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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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Andrade NN, Kapoor P, Mathai P, Gupta V, Lakshmi V, Sharma S. Management of paediatric ankylosis. J Oral Biol Craniofac Res 2023; 13:191-201. [PMID: 36691651 PMCID: PMC9860352 DOI: 10.1016/j.jobcr.2023.01.006] [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: 09/04/2021] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Temporomandibular joint ankylosis (TMJa) is one of the most crippling craniomaxillofacial pathological conditions characterized by replacement of normal architecture of temporomandibular joint (TMJ) with fibrous or bony tissue. The incidence of TMJa is most common in the paediatric population [first and second decades of life] and is commonly associated with maxillofacial trauma. Comprehensive management entails a thorough evaluation of the associated anatomy of the ankylotic mass and other pertinent details like the presence or absence of obstructive sleep apnoea. Categorizing patients based on these variables helps in selecting an appropriate surgical intervention. Various resective and reconstructive surgical techniques are discussed; along with their merits and demerits. Long-term physiotherapy, long-term clinical follow-up and appropriate family counselling are the essential pillars for success. In this review, the authors present an algorithmic approach to evaluation and management of paediatric TMJa. Appropriate recommendations are made based on evidence to select optimum surgical intervention.
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Affiliation(s)
- Neelam Noel Andrade
- Head of Department of Oral & Maxillofacial Surgery and Dean of Nair Dental College & Hospital, Mumbai and Dean of NESCO Jumbo Covid Care Center, Mumbai, Dean's Office, Nair Dental College & Hospital, Dr Anandrao Nair Marg, Mumbai Central, Mumbai, Maharashtra, 400008, India
| | - Prathmesh Kapoor
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Paul Mathai
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
- The Center For Oral, Maxillofacial and Facial Plastic Surgery, Mumbai
| | - Varsha Gupta
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - V.K. Lakshmi
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Shelly Sharma
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
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Singh AK, Jose A, Khanal N, Krishna K, Chaulagain R, Roychoudhary A. Dermis fat graft compared to temporalis myofascial graft for interpositional arthroplasty in TMJ ankylosis. A systematic review and metanalysis. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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TMJ Ankylosis in Children: A Case Report and Literature Review. Case Rep Dent 2023; 2023:6474478. [PMID: 36643593 PMCID: PMC9836793 DOI: 10.1155/2023/6474478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Temporomandibular joint (TMJ) ankylosis is a serious disabling condition characterized by fusion of the mandibular condyle with the glenoid fossa, disc, and/or eminence, resulting in severely restricted mouth opening and significantly reduced mandibular movements. The condition often has a deteriorating effect on the patient's daily functions such as speech, chewing, breathing, and oral hygiene as well as their wellbeing and quality of life. Furthermore, childhood TMJ ankylosis frequently has a detrimental impact on the facial growth resulting in facial asymmetry, micrognathia, and/or class II malocclusion with posterior or anterior open bite. Trauma is the main cause of TMJ ankylosis, but the condition can also occur as a result of surgery, local or systemic infections, or systemic disease. Surgery is the mainstay of treatment, and several approaches have been applied, including gap arthroplasty (GA), interpositional gap arthroplasty (IGA), reconstruction arthroplasty (RA), or distraction osteogenesis (DO). The aim of this article is to present a post-traumatic TMJ ankylosis case in a 5-year-old male child who was treated with resection and simultaneous costochondral grafting and to provide a succinct update of literature.
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Matheus HR, Özdemir ŞD, Guastaldi FPS. Stem cell-based therapies for temporomandibular joint osteoarthritis and regeneration of cartilage/osteochondral defects: a systematic review of preclinical experiments. Osteoarthritis Cartilage 2022; 30:1174-1185. [PMID: 35597373 DOI: 10.1016/j.joca.2022.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this systematic review was to assess the effects of stem cell-based therapies on the treatment of Temporomandibular Joint Osteoarthritis (TMJ-OA) and the regeneration of cartilage/osteochondral defects. METHODS Data on preclinical studies evaluating the effectiveness of stem cell-based therapies for treating Temporomandibular Disorders (TMDs) were extracted from PubMed, Web of Science, and Cochrane Library and the grey literature by three independent reviewers. A manual search was performed in the databases, the reference list of review studies, and relevant journals in the field. Compliance with the ARRIVE guidelines was evaluated for quality assessment. SYRCLE's risk of bias tool for animal experimental studies was assessed to define internal validity. RESULTS After applying the inclusion and exclusion criteria, 10 studies were included in the qualitative synthesis. Regardless of cell origin, stem cell-based therapeutic approaches induced protective, anti-inflammatory, and chondroregenerative potential in the treatment of TMJ-OA. Regeneration of the cartilage layer on the surface of the condyle was achieved when stem cells were directly flushed into the defect or when delivered within a carrier. CONCLUSION Stem cell-based therapies may be considered a promising approach for the treatment of TMJ-OA and for the regeneration of full-thickness cartilage and osteochondral defects in the TMJ. Human studies shall be performed to validate these results found in animals.
