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1.
J Mech Behav Biomed Mater ; 119: 104512, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33930652

RESUMEN

Additive manufacturing (AM) offers great design freedom that enables objects with desired unique and complex geometry and topology to be readily and cost-effectively fabricated. The overall benefits of AM are well known, such as increased material and resource efficiency, enhanced design and production flexibility, the ability to create porous structures and on-demand manufacturing. When AM is applied to medical devices, these benefits are naturally assumed. However, hard clinical evidence collected from clinical trials and studies seems to be lacking and, as a result, systematic assessment is yet difficult. In the present work, we have reviewed 23 studies on the clinical use of AM patient-specific surgical guides (PSGs) for the mandible surgeries (n = 17) and temporomandibular joint (TMJ) patient-specific implants (PSIs) (n = 6) with respect to expected clinical outcomes. It is concluded that the data published on these AM medical devices are often lacking in comprehensive evaluation of clinical outcomes. A complete set of clinical data, including those on time management, costs, clinical outcomes, range of motion, accuracy of the placement with respect to the pre-operative planning, and extra complications, as well as manufacturing data are needed to demonstrate the real benefits gained from applying AM to these medical devices and to satisfy regulatory requirements.


Asunto(s)
Prótesis Articulares , Humanos , Porosidad , Articulación Temporomandibular/cirugía
2.
J Oral Maxillofac Surg ; 79(6): 1214-1229, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33716006

RESUMEN

PURPOSE: The purpose of this study was to describe the characteristics of the patient history, clinical findings, laboratory tests, treatment, and long-term function of septic arthritis of the temporomandibular joint (SATMJ). METHODS: All articles in the English literature related to SATMJ were queried using PubMed, Embase, and the Cochrane Library (1950 to July 1, 2020). The reference lists were reviewed for additional articles. RESULTS: A preliminary search of the literature returned 241 results, of which 37 met inclusion criteria, with an additional article from reference review. There were 93 total cases, with a mean age of 35.7 years (0.1 to 85). Symptoms mostly consisted of pain in the temporomandibular joint/preauricular region (n = 84, 90.3%), trismus (n = 73, 78.5%), and facial/preauricular swelling (n = 68, 73.1%). Most patients had no systemic symptoms (n = 80, 86.1%). The mean degree of mouth opening was 13.1 mm (5 to 35). Diagnosis was made with the following imaging modalities: radiograph (n = 48, 51.6%), CT scan (n = 35, 37.6%), MRI (n = 25, 26.9%), and ultrasound (n = 3, 3.2%). Staphylococcus aureus (n = 19, 20.4%) was most commonly isolated. About 92 patients (98.9%) received antibiotics and 85 patients underwent surgery (eg, arthrocentesis, arthroscopy, etc.), of which 15 patients (17.6%) required repeat surgery. Most long-term outcomes were favorable. Sequelae occurred in 26 of 85 patients (30.6%) with documented follow-up. CONCLUSIONS: SATMJ should be suspected in the presence of trismus, jaw pain, and preauricular swelling. Management includes prompt evaluation and treatment with broad-spectrum antibiotics. Surgery is not always indicated but can be life-saving in severe cases.


Asunto(s)
Artritis Infecciosa , Infecciones Estafilocócicas , Trastornos de la Articulación Temporomandibular , Adulto , Artritis Infecciosa/diagnóstico , Artrocentesis , Humanos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico
3.
J Oral Maxillofac Surg ; 79(6): 1191-1194.e1, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33736988

RESUMEN

Severe temporomandibular joint (TMJ) disorders result in structural changes that can significantly and negatively impact the jaw and airway, resulting in pain, difficulty chewing, dietary restrictions, sleep apnea, and other functional changes.1 For more than 5 decades, alloplastic total TMJ replacement has been used to treat end-stage intra-articular TMJ disorders. Commonly accepted measures of postsurgical success include maximal incisal opening (MIO), pain relief, and dietary and functional improvement.1 Diminished or unimproved lateral and protrusive jaw movement is a commonly accepted consequence of complete TMJ replacement.2 Lateral excursive and protrusive function should, however, be considered and reported as an important measure of success after alloplastic TMJ replacement. To achieve such success, surgeons must comprehensively plan the reconstruction and reattach the lateral pterygoid muscle's inferior head (LPM-IH) to the prosthetic TMJ to support normal functional occlusion and mandibular motion.


