Nuevos avances en las prótesis ATM customizadas: nuestra experiencia en el Hospital Universitario La Princesa / New advances in customized TMJ prosthesis: our experience at La Princesa University Hospital

INTRODUCCIÓN: Presentamos nuestra experiencia y serie de casos en los que se ha utilizado la prótesis de ATM diseñada y desarrollada en España por el Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant) junto con el Instituto Tecnológico de Canarias y Maxilaria. MATERIALES Y MÉTODOS: Pacientes tratados con patología de la articulación temporomandibular y que han sido reconstruidos con una prótesis de ATM. Esta prótesis tiene cuatro componentes, dos de la fosa articular (una parte de titanio y la otra de polietileno) y dos del cuerpo de la prótesis (cabeza de cromo-cobalto y rama de titanio). RESULTADOS: Se presentan los resultados preliminares de los pacientes reconstruidos con prótesis de ATM en los últimos 2 años en nuestro centro. Se han colocado un total de 8 prótesis en 6 PACIENTES: El diagnóstico de los pacientes fue anquilosis en 4 de los casos, y disfunción ATM avanzada en los otros 2. Se vio una mejoría, tanto del dolor como de la apertura oral, en un seguimiento mínimo de 6 meses. CONCLUSIÓN: Esta prótesis de ATM, de desarrollo nacional, tiene varias ventajas como son la posibilidad de recambio de algún componente y también el diseño del mismo hace que las fuerzas masticatorias se transmiten a la rama mandibular y no a los tornillos de la prótesis

INTRODUCTION: We present our experience and case series in which we used a TMJ prosthesis designed and developed in Spain by Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant), together with the Technological Institute of Canarias and Maxilaria. MATERIALS AND METHODS: Patients diagnosed with temporomandibular joint pathology who were reconstructed with a TMJ prosthesis. This prosthesis has four components, two of the articular fossa (one part of titanium and the other part of polyethylene) and two of the body of the device (condylar head of cobalt-chrome and ramus of titanium). RESULTS: We present the preliminary results of the patients reconstructed with a TMJ prosthesis in the past 2 years in our center. A total of 8 prosthesis were place in 6 PATIENTS: The diagnosis of the patients was TMJ ankylosis in 4 cases, and severe TMJ dysfunction in the other 2 cases. An improvement of both pain and also mouth opening was observed after a follow-up of at least 6 months. CONCLUSION: This TMJ prosthesis, developed in Spain, has many advantages, such as the possibility of replacement of some of the parts, as well as its design since the masticatory forces are transmitted to the mandibular ramus and not to the screws of the device

Arthroscopic disc fixation to the condylar head. Use of resorbable pins for internal derangement of the temporomandibular joint (stage II-IV). Preliminary report of 34 joints.

AIM: The study describes the arthoscopic use of resorbable pins for the internal derangement of the temporomandibular joint with McCain's technique. Clinical and image features are reported retrospectively. METHODS: Twenty-seven consecutive patients (34 joints) were included. Symptomatic internal derangement and anterior-medial disc displacement with or without reduction in magnetic resonance images (MRI) were diagnosed in all cases. Two resorbable pins (SmartNail) were placed in each joint employing arthroscopic surgery with a third portal for disc recapture and fixation to condylar head. Clinical data 24 months after surgery are reported (movements, pain score, clicking, laterodeviation, occlusal changes). In eight joints a MRI control was required between 1 and 2 years after surgery. RESULTS: Visual analogue scale values (0-100) decreased from 70.8 to 11.9 (p < 0.001) in the first control (week) and kept down after 24 months of follow-up (VAS: 4.8). Movements began to recover in 3 months and mouth opening increased from 34 mm to 43.2 mm 1 year after surgery (p < 0.001). Clicking, laterodeviation and contralateral excursions improvement were statistically significant (p < 0.001). MRI showed disc fixation to condyle head in closed and opened mouth. CONCLUSION: Disc fixation to condylar head with resorbable pins is a safe and satisfactory procedure. Pain becomes drastically reduced and mandibular function recovers normal parameters in patients with internal derangement.

Osteosíntesis intraoral asistida por endoscopia en las fracturas del proceso condilar de la mandíbula: revisión de 53 casos / Endoscopically assisted intraoral osteosynthesis in mandibular condylar process fractures: a review of 53 cases

