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Nnko KA, Pima RT, Baraka C, Robi EA, Rwakatema DS, Mremi A. Surgical management of mandibular ameloblastoma and immediate reconstruction with iliac crest and costochondrial bone grafts: A case report. Int J Surg Case Rep 2024; 121:110023. [PMID: 38991367 PMCID: PMC11296295 DOI: 10.1016/j.ijscr.2024.110023] [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: 06/18/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Ameloblastoma is a benign but locally aggressive odontogenic tumor mostly occurring in the jaws. Ameloblastoma can be difficult to diagnose because it mimics other benign lesions. Its diagnosis requires a combination of imaging data, histopathological analysis, and molecular tests. Its treatment modality diverges from simple enucleation with bone curettage up to wide surgical resections. CASE PRESENTATION A 25-year-old female presented with a right-sided mandibular mass for five years. Histopathology and radiology tests confirmed it to be an ameloblastoma. A hemimandibulectomy was done, followed by immediate reconstruction using an autogenously inserted iliac crest bone and a costochondral graft as an interposition graft for the lost part. The patient had a satisfactory clinical outcome, and no sign of recurrence after a follow-up of six months. CLINICAL DISCUSSION The ideal management of ameloblastoma should minimize recurrence, restore function and appearance, and present minimal donor site morbidity. While the removal of a wide part of the bone and soft tissue leads to defects that may cause functional and aesthetic concerns, conservative management is associated with minimal downtime but high recurrence rates. Reconstructive surgery is of paramount importance for the recovery of the lost parts in these patients. CONCLUSION Radical surgery is the treatment of choice for large tumors to minimize recurrence, and immediate reconstruction utilizing grafting techniques is essential to restoring function and appearance. The autologous bone graft technique is satisfactory for immediate mandibular reconstruction as it represents a simple, easy, less costly, and reliable method for restoring mandibular continuity defects.
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Affiliation(s)
- Kanankira A Nnko
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Raphael T Pima
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Calvin Baraka
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Enock A Robi
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Deogratius S Rwakatema
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Clinical Research Unit, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
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Jacobs T, Mohammed S, Ziccardi V. Assessing the Efficacy of Allogeneic Nerve Grafts in Trigeminal Nerve Repair: A Systematic Review. J Oral Maxillofac Surg 2024; 82:294-305. [PMID: 38182118 DOI: 10.1016/j.joms.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Our primary objective was to assess the efficacy of allogeneic nerve grafts in inferior alveolar nerve or lingual nerve repair. We hypothesized that using allogeneic nerve grafts would be effective, as evidenced by achieving high rates of functional sensory recovery (FSR). Additionally, we looked if sex, time from injury to repair, etiology of nerve damage, and graft length affected outcomes. METHODS A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. PubMed and Scopus databases were searched using specific search strategies to generate eligible studies. Inclusion criteria encompassed studies reporting use of allogeneic grafts, assessing FSR using either Medical Research Council Scale or Neurosensory Testing, and published within the past 15 years. RESULTS Across 10 studies conducted between 2011 and 2023, analysis was performed on 149 patients and 151 reconstructed nerves. Allogeneic nerve grafts showed an average FSR rate of 88.0%. Kaplan-Meier analysis of time to FSR postoperatively revealed that of those achieving FSR, 80% achieved it within 6 months and 98% achieved it by 1 year. The mean graft length was 29.92 mm ± 17.94 mm. The most common etiology for nerve damage was third molar extractions (23.3%). Sex distribution among patients revealed that 85 were female (57.0%) and 64 were male (43.0%). CONCLUSION Our primary hypothesis was supported as nerve allografts achieved high rates of FSR. FSR was achieved in normative timeframes, which is 6 to 12 months postoperatively. Furthermore, allografts reduced the risk of posttraumatic trigeminal neuropathy. Time from injury to repair, graft length, etiology of nerve damage, and sex did not affect FSR. As the assessed variables in our study did not affect outcomes, there needs to be a more nuanced approach to understanding and addressing various factors influencing sensory recovery.
