Auricular cartilage graft interposition after temporomandibular joint ankylosis surgery in children

Interpositional arthroplasty using cartilage allografts for treating temporomandibular joint arthrosis: a 3- and 5-year retrospective clinical follow-up study

OBJECTIVE

To evaluate the effect of arthroplasty using interpositional cartilage allografts in patients with temporomandibular joint (TMJ) arthrosis.

STUDY DESIGN

This retrospective study included patients treated consecutively between 2007 and 2013 using discectomy and interpositional grafting with lyophilized costal cartilage allograft (Tutoplast) sheets. TMJ pain based on the visual analogue scale (VAS), maximal interincisal opening (MIO), joint tenderness to palpation, crepitus from the affected joint, and postoperative complications were assessed.

RESULTS

Arthroplasty was performed on 37 joints among 34 patients (28 women; mean age: 54 years); 24 joints underwent simultaneous condyle shaving. At final follow-up (3 [n = 37] or 5 [n = 21] years), we observed reduced mean VAS (from 7.6 to 0.9; P < .001) increased mean MIO (from 32.5 to 41.1 mm; P < .001), number of joints with capsule tenderness (from 30 to 3; P < .001), and percentage of joints with crepitus (from 97% to 75%; P = .008). One joint required reoperation because of interposed cartilage fragmentation. No permanent facial nerve injury or malocclusion occurred after treatment.

CONCLUSIONS

Interpositional arthroplasty is a relatively simple, moderately invasive, and effective surgical treatment for TMJ arthrosis with few complications. However, long-term outcomes of this treatment, specifically beyond 3-5 years postoperatively, remain unknown.

Role of buccal fat pad to reduce the chances of re-ankylosis-A systematic review of literature

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.

Temporalis Myofascial Flap and Conchal Bowl Cartilage Grafting for Temporomandibular Joint Arthritis

Temporomandibular joint (TMJ) arthritis arises from a multitude of etiologies; however, there is no consensus definitive treatment. The complication profile of artificial TMJs is well known, and outcomes are variable and are reserved for salvage attempts. This case details a patient with persistent traumatic TMJ pain, arthritis, and single-photon emission computed tomography scan of potential nonunion. The present study reports on the first novel use of an alternative composite myofascial flap to help arthritic TMJ pain. This study details the successful use of a temporalis myofascial flap and conchal bowl autologous cartilage graft in posttraumatic TMJ degeneration.

Autogenous grafts for reconstruction arthroplasty in temporomandibular joint ankylosis: A systematic review and meta-analysis

Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present review was aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis. Major electronic databases and prominent subject-specific journals were searched up to December 2020. Randomised controlled trials (RCT), cohort studies, and retrospective studies reporting outcomes of autogenous grafts for RA in TMJ ankylosis were included. A total of 35 studies with 700 subjects was included. The most commonly employed grafts were costochondral grafts (CCG) and coronoid process grafts. Postoperative change in maximum incisor opening (MIO) was comparable amongst all grafts and was in the clinically acceptable range (27.21-31.38 mm). The recurrence rate was comparable for all grafts and was ≈ 8% except for coronoid grafts, where the recurrence rate was 2.98%. Growth assessment for CCG revealed that 55.89%, 30.89%, and 13.24% of subjects depicted optimal growth, overgrowth, and undergrowth, respectively. Within the limitations of the present review, the recurrence rate for all grafts was comparable except for coronoid graft, which depicted least recurrence rate and resultant postoperative change in MIO was in the clinically acceptable range.

Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients

Objective

Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ).

Study Design

We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis.

Results

Six of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage—not typical for the TMJ—was present.

Conclusions

We conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.

Indications and outcome of mandibular condylar and ramus surgeries

BACKGROUND

Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles.

PATIENTS AND METHODS

Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations.

RESULTS

There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory.

CONCLUSION

Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

The Use of a Bioadhesive (BioGlue(®)) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue(®); CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood.

Retrospective study of absorbable gelatin sponge soaked in triamicinolone acetonide as interpositioning material in temporomandibular joint ankylosis in 350 patients

AIM

To evaluate the feasibility and usefulness of absorbable gelatin sponge soaked in triamcinolone acetonide as an interposition material in the treatment of temporomandibular joint (TMJ) ankylosis.

MATERIALS AND METHODS

This retrospective study was conducted in 350 patients of TMJ ankylosis who visited our outpatient department between 2000 and 2010, and were treated by the same surgeon. Patients were randomly divided into two groups, where in group 1, absorbable gelatin sponge soaked with triamcinolone acetonide was interposed in the surgical gap created after arthroplasty and in group 2, temporalis fascia was interposed. Preoperative assessment included history and physical examination, along with cause of ankylosis, Postoperative observation were undertaken for maximum mouth opening (MMO), facial nerve paralysis and recurrence.

RESULTS

At one year follow-up, in group 1 MMO ranged from 35 to 45 mm with no case of re-ankylosis while in the other group 25-43 mm, with re-ankylosis in 20 patients (13.69%).

