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Yadav P, Devaraj SS. Role of buccal fat pad to reduce the chances of re-ankylosis-A systematic review of literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101619. [PMID: 37673302 DOI: 10.1016/j.jormas.2023.101619] [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: 07/27/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/08/2023]
Abstract
The role of buccal fat pad (BFP) as interpositional material in the temporomandibular joint ankylosis (TMJA) have been well documented. The purpose of the present systematic review is to reinforce the role of buccal fat pad as interpositional material in preventing re-ankylosis. A systematic search was conducted in PubMed, Google Scholar, Semantic scholar and Cochrane library database from 1980 to 2022 following the PRISMA guidelines. The studies using BFP as interpositional material in TMJA with more than 10 patients with atleast a follow-up of 6-months were included. All the human studies {prospective, retrospective, case reports/series (with more than 10 subjects), randomized or non-randomized trial) reporting the outcome of BFP as interpositional material were included. The present systematic review included 11 studies (prospective=7, Retrospective=3 and ambispective=1) using BFP as interpositional material. The total number of patients were 205. The number of unilateral TMJA and bilateral TMJA were 153 and 52 respectively, making a number of joint to 257. The distribution of gender was almost equal (few studies did not report the gender distribution). The minimum follow-up was 6-months and extended up to 5.3 years. Out of 205 patients, no re-ankylosis was reported in patients. The authors concluded that the BFP is nearly ideal and a preferred interpositional material to prevent re-ankylosis in temporomandibular joint ankylosis. Its vicinity to TMJ, ease of harvesting through the same surgical site and avoiding other scar makes it a preferred interpositional material in TMJA cases.
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Affiliation(s)
- Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Shanmuga Sundaram Devaraj
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Nelke K, Morawska A, Błaszczyk B, Janeczek M, Pasicka E, Łukaszewski M, Żak K, Dobrzyński M. Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries-Narrative Review. J Clin Med 2023; 12:4909. [PMID: 37568311 PMCID: PMC10419993 DOI: 10.3390/jcm12154909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The buccal fat pad, also called the Bichat's fat pad (BFP), is an encapsulated fat mass located in the cheek. This type of specialized fat mass can be used both as a pedicular or free graft in various surgeries and approaches. Due to its easy access from the oral cavity approach, it is commonly used for oroantral and palatal fistula closure. The knowledge of its anatomy and surrounding tissues plays a role in its mobilization and suturing onto the desired defect in the palatal or maxillary region. The BFP is mostly associated with the primary approach used for a fistula or bone surgery. Alternatively, the procedure can be performed with a single approach incision, which does not compromise the appearance or the function of the operating or adjacent areas. The most important inclusion criteria for BFP usage and surgical limitations are highlighted. The BFP is used for multiple purposes in reconstructive and oncology surgery and also has its use in esthetic and facial contouring procedures. The amount, volume, and shape of the BFP are mostly associated with the scope of their usage. The aim of the following narrative review is to present the surgical and anatomical implications of fat pads in maxillary and palatal surgeries.
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Affiliation(s)
- Kamil Nelke
- Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wrocław, Poland
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Alicja Morawska
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland; (A.M.); (M.D.)
| | - Bartłomiej Błaszczyk
- Student Scientific Circle of Experimental Dentistry and Biomaterial Research, Faculty of Dentistry, Wroclaw Medical University, Bujwida 44, 50-345 Wrocław, Poland
| | - Maciej Janeczek
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland; (M.J.); (E.P.)
| | - Edyta Pasicka
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland; (M.J.); (E.P.)
| | - Marceli Łukaszewski
- Department of Anaesthesiology and Intensive Care, Sokołowski Hospital, Sokołowskiego 4, 58-309 Wałbrzych, Poland;
| | - Krzysztof Żak
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland; (A.M.); (M.D.)