Objetivos. La reducción anatómica con fijación rígida de la fractura extracapsular del cóndilo de la mandíbula es esencial para asegurar la correcta función articular. El abordaje intraoral ha demostrado ser una vía segura y de escasa morbilidad. Los autores revisan una serie de 53 pacientes con fracturas extracapsulares de cóndilo mandibular tratados mediante reducción abierta y fijación interna rígida a través de un acceso exclusivamente intraoral asistido por endoscopia. Material y métodos. El objetivo de la cirugía fue la reducción anatómica y la fijación interna mediante osteosíntesis rígida a través de una incisión intraoral. Se realizó una revisión de los casos intervenidos entre 2007 y 2011. Resultados. Treinta y cinco fracturas subcondíleas y 20 fracturas de cuello de cóndilo fueron intervenidas por este método. Un 55% de las fracturas presentaron una o más fracturas asociadas. A partir del control postoperatorio con ortopantomografía, se constató la corrección o mejoría del alineamiento de los fragmentos en 51 fracturas (92%). En 37 pacientes (69,8%) se evitó la fijación intermaxilar. En estos pacientes se recuperó la apertura oral a las 5 semanas y media de la cirugía. En el resto, el plazo fue de casi 9 semanas de media tras la retirada del bloqueo. Cinco pacientes presentaron alteraciones oclusales, mientras que una paciente presentó limitación de apertura oral. Conclusiones. La reducción abierta con fijación interna rígida de las fracturas extracapsulares de cóndilo mandibular mediante abordaje intraoral asistido por endoscopia es un tratamiento eficaz, seguro y reproducible(AU)

Objectives. The anatomic reduction with rigid fixation of an extracapsular mandibular condyle fracture is essential to ensure that the joint functions correctly. The intraoral approach has been shown to be safe and with a low morbidity. The authors review a series of 53 patients with extracapsular mandibular condyle fractures treated using open reduction and rigid internal fixation by an exclusively endoscopically assisted intraoral access. Material and methods. The purpose of the surgery was the anatomical reduction and internal fixation by means of rigid osteosynthesis via an intraoral incision. A review is presented of the cases where this procedure was used between 2007 and 2011. Results. Thirty five sub-condyle fractures and 20 condylar neck fractures repairs were made using this method. Over half of the fractures (55%) had one or more associated fractures. The correction or improved alignment of the fragments were observed in 51 (92%) using orthopantomography. Inter-maxillary fixation was avoided in 37 (69.8%) of the patients. In these patients the oral aperture recovered at five and a half weeks form the surgery. In the rest, the period was almost 9 weeks after the removal of the block. Five patients had occlusal changes, while one patient had an oral aperture limitation. Conclusions. Open reduction with rigid internal fixation of extracapsular mandibular condyle fractures using an endoscopically assisted intraoral approach is an effective, safe, and reproducible treatment(AU)

Osteonecrosis of the jaws and bisphosphonates. Report of three cases.

Bisphosphonates are recently acquiring increasing relevance in the treatment of several diseases. In line with the increased use of these compounds, cases of mandibular osteonecrosis, and to a lesser extent, maxillary osteonecrosis, are being reported. This necrosis is difficult to treat in patients who usually have a previously limited quality of life. A surgical performance carried out by oral and maxillofacial surgeons, stomatologists and odontologists might lead to bone exposure. A treatment based on conservation and as harmless as possible seems to be the most advisable way of acting with these patients in order to minimize the incidence and treat the complications, once the lesions have been ascertained. We report three cases treated in our service of osteonecrosis of the jaws after exodontics. This side effect should be remembered before starting any surgical treatment in these patients.

Osteonecrosis maxilar y bisfosfonatos. Presentación de tres nuevos casos / Osteonecrosis of the jaws and bisphosphonates. Report of three cases

Los bisfosfonatos están adquiriendo una relevancia terapéutica cada vez mayor, dada su utilidad en el manejo de diversas patologías.Con el incremento de su uso, se están documentando casos de necrosis ósea mandibular, y en menor medida maxilar, de difícil solución y con una importante afectación de la calidad de vida de los pacientes en tratamiento con estos fármacos.El factor que con mayor frecuencia desencadena el proceso es la actuación de los profesionales: odontólogos, estomatólogos y cirujanos orales y maxilofaciales. La previsión, las intervenciones atraumáticas y el tratamiento conservador, parecen ser los medios más adecuados para minimizarla incidencia o resolver las complicaciones.Este artículo presenta tres casos, seguidos por nuestro servicio, de pacientes con necrosis ósea maxilar tras procedimientos dentales, fundamentalmente exodoncias.El conocimiento de este posible efecto secundario de los bisfosfonatos debería ser tenido en cuenta antes de cualquier intervenciónen este tipo de pacientes

Bisphosphonates are recently acquiring increasing relevance in the treatment of several diseases.In line with the increased use of these compounds, cases of mandibular osteonecrosis, and to a lesser extent, maxillary osteonecrosis,are being reported. This necrosis is difficult to treat in patients who usually have a previously limited quality of life.A surgical performance carried out by oral and maxillofacial surgeons, stomatologists and odontologists might lead to bone exposure.A treatment based on conservation and as harmless as possible seems to be the most advisable way of acting with these patients in order to minimize the incidence and treat the complications, once the lesions have been ascertained.We report three cases treated in our service of osteonecrosis of the jaws after exodontics.This side effect should be remembered before starting any surgical treatment in these patients