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Panagatla P, Ravula P, Praveen S, Varagani NR, Srikanth R, Appaka JK. Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution. Indian J Plast Surg 2021; 54:192-196. [PMID: 34239243 PMCID: PMC8257313 DOI: 10.1055/s-0041-1729504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.
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Affiliation(s)
- Prakash Panagatla
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Parvathi Ravula
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - S Praveen
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - R Srikanth
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jagadish Kiran Appaka
- Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Kelly M, Bowen A, Murray DJ. Efficacy of temporomandibular joint arthroplasty and insertion of a Matthews device as treatment for ankylosis of the joint: a case series. Br J Oral Maxillofac Surg 2020; 59:1113-1119. [PMID: 34772559 DOI: 10.1016/j.bjoms.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 10/18/2020] [Indexed: 11/17/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is a condition in which bony or fibrous adhesion of the anatomical joint components results in loss of function. This is particularly distressing and debilitating for patients who struggle to maintain good oral hygiene, which results in additional pain, oral disease, and ultimately, a poor aesthetic profile. A retrospective chart review was carried out to document the cases of three patients who attended a single centre for the management of ankylosis of the TMJ. Consent for chart review and use of photographs was gained from each one. Charts were obtained, records reviewed, and each of the cases written up for presentation in a case series. All three underwent arthroplasty of the TMJ and insertion of Matthews devices (two patients unilateral, one bilateral). All were followed up postoperatively. They experienced significant improvements in vertical mouth opening which have been maintained to the present. The Matthews device allows movement and physiotherapy postoperatively whilst maintaining the surgically created space. This prevents impingement on the tissues placed between the glenoid fossa and mandible, and appears to prevent relapse and further ankylosis. To our knowledge, few studies to date have documented the use of the Matthews device following interpositional arthroplasty of the TMJ.
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Affiliation(s)
- M Kelly
- Sheffield Teaching Hospitals, NHS England.
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Lee SM, Baek JA, Kim Y. Ankylosis of the Coronoid Process to the Zygomatic Bone: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2018; 77:1230.e1-1230.e11. [PMID: 30439329 DOI: 10.1016/j.joms.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are fewer than 40 cases reported in the English-language literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review. MATERIALS AND METHODS Through a PubMed search from 1946 to February 2018, using the terms ("extra-capsular" OR "zygomatico-coronoid" OR "extra-articular") AND ("ankylosis"), 61 articles were initially identified. After screening, manual reviewing, and including additional articles through reviews of the reference lists, 26 reports (33 patients) were included in the analysis. RESULTS Patients' age ranged from 12 to 71 years (mean, 36.62 yr; standard deviation, 16.24 yr). The gender composition of patients was male (n = 20; 60.6%), female (n = 12; 36.4%), and unknown (n = 1; 0.3%), with a clear male predominance. The etiologies were trauma (n = 25; 75.8%), infection (n = 3; 9.1%), surgical complication (n = 4; 12.1%), and radiotherapy for maxillary cancer (squamous cell carcinoma; n = 1; 3.0%). The treatment options were surgical intervention through an intraoral approach (n = 19; 57.6%), an extraoral approach (n = 10; 30.3%), and intraoral and extraoral approaches (n = 2; 6.1%) and nonsurgical intervention (n = 2; 6.1%). CONCLUSION Zygomatico-coronoid ankylosis is a possible cause of mouth-opening limitation, particularly in relation to facial trauma. However, it can be easily overlooked because of the rarity of zygomatico-coronoid ankylosis and the attention focused on the joint. Surgical intervention is regarded as a good treatment to improve mouth-opening limitation.
