Interpositional dermatofat graft for the treatment of ankylosis of the temporomandibular joint (2023)

The aim of this study was to evaluate the subjective and objective outcomes in patients with temporomandibular joint (TMJ) ankylosis treated with alloplastic TMJ (TMJ) reconstruction.

All patients diagnosed with TMJ ankylosis who underwent TMJ reconstruction in our service between 2010 and 2019 were retrospectively reviewed. Patients were divided into 2 cohorts: bone and fibrous ankylosis. The subjective variables evaluated were facial and headache pain, temporomandibular joint pain, jaw function, diet, and disability. The objective variables evaluated were the maximum interincisal opening and the lateral excursions. The Mann-Whitney test was used to analyze subjective variables and the unpaired t test to analyze objective variables. P<0.05 was considered statistically significant.

Twenty-eight patients met the inclusion criteria (21 women, 7 men). The mean age at surgery was 42 years and the mean number of previous TMJ surgeries was 3. A total of 52 TMJ surgeries were performed on the 28 patients and the mean follow-up was 46 months. All subjective variables improved significantly and the mean maximum interincisal opening increased from 16.9 mm to 37.25 mm.

The results of the study indicate that TMJR is an effective and reliable method of treating osseous and fibrous ankylosis of TMJ.

The aim of this study was to establish a treatment protocol for TMJ heterotopic ossification (HO) cases, particularly those that do not respond to current TMJ-HO protocols. Furthermore, we demonstrate the success of this protocol in a unique case of recurrent HO, where several TMJ-HO protocols failed in the context of an improvised explosive device (IED) blast on a wounded warrior.

An electronic literature search was performed through PubMed and Web of Science. Twenty-five studies were identified to provide supporting evidence for a current proposed protocol for the treatment of refractory TMJ HO. The authors present a case report of a wounded warrior with HO ankylosis of the bilateral temporomandibular joints during an IED burst and demonstrate the successful application of our surgical and pharmacotherapeutic protocol.

Based on the literature review, our proposed protocol consists of pharmacotherapy with celecoxib and etidronate, with weekly forced dilation (Brisement) and home physiotherapy with TheraBite Jaw Motion Rehab System. Surgically, the temporomandibular joint should be treated with a two-stage reconstruction using initial polymethylmethacrylate spacers and posterior total joint replacement with custom prostheses, fat grafting, and three-dimensionally navigated HO total resection. This protocol was used successfully in our patient with refractory ankylosed temporomandibular joint after IED burst, and the patient's maximum incisal opening recovered and remained stable 2 years after surgery without recurrent HO.

Our treatment regimen in this case deviated from the standard TMJ Concepts HO protocol, as it included a multimodal drug therapy with celecoxib and etidronate. Based on our review of the literature and our experience, we recommend that clinicians use our protocol for the management of all cases of craniofacial OH, particularly those cases of recurrent OH where conventional therapies fail and/or involve a high pressure blast trauma.

There is no uniform treatment protocol for temporomandibular ankylosis (TMJ) in adults. The aim of the study was to evaluate the outcome of total joint replacement (TJR) in conjunction with fat grafting around the joint in adult patients with TMJ. The specific objective was to find out if RTJ can be a definitive treatment for TMJ in adults.

Investigators conducted a prospective study in adult TMJ patients treated with osteoarthrectomy for ankylosis and temporomandibular joint (TMJ) with fat grafting. In some unilateral cases, orthognathic correction of facial asymmetry was performed at the same time. Follow-up visits were made at regular intervals to assess the primary outcome variables of maximum incisal opening (MIO) and scopeilosis. Secondary outcome variables included demographics, etiology, duration of ankylosis (DOA), correlation between pre- and postoperative DOA and MIO, occlusion and bleeding complications, facial nerve palsy, periprosthetic joint infection. , dislocation and implant failure.

The study sample consisted of 41 patients (54 joints) (bilateral, n=13; unilateral, n=28 [right side, n=12; left side, n=16]). The number of recurrent cases was 15. Trauma as an etiology of ankylosis was observed in n=30 (73.2%), infection in n=7 (17.1%), unknown in n=3 (7.3%) and ankylosing spondylitis in n=1 (2.4%) cases. The mean DOA was 11.95 years. Paired t-test revealed a statistically significant difference between preoperative and follow-up IOM (p<0.001). None of the cases presented scopeilosis in the follow-up period. Pearson's correlation revealed a statistically negative correlation between DOA and postoperative OMI.

