Temporomandibular joint ankylosis: A tertiary center-based epidemiological study

Secondary mandibular osteomyelitis complicated with a pathological fracture

INTRODUCTION AND IMPORTANCE

Pathological mandibular fractures, defined as fractures that occur in regions where bone has been weakened by an underlying pathological process, are rare, accounting for fewer than 2 % of all fractures of the mandible. Mandibular pathological fractures can have several aetiologies including osteomyelitis, osteoradionecrosis (ORN), surgical interventions, bisphosphonate-related osteochemonecrosis of the jaw and tumoral lesions.

CASE PRESENTATION

We present a case of a 13-year-old male patient following a tooth infection with a right facial swelling and limited mouth opening, multiple purulent cutaneous fistulas and mandibular hypoplasia. Intraoral examination revealed the presence of generalized calculus, dental mobility in quadrants 3 and 4. We carried out an orthopantomography which revealed a mandibular angle fracture and the diagnosis of secondary mandibular osteomyelitis with pathological fracture was retained. Sequestrectomy was carried out followed by an open reduction with mini reconstruction plates.

CLINICAL DISCUSSION

At 13 years old, this patient with a secondary mandibular osteomyelitis, to the best of our knowledge is the youngest case reported having a secondary mandibular osteomyelitis as etiology of his pathological fracture. Due to the early onset, the patient presented with a bird's profile clinically. His pathological fracture was due to a vicious cycle limiting bone turnover created by the secondary osteomyelitis.

CONCLUSION

Pathological mandibular fractures are complex and challenging to treat because of their different aetiologies and also clinicians often have to deal with individuals with grossly infected bone with the fracture management dependent on the resulting bony defect.

Temporomandibular Joint Ankylosis in a Girl Child: Immunochemical Evaluation of Tissue Material Obtained from Repeated Arthroplasty Surgeries

Temporomandibular joint ankylosis (TMJA) is a rare, but debilitating, condition that leads to TMJ joint hypomobility. Surgery is the mainstay for treatment, which is accompanied by rehabilitative and psychological support. Despite the advances in surgical techniques, the recurrence of TMJA post-surgery has been reported as a common complication. Therefore, it becomes essential to investigate and understand the histo-morpho-pathological processes governing these ankylotic changes. Given the lack of such studies in the literature, herein we present a case of a girl child who underwent primary surgery at the age of six years, followed by a second surgery at the age of twelve years. Ankylotic tissue samples collected during both surgeries were studied using various immunohistochemical markers for tissue remodeling, inflammation, antimicrobial activity, and transcriptional regulation. The expression of MMP-2 and -9 was downregulated in repeated surgery materials, whilst MMP-13 was rarely detected in both tissues. Strong MMP-8, TIMP-2, and TIMP-4 expressions were noted in both tissues, showing their anti-inflammatory and protective roles. Moderately strong expression of bFGF, FGFR-1, IL-1α, and TNF-α could indicate sustained tissue growth in the background of inflammation (wound healing). Interestingly, the expression of β-defensin-2 was found to be constant in both tissues, thereby indicating possible ECM remodeling and collagen breakdown. Finally, a moderate expression of RUNX-2, coupled with a low expression of WNT-1 and -3a, could indicate a slow and delayed bone regeneration process. Our results showcase the complex myriad of pathways that could be involved in the progression of TMJA and post-surgery healing processes. Immunopathological studies could aid in improving the diagnosis, treatment, and prognosis for patients affected with TMJA.

Surgical management of temporomandibular joint ankylosis with mersilene mesh interpositional arthroplasty: A case series study

Ankylosis of the temporomandibular joint (TMJ) is one of the most prevalent TMJ disorders in patients who have experienced trauma. Due to the high risk of recurrence, gap arthroplasty without interpositional material has been gradually discontinued as a treatment for TMJ ankylosis. After arthroplasty surgery, various interposition materials have been used to prevent a recurrence. Reporting on the effectiveness of TMJ bony ankylosis treatment using Mersilene mesh interpositional arthroplasty is the purpose of this study.This was a retrospective study carried out on five patients of TMJ ankylosis. All patients were treated through a Mersilene mesh interpositional arthroplasty procedure from January 2016 to April 2022 in Dr. Soetomo General Hospital and Universitas Airlangga General Hospital and evaluated 3 months postoperatively for the functional stability of TMJ. The result is preoperative mouth opening ranged between 0.7 and 13 mm. The patients achieved the interincisal opening between 27 and 40 mm postoperatively and had no complications for 3 months. In conclusion, Mersilene mesh interpositional arthroplasty is a very effective surgical treatment for TMJ bony ankylosis to achieve maximum mouth opening and avoid recurrences. The prevention of ankylosis recurrence necessitates thorough rehabilitation.

Pediatric temporomandibular joint ankylosis and arthritis: Forgotten complications of acute otitis media

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.