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Affiliation(s)
- Sang Min Lee
- Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jin-A Baek
- Full Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
| | - Yongsoo Kim
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Bouman MA, Dijkstra PU, Reintsema H, Roodenburg JLN, Werker PMN. Surgery for extra-articular trismus: a systematic review. Br J Oral Maxillofac Surg 2015; 54:253-9. [PMID: 26455659 DOI: 10.1016/j.bjoms.2015.08.269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/27/2015] [Indexed: 01/10/2023]
Abstract
The aim of this systematic review was to identify operations that are used to improve mouth opening in patients with extra-articular trismus (caused by cancer and its treatment, oral submucous fibrosis, or noma) and to find out if they work. We searched the electronic databases PubMed, Embase, Cinahl, and the Cochrane collaboration, and then systematically selected papers before we assessed their quality, extracted the data, and did a meta-analysis. We analysed 32 studies that included 651 patients, the median (IQR) size of which was 11 (7-26). The quality of the methods used and of reporting were relatively low. Median (IQR) duration of follow-up was 12 (8-22) months. Operations resulted in a weighted mean (SD) increase in mouth opening of 19.3 (6.3) mm. None of the operations was better than the others for the improvement of mouth opening. We conclude that operations can improve mouth opening in extra-articular trismus, but the evidence is of moderate quality and there is a need for further research.
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Affiliation(s)
- M A Bouman
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - P U Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - H Reintsema
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - J L N Roodenburg
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - P M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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Arnspiger SA, Felder JM, Wood BC, Rogers GF, Oh AK. Carotid artery dissection and stroke complicating treatment of postmandibular distraction ankylosis: a case report. Cleft Palate Craniofac J 2014; 52:373-6. [PMID: 25489770 DOI: 10.1597/14-008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mandibular distraction osteogenesis is an increasingly accepted treatment option for severe upper airway obstruction in grade 3 Robin sequence. Complications are rarely reported but can include fracture, pin dislodgement, tooth bud damage, and temporomandibular joint ankylosis. Operative correction of these complications can carry inherent risks of their own. We present a patient who incurred carotid artery dissection and stroke after release of postdistraction coronoid-zygomatic ankylosis for the treatment of mandibular micrognathia.
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Fujioka M. Surgical Reconstruction of Radiation Injuries. Adv Wound Care (New Rochelle) 2014; 3:25-37. [PMID: 24761342 DOI: 10.1089/wound.2012.0405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/11/2013] [Indexed: 12/18/2022] Open
Abstract
Significance: Patients with cancer receive benefits from radiation therapy; however, it may have adverse effects on normal tissue such as causing radiation-induced ulcer and osteoradionecrosis. The most reliable method to treat a radiation ulcer is wide excision of the affected tissue, followed by coverage with well-vascularized tissue. As usual, radiation-induced skin ulcers are due to therapeutic irradiation for residual cancer or lymph nodes; the locations of radiation ulcers are relatively limited, including the head, neck, chest wall, lumbar, groin, and sacral areas. Thus, suitable reconstructive methods vary according to functional and aesthetic conditions. I reviewed the practices and surgical results for radiation ulcers over the past 30 years, and present the recommended surgical methods for these hard-to-heal ulcers. Recent Advances: At a minimum, flaps are required to treat radiation ulcers. Surgeons can recommend earlier debridement, followed by immediate coverage with axial-pattern musculocutaneous and fasciocutaneous flaps. Free flaps are also a useful soft tissue coverage option. The choice of flap varies with the location and size of the wounds. Critical Issues: The most crucial procedure is the complete resection of the radiation-affected area, followed by coverage with well-vascularized tissue. Future Directions: Recent developments in perforator flap techniques, which are defined as flaps with a blood supply from isolated perforating vessels of a stem artery, have allowed the surgeons to successfully resurface these difficult wounds with reduced morbidity.