Asunto(s)
Prótesis Articulares , Músculos Pterigoideos , Cóndilo Mandibular/cirugía , Músculos Pterigoideos/cirugía , Rango del Movimiento Articular , Articulación Temporomandibular/cirugía
4.
J Int Med Res ; 49(3): 3000605211000526, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33752510

RESUMEN

Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.


Asunto(s)
Condromatosis Sinovial , Cuerpos Libres Articulares , Trastornos de la Articulación Temporomandibular , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Femenino , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Persona de Mediana Edad , Membrana Sinovial , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía
5.
Br J Oral Maxillofac Surg ; 59(4): 389-397, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33757662

RESUMEN

The aims of the present study were to comprehensively assess all the published cases on dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) in the literature in English and describe the clinical, imaging, and therapeutic variables for this condition. An electronic search was undertaken in March 2020 using PubMed/MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases. Eligibility criteria included publications with sufficient information to confirm the diagnosis. In addition, we have presented the case report of a 13-year-old boy with DMCCF, who was treated with craniectomy, arthroplasty, and reconstruction with a resorbable osteosynthesis material obtaining favourable and functional results. A total of 72 cases reported in English, including ours, were analysed and discussed. Most of the patients were female (n= 49) with a mean (range) age of 23.4 (5-72) years, the most affected condyle was the right (n= 42), the main aetiology was a motor vehicle accident, and half of the patients had intracranial lesions. Open treatment was performed in the majority with condylar surgery that included condylotomy and condylectomy. Temporomandibular joint arthroplasty was performed with bone, osteosynthesis material, and flap rotation. Timely treatment before four weeks was performed in most of the cases and, despite this, the persistence of the deviation was observed in more than a third of cases, with functional and neurosensorial sequelae. The present study allows an update of the characteristics of DMCCF and gives a current vision of how to manage this rare and complex fracture.


Asunto(s)
Luxaciones Articulares , Cóndilo Mandibular , Adolescente , Adulto , Anciano , Artroplastia , Fosa Craneal Media/cirugía , Femenino , Humanos , Luxaciones Articulares/cirugía , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Adulto Joven
6.
J Craniomaxillofac Surg ; 49(5): 373-380, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33663961

RESUMEN

The purpose of this study was to evaluate a modified method of interpositional arthroplasty for post-traumatic temporomandibular joint ankylosis. All patients were treated with a modified interpositional arthroplasty that included: navigation-assisted accurate bone dissection with minimal removal of only 5 mm of the ankylosed bony mass, novel application of bone wax and porcine acellular dermal matrix to prevent re-ankylosis, and a unique 3D-printed splint for occlusal stabilization and gap maintaining. The pre- and post-operative physical and radiological examinations of patients were recorded during routine follow-up visits. Postoperative follow-up visits lasted at least 12 months. Twelve patients, seven males and five females, ranging from 21 years to 59 years, were enrolled in this retrospective case series. All of the twelve patients with eighteen bony ankylosed temporomandibular joints were treated by our new method. The post-operative follow-up periods ranged from 1 year to 4 years. During the follow-up visits within at least 1 year, no one manifested re-ankylosis. The mean maximum incisor opening changed from 7.4 ± 5.3 mm (p < 0.001, before surgery) to 37.6 ± 3.9 mm (p < 0.001, last follow-up visit). No sign of post-operative infection or foreign body rejection was observed during the follow-up visits. The post-operative occlusal relationship was sound and stable. It is suggested that the modified method of interpositional arthroplasty provides favorable clinical and radiographic outcomes after a short-term follow up.


Asunto(s)
Anquilosis , Trastornos de la Articulación Temporomandibular , Animales , Anquilosis/diagnóstico por imagen , Anquilosis/cirugía , Artroplastia , Femenino , Humanos , Masculino , Estudios Retrospectivos , Porcinos , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía
7.
J Craniomaxillofac Surg ; 49(4): 256-268, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33622558