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Affiliation(s)
- H R Matheus
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA; Department of Diagnosis and Surgery - Periodontics Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil.
| | - Ş D Özdemir
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA; Istanbul Medipol University, School of Dentistry, İstanbul, Turkey.
| | - F P S Guastaldi
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
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Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg 2022; 51:1211-1225. [PMID: 35339331 DOI: 10.1016/j.ijom.2021.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023]
Abstract
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
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Treatment of Dentofacial Deformity Associated with Temporomandibular Joint Ankylosis Through Vertical and Sagittal Osteotomies of the Mandibular Ramus. J Craniofac Surg 2021; 33:e305-e308. [PMID: 34732668 DOI: 10.1097/scs.0000000000008193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ankylosis of the temporomandibular joint is a disorder resulting from fibrous, osseous, or fibro-osseous adhesion that directly affects the quality of life of the individual. The authors present a case of unilateral temporomandibular joint ankylosis treated by condilectomy and ipsilateral sliding vertical ramus osteotomy associated with contralateral sagittal osteotomy aiming to restore function and to correct dentofacial deformity class II. A 31-year-old female patient presented with a history of facial trauma and major complaint of oral opening limitation. Physical examination revealed hypoplasia of the lower third of the face, facial pattern type II, anterior open bite, and maximum mouth opening of 22.5 mm. Computed tomography showed an ankylotic mass in the right mandibular condyle with deformity of the condylar structure and fusion to the right zygomatic arch and a contralateral condylar fracture sequel. It was proposed to perform a condilectomy of the right mandibular condyle for the removal of the bone mass concomitant to the sliding vertical ramus osteotomy of the mandibular ramus for condylar reconstruction by rhytidectomy approach and the sagittal osteotomy of the left mandibular aiming the reestablishment of occlusion and the correction of dentofacial deformity. The condylar fracture was not operated because the condyle was remodeled. The patient is in her fourth year postoperative presenting satisfactory esthetic-functional re-stabilization, without clinical signs of recurrence. In conclusion, the authors believe that combined sliding vertical ramus osteotomy and sagittal osteotomy can bring satisfactory results in complex cases.
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Mokhtar EA, Rattan V, Rai S, Jolly SS, Lal V. Analysis of maximum bite force and chewing efficiency in unilateral temporomandibular joint ankylosis cases treated with buccal fat pad interpositional arthroplasty. Br J Oral Maxillofac Surg 2021; 60:313-319. [PMID: 34690017 DOI: 10.1016/j.bjoms.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/04/2021] [Indexed: 11/15/2022]
Abstract
There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function.
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Affiliation(s)
- Ejaz Ahmad Mokhtar
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Satnam Singh Jolly
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Val M, Ragazzo M, Bendini M, Manfredini D, Trojan D, Guarda Nardini L. Computer-assisted surgery with custom prostheses and human amniotic membrane in a patient with bilateral class IV TMJ reankylosis: a case report. Cell Tissue Bank 2021; 23:395-400. [PMID: 34176055 DOI: 10.1007/s10561-021-09940-w] [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: 01/06/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022]
Abstract
A gold-standard technique has yet to be found for the treatment of temporomandibular joint ankylosis (TMJa), particularly in patients with recurring ankylosis. A 58-year-old male patient, with a history of multiple TMJ surgeries and severe limitation of mouth opening (maximum interincisal distance [MID] was 10 mm). Computerised tomography (CT) imaging highlighted a bilateral type IV ankylosis. The surgical guides were manufactured using a 3D printing method after obtaining a proper design of the osteotomy lines. The positioning of the fossa and condyle components of the custom TMJ prosthesis was digitally performed. Osteotomies were carried out using surgical guides and TMJ prostheses were placed as per the virtual planning. A human amniotic mambrana is inserted between the two prosthetic components to avoid ranchylosis. The post-operative CT showed the correct positioning of the condylar prosthesis. MID after 10 days was 37 mm. Total joint reconstruction surgery using 3D virtual surgical planning may be an effective surgical option for achieving a precise surgical outcome and making use of a single-stage approach in cases of TMJa and the use of the amniotic membrane, thanks to its healing properties and reduction of pain perception, seems to improve the quality of the immediate post-operative period.