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Affiliation(s)
- Tyler Jacobs
- Resident, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ.
| | - Saad Mohammed
- BA Candidate, New Jersey Institute of Technology, Newark, NJ
| | - Vincent Ziccardi
- Professor, Chair, and Associate Dean for Hospital Affairs, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ
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Khattak YR, Arif H, Gull H, Ahmad I. Extended total temporomandibular joint reconstruction prosthesis: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101404. [PMID: 36720364 DOI: 10.1016/j.jormas.2023.101404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.
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Affiliation(s)
| | | | - Hanan Gull
- Farooq Hospital Lahore, Pakistan; Akhtar Saeed Trust Hospital Lahore, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Cortese A, Spirito F, Claudio PP, Lo Muzio L, Ruggiero A, Gargiulo M. Mandibular Reconstruction after Resection of Ameloblastoma by Custom-Made CAD/CAM Mandibular Titanium Prosthesis: Two Case Reports, Finite Element Analysis and Discussion of the Technique. Dent J (Basel) 2023; 11:dj11040106. [PMID: 37185484 PMCID: PMC10137091 DOI: 10.3390/dj11040106] [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: 01/03/2023] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Virtual surgical planning for CAD/CAM mandibular reconstruction by titanium prosthesis was recently reported for resected cases. Even if some advantages are evident, difficulties that may arise for TMJ function after reconstruction originate from prosthesis contamination through oral mucosa dehiscence. In these two cases reported of mandibular reconstruction after resection of ameloblastoma by custom-made CAD/CAM titanium prosthesis, the procedures were aimed to preserve the TMJ glenoid cavity and articular disc avoiding functional problems for hemi-mandibular resections that included the condyle (as in case #1) or with condylar preservation (as in case #2) and avoiding intraoral incisions in both cases. The entire surgical planning and prosthetic fabrication were explained with specifications and the sequence of the surgical procedure. Finite elements analysis (FEA) was performed to check the force distribution and efficacy of the prosthetic device (case 1 with hemi-mandibular resection and rehabilitation). Although successful in these two cases, surgical reconstruction of the mandibular defect after resection by a CAD-CAM custom-made prosthesis still shows some drawbacks and failure risks. Several advantages of this technique and the surgical success in these two cases were presented, but limitations and side effects must be considered when cases are selected.
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Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine, Surgery, and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Pier Paolo Claudio
- Department of Pharmacology and Toxicology, Cancer Center & Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Maxillofacial Surgery, Cancer Center & Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Alessandro Ruggiero
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, Nr. 132, 84084 Fisciano, Italy
| | - Maurizio Gargiulo
- U.O.C. Chirurgia Maxillofacciale, A.O.R.N. "A. Cardarelli", Via A. Cardarelli, 80131 Naples, Italy
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Subash P, V VP, Iyer S, Nerurkar S, Krishnadas A, Pullan SG. Concomitant Microvascular Aided Extended Temporo-Mandibular Joint Replacement (ME-TJR) and Stock Temporo-Mandibular Joint Replacement (MS-TJR) During Mandibular Reconstruction. J Maxillofac Oral Surg 2023; 22:110-117. [PMID: 37041942 PMCID: PMC10082882 DOI: 10.1007/s12663-023-01896-6] [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: 01/28/2023] [Accepted: 03/02/2023] [Indexed: 04/13/2023] Open
Abstract
Background Disarticulation is indicated when pathologic process involves the condyle or when a body/ramus lesion extends into condylar process. The goal of reconstruction is to reinstate joint mechanism for function and also to restore facial symmetry. Aim Retrospective evaluation of functional and aesthetic outcomes in patients with disarticulation defects of mandible treated with concomitant alloplastic temporomandibular joint replacement and microvascular free flap reconstruction. Materials and Methods Nine patients (8 benign pathologies and 1 secondary reconstruction for malignant neoplasm), who underwent mandibular resection with condylar disarticulation and reconstruction with Free microvascular flap and Alloplastic total joint replacement between 2015 and 2022 were included in the study. A modified functional intra-oral Glasgow scale (FIGS)2 was used for quality of life (QOL) scoring. Speech, mastication, swallowing, VAS pain score, mouth-opening, occlusion, facial symmetry and overall patient satisfaction were assessed. Results 8 patients with benign pathology reported excellent outcome with a QOL score of 13-15 in terms of speech, chewing and swallowing. Pre-operative occlusion of native mandible was maintained in all dentulous patients. VAS score of 0-1 was reported. Mouth opening was adequate in all patients. 2 patients reported mild ipsilateral deviation of mandible. Mild facial asymmetry was reported by 2 patients with an overall satisfaction of 8-9. There were no significant intra/post-operative complications in patients with benign pathology. Failure of stock joint was observed in secondary reconstruction for malignant neoplasm. Conclusion Microvascular free flap aided stock or custom alloplastic replacement of temporomandibular joint (MS-TJR, ME-TJR) restores function and aesthetics following mandibular resection with disarticulation of condyle.
