Treatment of Dentofacial Deformity Associated with Temporomandibular Joint Ankylosis Through Vertical and Sagittal Osteotomies of the Mandibular Ramus.

ABSTRACT: Ankylosis of the temporomandibular joint is a disorder resulting from fibrous, osseous, or fibro-osseous adhesion that directly affects the quality of life of the individual. The authors present a case of unilateral temporomandibular joint ankylosis treated by condilectomy and ipsilateral sliding vertical ramus osteotomy associated with contralateral sagittal osteotomy aiming to restore function and to correct dentofacial deformity class II. A 31-year-old female patient presented with a history of facial trauma and major complaint of oral opening limitation. Physical examination revealed hypoplasia of the lower third of the face, facial pattern type II, anterior open bite, and maximum mouth opening of 22.5 mm. Computed tomography showed an ankylotic mass in the right mandibular condyle with deformity of the condylar structure and fusion to the right zygomatic arch and a contralateral condylar fracture sequel. It was proposed to perform a condilectomy of the right mandibular condyle for the removal of the bone mass concomitant to the sliding vertical ramus osteotomy of the mandibular ramus for condylar reconstruction by rhytidectomy approach and the sagittal osteotomy of the left mandibular aiming the reestablishment of occlusion and the correction of dentofacial deformity. The condylar fracture was not operated because the condyle was remodeled. The patient is in her fourth year postoperative presenting satisfactory esthetic-functional re-stabilization, without clinical signs of recurrence. In conclusion, the authors believe that combined sliding vertical ramus osteotomy and sagittal osteotomy can bring satisfactory results in complex cases.

Uma forma rara de ocorrência do Schistosomus reflexus em bovinos / A rare form of occurrence of Schistosomus reflexus in bovine / Una Forma Rara De Ocurrencia De Schistosomus Reflexus En Vacuno Relato Del Caso

O Schistosomus reflexus (SR) é uma anomalia congênita fatal e rara, primariamente observada em ruminantes, gestando um feto com dobradura da coluna vertebral, exposição das vísceras abdominais e torácicas, anquilose dos membros, hipoplasia hepática e diafragmática, escoliose e anormalidade do sistema digestório e genitourinário. Foi trazido aoHospital Veterinário da FMVZ - UNESP Botucatu/ SP, uma aberração congênita disforme removida por tração forçada em um parto distócico de vaca mestiça, pertencente a um criador do Município de Lençóis Paulista/ SP. Pelas características gerais e achados de necropsia foi possível concluir tratar-se de um caso raro de SR, não havendo na literatura relato de caso similar desta má formação integralmente revestida pela epiderme e derme.(AU)

The Schistosomus reflexus (SR) is a fatal congenital and rare aberration, found primarily in ruminants, gestating a fetus with folding of the backbone, exposure of the abdominal and thoracic viscera, ankylosis of the limbs, diaphragm and liver hypoplasia, scoliosis and abnormalities of the digestive and genitourinary systems. A deformed congenital aberration removed by forced traction in dystocia of a crossbred cow, belonging to a breeder of Lençóis Paulista/ SP city was attended in Veterinary Hospital of FMVZ - UNESP Botucatu/ SP. Trough the general characteristics and necropsy findings we concluded that this is a rare case of SR. There are no reports about similar cases of this malformation, malformation completely covered by epidermis and dermis.(AU)

El Schistosomus reflexus (SR) es una anomalía congénita fatal y rara, que se encuentra principalmente en rumiantes, gestando un feto con plegado de la columna vertebral, la exposición de las vísceras abdominales y torácicas, anquilosis de las extremidades, hipoplasia hepática y diafragmática, escoliosis y anomalías del sistemas digestivo y genitourinario. Fue llevado al Hospital Veterinario, FMVZ - UNESP - Botucatu /SP, una aberración congénita deforme removida por tracción forzada en la distocia de vaca mestiza perteneciente a un ganadero en la ciudad de Lençóis Paulista /SP. Por las características generales y resultados de la necropsia fue posible concluir que este es un caso raro de SR, no hay informes sobre casos similares de esta malformación totalmente cubiertos por la epidermis y dermis. (AU)

