Restricted opening of the mouth with an extra-articular cause in children

Pseudoankylosis Between Lateral Pterygoid Plates and Mandible: Report of One Case

Temporomandibular joint (TMJ) ankylosis is the abnormal fusion of TMJ anatomic components that impedes free jaw movements. This restriction in motion ranges from minimal to a complete inability to open the jaw. This condition can be categorized as true ankylosis, which is attributed to pathologic conditions of the TMJ, or false ankylosis (pseudoankylosis), which describes restrictions of movement resulting from extracapsular abnormalities outside the TMJ. The literature shows that trauma is the leading cause of TMJ disorders and appears to be the most common cause of pseudoankylosis. Pseudoankylosis caused by pterygomandibular bony impingement has rarely been reported in the literature. This case report adds a new case of pseudoankylosis to the existing scanty literature, which was characterized by bilateral mechanical impingement between abnormally elongated lateral pterygoid plates and the coronoid processes of the mandible.

Treatment of oral submucous fibrosis using split skin graft and a polyethylene stent: a prospective study

AIM

Aim of this study was to evaluate the split skin graft held in place with a polyethylene stent for the treatment of oral submucous fibrosis.

METHODS

Fifteen prospective patients diagnosed clinically with oral submucous fibrosis, from June 2011 to 12 December 2012, were recruited for this study. All patients were treated surgically using the same surgical technique of fibrotomy followed by split skin graft along with a polyethylene stent. Preoperative and postoperative mouth opening measurements at 1 week and after a minimum of 6 months were evaluated by measuring the inter incisal distance.

RESULTS

Mean follow up was 9.8 months with a minimum of 6 months. Mean preoperative mouth opening was 12.9 mm (6-20 mm). Intraoperatively mean mouth opening was 37.9 mm (36-41 mm). After 1 week mean mouth opening was 35.8 mm (31-40 mm). At 6 months follow up, mean mouth opening was 33 mm (20-40 mm).

CONCLUSION

Fibrotomy followed by split skin graft along with a polyethylene sheet stent and sufficient postoperative physiotherapy is a simple, cost effective and viable treatment modality for oral submucous fibrosis.

Release of extra-articular ankylosis by coronoidectomy and insertion of a free abdominal flap: case report

INTRODUCTION

It is generally agreed that an effective treatment for extra-articular ankylosis may be coronoidectomy and excision of scar tissue. But these conventional procedures have shown a high rate of recurrence of ankylosis due to heterotopic bone and fibrous tissue formation. OBJECTIVE AND PATIENT: We report a case in whom a coronoid osteotomy and insertion of a free abdominal flap was used to treat ankylosis of the mandible following radiotherapy for maxillary cancer.

RESULTS

This procedure prevented recurrence of ankylosis by heterotopic bone and fibrous tissue formation. In addition, this flap reduced the risk of postoperative infection and promoted primary healing.

CONCLUSION

The procedure, coronoidectomy and insertion of a free flap, was successful because the well-vascularized musculocutaneous flap occupied the dead space, and replaced the shortage of oral mucosa consequently inhibiting the recurrence of extra-articular ankylosis.

Application of the buccal fat pad to the surgical treatment of oral submucous fibrosis

The pedicled buccal fat pad has been widely used for the repair of oral defects. A new application of this flap in the treatment of patients suffering from trismus caused by oral submucous fibrosis is reported. The patients underwent incision of the fibrotic bands and coverage of the buccal defect with a pedicled buccal fat pad flap. The surgical technique is described, and the results suggest that this is a logical, convenient, and reliable technique for the treatment of oral submucous fibrosis.

Intraoperatively fabricated bite block in the management of scar contracture hypomobility

Intraoral surgical procedures produce scar tissue formation that may limit mandibular opening. Many procedures have been developed to release these scar contractures, but most lead to further scar formation and greater limitation in opening. The purpose of this article to describe a technique with the use of an intraoperatively fabricated self-curing acrylic bite block combined with aggressive physical therapy in the management of this difficult clinical problem.

Timing of facial osteotomies. A consensus conference

A concensus conference on the timing of facial osteotomies was held in Jönköping, Sweden. Seven teams consisting of a maxillofacial surgeon and an orthodontist representing five countries discussed treatment planning for young patients with maxillomandibular deformities with special emphasis on timing. Patients with severe syndromic facial deformities were not considered. Consensus was reached that for most deformities it is best advised to wait until growth has ceased, as determined by longitudinal cephalometric data. This rule is less tight for Angle Class II than for Class III cases. For asymmetries often there is still not enough scientific evidence to obtain well-founded uniform agreement.