Remodelling of mandibular condylar head after fixation of fractures with ultrasound activated resorbable pins: A retrospective case series.

The aim of this study was to assess whether the resorption of poly-lactic acid pins, used for condylar head fracture fixation, adversely affect remodelling of the condylar head. A retrospective review of patients was performed that underwent ORIF of CHF with ultrasound activated resorbable poly-lactic acid pins and had CT/CBCT scans of the condyle at least 18 months after surgery, at which point the fixation material was expected to be resorbed. We reviewed the size, shape and position of the condylar head and compared this to the normal side and compared this to the results of conservative management and ORIF with titanium screws in the literature. Most patients had condylar heads normally positioned and shaped, with minimal bone changes. The position of the condyle in the fossa, its shape and bone changes compare favourably with previous studies on CHF managed conservatively or with titanium screw fixation. There was no radiographic evidence of the pins after 18 months. In conclusion, ultrasound activated resorbable pins can provide suitable fixation for ORIF of condylar head fractures, avoiding the need for screw removal, and there was no evidence that the resorption process adversely affected the remodelling of the condylar head.

Management of the secondary growth defect.

Temporomandibular reconstruction has clear aims including the restoration of mandibular form and function, to decrease patient disability and to prevent disease progression. In addition paediatric patients have growth and re-modelling considerations and the need to minimise any secondary growth defect. The involvement of a multidisciplinary team is deemed essential for both the child and parents. In some patients crisis intervention may be required and early reconstruction might be necessary dependant on the severity of impairment. The aetiology of end stage TMJ disease, unilateral/bilateral disease and the degree of patient compromise will guide timing and choice of treatment. Reducing repeated surgery and facilitating patient compliance may potentiate mandibular growth.

Autogenous Reconstruction of the Temporomandibular Joint.

Reconstruction of the temporomandibular joint can optimize many basic functions (airway obstruction, feeding, speech difficulties) and rectify facial deformity. In children, it can restore potential growth. Reconstruction in adults is now mainly performed with alloplastic techniques but autogenous vascularized grafts are often required in patients with large composite facial defects or postradiation treatment. In children, autogenous grafting remains the primary reconstructive choice despite a high further surgery rate and increasing interest in alloplastic techniques. The costochondral graft remains the most widely used technique due to the potential for growth restoration and low donor site morbidity.

The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation.

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

Treatment of calcium pyrophosphate deposition in the temporomandibular joint with resection and simultaneous reconstruction using a custom joint prosthesis.

PURPOSE: The authors present a rare case of calcium pyrophosphate deposition disease (CPPD) in the temporomandibular joint (TMJ), successfully treated with complete resection and immediate reconstruction using a custom-made prosthesis. This one-stage approach has prevented the patient from requiring two surgeries and has proven effective in the management of the condition. METHODS: Our patient, a 56-year-old male, presented with left TMJ pain and trismus. Investigations showed a destructive left TMJ mass, confirmed by biopsy to be tophaceous pseudogout. The treatment involved excising all the affected tissues followed by condylectomy, coronoidectomy, and a total TMJ replacement. The patient recovered well from surgery with good mouth opening. RESULTS: CPPD disease is a metabolic arthropathy of poorly understood aetiology. Management options vary from conservative non-surgical to surgical treatment depending on the severity. CONCLUSION: This case demonstrates the feasibility of a one-stage procedure with reconstruction using a custom-made prosthesis and virtual planning.

Treatment of fractures of the mandibular condylar head with ultrasound-activated resorbable pins: early clinical experience.

Controversy continues about the benefits and disadvantages of open reduction and internal fixation of fractures of the condylar head. Once a decision to treat surgically has been made, an appropriate method of fixation must be chosen. Standard titanium fixation has a number of complications, including the risk of protrusion of the screw beyond the condylar head and the possible need for removal later. Resorbable fixation is an alternative, and ultrasound-activated resorbable pins are a new innovation. We have treated a series of 15 patients with 17 fractures of the condylar head, in which the use of ultrasound-activated resorbable fixation has provided adequate strength and stability during early healing. Complications included technical difficulties in achieving complete anatomical reduction as a result of fragmentation of the condylar head, and three facial nerve palsies, two of which recovered within three months. No pins failed, and there was no sign of instability during healing.

Chronic pain related to first bite syndrome: report of two cases.

First bite syndrome is the classic symptomatology of pain in the parotid region that occurs in response to the first bite of a meal. We report two cases of this syndrome in patients after operations to the parapharyngeal space.

Acute bilateral tongue necrosis--a case report.

We report the case of an 88-year-old lady who presented with acute necrosis of the whole tongue. Giant cell arteritis was suspected, and early treatment with corticosteroids led to complete resolution and no need for further intervention. We emphasise the importance of early diagnosis of giant cell arteritis and treatment with corticosteroids to stabilise the condition and to avoid serious ocular complications.

Birth prevalence of cleft lip and palate in Sucre, Bolivia.

OBJECTIVES: To determine the birth prevalence of cleft lip and palate (CL +/- P) in the municipality of Sucre, Bolivia. To ascertain whether the birth prevalence in this region differs significantly from birth prevalence reported in similar populations and other racial groups. RESULTS: Twenty-eight clefts were identified among 22,746 live births between the years 1995 and 2001 in three maternity hospitals in the city. The total birth prevalence of CL +/- P was 1.23/1000 live births per year. There were 12 clefts of the lip alone (birth prevalence 0.53/1000 per year), 15 cleft lip and palate (0.66/1000 per year), and one cleft palate only (0.04/1000 per year). CONCLUSIONS: The birth prevalence was not significantly different from birth prevalence published previously in South American populations, although it is lower than previously published data from Bolivia. The birth prevalence of CL +/- P in this South American population was similar to published data in white subjects and between those found in black and oriental groups. The sex ratio and birth prevalence of simultaneous congenital malformations also did not differ from previously published figures.