Uma forma rara de ocorrência do Schistosomus reflexus em bovinos / A rare form of occurrence of Schistosomus reflexus in bovine / Una Forma Rara De Ocurrencia De Schistosomus Reflexus En Vacuno – Relato Del Caso

O Schistosomus reflexus (SR) é uma anomalia congênita fatal e rara, primariamente observada em ruminantes, gestando um feto com dobradura da coluna vertebral, exposição das vísceras abdominais e torácicas, anquilose dos membros, hipoplasia hepática e diafragmática, escoliose e anormalidade do sistema digestório e genitourinário. Foi trazido aoHospital Veterinário da FMVZ - UNESP – Botucatu/ SP, uma aberração congênita disforme removida por tração forçada em um parto distócico de vaca mestiça, pertencente a um criador do Município de Lençóis Paulista/ SP. Pelas características gerais e achados de necropsia foi possível concluir tratar-se de um caso raro de SR, não havendo na literatura relato de caso similar desta má formação integralmente revestida pela epiderme e derme.

The Schistosomus reflexus (SR) is a fatal congenital and rare aberration, found primarily in ruminants, gestating a fetus with folding of the backbone, exposure of the abdominal and thoracic viscera, ankylosis of the limbs, diaphragm and liver hypoplasia, scoliosis and abnormalities of the digestive and genitourinary systems. A deformed congenital aberration removed by forced traction in dystocia of a crossbred cow, belonging to a breeder of Lençóis Paulista/ SP city was attended in Veterinary Hospital of FMVZ - UNESP – Botucatu/ SP. Trough the general characteristics and necropsy findings we concluded that this is a rare case of SR. There are no reports about similar cases of this malformation, malformation completely covered by epidermis and dermis.

El Schistosomus reflexus (SR) es una anomalía congénita fatal y rara, que se encuentra principalmente en rumiantes, gestando un feto con plegado de la columna vertebral, la exposición de las vísceras abdominales y torácicas, anquilosis de las extremidades, hipoplasia hepática y diafragmática, escoliosis y anomalías del sistemas digestivo y genitourinario. Fue llevado al Hospital Veterinario, FMVZ - UNESP - Botucatu /SP, una aberración congénita deforme removida por tracción forzada en la distocia de vaca mestiza perteneciente a un ganadero en la ciudad de Lençóis Paulista /SP. Por las características generales y resultados de la necropsia fue posible concluir que este es un caso raro de SR, no hay informes sobre casos similares de esta malformación totalmente cubiertos por la epidermis y dermis.

A anquilose tíbio-társica e sua importância na insuficiência venosa crônica / Ankle ankylosis and its importance in chronic venous insufficiency

CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC) pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII) medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens) com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados) de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle), 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54); a do grupo C3 foi de 37,9º (variação de 10-61); e a do grupo C4 foi de 24,5º (variação de 8-50). A diferença das médias de C4 e C3 foi de 36 por cento, e a de C3 comparada com o grupo-controle (C0), de 11 por cento, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.

BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI) can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males) with a mean age of 50.6 years had their ankles assessed by a goniometer. Patients were classified into three groups according to the severity of the CVI of the lower limbs (121 were assessed) using the CEAP classification. There were 40 limbs classified as C0 (control group), 40 limbs as C3 and 41 limbs as C4. Measurements of all groups were compared. RESULTS: The average ankle range of motion was 42.4º (from 26º to 54º) in C0 group, 37.9º (from 10º to 61º) in C3 group and 24.5º (from 8º to 50º) in group C4. The difference between C4 and C3 average values was 36 percent and that between C3 and the control group (C0) was 11 percent; thus, the contrast between C3 and C4 was more significant. CONCLUSION: Ankle goniometry may be used to assess chronic venous hypertension, as it reveals a correlation between the severity of ankylosis and the severity of CVI.

