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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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Huang D, Zou L, Lu C, Zhao J, He D, Yang C. Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study. Clin Oral Investig 2024; 28:163. [PMID: 38383876 PMCID: PMC10881754 DOI: 10.1007/s00784-024-05543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. METHODS Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. RESULTS Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. CONCLUSION Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.
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Affiliation(s)
- Dong Huang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Luxiang Zou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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Uppal N, Ansari MN, Dadsena K, Xavier F, Mithani H. Acrylic "lollipop" for jaw rehabilitation after release of joint ankylosis in paediatric patients. Trop Doct 2023:494755221114706. [PMID: 37050881 DOI: 10.1177/00494755221114706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Falls are a leading cause of injuries to the temporomandibular joint (TMJ) in the paediatric age group. In low- and middle-income nations, after injury to a child's chin, a careful clinical examination of the mandible and TMJ is sometimes omitted. Paediatric mandibular condylar fractures tend to shatter the relatively narrow condylar head, leading to ankylosis to the skull base, which leads to debilitating progressive deformity.1 Early surgical release is then the sole modality of treatment and needs to be followed up by several weeks of active mouth-opening exercises to prevent re-ankylosis, which are crucial in the immediate post-operative period. Unfortunately, as patient cooperation is low owing to uncomfortable jaw mobilization, we fabricated a simple acrylic appliance which is easy to use.
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Affiliation(s)
- Nakul Uppal
- Maxillofacial Surgery Division, Department of Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mohd Naseemuddin Ansari
- Maxillofacial Surgery Division, Department of Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Kamini Dadsena
- Maxillofacial Surgery Division, Department of Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Frijo Xavier
- Maxillofacial Surgery Division, Department of Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Andrade NN, Kapoor P, Mathai P, Gupta V, Lakshmi V, Sharma S. Management of paediatric ankylosis. J Oral Biol Craniofac Res 2023; 13:191-201. [PMID: 36691651 PMCID: PMC9860352 DOI: 10.1016/j.jobcr.2023.01.006] [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: 09/04/2021] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Temporomandibular joint ankylosis (TMJa) is one of the most crippling craniomaxillofacial pathological conditions characterized by replacement of normal architecture of temporomandibular joint (TMJ) with fibrous or bony tissue. The incidence of TMJa is most common in the paediatric population [first and second decades of life] and is commonly associated with maxillofacial trauma. Comprehensive management entails a thorough evaluation of the associated anatomy of the ankylotic mass and other pertinent details like the presence or absence of obstructive sleep apnoea. Categorizing patients based on these variables helps in selecting an appropriate surgical intervention. Various resective and reconstructive surgical techniques are discussed; along with their merits and demerits. Long-term physiotherapy, long-term clinical follow-up and appropriate family counselling are the essential pillars for success. In this review, the authors present an algorithmic approach to evaluation and management of paediatric TMJa. Appropriate recommendations are made based on evidence to select optimum surgical intervention.
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Affiliation(s)
- Neelam Noel Andrade
- Head of Department of Oral & Maxillofacial Surgery and Dean of Nair Dental College & Hospital, Mumbai and Dean of NESCO Jumbo Covid Care Center, Mumbai, Dean's Office, Nair Dental College & Hospital, Dr Anandrao Nair Marg, Mumbai Central, Mumbai, Maharashtra, 400008, India
| | - Prathmesh Kapoor
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Paul Mathai
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
- The Center For Oral, Maxillofacial and Facial Plastic Surgery, Mumbai
| | - Varsha Gupta
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - V.K. Lakshmi
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
| | - Shelly Sharma
- Department of Oral & Maxillofacial Surgery, Nair Dental College & Hospital, India
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Singh AK, Jose A, Khanal N, Krishna K, Chaulagain R, Roychoudhary A. Dermis fat graft compared to temporalis myofascial graft for interpositional arthroplasty in TMJ ankylosis. A systematic review and metanalysis. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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TMJ Ankylosis in Children: A Case Report and Literature Review. Case Rep Dent 2023; 2023:6474478. [PMID: 36643593 PMCID: PMC9836793 DOI: 10.1155/2023/6474478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Temporomandibular joint (TMJ) ankylosis is a serious disabling condition characterized by fusion of the mandibular condyle with the glenoid fossa, disc, and/or eminence, resulting in severely restricted mouth opening and significantly reduced mandibular movements. The condition often has a deteriorating effect on the patient's daily functions such as speech, chewing, breathing, and oral hygiene as well as their wellbeing and quality of life. Furthermore, childhood TMJ ankylosis frequently has a detrimental impact on the facial growth resulting in facial asymmetry, micrognathia, and/or class II malocclusion with posterior or anterior open bite. Trauma is the main cause of TMJ ankylosis, but the condition can also occur as a result of surgery, local or systemic infections, or systemic disease. Surgery is the mainstay of treatment, and several approaches have been applied, including gap arthroplasty (GA), interpositional gap arthroplasty (IGA), reconstruction arthroplasty (RA), or distraction osteogenesis (DO). The aim of this article is to present a post-traumatic TMJ ankylosis case in a 5-year-old male child who was treated with resection and simultaneous costochondral grafting and to provide a succinct update of literature.
