Treatment of pediatric ankylosis
2023, Journal of Oral Biology and Craniofacial Research
Temporomandibular joint (TMJ) ankylosis is one of the most debilitating pathological conditions of the face and jaw, characterized by the replacement of the normal architecture of the temporomandibular joint (TMJ) by fibrous or bony tissue. The incidence of TMJ is more common in the pediatric population [first and second decade of life] and is frequently associated with maxillofacial trauma. Comprehensive management includes a thorough evaluation of the associated anatomy of the ankylotic mass and other relevant details, such as the presence or absence of obstructive sleep apnea. Categorizing patients based on these variables helps select an appropriate surgical procedure. Various resective and reconstructive surgical techniques are discussed; along with its merits and demerits. Long-term physiotherapy, long-term clinical follow-up and adequate family counseling are fundamental pillars for success. In this review, the authors present an algorithmic approach to the evaluation and treatment of pediatric temporomandibular joint syndrome. Appropriate evidence-based recommendations are made to select the optimal surgical procedure.
Low-level arthroplasty with ultrasonic bone cutter for recurrent temporomandibular ankylosis - case report
2022, Journal of Oral and Maxillofacial Surgery, Medicine and Pathology
A 42-year-old man with recurrent temporomandibular ankylosis (TMJ) underwent low-level arthroplasty (LLGA) using an ultrasonic bone-cutting device. The patient had already undergone three surgical procedures for trauma-induced TMJ, resulting in reattachment. The results of the clinical examination showed that the maximum area of mouth opening is 1 mm. ALLGA surgical procedure was performed under general anesthesia using an ultrasonic bone cutter to detect vascular and nerve damage. A 25mm slot arthroplasty was performed for the right mandible and a 30mm slot arthroplasty for the left mandible. Intraoperative mouth opening was measured at 55 mm. After AGLL, muscle tissue with fascia was inserted between the bone stumps and dermal fat was placed around the muscle graft and bone stumps. On the seventh day, the fixation between the jaws was released and the patient began the opening exercises. Four years after the operation, the maximum mouth opening was 42 mm and the evolution was stable.
Comparison of surgical outcomes associated with interposition of arthroplasty materials used in patients with TMJ ankylosis: systematic review and meta-analysis
2022, British Journal of Oral and Maxillofacial Surgery
Surgical treatment of temporomandibular joint (TMJ) ankylosis involves several techniques, among which interposition arthroplasty (IPA) involves the use of multiple materials. The objectives of this study were to evaluate and compare the maximum mouth opening (MMO) after arthroplasty, symptoms such as pain and discomfort during jaw opening and movement, failures such as rechilosis, neurosensory alterations, and the effect of variables. of confusion such as age, sex. , physiotherapy etc. The search (carried out in September 2021) included studies published in English in healthy subjects (11 months to 88 years) undergoing arthroplasty with a minimum follow-up of six months. We use search engines such as the Cochrane Database, PubMed, Embase, Scopus, EBSCO Host, Pro Quest, J Gate, Google Scholar, and manual search to include books and gray literature. Randomized and non-randomized clinical trials (RCTs), observational studies, case series, and reports that met the inclusion criteria were selected. Two reviewers (HD and NP) independently extracted data. Risk of bias was assessed using the Cochrane tool, Rangel's checklist, and the Joanna Briggs Institute. Data were analyzed with RevMan (version 5.4). Fifty studies with 1524 participants (442 bilateral and 891 unilateral joints) were included; six RCTs, 31 retrospective, 10 prospective, and three case series and reports. Among all interpositional materials, the greatest increase in mouth opening was seen with dermal fat grafting with a mean difference (pooled MD) of 35.29 mm (95% CI [32.36 to 38.22 ]). Comparison of temporary myofascial arthroplasty versus gap arthroplasty (GA) showed a significant increase in MMO (pooled mm MD 1.30, 95% CI [0.14 to 2.45]). Recurrences were significantly reduced when (IPA) was used compared with GA (risk difference 0.08 mm 95% CI [−0.15 to −0.02]) and for temporal myofascial flap (TMF) compared with GA (risk difference -0.07 mm 95% CI [-0.15 to 0]). A higher probability of developing neurosensory abnormalities was found with the Al Kayat-Bramley incision (pool OR 0.11, 95% CI [0.04 to 0.34]) compared with the preauricular incision (pool OR 0.03 , 95% CI [0.01 to 0.09]) observed. IPA was superior to GA in terms of maximum mouth opening (MMO) (mm pooled MD 1.21, 95% CI [0.41 to 2.07]). Dermis Fat Graft offers the highest MMO. The overall quality of evidence from RCTs is poor, while that from observational studies is moderate as measured by quality of evidence. More research with appropriate study designs is needed. Similar to the results of previous reviews, the results with IPA compared with GA were superior in terms of mouth opening and fewer recurrences.