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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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Grillo R, de la Puente Dongo JL, de Moura Moreira L, Dos Santos Queiroz AG, Teixeira RG. Effectiveness of bandage in the incidence of major complications on bichectomy: literature review and case series of 643 bichectomies. Oral Maxillofac Surg 2022; 26:511-517. [PMID: 34611798 DOI: 10.1007/s10006-021-01008-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/23/2021] [Indexed: 04/23/2023]
Abstract
Buccal fat pad removal or bichectomy is an esthetic surgical procedure that is gaining notoriety and increasing number worldwide. This paper aims to discuss the effectiveness of bandage in bichectomy postoperative concerning major complications like bleeding and subcutaneous emphysema. This is a retrospective case series according to PROCESS guidelines of 643 bichectomy surgeries performed by two different surgeons with the same technique from January 2018 until December 2020. Effectiveness of bandage is evaluated in complications rate decrease with statistical tests (p < 0.05). A literature review was performed to sediment knowledge about this theme. Female patients search for buccal fat pad removal more for esthetic reasons and male patients for functional purposes. Bichectomy has a low incidence of major complications, and this incidence decreases more with a bandage use (95%CI). Bandages are effective in the decrease of major complications related to bichectomy.
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Affiliation(s)
- Ricardo Grillo
- School of Dentistry, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Rua Dr. José Rocha Junqueira 13 Ponte Preta - Campinas, São Paulo, 13045-755, Brazil.
- Master Degree Program, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
| | - José Luis de la Puente Dongo
- Master Degree Program, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - Lourimar de Moura Moreira
- Master Degree Program, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil
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Desai H, Satish Pande N, Jawdekar A. Comparison of surgical outcomes related to interpositional arthroplasty materials used in patients with Temporomandibular Joint (TMJ) ankylosis: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1023-1034. [DOI: 10.1016/j.bjoms.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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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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Surgical navigation system for temporomandibular joint ankylosis in a child: a case report. J Med Case Rep 2021; 15:464. [PMID: 34507610 PMCID: PMC8431844 DOI: 10.1186/s13256-021-03020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Computer-assisted surgical navigation systems were initially introduced for use in neurosurgery and have been applied in craniomaxillofacial surgery for 20 years. The anatomy of the oral and maxillofacial region is relatively complicated and includes critical contiguous organs. A surgical navigation system makes it possible to achieve real-time positioning during surgery and to transfer the preoperative design to the actual operation. Temporomandibular joint ankylosis limits the mouth opening, deforms the face, and causes an increase in dental caries. Although early surgical treatment is recommended, there is controversy regarding the optimal surgical technique. In addition, pediatric treatment is difficult because in children the skull is not as wide as it is in adults. There are few reports of pediatric temporomandibular joint ankylosis surgery performed with a navigation system. Case presentation A 7-year-old Japanese girl presented severe restriction of the opening and lateral movement of her mouth due to a temporomandibular joint bruise experienced 2 years earlier. Computed tomography and magnetic resonance imaging demonstrated left condyle deformation, disappearance of the joint cavity, and a 0.7-mm skull width. We diagnosed left temporomandibular joint ankylosis and performed a temporomandibular joint ankylosis arthroplasty using a surgical navigation system in order to avoid damage to the patient's brain. A preauricular incision was applied, and interpositional gap arthroplasty with temporal muscle was performed. After the surgery, the maximum aperture was 38 mm, and the limitation of the lateral movement was eliminated. Conclusions A navigation system is helpful for confirming the exact target locations and ensuring safe surgery. In our patient's case, pediatric temporomandibular joint ankylosis surgery was performed using a navigation system without complications.
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Rahpeyma A, khajehahmadi S. Buccal Fat Pad Graft in Maxillofacial Surgery. Indian J Surg Oncol 2021; 12:802-807. [DOI: 10.1007/s13193-021-01436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
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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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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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Roychoudhury A, Acharya S, Bhutia O, Seith Bhalla A, Manchanda S, Pandey RM. Is There a Difference in Volumetric Change and Effectiveness Comparing Pedicled Buccal Fat Pad and Abdominal Fat When Used as Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis? J Oral Maxillofac Surg 2020; 78:1100-1110. [DOI: 10.1016/j.joms.2020.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/23/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
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Anchlia S, Vyas SM, Dayatar RG, Domadia HL, Nagavadiya V. Guidelines for Single-Stage Correction of TMJ Ankylosis, Facial Asymmetry and OSA in Adults. J Maxillofac Oral Surg 2019; 18:419-427. [PMID: 31371885 DOI: 10.1007/s12663-018-1121-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Treatment for TMJ Ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. Mouth opening is achieved by gap arthroplasty with various options of interpositional materials. Ramus-condyle unit (RCU) reconstruction maintains the height of the ramus and prevents secondary occlusal problems. Advancement genioplasty corrects chin deformities as well as increases the posterior airway space (N-PAS) by the forward pull exerted on geniohyoid and genioglossus. Materials and Methods This prospective single-centre study on 43 joints in 25 adult patients with TMJ Ankylosis aimed at providing a single-staged management plan of ankylosis release, RCU reconstruction and extended advancement centering genioplasty. Interpositional arthroplasty was done using temporalis myofascial flap, abdominal dermis fat or buccal fat pad. RCU reconstruction was done either by vertical ramus osteotomy or L osteotomy. Observations and Results Follow-up ranged from 12 to 20 months (mean 14.4). Average mouth opening at maximum follow-up was 34.36 mm with re-ankylosis in no case. Cephalometric parameters showed increase in point P to Pog, decrease in N perpendicular to Pog, angle N-A-Pog, Cg-ANS to Cg-Menton, neck-chin angle and labiomental angle. N-PAS increased, and average 50% improvement in AHI was seen in all patients with OSA. Most common complications involved transient paraesthesia of temporal and zygomatic branches of facial nerve. Conclusion Based on the findings of the above study, we propose treatment guidelines for treatment of TMJ ankylosis in adult patients with AHI < 20.
