Prospective analysis of temporomandibular joint reconstruction in ankylosis with sternoclavicular graft and buccal fat pad lining.

PURPOSE: To evaluate the feasibility of sternoclavicular graft (SCG) as an adaptive center along with buccal fat pad (BFP) lining for temporomandibular joint (TMJ) reconstruction in TMJ ankylosis. PATIENTS AND METHODS: A prospective, preliminary, short-term study with only 6 months' follow-up was performed in 10 patients with TMJ ankylosis. All patients had complete osseous ankylosis, and the mean duration of ankylosis was 6.4 years (range, 3 to 13 years). Interpositional arthroplasty with SCG along with BFP lining was done in all cases. Postoperative clinical and radiographic follow-up was performed for 6 to 9 months. RESULTS: Maximum interincisal opening at 6 months' follow-up was 35.6 ± 4.97 mm (range, 31 to 45 mm). Similarly, protrusive movement at follow-up of 6 months was 2.7 ± 1.25 mm (range, 1.5 to 5.5 mm), whereas laterotrusive movement was 4.1 ± 1.98 mm (range, 1.5 to 7.0 mm) toward the affected side and 2.4 ± 0.99 mm (range, 1 to 4.0 mm) toward the normal side. After 3 months, 9 of 10 patients had no pain on function, and all the patients were relieved of pain at the end of 6 months. On radiographic follow-up at 9 months, there was noticeably significant adaptation and remodeling of SCG as observed on panoramic radiography and computed tomography scan. In all the patients there was some degree of mandibular deviation toward the operated side, although the occlusion was satisfactory and they were pleased with the outcome. CONCLUSION: On the basis of the findings of this study, we conclude that after release of TMJ ankylosis, reconstruction with SCG combined with interposition of BFP lining followed by vigorous physiotherapy is a successful strategy for the management of TMJ ankylosis with short-term follow-up of 6 months.

A comparative clinical evaluation of the outcome of patients treated for bilateral fracture of the mandibular condyles.

AIM: To compare open reduction and internal fixation (ORIF) with closed treatment and maxillomandibular fixation (CRMMF) for management of bilateral subcondylar fractures of the mandible. PATIENTS AND METHODS: This study involved a retrospective analysis of bilateral subcondylar fractures of the mandible treated at Government Dental College, Rohtak from 2007 to 2010. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic results. Patients were followed up weekly for 4 weeks and then at 2, 3 and 6 months after surgery. At these visits, careful attention was paid to clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening and occlusion. RESULTS: The patient sample ranged in age from 19 to 55 years, with an average age of 28.2 years. In total, 44 patients with 88 mandibular subcondylar fractures were included in the study. Out of these, 20 patients were managed by closed treatment and 24 by ORIF of the subcondylar fractures (19 unilateral and 5 bilateral). Regarding mouth opening/lateral excursion/protrusion, significant (p=0.00) differences were observed between both groups (open 37.6/11.5/5.9 mm versus closed 31.5/7.8/3.1mm). The visual analogue scoring revealed significant (p=0.00) difference with less pain in the operative treatment group (1.3 open versus 7.2 closed). Statistically significant difference was found between two groups for occlusion (p=0.00). CONCLUSION: The current retrospective study shows that operative treatment was superior in all objective and subjective functional parameters. It is concluded that if either of the condyles is displaced ORIF is the most satisfactory method of treatment.

Retrospective analysis of use of buccal fat pad as an interpositional graft in temporomandibular joint ankylosis: preliminary study.

PURPOSE: To evaluate the feasibility and usefulness of buccal fat pad as an interpositional graft in the treatment of temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: A retrospective study of 10 patients with TMJ ankylosis (9 unilateral and 1 bilateral) was performed with follow-up of 6 months to 2 years. RESULTS: In the present study, patients had a maximum interincisal opening of 32 to 41 mm (mean, 35.1 mm) at the latest follow-up. Mean deviation to the affected side on mouth opening was 1.6 mm (range, 0 to 4 mm), but chewing function was good and all the patients were satisfied. No major occlusal changes were observed and all the patients had satisfactory occlusion at the follow-up periods. No facial paresis of temporal and zygomatic branch of facial nerve was observed in any case. Periodic panoramic radiographs showed well-maintained intra-articular space because of the interposed tissue, with no signs of relapse. CONCLUSION: The findings of this study showed the short-term successful management of TMJ ankylosis using buccal fat pad as an interpositional graft.