Management of temporomandibular joint ankylosis: a case report of joint replacement with piezoelectric surgery

AIM

Temporomandibular joint (TMJ) ankylosis is a joint disorder which refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. This report describes the management of a case of bilateral TMJ ankylosis in a 20-year-old patient with prosthetic replacement with the aid of a piezoelectric instrument (MECTRON (R).

METHODS

The right ankylotic mass was surgically removed and replaced by a custom-made prosthesis based on data obtained from three-dimensional computed tomography (CT) reconstruction of the skull of the patient using a stereolithography model.

RESULTS

At six months postoperative, the opening of the mouth was stable at 36 mm and imaging studies (CT and magnetic resonance imaging [MRI]) showed a great condylar prosthesis and surrounding tissues in addition to partial remodeling of the left TMJ.

CONCLUSION

In this patient, despite the bilateral ankylosis, it was sufficient to intervene only on the right TMJ, which presented a serious bone block, with mobilization since surgery gradually restored the anatomical and functional conditions of the left TMJ compatible with normal activities of mastication and speech.

The piezoelectric osteotomy technique compared to the one with rotary instruments in the surgery of included third molars. A clinical study

AIM

The purpose of this study is to compare surgical times, the saving of bonytissues, the postoperative course of the extraction of included third molars in patients treated with piezoelectric surgery compared to those treated with conventional rotary instruments.

METHODS

The study included 140 patients with upper and lower third molars included. 70 of them were treated with osteotomy using conventional rotary instruments (Group 1) and 70 more with osteotomy through piezosurgery Mectron® (GROUP 2). The treatment protocol was the same for both groups. The time of surgery and the saving of bonytissues in the intra-operative have been estimated; moreover, 24-48-72 hours and 7 days after the surgery, two other parameters have been estimated: facial swelling and trismus. The swelling, trismus and the saving of bony tissues were assessed by a surgery gauge.

RESULTS

The average surgical time was 15 minutes in Group 1 and 20 minutes in Group 2. The savings of bonytissues was greater in Group 2 than in group 1 by 2.7 mm. The average facial swelling was 6.23 mm for group 1 and 2.86 mm for group 2 24 hours after the surgery, of 5.22 mm for group 1 and 1.76 mm for group 2 48 hours after the intervention, of 3.75 mm for Group 1 and 0.85 for group 2 72 hours after the surgery, of 0.86 mm for group 1 and 0.12 for group 2. The average trismus was of 14.76 mm in Group 1 and 11.15 mm in Group 2. Statistical analysis showed a significant reduction of swelling, trismus and a bigger saving of bony tissues in Group 2 and a reduction in surgical time in Group 1.

CONCLUSION

The osteotomy technique with a piezoelectric instrument has produced a significant reduction in facial swelling, trismus and a bigger saving of bony tissues than with conventional rotary instruments. A slight lengthening in terms of surgical time has been recorded, compared to the use of conventional rotary instruments.

Benefits of piezoelectric surgery in oral and maxillofacial surgery. Review of literature

Piezoelectric surgery is based on the use of ultrasound for the cutting of bones. It represents an innovative technique, as it offers the maxillofacial surgeon the opportunity of making precise bone cuts without damaging any soft tissue, minimizing the invasiveness of surgical procedure, and the opportunity of working in a field which is almost totally blood-free. It reduces the impact on soft tissues (vessels and nerves) which lie adjacent to the areas of treatment. Compared to traditional methods, it enables optimal healing because it reduces the postsurgery swelling and discomfort. In this article the authors realized a review of the literature.

Chondroid syringoma: a rare tumor of orofacial region

Chondroid syringoma is a rare tumor arising from the major and minor salivary glands. The incidence of chondroid syringoma is reported to be <0.01% among the primary skin tumors. Eighty percent of the chondroid syringomas are seen in older patients , commonly on head and neck region and mostly on the cheek and nose. The authors report a case discussing the surgical management of a chondroid syringoma and pointing out the importance of including this tumor in the differential diagnosis of small subcutaneous nodules in the head and neck region, in middle-age male patients.