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Affiliation(s)
- Sonal Anchlia
- Government Dental College and Hospital, Ahmedabad, Ahmedabad, India
| | | | | | | | - Vipul Nagavadiya
- Government Dental College and Hospital, Ahmedabad, Ahmedabad, India
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Malhotra VL, Singh V, Rao JD, Yadav S, Gupta P, Shyam R, Kirti S. Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis. J Korean Assoc Oral Maxillofac Surg 2019; 45:129-134. [PMID: 31334100 PMCID: PMC6620302 DOI: 10.5125/jkaoms.2019.45.3.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis. Materials and Methods Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (≥35 mm) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle. Results With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed. Conclusion Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.
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Affiliation(s)
- Vijay Laxmy Malhotra
- Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM), Govt. Medical College, Mewat, India
| | - Virendra Singh
- Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Jk Dayashankara Rao
- Department of Oral and Maxillofacial Surgery, SGT Dental College & Hospitals, Gurgaon, India
| | - Sunil Yadav
- Department of Dentistry, BPS Govt. Medical College for Women, Sonepat, India
| | - Pranav Gupta
- Department of Dentistry, Government Medical College, Bharatpur, India
| | - Radhey Shyam
- Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM), Govt. Medical College, Mewat, India
| | - Shruti Kirti
- Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM), Govt. Medical College, Mewat, India
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Mannelli G, Arcuri F, Comini L, Valente D, Spinelli G. Buccal Fat Pad: Report of 24 Cases and Literature Review of 1,635 Cases of Oral Defect Reconstruction. ORL J Otorhinolaryngol Relat Spec 2018; 81:24-35. [DOI: 10.1159/000494027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022]
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Temporomandibular Joint Ankylosis After Early Mandibular Distraction Osteogenesis. J Craniofac Surg 2017; 28:1185-1190. [DOI: 10.1097/scs.0000000000003612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Kim MK, Han W, Kim SG. The use of the buccal fat pad flap for oral reconstruction. Maxillofac Plast Reconstr Surg 2017; 39:5. [PMID: 28286743 PMCID: PMC5325802 DOI: 10.1186/s40902-017-0105-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.
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Affiliation(s)
- Min-Keun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 Republic of Korea
| | - Wonil Han
- Han Dental Clinic, Guri, Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 Republic of Korea
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Gagnani SP, Agarwal B, Bhutia O, Roychoudhury A. New method of harvesting a buccal fat pad for interposition after gap arthroplasty of the temporomandibular joint. Br J Oral Maxillofac Surg 2016; 54:469-70. [DOI: 10.1016/j.bjoms.2015.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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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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Bansal V, Bansal A, Mowar A, Gupta S. Ultrasonography for the volumetric analysis of the buccal fat pad as an interposition material for the management of ankylosis of the temporomandibular joint in adolescent patients. Br J Oral Maxillofac Surg 2015; 53:820-5. [PMID: 26169502 DOI: 10.1016/j.bjoms.2015.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 06/16/2015] [Indexed: 12/01/2022]
Abstract
The aim of this study was to analyse preoperatively with ultrasound the minimum volume of buccal fat that would be required for interposition of a pad after gap arthroplasty, and to emphasise the value of such a pad in the management of ankylosis of the temporomandibular joint (TMJ) during a short term follow up. Nineteen patients with ankylosis of the TMJ (22 joints) were selected, whose mean (SD) mouth opening was 4.9 (3.7) mm. In 10 joints in which the mean (SD) volume of the buccal fat pad was 0.7 (0.2) ml, the harvested buccal fat was inadequate for interposition, so they were treated with other materials. The remaining 12 joints had a mean (SD) volume of 1.1 (0.3) ml, which gave enough fat for interposition after gap arthroplasty. Investigation with ultrasound at 15 days and 6 months postoperatively showed that the fat pad was viable and the volume had shrunk by 28%. The 6-month postoperative computed tomographic (CT) scan showed little or no heterotopic calcification. We conclude that a buccal fat pad with a preoperative mean (SD) volume of 1.1 (0.3) ml is easy to harvest as interposition material. At a mean follow up of the 12 joints after 31 (range 24-36) months there was progressive improvement in mouth opening with a mean (SD) of 32.5 (5.0) mm, which established that a pedicled buccal fat pad is a stable, efficient, viable soft tissue barrier in the management of ankylosis of the TMJ.