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Affiliation(s)
- Pramod Subash
- Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Vinanthi P. V
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Subramania Iyer
- Department of Head & Neck Surgery, Plastic & Reconstructive Surgery, Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Shibani Nerurkar
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Arjun Krishnadas
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Sony G. Pullan
- Oral & Maxillofacial Surgery, Royal Free NHS Foundation Trust, Barnet & Chase Farm Hospitals, Wellhouse Lane, Barnet, EN5 3DJ UK
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Hurrell MJL, Singh J, Leinkram D, Clark JR. Patient specific implant with high condylar neck osteotomy for temporomandibular joint preservation in segmental mandibulectomy. Oral Oncol 2022; 134:106084. [PMID: 35981425 DOI: 10.1016/j.oraloncology.2022.106084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Letter to the Editor. OBJECTIVE Disarticulation may be considered during segmental mandibulectomy where margins necessitate high condylar neck osteotomy. Although a number of techniques have been reported for reconstruction of the condyle, successful preservation of normal joint anatomy, where possible, should be considered as a superior alternative. This report demonstrates a safe and predictable approach to condylar head preservation with high condylar neck osteotomy. METHODS We present two cases of native TMJ preservation with a very short salvageable condylar component utilising 3D-printed patient specific cutting guides and implants. RESULTS The condyle preserving reconstructive technique described successfully preserves the capsule of the TMJ, and with careful execution can preserve the intra-articular components of the joint and their relationships to each other. Both patients have experienced excellent outcomes to date. CONCLUSIONS As opposed to disarticulation reconstructions, this technique is more likely to achieve long-term normal occlusion, maintain normal alignment of reconstructed segments, and preserve condylar translation as opposed to simple hinging, in addition to avoiding the potential pitfalls of alternative techniques.
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Affiliation(s)
- Michael J L Hurrell
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
| | - Jasvir Singh
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - David Leinkram
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Histopathologic Feature of Hyalinization Predicts Recurrence of Conventional/Solid Multicystic Ameloblastomas. Diagnostics (Basel) 2022; 12:diagnostics12051114. [PMID: 35626270 PMCID: PMC9139534 DOI: 10.3390/diagnostics12051114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
The histologic properties of tumors seem to affect their biological behavior, and the same holds good for solid multicystic ameloblastoma (SMA), a benign, locally destructive lesion. Hyalinization is one such histological factor that has been demonstrated to correlate with the biological behavior of neoplasms. The present study aimed to analyze the correlation between the severity of hyalinization (SOH) and the recurrence potential of SMAs. The study was performed on formalin-fixed, paraffin-embedded (FFPE) diagnosed archival cases of SMA, follicular SMA (n = 35) and plexiform SMA (n = 25). The cases were evaluated for SOH and scored from 0–3, and the correlation between SOH and recurrence was analyzed for statistical significance. The clinical parameters of the lesion were analyzed for statistical correlation with recurrence. The SOH significantly correlated with the recurrence of SMA (p = 0.001). The histologic type did not influence the biological behavior of SMA. The location of SMA in the body of the mandible (p = 0.036), multilocular radiolucency (p = 0.001) and root resorption (p = 0.002) also showed strong statistical correlation with recurrence. It is evident from the present study that hyalinization strongly correlates with the biological behavior of SMA. Future studies with advanced investigations could validate the presence of hyalinization and identify the origin of the hyalinized product in SMAs.
