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Andrade NN, Nerurkar SA, Chalakuzhy PM, Venkatakrishan L, Gandhewar T, Murjani B, Katta NA, Gupta V. Variations in the Position of Mandibular Foramen in Temporomandibular Ankylosis Patients. J Maxillofac Oral Surg 2024; 23:660-669. [PMID: 38911403 PMCID: PMC11189838 DOI: 10.1007/s12663-023-02072-6] [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: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 06/25/2024] Open
Abstract
Aim To evaluate the variation in the position of the mandibular foramen and mandibular canal in patients with and without temporomandibular joint ankylosis. Materials and Methods 100 temporomandibular joints were evaluated of which 50 joints were ankylosed joints (Group A) and the rest 50 were normal joints (Group B) without ankylosis. These groups were further divided into those with growing potential (less than 18 years) and those without growing potential (above 18 years). The position of the mandibular foramen was measured from its center to the glenoid fossa, sigmoid notch, coronoid notch, gonion and posterior border on CBCT scans. The position of the mandibular canal was measured from the outer aspect of the canal to the lower border of the mandible, buccal and lingual cortical plates and the alveolus in the region of the 1st, 2nd and 3rd molars. Results The mean distance of the foramen from the base of the skull in Group A was 19.01 mm while the same for Group B was 31.26 mm. The mandibular foramen was found to be closer to the occlusal plane (5.43 mm) in Group A as compared to the mean distance of 6.21 mm reported in Group B. There was no significant difference in the position of the foramen from the posterior border, gonion and sigmoid notch between the groups. The mental foramen was seen more commonly posterior to the 2nd premolar and closer to the first molar region in Group A while in Group B it was seen anterior or near the 2nd premolar. In Group A, the mean distance of the canal to the buccal cortical plate in the 1st and 2nd molar regions was 3.65 mm and 5.76 mm, respectively, while in Group B it was 6.09 mm and 6.59 mm. The canal was further away from the lower border in ankylosis cases (8.79 mm) than the control group (7.41 mm). On comparing the unaffected side in unilateral cases with the normal mandible, the canal and the foramen location were similar to that of a normal mandible with the values in the lower range that is usually seen in normal mandibles. Conclusion Ankylosis of the mandible is a debilitating condition especially when it develops in an individual prior completion of growth as it can affect the mandibular anatomy. Understanding the variations that accompany a deranged mandible can assist the surgeon in planning of surgical procedures in a manner that limits the possible complications resulting from surgery.
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Affiliation(s)
- Neelam N. Andrade
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
| | - Shibani A. Nerurkar
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
| | - Paul Mathai Chalakuzhy
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
- Center for Orak and Facial Plastic Surgery, Mumbai, Maharashtra India
| | - Lakshmi Venkatakrishan
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
| | - Trupti Gandhewar
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
| | - Bhavana Murjani
- Department of Dentistry, All India Institute of Medical Sciences, Kalyani, West Bengal India
| | - Neha Aggarwal Katta
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
| | - Varsha Gupta
- Nair Hospital Dental College, 55, Dr. Anandrao Nair Marg, Mumbai Central, Mumbai, 40008 Maharashtra India
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Chen S, Jie B, Yue Z, Zhang Y, Liu D, He Y. Growth Evaluation After Costochondral Graft Combined With Functional Appliance in Children With Temporomandibular Joint Ankylosis. J Craniofac Surg 2024:00001665-990000000-01614. [PMID: 38771188 DOI: 10.1097/scs.0000000000010194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/06/2024] [Indexed: 05/22/2024] Open
Abstract
The treatment of temporomandibular joint (TMJ) ankylosis in children is a great challenge for surgeons. Costochondral graft (CCG) is a common method of reconstructing the TMJ in children. However, the growth pattern of CCG is unpredictable. In this study, we introduced a surgical-orthodontic approach and evaluated the growth results of the mandible and maxilla in children with TMJ ankylosis through 3-dimensional computed tomography measurements. A prospective cohort study was conducted on child patients diagnosed as having TMJ ankylosis between September 1, 2018 and June 1, 2020. Computer-aided virtual mandibular position guided the CCG, and removable functional appliance was used after surgery. The maximal incisal opening (MIO), the maxilla height, and the length of mandibular ramus were determined. Paired t test was performed to analyze the differences among various stages. Six patients (3 females, 3 males; aged 6-9 y) were included in this study. MIO was 12.4 mm before surgery and improved to 36.8 mm after 42.8 months' follow-up. Mandible length increased by 5.1 mm in the affected side and by 5.3 mm in the unaffected side, without significant difference. The affected maxilla height increased by 6.7 mm, which was more than 5.0 mm in the unaffected side. In conclusion, continued growth of mandible and maxilla can be achieved through CCG combined with functional appliance treatment for children TMJ ankylosis.
