] Open
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Yew CC, Rahman SA, Alam MK. Temporomandibular joint ankylosis in a child: an unusual case with delayed surgical intervention. BMC Pediatr 2015; 15:169. [PMID: 26546159 PMCID: PMC4635686 DOI: 10.1186/s12887-015-0495-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background The Temporomandibular Joint (TMJ) ankylosis in child is rare and yet the causes still remain unclear. This condition that affects the feeding and possible airway obstruction do not only worry the parents, but also possesses as a great challenge to the surgeons. Furthermore, it interferes with the facial skeletal and dento-alveolar development in the on growing child. Case presentation In this case report, we presented the management of a 7 year old with left TMJ ankylosis discovered since infant. Clinical and imaging investigations were consistent with left temporomandibular joint ankylosis (Type IV) possible secondary to childhood septic arthritis. Left gap arthroplasty via modified Al Kayat Bramley and retromandibular approach was performed, with interpositional arthroplasty placement of temporalis fascia graft. No complications from the surgery except reduced mouth opening were seen. Possible contributing factors to this less than satisfactory mouth opening are adressed. Conclusion We describe here, an unusual childhood temporomandibular joint ankylosis possible due to septic arthritis with delayed surgical intervention. The aetiology, classifications, timing and choice of surgical techniques along with its considerations and complications are discussed. Although there is no consensus on the surgical treatment of TMJ ankylosis, early mobilisation, aggressive physiotherapy and close follow-up are advocated by many authors for successful treatment.
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Affiliation(s)
- Ching Ching Yew
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia. .,Oral and Maxillofacial Surgery Department, School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Shaifulizan Ab Rahman
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Mohammad Khursheed Alam
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
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Ma J, Jiang H, Liang L. Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg 2015; 43:1202-7. [DOI: 10.1016/j.jcms.2015.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 03/21/2015] [Accepted: 04/22/2015] [Indexed: 11/29/2022] Open
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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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Ma J, Liang L, Jiang H, Gu B. Gap Arthroplasty versus Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A Meta-Analysis. PLoS One 2015; 10:e0127652. [PMID: 26010224 PMCID: PMC4444315 DOI: 10.1371/journal.pone.0127652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/17/2015] [Indexed: 11/18/2022] Open
Abstract
Gap arthroplasty (GA) and interpositional arthroplasty (IA) are widely used for the treatment of temporomandibular joint ankylosis (TMJA). However, controversy remains as to whether IA is superior to GA. PubMed, EMBASE, the Cochrane Library, the Web of science and the China National Knowledge Infrastructure were searched for literature regarding these procedures (published from 1946 to July 28, 2014). A study was included in this analysis if it was: (1) a randomized controlled trial or non-randomized observational cohort study; (2) comparing the clinical outcomes between GA and IA with respect to the maximal incisal opening (MIO) and reankylosis; (3) with a follow-up period of at least 12 months. The methodological quality of the included studies was evaluated according to the Newcastle-Ottawa Scale Eight non-randomized observational cohort studies with 272 patients were included. All the statistical analyses were performed using the RevMan 5.3 and Stat 12. The pooled analysis showed no significant difference in the incidence of reankylosis between the IA group (13/120) and the GA group (29/163) (RR= 0.67, 95% CI=0.38 to 1.16; Z=1.43, p=0.15). The IA group showed a significantly larger MIO than the GA group (MD=1.96, 95% CI=0.21 to 3.72, Z=2.19, p=0.03, I2=0%). In conclusion, patients with TMJA could benefit more from IA than GA, with a larger MIO and a similar incidence of reankylosis. IA shows to be an adequate option in the treatment of TMJA based on the results of maximal incisal opening.