Analysis of the maximum bite force and masticatory efficiency in cases of unilateral TMJ ankylosis treated with interposition buccal fat arthroplasty
2022, British Journal of Oral and Maxillofacial Surgery(Video) Oxford University surgical lectures: helping with breathing and eating
There is limited knowledge of masticatory function after resolution of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was assessed by measuring maximum voluntary bite force (MVBF) and masticatory efficiency in 30 patients with unilateral temporomandibular ankylosis treated with buccal interpositional fat arthroplasty (BFP). Eighteen subjects older than 12 years were included in Study Group A and 12 subjects younger than 12 years in Study Group B. Patients in both study groups completed at least one year of postoperative follow-up. Control groups C (older than 12 years, n=18) and D (less than 12 years, n=12) consisted of normal subjects of equivalent age, sex, and weight. Mean MVBF was measured between occluded molars using a strain gauge transducer. Chewing efficiency was measured with two different colored sticks of chewing gum. These were chewed for 5, 10, 20, 30, and 50 puffs. Compared with normal subjects, study groups (A and B) were able to generate 64.7% (p=0.004*) and 89.8% (p=0.121) MVBF, respectively. Global masticatory efficiency was 88.7% in Group A and 92.9% in Group B (p=0.014* and p=0.138, respectively) compared to healthy subjects. The study showed that BFP interposition arthroplasty effectively restores masticatory function.
Is there a difference in volume change and efficacy compared to buccal and abdominal pedunculated fat when used as an interposition arthroplasty in the treatment of TMJ ankylosis?
2020, Journal of Oral and Maxillofacial SurgerySee AlsoIntermediate and long-term follow-up after pyrocarbon disc interposition arthroplasty for the treatment of arthritis of the CMC thumb jointInterpositional dermatofat graft for the treatment of ankylosis of the temporomandibular jointInterpositionele elleboogprotheseInterpositionele versus reconstructieve artroplastiek voor ankylose van het temporomandibulair gewricht: systematische review en meta-analyse
There is limited evidence in the literature for fat grafting in the treatment of temporomandibular ankylosis (TMJ). The objective was to investigate which interpositional fat grafting technique is superior in the surgical treatment of TMJ. The specific objective was to compare the volumetric change and the maximum oral opening (MIO) when interposing pedicled buccal fat or abdominal fat in patients treated for TMJ.
A randomized controlled trial was conducted in TMJ patients who were divided into 2 groups: in group A, a pedicled buccal fat pad was used for interposition, while in group B, abdominal fat was used. At the end of 1 year, volumetric change in fat was analyzed by comparison immediately after surgery and 1-year follow-up magnetic resonance imaging (MRI). MIO and re-ankylosis were recorded. Categorical variables were analyzed using χ2Test or Fisher's exact test. Continuous variables were compared using the Wilcoxon t test and the signed rank test. A linear regression analysis was performed.
A total of 36 patients were included (51 joints [15 bilateral and 21 unilateral]), 18 in group A and 18 in group B. Mean preoperative MIO was 6.8 mm in group A and 4.2 mm in group A. Group B. postoperative period The volume of fat in the MRI was 4.3 cm3in group A and 10.8 cm3in group B. The one-year follow-up MRI showed a fat retention rate of 32.44% in group A and 58.17% in group B. The volumetric contraction rate was 67.5 % in group A and 41.9% in group B (P<0.001). Analysis of variance showed a statistically significant difference between volumetric contraction and both treatment groups (P<0.001). MIO improved to 30.6 mm in the pedunculated buccal fat group (Group A) and to 41.9 mm in the abdominal fat group (Group B) (p<0.001). At the 1-year follow-up, there was no recurrence of ankylosis in either group.