SAPHO syndrome with temporomandibular joint ankylosis: clinical, radiological, histopathological, and therapeutical correlations.

The SAPHO syndrome is characterized by specific clinical manifestations of synovitis, acne pustulosis, hyperostosis, and osteitis. It is a rare disease with a combination of osseous and articular manifestations associated with skin lesions. We describe a patient with SAPHO syndrome of the mandible and involvement of the temporomandibular joint (TMJ ankylosis). The findings from orthopantomography, computed tomography (CT), and clinical and histopathological examinations are compared and analyzed to improve the final diagnosis. Our patient was submitted to a bilateral high condylectomy and coronoidectomy to correct the open mouth limitation. No previous report of SAPHO syndrome associated with secondary TMJ ankylosis was found in the literature.

Orthodontic and surgical treatment of a patient with an ankylosed temporomandibular joint.

This article describes the surgical and orthodontic treatment of a girl with facial deformities and functional involvement. The left temporomandibular joint was ankylosed, and the lower third of the face was markedly deficient, with mandibular retrusion and severe laterognathism to the left side. Mouth-opening was limited, and the patient had problems speaking and chewing. Two surgical procedures had been performed previously at another institution. We treated the patient with condylar surgery while she was still growing, followed by orthodontic treatment and orthognathic surgery after growth was complete. Twelve-year follow-up records are presented.

Prospective study of facial nerve function after surgical procedures for the treatment of temporomandibular pathology.

PURPOSE: The aim of this prospective study was to report facial nerve injury following surgical procedures for the treatment of temporomandibular pathology, using the House-Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury. PATIENTS AND METHODS: The sample consisted of 32 patients who underwent temporomandibular joint (TMJ) surgery. A total of 50 approaches were carried out. Surgical procedures consisted of TMJ reconstruction, gap arthroplasty, eminectomy, bone plates for the treatment of chronic mandibular luxation, and disc plication. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, and 3 months. RESULTS: Of the 32 patients, 12.5% (ie, 8% of the 50 approaches) showed signs of facial nerve injury after TMJ surgery. The prevalence of postoperative facial nerve injury was significantly greater in the patients who had ankylosis (P = .014) and in those submitted to gap arthroplasty (P = .011). At 24 hours, none of the patients showed total nerve paralysis or severe dysfunction, only a moderately severe dysfunction (50%), or moderate dysfunction (50%). The forehead was the most affected area measured. At 3 months, all patients had recovered their normal facial nerve function. The overall improvement in facial nerve function was 40% for the patients classified initially with moderately severe dysfunction and 60% for those with moderate dysfunction. CONCLUSION: The frequency of facial nerve injury was related to the diagnosis of the temporomandibular pathology and surgical procedures. Facial nerve impairment was shown to be of a temporary nature. Moreover, there is a need to standardize the reporting of facial nerve recovery.

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty.

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.

A possible case of white muscle disease complicated by arthrogryposis and atresia ani in and Anglo Nubian kid in Trinidad and Tobago

There have been many instances of livestock congenital defects in Trinidad and Tobago; however, this case is an interesting one because of the number of defects observed and systems involved in an individual animal. A 2-day-old male Anglo Nubian kid was presented to The University of the West Indies, Faculty of Medical Sciences, School of Veterinary Medicine. The kid was weak, unable to walk, unable to stand and had not suckled since birth, unlike its twin. After detailed physical examination the kid was euthanized and subsequent post mortem examination and histological analysis of tissues revealed atresia ani, numerous muscular defects, severe hepatic necrosis and ankylosis of the joints, strongly suggesting a possible complicated case of White Muscle Disease.

Osteogenic distraction and orthognathic surgery to correct sequelae of ankylosis of the temporomandibular joint: a case report.