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Affiliation(s)
- Shuo Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Bimeng Jie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Zhihao Yue
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Dawei Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
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Keith DA, Handa S, Mercuri LG. Peri-articular bone formation involving the temporomandibular joint: a narrative summary and Delphi consensus of a new classification system. Int J Oral Maxillofac Surg 2024; 53:212-218. [PMID: 37777385 DOI: 10.1016/j.ijom.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/02/2023]
Abstract
Heterotopic ossification (HO) is defined as 'bone where it does not belong'. Given the historical variety of nomenclature and eponyms, there is significant confusion about the etiology, pathogenesis, classification, and treatment of HO related to the temporomandibular joint (TMJ). The existing classifications for TMJ HO have shortcomings: they relate to specific populations, use differing imaging studies and demographic data, do not universally include alloplastic/autologous replacements, are based variously on radiological and/or clinical presentations that cannot always be combined, and were largely developed to assist oral and maxillofacial surgeons in surgical management. These deficiencies make it problematic to compare studies, draw valid conclusions, and pursue research. The aim of this study was to develop a new, more inclusive classification for TMJ HO. Currently available classifications were evaluated and a Delphi-type system used to build consensus from clinicians and researchers to develop a new system. Fourteen unique classifications for TMJ ankylosis/HO were identified. In light of the biological specifics related to heterotopic calcification of extracellular matrix versus heterotopic formation of actual bone, the group recommends a more unambiguous term - peri-articular bone formation - and proposes a new classification. This will help clinicians and researchers to study, describe, and manage various types of ectopic bone associated with the TMJ.
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Affiliation(s)
- D A Keith
- Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
| | - S Handa
- Orofacial Pain Division, Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Orofacial Pain Division, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Paget’s disease of bone involving the mandible may causes temporomandibular joint ankylosis: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Puricelli E. Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report. Head Face Med 2022; 18:27. [PMID: 35906643 PMCID: PMC9335964 DOI: 10.1186/s13005-022-00331-4] [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: 04/22/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. Case presentation In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. Conclusions The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
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Affiliation(s)
- Edela Puricelli
- Oral and Maxillofacial Surgery Unit/ Clinical Hospital of Porto Alegre (HCPA), School of Dentistry/Federal University of Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
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Singh R, Bhalla AS, Manchanda S, Roychoudhury A. Multidetector computed tomography in preoperative planning for temporomandibular joint ankylosis: A pictorial review and proposed structured reporting format. Imaging Sci Dent 2021; 51:313-321. [PMID: 34621659 PMCID: PMC8479430 DOI: 10.5624/isd.20210027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Ankylosis of the temporomandibular joint (TMJ) is a disabling disease resulting from fibrous or bony fusion of the mandibular condyle and the glenoid fossa. Early diagnosis and surgical treatment are essential to prevent facial deformity and other complications. Conventional radiography has limitations in demonstrating the true extent of ankylosis. It is important for surgeons to be aware of the size and degree of bony ankylosis in order to perform complete resection of the ankylotic mass. In addition, a detailed evaluation of the relationship with adjacent vital structures such as the internal maxillary artery, inferior alveolar nerve canal, external auditory canal, and skull base are crucial to avoid iatrogenic injury. Multidetector computed tomography (MDCT) is the current imaging modality of choice for preoperative assessments. Herein, the authors propose a structured CT reporting template for TMJ ankylosis to strengthen the value of the preoperative imaging report and to reduce the rates of intraoperative complications and recurrence.