CONCLUSION

The findings of this study showed successful management of TMJ ankylosis using absorbable gelatin sponge soaked in triamcinolone acetonide in cases which did not require condylar reconstruction.

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.

Modified gap arthroplasty and Myrhaug's incision as a treatment option in management of temporomandibular joint ankylosis: a study of 10 cases

PURPOSE OF THE STUDY

The purpose of this study was to evaluate effectiveness of modified gap arthroplasty procedure and modified Myrhaug's preauricular incision for treating bony temporomandibular joint (TMJ) ankylosis.

MATERIALS AND METHODS

A total of 10 cases were included in the study with Sawhney's type III and IV TMJ ankylosis. Study consisted of 6 males and 4 females. Three cases were treated for bilateral ankylosis and 7 were treated for unilateral ankylosis. All the patients were treated with modified gap arthroplasty and modified Myrhaug's incision was used. In this modification, osteotomy cuts were modified in such a way that coronoid process was also removed simultaneously along with the osteotomized ankylosed mass in one piece.

RESULTS

All the patients were followed up for 5 years and none of them presented with recurrence. Two patients had transient paresis to zygomatic and temporal branch of facial nerve and none had permanent damage to the nerve. Seven patients had mouth opening more than 25 mm (p) when followed for 5 years. Anterior open bite was seen in 4 patients and deviation of the jaw on ipsilateral side was noted in 2 patients.

CONCLUSION

Modified gap arthroplasty gave successful results in the follow-up period and eliminated the need of separate coronoidectomy. Use of modified Myrhaug's preauricular approach, provided excellent visibility particularly of the elongated coronoid process, minimized bleeding, prevented damage to the vital anatomical structures surrounding the joint and gave acceptable cosmetic results.

CLINICAL SIGNIFICANCE

The modified incision has been found to be reducing intra- and postoperative morbidity as well as provides excellent accessibility. The modified osteotomy technique eliminated the need for separate coronoidectomy thus significantly reducing the operating time.

Free Auricular Cartilage Autograft for Repair of an Oronasal Fistula in a Dog

An eight-year-old female/spayed Pomeranian dog was presented for surgical treatment of an acquired right oronasal fistula. The maxillary right canine tooth had been extracted non-surgically 7-weeks prior to presentation. Clinical signs were consistent with an oronasal fistula during this time period. Oral examination showed an oronasal fistula in the area of the extracted tooth. The referring veterinarian performed simple debridement and suturing with subsequent recurrence of the oronasal fistula. This case report describes the successful surgical treatment of an acquired oronasal fistula with a free auricular cartilage autograft and reviews techniques described for oronasal fistula repair, including free auricular cartilage autografts.

Temporo mandibular joint ankylosis

Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate.

AIM

The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature.

METHODS

The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth opening (MMO), etiology and type of ankylosis, recurrence rate and presence of facial nerve paralysis.

RESULTS

The mean MMO in the pre-operative period was 9.6 mm (0 mm to 17 mm) and in the post-operative period it was of 31.33 mm (14 mm to 41 mm), there was no facial nerve paralysis and there was recurrence in just one case.

CONCLUSION

The joint reconstruction with alloplastic or autogenous grafts for the ankylosis treatment proved to be efficient in relation to the post-operative MMO, recurrence and joint function.

Interpositional arthroplasty using autogenous costal cartilage graft for temporomandibular joint ankylosis in adults

This retrospective study evaluated 11 adult patients with TMJ ankylosis treated by interpositional arthroplasty using autogenous costal cartilage grafts between 1985 and 2003. Minimum follow-up was 2 years. Basic personal data, function of TMJ and complications of operation were recorded. Mouth opening increased during operation by a mean of 25.5mm and postoperatively by a mean of 26.2mm. The procedure failed in one case with recurrent ankylosis. The remaining 10 cases had final opening ranges in excess of 30mm. Complications included one numb lower lip. There were no instances of a facial nerve or internal maxillary artery injury. Consideration is given to the width and level of gap arthroplasty, fixation of the grafts, complications at both donor and recipient sites, postoperative physical therapy, occlusal change, and the need for coronoidectomy. This study demonstrated that autogenous costal cartilage is a suitable material for interpositional arthroplasty in adults. Complications were low. The intraoral approach and the role of postoperative physical therapy appear key elements in the success of this procedure.

Effect of Auricular Cartilage Graft in the Surgical Treatment of Temporomandibular Joint Ankylosis: An Animal Study Using Sheep

PURPOSE

The purpose of this study was to test the functional and histologic fate of an auricular cartilage graft used in reconstruction of an ankylosed sheep temporomandibular joint (TMJ).

MATERIALS AND METHODS

Five sheep were used in this study. TMJ ankylosis was induced in the right joints and the left joints were used as controls. The ankylosed TMJ was released by gap arthroplasty with an interposed auricular cartilage graft at 3 months. The sheep were sacrificed at 3 months after the arthroplasty. The maximal mouth opening was measured pre- and postoperatively. The joints were evaluated radiologically and histologically.