RESUMEN

A novel total temporomandibular joint replacement (TMJR) was developed with CADskills BV (Ghent, Belgium), aiming to achieve reinsertion of the (LPM) onto a scaffold in the implant. In order to investigate the possibility of reinsertion of the LPM, an animal experiment was conducted. An in vivo sheep experiment was conducted, which involved implanting sheep with a TMJR. Clinical parameters were recorded regularly and computed tomography (CT) scan images of two randomly selected sheep per scan were made at 1, 3, and 6 months. After 9.5 months, the sheep were euthanized, and CT scans of all animals were performed in order to evaluate the LPM's enthesis. A total of 13 sheep were implanted with a TMJR. One sheep was used as a sham. Radiographs revealed four outcome types of enthesis reconstruction. In four sheep, there was no reconstruction between the implant and the LPM. In three sheep, there was a purely soft tissue connection of 0.5-0.9 mm (average 0.7 mm) between the ostectomized bony LPM insertion and the implant's lattice structure. A combination of partial bony and partial soft tissue enthesis attachment (0.3-0.5 mm, average 0.4 mm) was found in three sheep. A bony ingrowth of the enthesis into the scaffold occurred in two sheep. A secondary bony connection between the mandible and the insertion of the LPM was found in 10 of 13 sheep. Four fossa components were found to be displaced, yet TMJ function remained in these ewes. The heterotopic ossification that was seen may be a confounding factor in these results. This in vivo experiment showed promising results for improving the current approach to TMJR with the possibility of restoring the laterotrusive function. The fossa displacement was considered to be due to insufficient fixation and predominant laterotrusive force not allowing for proper osseointegration. Further optimization of the reattachment technique, scaffold position and surface area should be done, as well as trials in humans to evaluate the effect of proper revalidation.


Asunto(s)
Experimentación Animal , Músculos Pterigoideos , Animales , Bélgica , Femenino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Ovinos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía
8.
J Oral Maxillofac Surg ; 79(6): 1344.e1-1344.e11, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33609445

RESUMEN

PURPOSE: Obstructive sleep apnea (OSA) is common in patients with bilateral temporomandibular joint ankylosis (TMJA). The purpose of this study was to compare the preoperative and postoperative apnea-hypopnea index (AHI) in patients with TMJA undergoing bilateral gap arthroplasty (BGA). METHODS: The investigators implemented a prospective cohort study on patients with bilateral TMJA treated with BGA. The primary predictor variable was time (before and after BGA). The primary outcome variable was AHI and secondary outcome variable included posterior airway space, skeletal changes, Epworth sleepiness scale, minimum oxygen, average oxygen saturation, and maximal incisal opening at preoperative time (T0), 1 month (T1), and at 6 months (T2). The statistical test used were Greenhouse-Geisser test, repeated measure ANOVA (1 way), followed by post hoc Bonferroni test. The P-value was taken significant when <0.05 at a confidence interval of 95%. RESULTS: The study sample included 12 (m:f = 1:2) patients of bilateral TMJA with a mean age of 14.9 ± 4.8 years and mean follow-up of 6 months. Mean duration of ankylosis was 10.5 ± 6.9 years (median = 12). Trauma was the main etiological factor in 11 (91.7%) patients followed by infection in 1 (8.3%) patient. The mean increase in AHI was 8.6 (T0 to T1) with P-value = .002 and 23.4 (T1 to T2) and was statistically significant (P = .001). The mean decrease in posterior airway space was 4.5 ± 1.0 to 3.5 ± 0.5 (T0 to T2) and was statistically significant (P = .02). Mean difference in minimum oxygen was 6.8 (P-value = .015). Skeletal changes are consistent with clockwise rotation of the mandible and statistically significant changes in horizontal and vertical dimension. The mean change in average oxygen was statistically insignificant (P = 1.0). CONCLUSIONS: The present study concludes that gap arthroplasty in patients with bilateral TMJA can lead to development or worsening of pre-existing mild to moderate OSA. Ramus-condyle reconstruction should be performed to prevent the retropositioning of mandible and worsening of OSA.


Asunto(s)
Anquilosis , Apnea Obstructiva del Sueño , Adolescente , Adulto , Anquilosis/diagnóstico por imagen , Anquilosis/cirugía , Artroplastia , Niño , Humanos , Estudios Prospectivos , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/cirugía , Articulación Temporomandibular/cirugía , Resultado del Tratamiento , Adulto Joven
9.
Br J Oral Maxillofac Surg ; 59(3): 286-291, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33589310

RESUMEN

With this research, we aimed to evaluate the effect of condylar osteochondroma (OC) resection through an intraoral approach on the masticatory functions. Resection of condylar OC was carried out via an intraoral approach with the help of three-dimensional (3D) design, endoscope, and navigation system. The T-Scan III computerised occlusal analysis system was used to evaluate the occlusal force distribution, recorded at pre-treatment (T1) and post-treatment (T2) intervals. Records of the clinical examination of the temporomandibular joint (TMJ), including maximal interincisal opening, mandibular lateral and forward movements, were also collected. Ten patients with condylar OC were enrolled in this study. The difference of force distribution between bilateral occlusion was reduced in T2 compared with T1 (11.92% ± 4.41% vs 48.52 % ± 28.37%, p<0.05), indicating better occlusal force distribution obtained after surgery. There was no significant difference in functions of the TMJ, such as maximal interincisal opening, and mandibular lateral and forward movements between T2 and T1 (p>0.05). Accordingly, condylar OC resection through an intraoral approach would obtain a satisfactory occlusal balance with no impairment of the temporomandibular joint functions.