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Affiliation(s)
- Matteo Val
- Unit of Oral and Maxillofacial surgery, Ca Foncello Hospital, 31100, Treviso, Italy.
| | - Mirko Ragazzo
- Unit of Neuroradiology, Ca Foncello Hospital, 31100, Treviso, Italy
| | - Matteo Bendini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Daniele Manfredini
- Treviso Tissue Bank Foundation, Via dell'Ospedale 3, 31100, Treviso, Italy
| | - Diletta Trojan
- Unit of Oral and Maxillofacial surgery, Ca Foncello Hospital, 31100, Treviso, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial surgery, Ca Foncello Hospital, 31100, Treviso, Italy
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Zhu F, Zhi Y, Xu X, Wu J, Si J, Shi J, Xu B. Interpositional arthroplasty of post-traumatic temporomandibular joint ankylosis: A modified method. J Craniomaxillofac Surg 2021; 49:373-380. [PMID: 33663961 DOI: 10.1016/j.jcms.2021.01.032] [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: 12/25/2019] [Revised: 11/02/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate a modified method of interpositional arthroplasty for post-traumatic temporomandibular joint ankylosis. All patients were treated with a modified interpositional arthroplasty that included: navigation-assisted accurate bone dissection with minimal removal of only 5 mm of the ankylosed bony mass, novel application of bone wax and porcine acellular dermal matrix to prevent re-ankylosis, and a unique 3D-printed splint for occlusal stabilization and gap maintaining. The pre- and post-operative physical and radiological examinations of patients were recorded during routine follow-up visits. Postoperative follow-up visits lasted at least 12 months. Twelve patients, seven males and five females, ranging from 21 years to 59 years, were enrolled in this retrospective case series. All of the twelve patients with eighteen bony ankylosed temporomandibular joints were treated by our new method. The post-operative follow-up periods ranged from 1 year to 4 years. During the follow-up visits within at least 1 year, no one manifested re-ankylosis. The mean maximum incisor opening changed from 7.4 ± 5.3 mm (p < 0.001, before surgery) to 37.6 ± 3.9 mm (p < 0.001, last follow-up visit). No sign of post-operative infection or foreign body rejection was observed during the follow-up visits. The post-operative occlusal relationship was sound and stable. It is suggested that the modified method of interpositional arthroplasty provides favorable clinical and radiographic outcomes after a short-term follow up.
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Affiliation(s)
- Fangxing Zhu
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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
| | - Yin Zhi
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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
| | - Xiaofeng Xu
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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
| | - Jinyang Wu
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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
| | - Jiawen Si
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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.
| | - Jun Shi
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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 & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, 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.
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Abreu Silva ML, Henriques de Castro W, Baires Campos FE. Temporomandibular Joint Ankylosis Surgery in Children. J Oral Maxillofac Surg 2020; 79:473.e1-473.e7. [PMID: 33137301 DOI: 10.1016/j.joms.2020.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE A variety of techniques have been described in the literature for the treatment of temporomandibular joint ankylosis. However, 1 of the factors most commonly related to the failure of maintenance mouth opening in the postoperative period is the inadequate excision of the ankylotic mass. Furthermore, the surrounding noble structures, such as the base of the skull, internal maxillary artery, and dental germs, are at risk of being affected during the procedure. MATERIALS AND METHODS For this reason, prototyped guides have been proposed to steer osteotomies and resections of the ankylotic block in the temporomandibular joint. RESULTS Nevertheless, access to this technology, especially in developing countries, can represent a financial barrier. CONCLUSION Therefore, our proposal is to manufacture low-cost surgical cutting guides to increase their applicability.
