1
|
Bhusari N, Dhage P, Dhage PP. The Crucial Role of Physiotherapy in the Postoperative Case of Temporomandibular Joint Ankylosis for Restoration and Normalization of Functions in a 23-Year-Old Patient. Cureus 2024; 16:e62291. [PMID: 39006638 PMCID: PMC11246178 DOI: 10.7759/cureus.62291] [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] [Received: 01/24/2023] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Ankylosis of the temporomandibular joint (TMJ) is a pathological condition of the joint. The disease manifests as a limitation to total failure of movement of the TMJ, usually following trauma or surgery or due to local infection. The condition may result in difficulty masticating, speaking, structure of the mouth, face, or jaw, and maintaining oral hygiene to a significant degree. A computed tomography (CT) scan is the best method of evaluating the bony anatomy of the TMJ. The present report shows the surgical correction of the TMJ ankylosis. A 23-year-old female attended the hospital, showing severe mouth opening limitation (9 mm). On investigations, left TMJ ankylosis was diagnosed. The surgical approach consisted of distraction osteogenesis of the left side, followed by vigorous physiotherapy. In patients with TMJ ankylosis, restoration of normal function and jaw movement is difficult. This case report highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ ankylosis. There have also been several treatment methods used to improve the patient's self-esteem and confidence, including speech therapy and psychological counseling.
Collapse
Affiliation(s)
- Nikita Bhusari
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Pooja Dhage
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Prasad P Dhage
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|
2
|
Prabhu N, Issrani R, Ganji KK. Current trends in managing TMJ ankylosis in children-summing it up with a case report. J Surg Case Rep 2023; 2023:rjac550. [PMID: 36818808 PMCID: PMC9931400 DOI: 10.1093/jscr/rjac550] [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: 10/12/2022] [Accepted: 11/09/2022] [Indexed: 02/16/2023] Open
Abstract
Temporomandibular joint (TMJ) ankylosis involves fusion of the mandibular condyle to the base of the skull. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. The experience of managing one such case is reported in light of a review of the literature on this condition. This report describes a case of a 7-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. Key management principles included adequate removal of the ankylotic mass, gap arthroplasty with interpositional temporalis myofascial grafting and post-operative physiotherapy. The patient maintains a satisfactory maximal incisal opening till the present day. A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy might be beneficial to restore physical, psychological and emotional health of the child patient with TMJ ankylosis.
Collapse
Affiliation(s)
- Namdeo Prabhu
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | - Rakhi Issrani
- Correspondence address. Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia. E-mail: ; alternative e-mail:
| | - Kiran Kumar Ganji
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia,Department of Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra, India
| |
Collapse
|
3
|
Dowgierd K, Pokrowiecki R, Kulesa Mrowiecka M, Dowgierd M, Woś J, Szymor P, Kozakiewicz M, Lipowicz A, Roman M, Myśliwiec A. Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents. J Clin Med 2022; 11:jcm11020428. [PMID: 35054121 PMCID: PMC8779060 DOI: 10.3390/jcm11020428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/12/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022] Open
Abstract
Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.
Collapse
Affiliation(s)
- Krzysztof Dowgierd
- Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, ul. Oczapowskiego 2, 10-719 Olsztyn, Poland;
| | - Rafał Pokrowiecki
- Head and Neck Surgery Department—Maxillofacial Surgery Department, Craniofacial Center, Regional Specialized Children’s Hospital, ul. Zolnierska 18A, 10-561 Olsztyn, Poland
- Correspondence:
| | - Małgorzata Kulesa Mrowiecka
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, ul. P. Michalowskiego 12, 31-126 Krakow, Poland;
| | - Martyna Dowgierd
- Center of Craniofacial Malformations for Children and Young Adults, Regional Specialized Children’s Hospital, ul. Zolnierska 18A, 10-561 Olsztyn, Poland;
| | - Jan Woś
- Department of Laryngology, Stefan Zeromski Hospital, Os. Na Skarpie 66, 31-913 Cracow, Poland;
| | - Piotr Szymor
- Department of Maxillofacial Surgery, Medical University in Łodz, Pl. Hallera 1, 90-647 Łodz, Poland; (P.S.); (M.K.)
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University in Łodz, Pl. Hallera 1, 90-647 Łodz, Poland; (P.S.); (M.K.)