The results of our study indicate that the percentage of interposed abdominal fat retention is greater than that of pedunculated buccal fat pockets per year. Volumetric contraction is greatest in the buccal fat pad, which is a paradox given the pedunculated blood supply. Abdominal fat is superior to buccal pedunculated fat when used for interposition in TMJ treatment.
New method for removing a buccal fat pad for interposition after cleft temporomandibular joint arthroplasty
2016, British Journal of Oral and Maxillofacial Surgery
Results of the surgical protocol for the treatment of ankylosis of the temporomandibular joint based on the pathogenesis of ankylosis and reankylosis. A prospective clinical study with 14 patients
Journal of Oral and Maxillofacial Surgery, Band 73, Ausgabe 12, 2015, S. 2300-2311
Trauma is the main cause of temporomandibular joint (TMJ) ankylosis and the management of this condition presents significant challenges due to the high rate of recurrence. recurrence rate.
The author designed and implemented a prospective clinical study. The sample consisted of patients with TMJ ankylosis. The predictor variables were the affected side and the age and sex of the patient. The outcome variable was the maximum interincisal opening (MIO outcome). Descriptive and bivariate statistics were calculated and the P value was defined as less than 0.05. The protocol consisted of the following steps: 1) perioperative indomethacin for 2 weeks; 2) the creation of a minimum light of 5 to 10 mm; 3) ipsilateral coronoidectomy and (if necessary) contralateral coronoidectomy; 4) loosening of the pterygomasseteric loop and temporal muscle; 5) interpositional dermal fat graft adhered to the condylar stump; 6) suction drain insert; 7) immediate aggressive physical therapy for at least 6 months; 8) regular long-term follow-up; and 9) late reconstruction by distraction osteogenesis.
The sample consisted of 14 patients (3 men and 11 women). Of these patients, 9 and 5 had unilateral and bilateral ankylosis, respectively, and their ages ranged from 12 to 38 years (median 18.5 years). The follow-up period varied between 24 and 48 months (mean 32.5 months). Intraoperative IOMs ranged from 38 to 52 mm (mean 45.7 mm). Postoperative MIO showed a slight decrease in mouth opening (mean 43.5 mm). The resulting MIOs ranged from 35 to 55 mm (mean 43.5 mm). 21.4% of all patients developed temporary facial paralysis (grade II).
The results of the present study suggest that this surgical protocol is effective in the treatment of temporomandibular ankylosis and in the prevention of recurrent ankylosis.See AlsoPatronen van glenoïdbotverlies bij anatomische revisie schouderartroplastiek: de impact van eerdere glenoïdresurfacingFunctionele uitkomsten van trapeziometacarpale artrodese van de duim met vergrendelde plaat versus ligamentreconstructie en peesinterpositieAnalyse van maximale bijtkracht en kauwefficiëntie in gevallen van unilaterale TMJ-ankylose behandeld met buccale vetkussen-interpositie-artroplastiekChirurgische behandeling van TMJ ankylose met Mersilen mesh interpositie arthroplastiek: een case-serie studie
Does temporomandibular disc repositioning with bone anchors offer better clinical outcomes than traditional disc plication procedures for anterior disc displacement without reduction in patients who do not respond to non-surgical treatments?
Journal of Oral and Maxillofacial Surgery, Band 78, Ausgabe 12, 2020, S. 2160-2168
Although open temporomandibular arthroplasty with discopexy is a common treatment for patients with anterior advancement of the disc without reduction (ADDWo) unresponsive to medical treatment, there are no studies comparing disc reduction with bone anchors and a conventional discopexy procedure. The aim of the study was to compare the effectiveness between bone-anchored disc reduction and the traditional Discopexy procedure in ADDWo temporomandibular joint unresponsive to medical treatment.