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Affiliation(s)
- Vishal Bansal
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India.
| | - Avi Bansal
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India
| | - Apoorva Mowar
- Department of Oral & Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Meeurt By Pass Road, Meerut (Uttar Pradesh), 250005, India
| | - Sanjay Gupta
- Healthcare & Imaging Centre. 43, Shivaji Road, Near N.A.S. College, Meerut (Uttar Pradesh), India
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Clauser LC, Consorti G, Elia G, Tieghi R, Galiè M. Management of temporomandibular joint reankylosis in syndromic patients corrected with joint prostheses: surgical and rehabilitation protocols. Craniomaxillofac Trauma Reconstr 2013; 7:71-8. [PMID: 24624260 DOI: 10.1055/s-0033-1356759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/27/2013] [Indexed: 10/25/2022] Open
Abstract
Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success.
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Affiliation(s)
- Luigi C Clauser
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy
| | - Giuseppe Consorti
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy
| | - Giovanni Elia
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy
| | - Riccardo Tieghi
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy
| | - Manlio Galiè
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy
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Khiabani K, Keyhan SO, Varedi P, Hemmat S, Razmdideh R, Hoseini E. Buccal fat pad lifting: an alternative open technique for malar augmentation. J Oral Maxillofac Surg 2013; 72:403.e1-15. [PMID: 24438602 DOI: 10.1016/j.joms.2013.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to introduce a novel technique for malar augmentation using buccal fat pad pedicle flaps and to evaluate the long-term results and complications of the technique. MATERIALS AND METHODS The investigators designed and conducted a prospective clinical trial. Patients underwent unilateral malar augmentation surgery using buccal fat pad pedicle flaps from June 2011 through June 2012. Patients underwent surgery for esthetic reasons or for trauma with severely comminuted or old zygomaticomaxillary complex fractures that could not be reduced precisely. The primary predictor variable was the buccal fat pad pedicle flap technique. The primary outcome variables included the amount of augmentation and resorption (which was estimated by comparing pre- with postsurgical photographic views), pain, edema, bruising, and nerve and parotid duct injuries. RESULTS Thirteen patients (8 men and 5 women) underwent malar augmentation in the cheekbone area using the buccal fat pad pedicle flap technique. One year after surgery, the average amount of resorption was 0.376 mm. Other major complications, such as prolonged bruising, massive hematoma, intense pain, asymmetry, and parotid duct injury, were not observed. CONCLUSION These results indicate that this new open-access technique should be considered an alternative method for the management of mild to moderate malar depression in patients undergoing esthetic and post-trauma surgery.
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Affiliation(s)
- Kazem Khiabani
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran.
| | - Seied Omid Keyhan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Shahid Rahnemoon Hospital, Yazd, Iran
| | - Payam Varedi
- Chief Resident, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seifollah Hemmat
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Bandar Abbas University of Medical Science, Bandar Abbas, Iran
| | - Roohollah Razmdideh
- Resident, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran
| | - Elham Hoseini
- Resident, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran
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Gaba S, Sharma RK, Rattan V, Khandelwal N. The long-term fate of pedicled buccal pad fat used for interpositional arthroplasty in TMJ ankylosis. J Plast Reconstr Aesthet Surg 2012; 65:1468-73. [DOI: 10.1016/j.bjps.2012.05.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/14/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022]
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