A 17-year-old female patient presented with sequelae to ankylosis of the temporomandibular joint, which included vertical maxillary protrusion, anterior open bite, labial incompetence, micrognathia, undefined neck angle, facial asymmetry, Class II molar relationship, and Class III canine relationship. She presented with the following cephalometric and soft tissue data: SNA angle = 78 degrees, SNB angle = 70 degrees, incisor-nasion-point A = 11 degrees, incisor-nasion-point B = 33 degrees, Frankfort-mandibular plane angle = 43 degrees, occlusal plane = 25 degrees, subnasale-stomion = 20 mm, stomion superius-stomion inferius = 9 mm, stomion inferius-soft tissue menton = 30 mm, neck angle = 144 degrees, and chin projection = 10 mm. Orthognathic surgery and mandibular osteogenic distraction were employed, specifically Le Fort I osteotomy to decrease a vertical excess of 12 mm, augmentation genioplasty of 17 mm, and bilateral extraoral distractors of bidirectional vector for a 14-mm augmentation of the mandible. The result was satisfactory with minimal adverse complications.

Reabsorção radicular: etiologia, patogênese, classificação e manifestações clínicas / Root resorption: etiology, pathogenesis, classification and clinical manifestations

Este artigo revisa a classificação, os inúmeros agentes etiológicos e a patogênese da reabsorção radicular. A estrutura dentária mineralizada não é normalmente reabsorvida, pois possui células capazes de promover sua manutenção, defesa e reparação. Caso essas células sejam danificadas ou removidas, células multinucleadas colonizarão essa região e o processo reabsortivo se iniciará. Esse tipo de reabsorção foi denominada reabsorção radicular inflamatória. Ocorrendo nas paredes do canal radicular, é dita interna e, na superfície externa da raiz, externa. A reabsorção radicular pode ser transitória ou progressiva

Pierre Robin sequence and obstructive sleep apnea.

The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS) and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT) performed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

Pierre Robin sequence and obstructive sleep apnea

É relatado o caso de paciente do sexo feminino de 12 anos de idade, com sequência de Pierre Robin, cuja reduçäo da luz faríngea leva a apnéia do sono tipo obstrutivo e consequente sonolência excessiva diurna. Estudo radiológico articular, tomografia computadorizada e ressonância nuclear magnética evidenciam anquilose bilateral da articulaçäo têmporo-mandibular. Cefalometria mostra reduçäo acentuada do espaço aéreo posterior. Polissonografia realizada durante três noites inteiras apresenta síndrome de apnéia do sono tipo obstrutivo, severa, acompanhada de reduçäo da saturaçäo de oxigenio. No Teste das Latências Múltiplas do Sono (TLMS) há objetivamente sonolência excessiva diurna, com descréscimo da latência do sono; näo ocorre estágio REM. Avaliaçäo polissonográfica, do TLMS e radiológica extensa permitem, neste caso, estagiar a severidade de acometimento e as malformaçöes concomitantes e detectar o sítio de obstruçäo

Complicações das fraturas mandibulares / Complication of mandibular fractures

Os autores apresentam revista da literatura a respeito das complicações das fraturas mandibulares, evidenciando os tipos, sua etiologia e seus aspectos clínicos. Destacam que a ocorrência de infecções, pseudoartrose, consolidação viciosa e anquilose da articulação temporomandibular está relacionada principalmente a procedimentos iatrogênicos

Tarsal ankylosis in juvenile and adult onset rheumatoid arthritis.

It has been suggested that tarsal arthritis with ankylosis may be characteristic of late onset Still's disease. In our study 16 of 88 (18%) patients with juvenile rheumatoid arthritis (JRA) and 22 of 97 (23%) patients with adult RA had radiographic findings of tarsal joint ankylosis. In our patients, tarsal bony fusion was not related to type of disease onset, age of onset or sex; rather it was related to a longer duration of disease. Tarsal ankylosis should not be regarded as a special feature of Still's disease since it can also be seen in adult RA.