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Lovásová K, Borza B, Kizek P, Almaši M, Kachlík D, Hodorová I. A case of giant ameloblastoma: destructive effect on the facial skeleton and soft tissues of the head and neck. J Int Med Res 2021; 49:3000605211050185. [PMID: 34648377 PMCID: PMC8521770 DOI: 10.1177/03000605211050185] [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] [Indexed: 11/17/2022] Open
Abstract
Ameloblastoma is a benign odontogenic tumor characterized by slow growth causing painless facial swelling. The tumor can behave locally aggressively, and may have direct destructive effects on the surrounding soft and hard tissues. This paper reports the unique case of a female patient with giant ameloblastoma of the mandible. Computed tomography (CT) revealed an enormous swelling of the left side of the face, resorption of the affected hemi-mandible, left maxilla, and tissues of the temporal, infratemporal, and pterygopalatine fossae. Pressure from the tumor resulted in displacement and destruction of the facial skeleton, upper aero-digestive tract structures, and some structures of the neck. The patient was treated by radical hemimandibulectomy with removal of the tumorous mass. Precise knowledge of the anatomical structures, and their locations and topographical relationships is required in the diagnosis and treatment plan for each surgical procedure in cases of giant ameloblastoma. CT imaging can be used to determine the extent and exact location of the lesion, revealing other important details that may help in selecting appropriate treatment.
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Affiliation(s)
- Květuše Lovásová
- Department of Anatomy, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Branislav Borza
- 1st Clinic of Stomatology, 83513Louis Pasteur University Hospital, Louis Pasteur University Hospital, Košice, Slovak Republic
| | - Peter Kizek
- 1st Clinic of Stomatology, 83513Louis Pasteur University Hospital, Louis Pasteur University Hospital, Košice, Slovak Republic
| | - Milan Almaši
- Department of Otorhinolaryngology, 256189East Slovakia Oncology Institute, East Slovakia Oncology Institute, Košice, Slovak Republic
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ingrid Hodorová
- Department of Anatomy, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
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Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection. J Craniofac Surg 2021; 33:284-288. [PMID: 34510060 DOI: 10.1097/scs.0000000000008124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.
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Le Donne M, Jouan R, Bourlet J, Louvrier A, Ducret M, Sigaux N. Inferior alveolar nerve allogenic repair following mandibulectomy: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:233-238. [PMID: 33933668 DOI: 10.1016/j.jormas.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Processed nerve allografts (PNA) are an alternative to nerve autografts to reconstruct the inferior alveolar nerve (IAN) when it is damaged. The purpose of this study was to report the results of IAN reconstruction using PNA in the context of aggressive benign mandibular pathology. MATERIAL AND METHOD A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement through the MEDLINE (Pubmed) and SCOPUS (Elsevier) databases. Studies concerning reconstructive surgeries of IAN by PNA, performed at the same time as the surgical resection of the benign pathologies of the mandible were included. The following data were analyzed: gender and patient age, cause of mandibular resection, graft dimensions, sensory recovery at least 6 months after surgery according to the MRC scale, and adverse events related to the intervention. RESULTS The initial search yielded 290 studies and 5 were included in the final review. A total of 33 patients underwent 36 IAN reconstructions; 14 patients were female (42.4%) and mean age was 30 years old. The mean length of graft used was 64.0 ± 9.1 mm. The most common pathology that led to nerve resection was ameloblastoma (52%). Among the reconstructions for which follow-up data were available, functional sensory recovery occurred in 92.9% of cases. CONCLUSION PNA are a reliable, safe, and effective alternative to nerve autografts for the rehabilitation of the IAN with 92.9% of functional recovery according to the reported literature, avoiding any comorbidity associated with the use of a donor site.