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Affiliation(s)
- Maynara Lemos Abreu Silva
- Resident, Department of Oral and Maxillofacial Surgery, Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Wagner Henriques de Castro
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil and Surgeon, Department of Oral and Maxillofacial Surgery, Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Eduardo Baires Campos
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; and Surgeon, Department of Oral and Maxillofacial Surgery, Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Olate S, Bahls V, Uribe F, Unibazo A, Martínez F. Patient-specific Implant for Temporomandibular Joint Replacement in Juvenile Arthritis and Facial Asymmetry. Ann Maxillofac Surg 2020; 10:275-278. [PMID: 32855958 PMCID: PMC7433974 DOI: 10.4103/ams.ams_82_19] [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: 04/03/2019] [Revised: 11/13/2019] [Accepted: 04/18/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of this report is to present a patient with juvenile arthritis, condylar resorption, and residual facial asymmetry treated with orthognathic surgery and unilateral joint replacement with a full three-dimensional computer-aided design and computer-aided manufacture (CAD-CAM) temporomandibular joint (TMJ) prosthesis, including an increase in the left ramus and mandibular angle to achieve facial symmetry. The patient, a 30-year-old male, came to our department for orthosurgical treatment. The patient had been receiving treatment for juvenile arthritis for 15 years; at facial level, he had a chin deviation of 12 mm from the facial midline, maxillary retrusion, and Angle Class III. The computed tomography revealed a reduced height of the left condyle and a significant difference in the morphology of the mandibular ramus and angle. Using CAD-CAM technology and additive manufacturing, a TMJ prosthesis was produced, through the use of the mirror image, orthognathic surgery was realized using the right side as “esthetic side” with suitable shape and angulation. The prosthesis was created, and this was taken to the surgery. The surgery was performed without problems, a mouth opening of 35 mm and absence of pain were noted after 12 months of follow-up. The surgery remained stable, and facial symmetry was restored. In conclusion, it is viable to develop a TMJ prosthesis by CAD-CAM that includes esthetic modifications to the face; prospective and clinical studies must be conducted to confirm protocols. Level of Evidence: V.
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Affiliation(s)
- Sergio Olate
- Center of Excellence in Morphological and Surgical Studies, Universidad de La Frontera, Temuco, Chile.,Division of Oral and Maxillofacial Surgery, A.G.P. General Hospital, Lautaro, Chile
| | - Victor Bahls
- Department of Biomedical Research Enterprises, Pinhais, Paraná, Brazil
| | - Francisca Uribe
- Center of Excellence in Morphological and Surgical Studies, Universidad de La Frontera, Temuco, Chile.,Division of Oral and Maxillofacial Surgery, H.H.A. General Hospital, Temuco, Chile
| | - Alejandro Unibazo
- Division of Oral and Maxillofacial Surgery, A.G.P. General Hospital, Lautaro, Chile
| | - Felipe Martínez
- Center of Excellence in Morphological and Surgical Studies, Universidad de La Frontera, Temuco, Chile.,Division of Oral and Maxillofacial Surgery, H.H.A. General Hospital, Temuco, Chile
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Evaluating the remodeling of condyles reconstructed by transport distraction osteogenesis in the treatment of temporomandibular joint ankylosis. J Craniomaxillofac Surg 2020; 48:494-500. [DOI: 10.1016/j.jcms.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/05/2020] [Accepted: 03/08/2020] [Indexed: 11/20/2022] Open
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Hawkins A, Mercuri LG, Miloro M. Are Rib Grafts Still Used for Temporomandibular Joint Reconstruction? J Oral Maxillofac Surg 2020; 78:195-202. [DOI: 10.1016/j.joms.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/08/2019] [Accepted: 09/08/2019] [Indexed: 01/05/2023]
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15
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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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Mittal N, Goyal M, Sardana D, Dua J. Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg 2019; 47:1120-1133. [DOI: 10.1016/j.jcms.2019.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
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Treatment of Atypical Bifid Mandibular Condyle Associated with Ankylosis of the Temporomandibular Joint. Case Rep Surg 2019; 2019:6372897. [PMID: 30733884 PMCID: PMC6348796 DOI: 10.1155/2019/6372897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction The bifid mandibular condyle (BMC) is an unusual temporomandibular joint (TMJ) disorder with controversial etiology. The association of this entity with ankylosis is rare. Objective The objective of the present study is to report a case of BMC with associated TMJ ankylosis in a patient with no history of trauma and/or infection. Case Report A 17-year-old male patient sought care reporting pain on the right TMJ region and mastication difficulty due to a severe limitation of mouth opening. In the clinic and imaging examinations, a 15 mm mouth opening and BMC associated with ankylotic mass of the right TMJ were observed, besides a facial asymmetry with chin deviation to the right. The proposed treatment plan was condylectomy on the right side, bilateral coronectomy, and genioplasty, so the chin lateral deviation could be corrected, under general anesthesia. The patient remains under clinical and imaging follow-up of two years with functional stability and no signs of relapse of the ankylosis. Conclusion The association of BMC with ankylosis is an atypical entity which must be diagnosed and treated early to prevent aesthetic and functional damages to the patient.