A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening (main outcome variable) between the two treatment groups (main predictor): disc reduction with bone anchors versus traditional disc plication. Secondary outcome variables were pain, measured by visual analogue scale, lateral displacement, and disc position, assessed by magnetic resonance imaging (MRI). Other variables of interest were age, sex, and duration of symptoms. Parameters were assessed preoperatively, on the first postoperative day, and at 1, 6, and 12 months postoperatively. Categorical variables were compared with χ2Test and continuous variables with analysis of variance and adjusted for multiple comparisons with Bonferroni test.
The study sample included 14 patients (7 in each group) with ADDWo confirmed by MRI. Statistically significant differences were found in the improvement of mouth opening between the 2 groups, showing improvement with bone anchors (14.42 ± 5.96 vs. 7.57 ± 7.25 mm; P<0.05). The reduction in visual analogue scale also showed a statistically significant difference with better pain reduction obtained with bone anchorage (4.57 ± 1.61 vs. 3.28 ± 0.75; P < 0.05). There were no statistically significant differences in lateral displacements and MRI-assessed postoperative disc position between the groups at the 12-month follow-up period.
Bone-anchored disc reduction provides better clinical outcomes in terms of maximum mouth opening and pain scores compared to traditional disc plication.
Use of a vascularized free fibular myosal flap to reconstruct a hemimandibular defect with an associated cranial defect resulting from displacement of the standard condylar prosthesis into the middle cranial fossa
Journal of Oral and Maxillofacial Surgery, Band 77, Ausgabe 6, 2019, S. 1316.e1-1316.e12
Functional reconstruction of the temporomandibular joint (TMJ) is a controversial issue among oral and maxillofacial surgeons; This controversy is complicated when plunged into the dilemma of the ideal reconstructive modality. TMJ defects may be due to a variety of etiologies, including blunt or penetrating traumatic injuries, advanced degenerative joint disease, or various pathologic conditions, including benign and malignant conditions, that may arise from the temporomandibular joint or adjacent tissues. Reconstruction of the temporomandibular joint is critical due to its essential function in mastication, articulation, speech, facial aesthetics, and symmetry. In the pediatric population, the temporomandibular joint serves as a growth center. Reconstructive surgery of the temporomandibular joint can be influenced by several factors that may lead the surgeon to use a specific reconstructive modality. These factors can be categorized into preoperative factors, including the general health, expectations, and socioeconomic status of the patient that may represent a barrier to the use of personalized solutions. The experience, comfort and training of the surgeon are decisive factors. TMJ reconstruction options consist of autografts or alloplastic options. Autografts are divided into 2 main subcategories. The first is the vascularized option and a good example is the vascularized fibula free flap. The second subcategory includes nonvascularized grafts such as B. costochondral grafts and sternoclavicular grafts. Alloplastic grafts include multiple temporomandibular joints or custom prostheses for specific patients and condylar prostheses. The goals of TMJ reconstruction are to provide a normal range of mouth opening without pain, stable occlusion, and the absence of facial deformities. Complication rates from TMJ surgery are low and include surgical infection, nerve damage, failure or fracture of the prosthesis, or injury to adjacent structures. This report presents a case of a displaced condylar prosthesis in the middle cranial fossa and treated with a two-stage approach in which the displaced prosthesis was removed and then reconstructed with a vascularized free fibula flap and concomitant contralateral split sagittal osteotomy.
Silicone versus temporalis fascia interposition in temporomandibular ankylosis: a comparison
Journal of Oral Biology and Craneofacial Research, Band 6, Ausgabe 2, 2016, S. 107-110
Temporomandibular ankylosis (TMJE) is a debilitating condition, but it can be treated surgically with cleft or interpositional arthroplasty with the goal of restoring joint function and preventing recurrence of ankylosis. The objective of this article is to compare two interposition materials used in the treatment of temporomandibular ankylosis.
Fifteen patients with TMJ were randomly divided into two groups: Group A (n=6), where the interposition material used was medical grade silicone elastomer, and Group B (n=9), where the interposition material used was temporal fascia. The patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months and 6 months and evaluated according to the following parameters: pain according to the VAS scale, maximum mouth opening (MMO), implant rejection and recurrence.