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Affiliation(s)
- Mélanie Le Donne
- Private Practitioner, 3 Rue du Dr François Broussais 17100 Saintes, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin, 69008 Lyon, France.
| | - Robin Jouan
- Clinical Doctor, Chirurgie Maxillo-faciale, Hôpital Nord-Ouest, Plateau d'Ouilly 69400 Gleizé Villefranche sur Saône, France
| | - Jérôme Bourlet
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Stomatologie, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Aurélien Louvrier
- Clinical Doctor, Service de chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Régional Universitaire Jean Minjoz, 3 boulevard Alexandre Fleming, 25000 Besançon, France
| | - Maxime Ducret
- Associate Professor, Hospices Civils de Lyon, PAM Odontologie, Lyon, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin 69008 Lyon, France; Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500 Montreal QC H3A 1G1, Canada
| | - Nicolas Sigaux
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Plastique de la face, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France,; UFR de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Université de Lyon, 165 Chemin du petit Revoyet, 69221 Oullins, France
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Mehrotra D, Kumar S, Mehrotra P, Khanna R, Khanna V, Eggbeer D, Evans P. Patient specific total temporomandibular joint reconstruction: A review of biomaterial, designs, fabrication and outcomes. J Oral Biol Craniofac Res 2021; 11:334-343. [PMID: 33786297 DOI: 10.1016/j.jobcr.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this article was to systematically review the available literature on patient specific total temporomandibular joint total joint replacement (PS-TMJR) implants for their biomaterial, designs, fabrication techniques and their outcomes. Methods A literature review was conducted using PubMed, and science direct databases using the key words three-dimensional printing, 3D printing, CAD CAM, computer aided designing, computer aided manufacturing, additive technology, custom made implants, patient specific implants in combination with Temporomandibular joint, TMJ surgery. Results The search revealed 2760 articles, of which 374 were in English and discussed TMJ reconstruction. Further filtering shortlisted 74 articles that discussed PS-TMJR. Duplicates were removed and additional added from article references. 39 articles describing biomaterial, designing and fabrication of PS-TMJR implants and their outcomes were selected for analysis. Conclusions Although PS-TMJR implants allow a better anatomical fit, improved fixation, and safeguard various structures such as the inferior alveolar nerve, they vary in designs, material and fabrication techniques. However, PS-TMJR printed with SLM and EBM technologies have yet to be compared with the conventional ones in terms of mechanical strength, and clinical outcome. With emerging bioprinting technologies, even newer biomaterials should be considered for 3D printing of PS-TMJR devices designed to achieve harmony in function between the joint device, bone and masticatory muscles.
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Affiliation(s)
- Divya Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Sumit Kumar
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Pankhuri Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Richa Khanna
- Dept of Preventive and Paediatric Dentistry, King George's Medical University, Lucknow, India
| | - Vikram Khanna
- Dept of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | | | - Peter Evans
- Healthcare Consultant in Maxillofacial Prosthetics, Maxillofacial Laboratory, Morriston Hospital, Swansea, Wales, UK
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Chang VKO, Thambar S. TMJ pain as a presentation of metastatic breast cancer to the right mandibular condyle. BMJ Case Rep 2021; 14:14/3/e241601. [PMID: 33653870 PMCID: PMC7929852 DOI: 10.1136/bcr-2021-241601] [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] [Indexed: 11/03/2022] Open
Abstract
Cancer metastasis to the oral and maxillofacial region is uncommon, and metastasis to the mandibular condyle is considered rare. We present a case of a 56-year-old woman with a history of invasive ductal cell carcinoma of the right breast, 10 years in remission, presenting with a 6-month history of symptoms typical of temporomandibular joint (TMJ) dysfunction. Imaging revealed an osteolytic lesion of her right TMJ and subsequent open biopsy confirmed the diagnosis of metastatic breast cancer. Despite the rarity of metastatic cancer to the head and neck region, it is still important for clinicians from both medical and dental backgrounds to consider this differential diagnosis, particularly in patients with a history of hormonal positive subtype of breast cancer. Given that bony metastasis can manifest even 10 years after initial diagnosis, surveillance which includes examination of the head and neck region is important, and may include routine plain-film imaging surveillance with an orthopantomogram (OPG).