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Affiliation(s)
- Junli Ma
- Department of Stomatology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
- * E-mail:
| | - Limin Liang
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - Hua Jiang
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - Bin Gu
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
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Tissue engineering of the temporomandibular joint disc: current status and future trends. Int J Artif Organs 2015; 38:55-68. [PMID: 25744198 DOI: 10.5301/ijao.5000393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Temporomandibular joint disorders are extremely prevalent and there is no ideal treatment clinically for the moment. For severe cases, a discectomy often need to be performed, which will further result in the development of osteoarthritis. In the past thirty years, tissue engineering has provided a promising approach for the effective remedy of severe TMJ disease through the creation of viable, effective, and biological functional implants. METHODS Although TMJ disc tissue engineering is still in early stage, unremitting efforts and some achievements have been made over the past decades. In this review, a comprehensive summary of the available literature on the progress and status in tissue engineering of the TMJ disc regarding cell sources, scaffolds, biochemical and biomechanical stimuli, and other prospects relative to this field is provided. RESULTS AND CONCLUSIONS Even though research studies in this field are too few compared to other fibrocartilage (e.g., knee meniscus) and numerous, difficult tasks still exist, we believe that our ultimate goal of regenerating a biological implant whose histological, biochemical, and biomechanical properties parallel native TMJ discs for clinical therapy will be achieved in the near future.
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Functional Outcomes of Gap and Interposition Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis. J Oral Maxillofac Surg 2014; 72:2434-9. [DOI: 10.1016/j.joms.2014.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/19/2014] [Accepted: 08/06/2014] [Indexed: 11/24/2022]
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Yan YB, Liang SX, Shen J, Zhang JC, Zhang Y. Current concepts in the pathogenesis of traumatic temporomandibular joint ankylosis. Head Face Med 2014; 10:35. [PMID: 25189735 PMCID: PMC4158390 DOI: 10.1186/1746-160x-10-35] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 08/25/2014] [Indexed: 01/10/2023] Open
Abstract
Traumatic temporomandibular joint (TMJ) ankylosis can be classified into fibrous, fibro-osseous and bony ankylosis. It is still a huge challenge for oral and maxillofacial surgeons due to the technical difficulty and high incidence of recurrence. The poor outcome of disease may be partially attributed to the limited understanding of its pathogenesis. The purpose of this article was to comprehensively review the literature and summarise results from both human and animal studies related to the genesis of TMJ ankylosis.
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Affiliation(s)
- Ying-Bin Yan
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Su-Xia Liang
- Department of Operative Dentistry and Endodontics, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Jun Shen
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Jian-Cheng Zhang
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun Nandajie, Haidian District, Beijing 100081, PR China
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The use of temporalis muscle graft, fresh and cryopreserved amniotic membrane in preventing temporomandibular joint ankylosis after discectomy in rabbits. J Craniomaxillofac Surg 2014; 42:1868-76. [PMID: 25218148 DOI: 10.1016/j.jcms.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate the efficacy of temporalis muscle-fascia graft, fresh and cryopreserved human amniotic membrane as an interpositional material in preventing temporomandibular joint ankylosis in a rabbit model. MATERIALS AND METHODS In this experimental study, 21 New Zealand white rabbits were used. The condyle and the joint disc were removed to induce ankylosis in left TMJs. Reconstruction was immediately performed with temporalis muscle-fascia graft (tMFG) in group I (n = 7), fresh human amniotic membrane (fHAM) in group II (n = 7) and cryopreserved human amniotic membrane (cHAM) in group III (n = 7). All rabbits were sacrificed at 3 months after the operation. The comparison was made among three groups by means of vertical mouth opening and weight measurements, radiologic and histologic findings obtained before and after surgery. RESULTS In all rabbits, there was no statistically significant difference in the jaw movements and weight among groups at commencement and 3 months after surgery. The condylar surfaces were more irregular in HAM groups. There were mild osteophyte formations, sclerosis, fibrosis and calcification around the condyle in all groups however the joint gap was more preserved in group I. All interpositional materials were also seen to be partially present in the joint gap at 3 months. Ankylosis was not seen in the joint gap in any group. CONCLUSION With the results of this study it was concluded that interpositional arthroplasty with HAM and tMFG have an almost similar effect in preventing TMJ ankylosis after discectomy in the rabbit model.
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