The results showed a loss of 4.6% and 7.9% in maximum interincisal mouth opening at 3 and 6 months in Group A, while Group B had a mean loss of 9% and 10% at 3 months. and 6 months, respectively, with no significant difference. None of our cases presented recurrence or rejection of the implant.
We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and conformability. It not only restores mandibular function and ensures a good maximum interincisal opening, but also maintains the vertical height of the ramus. In addition, it requires less operating time and is easy to operate, but it is not cost effective. It can be an effective way to restore function and prevent recurrence of ankylosis.See AlsoInterpositionele artroplastiek: indicaties, techniek en huidige verwachtingenWeer aan het werk na een operatie voor artrose van het trapeziometacarpale gewricht in verband met de eisen van handenarbeidReumatoïde polsartroplastiek met siliconenrubber: een vroege beoordelingBoeken Artroplastiek van de onderste ledematen A Matter of Orthopedic Clinics (PDF downloaden)
Management of type III temporomandibular joint ankylosis: lateral endoprosthesis as the therapy of choice
International Journal of Oral and Maxillofacial Surgery, Band 43, Ausgabe 4, 2014, S. 460-464
Many surgical techniques have been described in the literature for the treatment of temporomandibular joint (TMJ) ankylosis. The aim of this study was to report our experience with the lateral arthroplasty technique in the treatment of type III ankylosis. The records of 15 patients treated for temporomandibular ankylosis in our service between 2007 and 2011 were reviewed. The pre- and postoperative information collected included age, sex, etiology, type/classification of ankylosis, existing facial asymmetry, pre- and postoperative maximum mouth opening, complications and recurrence of ankylosis. The mean maximum interincisal opening before the operation was 12.9 mm and 36.2 mm after the operation. No major complications were observed in any patient. No patient had recurrence. Our working hypothesis was that in patients with type III ankylosis, medially displaced condyles and intervertebral discs may play a role in mandibular function and growth after removal of the ankylosed mass. Although they are in an awkward medial position, they should function just as they would after a properly treated displaced condyle fracture.
20-Year Follow-Up Study of a Patient-Fitted TMJ Prosthesis: The Techmedica/TMJ Concepts Device
Journal of Oral and Maxillofacial Surgery, Band 73, Ausgabe 5, 2015, S. 952-960
To assess the subjective and objective outcomes of patients who received Techmedica (now TMJ Concepts) total joint replacement (TJR) appliances placed in the temporomandibular joint (TMJ) after 19 to 24 years of service.
This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica TJR TMJ (Camarillo, CA) devices from November 1989 through July 1993. Patients were evaluated before surgery and for at least 19 years after surgery. Subjective ratings were made using standard questionnaires and questions on a Likert scale of 1) temporomandibular joint pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) nutrition (0, no restriction; 10, fluids only), and 4) quality of life (QoL; better, the same, or worse). The objective evaluation measured the maximum incisal opening (MIO). Comparative analysis of preoperative and longer follow-up data used the Mann-Whitney and Wilcoxon nonparametric tests. Spearman's correlations evaluated the number of previous surgeries in terms of objective and subjective variables.
Of the 111 patients, 56 (50.5%) could be contacted and had sufficient documentation for their inclusion in the study. The median follow-up was 21 years (interquartile range [IQR], 20 to 22 years). The mean age at the time of the operation was 38.6 years (standard deviation 10 years). The mean number of previous TMJ surgeries was 3 (IQR, 4). Comparison of data before surgery and longer follow-up showed a statistically significant improvement (P<0.001) for MIO, TMJ pain, jaw function, and diet. At longer follow-up, 48 patients reported a better quality of life, 6 patients reported the same quality of life, and 2 patients reported a worse quality of life. Spearman's correlations showed that a greater number of previous surgeries resulted in less improvement in TMJ and OIM pain.
In an average of 21 years after the operation, Techmedica/TMJ Concepts TJR continued to perform well. More prior TMJ surgeries showed a lesser degree of improvement. No equipment was removed due to material wear.
Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.