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Negulescu A, Scolozzi P. Bilateral temporomandibular joint ankyloses after bilateral sagittal split osteotomy of the mandible: An uncommon clinical case with long-term outcome evaluation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:45-48. [PMID: 30385425 DOI: 10.1016/j.jormas.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is an extremely handicapping condition characterized by a permanent restriction in the ability to open the mouth, and it is mainly caused by traumatic and infectious events. It rarely occurs as a complication following orthognathic surgery. The treatment goals are the restoration of viable mandibular function and, in growing pediatric patients, symmetrical mandibular development. We are reporting here the unusual case of a bilateral bony TMJ ankylosis in a patient who underwent a bilateral sagittal split osteotomy of the mandible for correction of a mandibular deficiency. The patient was treated by bilateral arthrotomies with the interposition of a full-thickness skin graft as well as bilateral coronoidectomies with a favorable long-term (6 years) functional outcome. Only one similar case has been previously reported in the literature.
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Affiliation(s)
- A Negulescu
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Hôpitaux Universitaire de Genève, Faculty of Medicine, 1211 Genève, Switzerland
| | - P Scolozzi
- Division of Stomatology and Maxillofacial Surgery, Clinique Saint-Pierre, 1340 Ottignies, Belgium
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Rinchuse DJ, Greene CS. Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017. Am J Orthod Dentofacial Orthop 2018; 154:35-46.e9. [DOI: 10.1016/j.ajodo.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
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Ankylosis of the Temporomandibular Joint and Reconstruction With a Costochondral Graft in a Patient With Juvenile Idiopathic Arthritis. J Craniofac Surg 2017; 28:203-206. [PMID: 27930467 DOI: 10.1097/scs.0000000000003266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA), the most common inflammatory autoimmune rheumatic disease in children, consists of a heterogeneous group of diseases with 7 distinct subtypes. Involvement of the temporomandibular joint (TMJ) in JIA varies from 17% to 87%, and can alter craniofacial growth due to damage to the condylar growth center. This study was a literature review and clinical report of bilateral ankylosis of the TMJ in a 13-year-old patient with polyarticular JIA. Temporomandibular joint reconstruction with a costochondral graft was carried out. The surgery was uneventful and the patient developed a mouth opening of 40 mm during the postoperative period of 24 months. The authors concluded that treatment of TMJ ankylosis should be surgical with removal of the ankylotic mass, and when necessary, joint reconstruction in patients undergoing a growth phase. Costochondral graft is still the gold standard due to its biological similarity and growth potential in patients with JIA. Research and early diagnosis of TMJ diseases should be carried out, because the earlier the identification of the disease, the better the chances of reducing its devastating effects, thus avoiding the worst possible outcome: TMJ ankylosis.
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Brown E, Wilson MH, Revington P. Single-stage temporomandibular joint arthroplasty in a patient with complete bony ankylosis and previous extradural haematoma. BMJ Case Rep 2016; 2016:bcr-2015-213917. [PMID: 28049115 DOI: 10.1136/bcr-2015-213917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a man aged 20 years who was referred with the inability to open his mouth as a consequence of severe ankylosis of his temporomandibular joint. He had previously undergone an attempt to release the ankylosis at the referring institution; however, this was complicated by an extradural haematoma as a result of iatrogenic injury. We describe a one-stage procedure which provided safe excision of the ankylotic mass along with immediate total joint replacement with a custom implant. We advocate the use of preoperative vascular imaging along with the use of custom-made cutting guides to minimise vascular injury.
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Affiliation(s)
- Emma Brown
- Department of Oral and Maxillofacial Surgery, North Bristol NHS Trust, Bristol, UK
| | - Mark H Wilson
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peter Revington
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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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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