| | - Anna Lipowicz
- Department of Anthropology, Institute of Environmental Biology, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | - Małgorzata Roman
- Faculty of Health Sciences, University of Warmia and Mazury, ul. Zolnierska 14C, 10-900 Olsztyn, Poland;
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland;
| |
Collapse
|
4
|
Evaluation of Mandibular Growth and Symmetry in Child with Congenital Zygomatic-Coronoid Ankylosis. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ankyloses in the area of the temporomandibular joint (TMJ) are mentioned as a potential etiological factor of mandibular growth disorders and facial asymmetry. The aim of this case study was to evaluate the changes in the mandible of a child with zygomatic-coronoid ankylosis during the first five years of life, in which two adhesion release procedures were performed. The adopted symmetrical approach is based on the assumption of symmetry of the structure of the stomatognathic system in relation to the sagittal median plane. However, the assessment of pathological changes in the structure of the skeletal system was performed using an asymmetrical approach. Computed tomography techniques and a system of computer-aided diagnosis (CAD) were used in the case study. During the child’s growth, linear and angular measurements were made thrice (at the age of 16, 25 and 54 months). The degree of asymmetry was estimated in the measurements made on the right and left sides of the three-dimensional mandible. Unilateral congenital hypoplasia of the articular process and zygomatic-coronoid adhesion caused asymmetrical growth of the mandible in the child along with shortening of the mandibular branch and body on the damaged side and a visible difference in the size of the mandibular angles. Removal of the adhesions during surgical procedures made it possible to reduce the asymmetry of the mandible and catch-up growth, although at the age of five, the mandible was still smaller than the mandible in healthy peers. It was shown that the early adhesion release procedures supported by the CAD analysis enabled the restoration of mandibular symmetry.
Collapse
|
5
|
Aghashani A, Verstraete FJM, Arzi B. Temporomandibular Joint Gap Arthroplasty in Cats. Front Vet Sci 2020; 7:482. [PMID: 32903530 PMCID: PMC7438723 DOI: 10.3389/fvets.2020.00482] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
Temporomandibular joint (TMJ) ankylosis is defined as fibrous or bony fusion of the mandibular head of the condylar process and the mandibular fossa of the squamous part of the temporal bone. Ankylosis of the TMJ may be intraarticular, extraarticular, or both. The objective of this report is to describe the surgical planning, technique, and outcome of gap arthroplasty for extensive TMJ ankylosis in cats. Client-owned cats (n = 7) were examined clinically and surgical planning included the use of cone-beam computed tomography (CBCT) and tridimensional (3D) printed models. In six of the seven cats, temporary tracheostomy intubation was required. Gap arthroplasty included zygomectomy, coronoidectomy, condylectomy, as well as fossectomy (removal of the mandibular fossa of the temporal bone) and was performed using a piezosurgical unit. In all seven cats, gap arthroplasty was performed without surgical complications. In addition, a clinically acceptable mouth opening was achieved in all cases. However, a noticeable mandibular instability was observed. Medium-term follow-up demonstrated acceptable quality of life with one case of recurrence of ankylosis requiring repeated bilateral surgery, and a second case with recurrence of ankylosis not requiring surgical intervention at the time of manuscript preparation. We concluded that TMJ gap arthroplasty in cats is a salvage procedure indicated in cases of severe intraarticular and extraarticular ankylosis. Diagnostic imaging by means of CBCT and 3D printing are essential for precise surgical planning. The use of a piezosurgical unit allows for safe and precise ostectomy. Clinically, despite the resulting mandibular instability, appropriate prehension of food and water was possible.
Collapse
Affiliation(s)
- Armeti Aghashani
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| |
Collapse
|
6
|
Zavodovskaya R, Vapniarsky N, Garcia T, Verstraete FJM, Hatcher DC, Arzi B. Intra- and Extra-articular Features of Temporomandibular Joint Ankylosis in the Cat (Felis catus). J Comp Pathol 2020; 175:39-48. [PMID: 32138841 DOI: 10.1016/j.jcpa.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is an uncommon clinical entity in human and veterinary medicine. However, the condition is severely debilitating and is life-limiting if not treated. This study sought to characterize the intra- and extra-articular features of naturally occurring TMJ ankylosis in cats. TMJs from client-owned cats (n = 5) that underwent bilateral TMJ gap arthroplasty were examined and compared with TMJs from healthy, age-matched feline cadavers (n = 2) by cone-beam computed tomography (CBCT), micro-computed tomography (μCT) and histologically. Features of bilateral intra- and extra-articular ankylosis compounded by degenerative joint lesions were identified radiographically and histologically in all affected cats. Features of TMJ 'true' ankylosis included variable intracapsular fibro-osseous bridging, degeneration of the disc and the articular surfaces, narrowing of the joint space and flattening of the condylar process of the mandible. Extra-articular features of TMJ ankylosis included periarticular bone formation and fibro-osseous bridging between the mandible, zygomatic arch and coronoid process. In addition, subchondral bone loss or sclerosis, irregular and altered joint contours and irregularly increased density of the medullary bone characterized the degenerative changes of the osseous components of the TMJ. Complex radiological and histological features of both ankylosis and pseudoankylosis were identified that clinically manifested in complete inability to open the mouth.
Collapse
Affiliation(s)
- R Zavodovskaya
- California Animal Health and Food Safety Laboratory System, USA
| | - N Vapniarsky
- Department of Pathology, Microbiology and Immunology, USA
| | - T Garcia
- Department of Anatomy, Physiology and Cell Biology, USA
| | - F J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - D C Hatcher
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - B Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA.
| |
Collapse
|
7
|
Yano T, Taniguchi M, Tsuneyoshi I. Food Choking in a Patient with Congenital Temporomandibular Joint Ankylosis. Turk J Anaesthesiol Reanim 2017; 45:380-381. [PMID: 29359080 DOI: 10.5152/tjar.2017.45143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Takeshi Yano
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Masahiko Taniguchi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Isao Tsuneyoshi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| |
Collapse
|