Retrospective analysis of the use of buccal fat pad as an interposition graft in temporomandibular joint ankylosis: a preliminary study (2023)

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.

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.

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.

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.

Journal of Oral and Maxillofacial Surgery, Band 73, Ausgabe 12, 2015, S. 2300-2311

Journal of Oral and Maxillofacial Surgery, Band 78, Ausgabe 12, 2020, S. 2160-2168

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.

Journal of Oral Biology and Craneofacial Research, Band 6, Ausgabe 2, 2016, S. 107-110

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.

Journal of Oral and Maxillofacial Surgery, Band 73, Ausgabe 5, 2015, S. 952-960