RESULTS

Maximal mouth opening was maintained after placement of an auricular graft into the gap arthroplasty. Radiographically the surfaces of the temporal bone and ramus stumps were irregular, but radiolucent gaps were formed between them. Histologically, the auricular cartilage graft was alive and well attached to the mandibular ramus stump. In all operated joints, there was joint space between the grafted cartilage and temporal bone, with the space filled with fibrous connective tissue, which was oriented parallel to the temporal surface.

CONCLUSION

Auricular cartilage graft with gap arthroplasty is useful in preventing reankylosis after TMJ gap arthroplasty for ankylosis.

A clinical study on ankylosis of the temporomandibular joint

INTRODUCTION

Restoration of normal function and jaw movement in patients with temporomandibular joint (TMJ) ankylosis is difficult. Various techniques have been defined for the treatment of the condition.

PATIENTS

This study is based on the pre-, intra- and post-operative evaluation of 78 TMJ operations in 59 patients who were treated for TMJ ankylosis between 1985 and 2002.

METHODS

The patients in this study were evaluated with regard to age, gender, aetiology of ankylosis, ankylosis type/classification, existing facial asymmetry, maximal pre- and post-operative mouth opening, the arthroplasty methods (gap and interpositional arthroplasty) including complications and recurrence of ankylosis.

RESULTS

Falls represented the most widespread aetiological factor (85%), and women constituted the group with the highest incidence of ankylosis (61%). Forty cases were unilateral (68%) and 19 bilateral (32%); 82% (64 joints) were of the bony type. Gap arthroplasty was applied in 34 of the 59 cases (58%) and interpositional arthroplasty in the remaining 25 (42%). Pre- and post-operative mean mouth opening were 3.5+/-1.7 and 30.7+/-3.0mm, respectively. Re-ankylosis was noted in 5%.

CONCLUSION

In addition to radical and sufficient resection of the ankylosed bone, early post-operative exercises, appropriate physiotherapy and close follow-up of the patient play an important role in the prevention of post-operative adhesions and re-ankylosis.

Preservation of disc for treatment of traumatic temporomandibular joint ankylosis

PURPOSE

A new operating method was used to treat traumatic temporomandibular joint (TMJ) ankylosis, to restore the structure of the TMJ, to improve the secondary maxillofacial deformity, and prevent recurrence of TMJ ankylosis.

PATIENTS AND METHODS

Thirty-six patients (20 females, 16 males; aged 5 to 54 years old) with TMJ ankylosis type II or III of 1 to 16 years' duration, with a maximal mouth opening from 0 to 15 mm preoperatively participated. The new method was to separate bony fusion between condyle and glenoid fossa, remove the condylar fragment that displaced medially or anteroinferiorly, mobilize the remains of the disc over the condylar stump and suture it with articular capsule, and shave the surface of the condylar stump and glenoid fossa smooth.

RESULTS

Follow-up was performed from 1 to 7 years postoperatively in 21 cases. No recurrences occurred in patients whose TMJ disc was retained during operation. Patients had an average maximal mouth opening of 33.7 mm postoperatively. An 11-year-old patient showed an improved facial symmetry after surgery.

CONCLUSION

By restoring the normal structure of the TMJ and preservation of the disc, recurrence of traumatic TMJ ankylosis and facial deformity in younger patients can be prevented.

The Role of Trauma on Temporomandibular Joint Ankylosis and Mandibular Growth Retardation: An Experimental Study

The purpose of this pilot study was to analyze the role of different types of trauma in the formation of temporomandibular joint ankylosis. The specific aim was to explore the physical and histological effects of trauma on temporomandibular joint and mandibular growth. Fifty-five growing white male guinea pigs were used for the study. Initially, cadaveric studies were performed (n = 1) to assess the topographic anatomy of the temporomandibular joint region. Animals were then assigned to pilot (n = 4), experimental (n = 40), and control (n = 10) groups. The pilot group was used to assess the technical feasibility of creating various trauma types and endurance of the animals to the surgery. Four types of trauma were carried out in the experimental group: A) intra-articular hematoma (n = 10), B) mechanical damage to the articular surface (n = 10), C) fracture of the condyle neck (n = 10), and D) excision of the condyle head (n = 10). Each trauma group was further divided into two subgroups. Procedures were performed unilaterally or bilaterally in the subgroups. In the control group, no procedure was performed. Subjects were examined after a 2-month follow-up period. The development and anatomical structure of the mandible were evaluated, and histopathological assessment of the temporomandibular joint was carried out in each group. The results revealed that hyaline cartilage of the condylar head had an important role in the development of the mandible and traumas targeting this site may cause ankylosis, growth retardation, and resultant facial malformations. Hence, mechanical damage to the articular surface (B1, B2) and resection of the condylar head (D1, D2) almost always resulted in ankylosis. Intra-articular hematoma alone (A1, A2) was established not be a causative factor for ankylosis formation, however.