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Affiliation(s)
- Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, Nagasaki University, Nagasaki, Japan
- Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan
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Agarwal M, Gupta DK, Tiwari AD, Jakhar SK. Extra-articular ankylosis after zygoma fracture; A case report & review of literature. J Oral Biol Craniofac Res 2013; 3:105-7. [PMID: 25737895 DOI: 10.1016/j.jobcr.2013.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/17/2013] [Indexed: 11/27/2022] Open
Abstract
Extra-articular temporomandibular bony ankylosis between the coronoid process and the zygoma is quite uncommon. In this paper we present a case of fusion of the left coronoid to the zygomatic bone in a 23-year-old male. This bony ankylosis was the result of five-week-old untreated zygomatic complex fracture. Ankylosis developed secondary to heterotopic bone formation following trauma. Zygomatico-coronoid ankylosis of the mandible is a complication which rarely occurs if fractures of the middle third of the facial skeleton have been adequately treated. The patient was treated by intraoral coronoidectomy. The rationale for clinical and radiographic diagnosis and treatment is reviewed.
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Affiliation(s)
- Mohit Agarwal
- Assistant Professor, Department of OMFS, Government Dental College, Subhash Nagar, Jaipur, Rajasthan, India
| | - D K Gupta
- Professor & Head, Department of OMFS, Government Dental College, Subhash Nagar, Jaipur, Rajasthan, India
| | - Anjali Dave Tiwari
- Professor, Department of OMFS, Government Dental College, Subhash Nagar, Jaipur, Rajasthan, India
| | - Sunil Kumar Jakhar
- Assistant Professor, Department of OMFS, Government Dental College, Subhash Nagar, Jaipur, Rajasthan, India
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Bhrany AD, Izzard M, Wood AJ, Futran ND. Coronoidectomy for the treatment of trismus in head and neck cancer patients. Laryngoscope 2008; 117:1952-6. [PMID: 17767087 DOI: 10.1097/mlg.0b013e31812eee13] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Trismus is a common adverse effect of tumor extension or treatment for those with head and neck malignancy. Physical therapy is the mainstay of treatment, but many patients still fail to maintain adequate mouth opening. Coronoidectomy is a treatment option for those with trismus, and the purpose of this study was to evaluate the effectiveness of coronoidectomy in treating trismus refractory to physical therapy. STUDY DESIGN Prospective case series. METHODS Eighteen head and neck cancer patients with interincisal distances less than or equal to 20 mm underwent coronoidectomy after failing physical therapy for at least 3 months. All patients had undergone maximal radiation therapy, half after tumor resection. RESULTS Postcoronoidectomy, mean interincisal distances improved 22.1 mm and 21.8 mm at 6 and 12 months, respectively, with all patients maintaining an interincisal distance greater than or equal to 35 mm. Tumor location, tumor histology, or the addition of surgical resection had no impact on outcome. CONCLUSION Coronoidectomy is effective at improving trismus refractory to physical therapy in head and neck cancer patients.
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Affiliation(s)
- Amit D Bhrany
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA
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Yano H, Yamamoto H, Hirata R, Hirano A. Post-traumatic Severe Trismus Caused by Impairment of the Masticatory Muscle. J Craniofac Surg 2005; 16:277-80. [PMID: 15750425 DOI: 10.1097/00001665-200503000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.
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Affiliation(s)
- Hiroki Yano
- Department of Plastic & Reconstructive Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Talmi YP, Horowitz Z, Yahalom R, Bedrin L. Coronoidectomy in maxillary swing for reducing the incidence and severity of trismus – a reminder. J Craniomaxillofac Surg 2004; 32:19-20. [PMID: 14729045 DOI: 10.1016/j.jcms.2003.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The maxillary swing approach is a proven method for access to the nasopharynx. However, often, trismus is incurred postoperatively, hampering adequate oral care and follow-up and affecting patients' quality of life. CASE REPORTS Coronoidectomy was performed in four patients undergoing maxillary swing. Minimal trismus was seen in one patient undergoing repeat irradiation and chemotherapy. After a 1-month period no trismus was observed in the other three patients. CONCLUSION Coronoidectomy, usually performed in maxillectomy for reducing trismus is a useful adjunct in the maxillary swing procedure.
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Affiliation(s)
- Yoav P Talmi
- Department of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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