The result of this study suggests that a TJR TMJ in conjunction with fat grafting around the joints provides adequate mouth opening without signs or symptoms of reankylosis. Standard TMJ TJR with fat grafting can be considered as a definitive treatment modality in adult TMJ with minimal comorbidity.

The aim of this study was to provide a systematic review of the efficacy of discopexy in the treatment of disorders of the internal temporomandibular joint (TMJ).

We searched MEDLINE through PubMed, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials, as well as gray literature accessed through Google Scholar, Openthesis, and handsearching from early to July 2019. 2020. The search strategy returned 363 potentially relevant studies. After title and abstract screening, 41 full-text articles were checked for eligibility and 7 studies were included in the meta-analysis.

There was an overall decrease in visual analogue scale (VAS) pain score of 4.59 cm (95% confidence interval [CI], 2.03-7.16; p<0.001) during the follow-up period and an overall increase of 10 mm (95% CI, 6.93–13.01; p<0.001) in mouth opening after temporomandibular joint surgery with discopexy.

Available evidence has shown an overall decrease in VAS pain score and improvement in mouth opening after TMJ discopexy surgery. Changes in maximum interincisal opening were greater after arthroscopic disc reduction than after the open hinge procedure.

Autologous fat grafts in the temporomandibular joint (TMJ) have shown positive clinical effects in the prevention of adhesions after surgery. However, the survival rate of transplanted fat has not yet been determined. The aim of this study was to evaluate the long-term survival of free fat grafts in the temporomandibular joint using magnetic resonance imaging (MRI).

89 patients (117 joints) with free fat grafts placed in the temporomandibular joints after a modified TMJ disc anchor were included in our study. They were divided into the following groups based on the time interval between temporomandibular joint surgery and the last MRI examination: 1-3 months, 4-6 months, 7-12 months, 13-24 months, and >24 months. Signal intensity changes and volume retention were assessed using magnetic resonance imaging.

The volume retention rate of the transplanted free fat showed that the size varied exactly around 50%, although it decreased very slowly with long-term follow-up. Almost half of the joints showed lower signal intensity of the transplanted fat on MRI at 6 months and recovered to normal 6 months later compared to the day after the operation.

Free fat transplanted into the temporomandibular joint cavity could remain alive for a long time with a survival rate of about 48.44%. However, the survival mechanism was still unknown, which we need to explore and study in the future.

Temporomandibular joint ankylosis results in a restricted mouth opening due to a fibrous or bony (non-neoplastic) connection of the mandibular head to the acetabulum. Early surgical treatment is recommended, but the optimal surgical technique is debated. Our aim was to quantify the effect of different surgical procedures on maximum (interincisal) mouth opening.

The systematic literature search (1960-2015) was based on PubMed, Web of Science, and Cochrane Library. Pooled mean differences and 95% confidence intervals between preoperative and postoperative maximum mouth opening (in mm) were calculated using random-effects meta-analysis. Surgical procedures were grouped according to their increasing complexity: slit arthroplasty, interposition arthroplasty, and reconstructive arthroplasty.

We identified 38 articles (1993-2015), including 1215 patients undergoing surgery; 84% of the cases were caused by trauma and 8% by infection.

Separation arthroplasty (n=463), interposition arthroplasty (n=409), and repair arthroplasty (n=293) resulted in an improved maximum mouth opening of 26.2 mm (95% CI, 24.1 -28.2), 26.7 mm (95% CI, 24.6 to 28.8), or 30.6 mm (95% CI, 28.7 to 32.5), and 28.7 mm overall (95% CI, 26.7 to 29.2). The combined mean maximum postoperative mouth opening ranged from 33.0 to 36.1 mm.

Maximum mouth opening improved more after reconstructive arthroplasty and less after gap arthroplasty. However, the maximum postoperative mouth opening was similar for all techniques.