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Affiliation(s)
- Victor Ken On Chang
- Oral and Maxillofacial Surgery, Gold Coast University Hospital, Southport, Queensland, Australia .,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Samuel Thambar
- Oral and Maxillofacial Surgery, Gold Coast University Hospital, Southport, Queensland, Australia,School of Medicine, Griffith University, Gold Coast, Queensland, Australia,School of Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons. J Craniofac Surg 2021; 31:1651-1658. [PMID: 32569038 DOI: 10.1097/scs.0000000000006595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic surgery.A retrospective case series of patients who underwent custom alloplastic TMJ reconstruction concurrent with orthognathic surgery between 2014 and 2019 was completed. Functional, aesthetic and orthodontic outcomes as well as complications were recorded.Seven TMJs in 5 skeletally mature patients (4 female, 1 male, ages 16-30) (2 bilateral, 3 unilateral) were replaced. All but 1 patient had previous attempts at reconstructive surgery with poor results. All cases were prepared using virtual surgical planning and underwent concomitant maxillomandibular orthognathic surgery. All patients demonstrated improved post-operative occlusions. Four of 5 patients achieved >30 millimeters of post-operative MIO. Complications included ear canal perforation and facial nerve dysfunction.There were no infections or other implant-related complications. Mean follow up was 2 years and 15 days. Alloplastic TMJ reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects is an alternative to existing management options. Further long-term prospective outcomes studies are ongoing.
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Chauvel-Picard J, Kreutzer K, Heiland M, Kreusch T, Ebker T, Beck-Broichsitter B. One stage microvascular mandible reconstruction by using scapula chimeric flap combined with computer-aided-design and computer-aided-manufacturing plate including bilateral alloplastic TMJ prosthesis: A case report. Microsurgery 2020; 41:263-269. [PMID: 33103294 DOI: 10.1002/micr.30669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/01/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022]
Abstract
This report focuses a defect comprising the complete mandible due to osteonecrosis, including both condyles, that required bilateral temporomandibular joint (TMJ) reconstruction with complete mandibular corpus using a computer-aided-design and computer-aided-manufacturing(CAD-CAM) planning to harvest a scapula chimeric free flap combined with plate including bilateral alloplastic TMJ prosthesis. This procedure was realized in one and the same surgery. A 73 year-old-man developed an osteoradionecrosis of the total mandible including both condyles after radiation therapy for a squamous cell carcinoma of the tongue base(cT4aN2bM0G3). A CAD-CAM reconstruction was planned with a plate extended by bilateral individual TMJ prosthesis, individual fossa components and combined with a composite free flap originating from the subscapular vessel system including scapula(circumflex subscapular artery) for reconstruction of the mandibular corpus which was osteotomized in three segments with a resection guide, the parascapular skin paddle (descending branch of circumflex subscapular artery) for compensation of the soft tissue deficiency of the cervical skin and latissimus dorsi muscle(thoracodorsal artery) for the inner mucosal lining and intraoral reconstruction. The subscapular artery was anastomosed to the external carotid artery and two concomitant veins were sutured end-to-side to the internal jugular vein. The patient was discharged without feeding tube and tracheostomy. No complications have been observed after 6 months follow-up. The patient was able to tolerate soft diet and had comprehensible speech. Thus, a total mandibular reconstruction including both condyles using alloplastic and autoplastic reconstruction in one and the same stage is a valid option and may be considered in comparably severe cases.
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Affiliation(s)
- Julie Chauvel-Picard
- Department of Oral and Craniomaxillofacial Surgery, Centre Hospitalo-Universitaire Nord, Saint-Etienne, France.,Jean Monnet University, Saint-Etienne, France
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Kreusch
- Department of Oral and Maxillofacial Plastic Surgery and Dentistry, Head and Neck Center, Hamburg, Germany
| | - Tobias Ebker
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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