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Parrino D, Val M, Lovato A, de Filippis C, Nardini LG. Pediatric temporomandibular joint ankylosis and arthritis: Forgotten complications of acute otitis media. Am J Otolaryngol 2022; 43:103599. [PMID: 35988366 DOI: 10.1016/j.amjoto.2022.103599] [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: 05/03/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Temporomandibular joint (TMJ) arthritis and ankylosis represent unusual but potential complications of ear suppuration, especially in children. We performed a review of the literature of pediatric otogenic TMJ arthritis and ankylosis, discussing their clinical and radiological features, their mechanism of infection spread, and the importance of a prompt diagnosis and treatment. We additionally describe a case of TMJ ankylosis following acute mastoiditis in a 4-year-old female patient. METHODS A search of English literature from January 1, 1980 to December 31, 2021 was performed on the electronic databases (PubMed, Web of Science and Scopus) in order to identify studies concerning TMJ complication after ear suppuration. RESULTS Seventeen articles were considered eligible for the review. Eight and nine studies described otogenic TMJ ankylosis and arthritis, respectively. A total of 17 children affected by ankylosis consequent to ear infection and a total of 31 cases of TMJ arthritis concurrent to otomastoiditis were identified. Mean time elapsed between ear infection and diagnosis of TMJ ankylosis was 4.8 years (range 0.5-13). CONCLUSION TMJ involvement during complicated otitis media should be kept in mind. Its prompt recognition is mandatory to set up appropriate treatment and follow-up and reduce the risk of ankylosis with its functional and psychological complications.
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Affiliation(s)
- Daniela Parrino
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Matteo Val
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
| | - Andrea Lovato
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, University of Padova, Audiology and Phoniatrics Unit, Ca'Foncello Hospital, Treviso, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial surgery, Ca'Foncello Hospital, Treviso, Italy
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Preoperative Arterial Coil Embolization for Temporomandibular Joint (TMJ) Surgery in Children with TMJ Ankylosis. J Craniofac Surg 2022; 33:2001-2004. [PMID: 35288496 DOI: 10.1097/scs.0000000000008629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/19/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Temporomandibular joint (TMJ) ankylosis in children can alter facial development and affect oral hygiene and function. Surgical release of the ankylosis is the mainstay of treatment. The authors hypothesize that preoperative arterial coil embolization is safe and effective in preventing major blood loss during TMJ surgery (loss prompting blood transfusion or hemodynamic instability requiring vasoactive medication administration) in children with TMJ ankylosis. Patients < 16 years who were diagnosed with TMJ ankylosis (<15 maximal interincisal opening) and had embolization before surgery in the last 5 years were included. Out of 9 initial search results, 3 patients were excluded (age > 16). Information gathered were patient demographics, diagnostic imaging, procedural details, complications, and clinical outcomes. Six patients, mean age 11.14 years (range 7-15 years) year and a mean weight of 40.8 ± 19 kg were included. Underlying etiologies for TMJ ankylosis: Pierre Robin Syndrome (n = 2), juvenile rheumatoid arthritis (n = 1), Goldenhar's syndrome (n = 1), trauma (n = 1), and micrognathia (n = 1). Neck computed tomography angiogram before embolization demonstrated an intimate approximation between the internal maxillary artery (IMAX) and/or external carotid artery and ankylotic mass in all patients. Eight successful embolizations were performed without procedural complication. In 1 patient with angiographic evidence of surgical internal maxillary artery ligation, embolization was performed via collaterals. Surgery was performed within 48 hours of embolization. Airway access during surgery was via nasal intubation (n = 4), oral intubation (n = 3). The estimated blood loss (EBL) during surgery was 78.33 ± 47.08 ml. Three patients had subsequent TMJ surgery with a mean estimated blood loss of 73.33 ± 46.18 ml. After a mean follow-up of 17 ± 15 months, patients showed a 13.8 mm mean increment of maximal interincisal opening with 95% CI (5.74-21.9), P < 0.007.
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Singh AK, Jose A, Khanal N, Krishna KC, Chaulagain R, Roychoudhury A. Transport distraction osteogenesis compared with autogenous grafts for ramus-condyle unit reconstruction in temporomandibular joint ankylosis: A systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:731-739. [PMID: 35304005 DOI: 10.1016/j.bjoms.2021.12.051] [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: 08/25/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
This systematic review was planned to assess the clinical outcomes of transport distraction osteogenesis (TDO) compared with autogenous grafts for reconstruction of the ramus condyle unit (RCU). We searched Medline, Embase, Cochrane Library, Clinicaltrial.gov, and the references of included trials. The primary outcome was maximal incisal opening (MIO). Of the 148 studies retrieved, five were included (TDO = 49, autogenous grafts =123). The mean difference in MIO between TDO and autogenous graft RCU reconstruction, based on the random-effects model was 1.28 mm (95% CI 0.167 to 2.403) in favour of TDO. Re-ankyosis was observed in four cases in the costochondral graft group and none in the TDO group. Reconstruction of the RCU using TDO is comparable to autogenous grafts after the release of TMJ ankylosis, though the evidence is weak considering the small number of trials, high risk of bias, and absence of long-term results.
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Affiliation(s)
- Ashutosh Kumar Singh
- Department of Oral and Maxillofacial Surgery, TU Dental Teaching Hospital, MMC, Institute of Medicine, Kathmandu, Nepal.
| | - Anson Jose
- Oral and Maxillofacial Surgery, Private Practice, New Delhi, India
| | | | - K C Krishna
- Department of Oral and Maxillofacial Surgery, TU Dental Teaching Hospital, MMC, Institute of Medicine, Kathmandu, Nepal
| | - Rajib Chaulagain
- Department of Oral Biology, Chitwan Medical College, Bharatpur, Nepal
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, CDER, AIIMS, New Delhi, India
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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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