Cone-beam computed tomography evaluation of the maxillofacial features of patients with unilateral temporomandibular joint ankylosis undergoing condylar reconstruction with an autogenous coronoid process graft

Temporomandibular Joint Ankylosis as a Sequel of an Overlooked Condylar Fracture in a Child

Temporomandibular joint ankylosis is an important entity that dentists and maxillofacial surgeons should know about. It clinically manifests through a permanent limitation of mandibular movements coupled with mouth opening inferior to 3 cm. This serious pathology can have serious functional repercussions, such as mastication problems, speech troubles, eating disorders, and jaw growth hindrance, in addition to the psychological difficulties in coping with such a condition in daily life. Herein, we present a radiological and chronological illustration of the evolution of temporomandibular joint ankylosis following an overlooked traumatic fracture of the mandibular condyle. The present case report involves an 8-year-old patient referred for a gradually evolving mouth opening limitation following a car accident. Tomodensitometry was helpful as it revealed an osseous block between the left temporomandibular joint surfaces, showing an ankylosis. Posttraumatic cerebral computed tomography scan was performed. It revealed an undetected fracture of the left condyle. The aim of this paper was to show how a traumatic ankylosis could have been avoided if enough attention was paid to the interpretation of immediate posttraumatic computed tomography scans. A thorough dental examination must be carried out once vital emergency is over. Early diagnosis of temporomandibular joint trauma is a crucial factor in preventing complications, such as ankylosis and its consequent oral dysfunctions. The dentist must automatically suspect condylar fracture when a child presents a history of head trauma, especially a mandibular trauma. This case should be a reminder that although temporomandibular joints are very often left out in patients' vital emergency first examination, temporomandibular joints/they are still a highly important structure which omission, and thus, dysfunction, if lesions are present, can lead to nonnegligible medico-legal consequences/that temporomandibular joints should be taken into account during patients' vital emergency first examination because if they are neglected, in the presence of lesions, they cause dysfunction, thus leading to nonnegligible medico-legal consequences.

Computer-Aided Autogenous Coronoid Process Graft Combined With Median and Unilateral Sagittal Split Osteotomy for Late Reconstruction of Condylar Fracture and Occlusion after Trauma

PURPOSE

This study proposes a high-precision surgical technique that combines both computer-aided design/computer-aided manufacturing (CAD/CAM) and the screw-track transfer technique for condylar and occlusal reconstruction.

MATERIALS AND METHODS

A 43-year-old male patient with facial asymmetry, limited mouth opening, and malocclusion underwent condylar and occlusal reconstruction surgery. An autogenous coronoid process graft was performed by combining CAD/CAM and the screw-track transfer technique.

RESULTS

The surgical plan was transformed successfully from preoperative virtual surgical planning to actual surgery; this was confirmed by merging the postoperative computed tomography images with the preoperative three-dimensional surgical design. The patient recovered well and had better occlusion and facial symmetry, as well as an increased degree of mouth opening post-surgery. No complications were observed.

CONCLUSIONS

CAD/CAM combined with the screw-track transfer technique is a precise and feasible method that can be applied to autogenous coronoid process grafts. This approach can be used to reconstruct the condylar process and achieve a good occlusal relationship.

Do simultaneous mandibular advancement and temporomandibular joint prosthesis impact the upper airway in TMJ ankylosis patients?

Background

Ankylosis of the temporomandibular joint (TMJ) is a pathological disorder which results in patients’ limited or even complete failure of mouth opening. When TMJ ankylosis occurs during the growing age, moderate to severe micrognathia might be the proposed scenario of such cases, accompanied by obstructive sleep apnea and hypopnea syndrome (OSAHS). TMJ reconstruction using total TMJ prostheses with mandibular advancement (MA) can simultaneously improve the function and aesthetic profile of such patients. The purpose of this study was to determine whether the upper airway can be improved after TMJ reconstruction with total TMJ prostheses combined with or without MA in TMJ ankylosis patients.

Methods

Fourteen patients with pre-(T1) and post-(T2) operative CT scans were included. Patients were divided into two groups according to the operation with or without MA (MA/WoMA). The changes of the upper airway and jaw bones were comparatively analyzed within and between the two groups.

Results

In MA Group, the volume of the total upper airway (Vt) and palatopharynx (V1), together with the surface area (SA) of the total upper airway (SAt) and palatopharynx (SA1) increased significantly after the operation by 41.4%, 43.2%, 36.3% and 36.6%, respectively. In WoMA Group, V1, SAt and SA1 increased significantly by 21.0%, 19.0% and 23.1% following surgery. The changes of Point B (P<0.01), Y-axis angle (P<0.01), SNB (P<0.01), and ANB (P<0.01) were significantly greater in MA Group than in WoMA Group. Comparing both groups, the maxilla, and mandible were more backward in MA Group than in WoMA group before the operation, but there was no significant difference of the final position of the maxilla and mandible after the operation between both groups.

Conclusions

Release of TMJ ankylosis and condylar reconstruction using total joint prostheses simultaneously with MA could significantly improve the total volume and other various parameters of the upper airway, while, only the dimension of the palatopharynx increased in cases without MA.

Reconstruction of the Mandibular Condyle

The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.