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Affiliation(s)
- Rashmi Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Upadya VH, Bhat HK, Rao BS, Reddy SG. Classification and surgical management of temporomandibular joint ankylosis: a review. J Korean Assoc Oral Maxillofac Surg 2021; 47:239-248. [PMID: 34462381 PMCID: PMC8408644 DOI: 10.5125/jkaoms.2021.47.4.239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/07/2022] Open
Abstract
The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.
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Affiliation(s)
- Varsha Haridas Upadya
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Yenepoya (Deemed to be University), Mangalore, India
| | - Hari Kishore Bhat
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and Hospital, Yenepoya (Deemed to be University), Mangalore, India
- Center for Craniofacial Anomalies, Yenepoya (Deemed to be University), Mangalore, India
| | | | - Srinivas Gosla Reddy
- Faculty of Dentistry, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India
- GSR Institute of Craniofacial Surgery, Hyderabad, India
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Temporomandibular Joint Ankylosis among Patients at Saint Paul's Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study. Int J Dent 2021; 2021:6695664. [PMID: 33679982 PMCID: PMC7906814 DOI: 10.1155/2021/6695664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study aimed to determine the pattern of TMJA at St. Paul's Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia. Methods A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program. Results A total of 130 patients' medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20-29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty. Conclusions TMJA was predominant among females than their male counterparts. Of note, 20-29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients' quality of life.
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Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series. Int J Oral Maxillofac Surg 2020; 50:604-609. [PMID: 33041166 DOI: 10.1016/j.ijom.2020.09.017] [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: 06/04/2020] [Revised: 07/25/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. We have used the medial femoral condyle (MFC) osseocartilaginous flap for repair of TMJ defects. The aim of this paper was to describe our technique and to present the preliminary results. The MFC osseocartilaginous flap was used as a free vascularized graft for TMJ defect in four patients who had undergone resection for benign tumor of the TMJ region (n = 2) or TMJ ankylosis (n=2). A computer-assisted technique was used in all cases. Symmetry of the mandible was objectively evaluated by postoperative computed tomography. Complications were recorded during follow-up visits. Lower extremity functional status was assessed by the Lower Extremity Functional Scale (LEFC) questionnaire. The MFC osseocartilaginous flap success rate was 100%; bony union was obtained in all four patients, and normal occlusion was achieved within 6-11 months after surgery. No flap-related complications occurred. All patients were satisfied with their postoperative facial symmetry and oral function. The LEFC score ranged from 72 to 80, indicating normal lower extremity function. Vascularized MFC osseocartilaginous flap appears to be a reliable option for reconstruction of large-scale TMJ defects.
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Surgical correction of ankylosed TMJ in a child: case report. Oral Maxillofac Surg 2020; 24:509-514. [PMID: 32572708 DOI: 10.1007/s10006-020-00864-5] [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: 01/16/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
The temporomandibular joint (TMJ) ankylosis describes the bone or fibrous adhesion of the TMJ components, with functional impairment. The present report shows the surgical correction the TMJ ankylosis due to a condyle fracture in a child. A 12-year-old patient, female, attended to the Oral and Maxillofacial Surgery Department of the Clinical Hospital/Federal University of Uberlândia, showing severe mouth opening limitation (9 mm) and history of bilateral condyle fracture and symphysis fracture. The right TMJ ankylosis was diagnosed, removed, reshaped, and repositioned to form the reshaped condyle, by the sliding reconstruction of the condyle using posterior border of mandibular ramus and myofascial interposition of the temporal fascia. Five months of follow-up showed mouth opening of 44 mm maintained after 2 years, without complaints. The surgical treatment of the TMJ ankylosis is needed for the reestablishment of the immediate function; however, the patient must be watched until the end of development.
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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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