Asunto(s)
Neoplasias Mandibulares , Osteocondroma , Asimetría Facial , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Osteocondroma/diagnóstico por imagen , Osteocondroma/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía
10.
J Craniomaxillofac Surg ; 49(3): 177-183, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33451942

RESUMEN

BACKGROUND: Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients. METHODS: During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed. RESULTS: A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p < 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p < 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%. CONCLUSION: For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.


Asunto(s)
Luxaciones Articulares , Trastornos de la Articulación Temporomandibular , Adolescente , Adulto , Femenino , Mentoplastia , Humanos , Imagen por Resonancia Magnética , Masculino , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento , Adulto Joven
11.
J Oral Maxillofac Surg ; 79(5): 1009-1018, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33434520

RESUMEN

PURPOSE: To evaluate the effect of preserving the muscle attachments when performing standard artificial temporomandibular joint replacement (TJR). PATIENTS AND METHODS: The clinical and radiological imaging data of patients who underwent standard artificial TJR with and without preservation of lateral pterygoid muscle (LPM) and masseter muscle attachments from January 2017 to December 2019 were collected. The maximum interincisal opening (MIO), lateral excursions and protrusion distances, visual analogue scale (VAS) scores of pain, diet, and quality of life (QoL) were recorded before the operation, and 1, 3, 6, and 12 months after the operation. The volumes of LPM and masseter muscles were measured and analyzed by computed tomography (CT) scans. RESULTS: Twenty-seven patients with 36 joints were included in the study. Among them, 11 joints had muscle attachment preserved, and 25 had no muscle attachment preserved. After surgery, the MIO, lateral excursions, and scores of diet, pain, and QoL in the preserved muscle attachment group were significantly better than those in the unpreserved group (P < .05). The measurement volumes of LPM and masseter muscles in the preserved group were significantly larger than that in the unpreserved group (P < .05). Changes of lateral excursion from the TJR side with and without LPM preservation were statistically correlated with the LPM volume (P < .05). CONCLUSION: Preserving muscle attachment for the standard artificial TJR is beneficial to the recovery of postoperative mandibular function.


Asunto(s)
Músculos Pterigoideos , Calidad de Vida , Humanos , Mandíbula , Músculos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía
12.
Medicine (Baltimore) ; 99(43): e22779, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120789

RESUMEN

This study aimed to measure temporomandibular joint (TMJ) with 3-dimensional (3D) reconstruction technique in Chinese northeast population, and to clarify the region for fixation and to provide morphological basis for the application of TMJ prosthesis in Chinese setting.Computed tomography (CT) scan and 3D reconstruction were performed with 132 individuals. Structural markers and measurements were further performed with a 3D model of the total TMJ, including the width, thickness and angle of zygomatic arch, the width and height of articular fossa, as well as the area, width, thickness and angle of mandible in the fixation region of the TMJ prosthesis. All the measured indicators values were compared between bilateral sides and gender groups.There was no statistical difference in the measured indicators between the left side and the right side (P > .05). However, certain parameters, including S, L5, L7, P4, and P5, were significantly different among males and females (P < .05).In this study, 3D CT image was used to obtain the measurement data of TMJ, which provided data support for the clinical application of TMJ prosthesis in Chinese population.


Asunto(s)
Imagenología Tridimensional/métodos , Mandíbula/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Prótesis Articulares , Masculino , Mandíbula/cirugía , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Factores Sexuales , Articulación Temporomandibular/cirugía , Adulto Joven
13.
PLoS One ; 15(9): e0238494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32886686

RESUMEN

The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.


Asunto(s)
Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Procedimientos Quirúrgicos Ortognáticos/métodos , Articulación Temporomandibular/cirugía , Adulto , Huesos Faciales , Femenino , Humanos , Masculino , Ortodoncia , Cirugía Ortognática , Dolor/complicaciones , Estudios Retrospectivos , Trastornos Somatomorfos/complicaciones , Trastornos de la Articulación Temporomandibular/terapia
14.
Tokai J Exp Clin Med ; 45(3): 152-155, 2020 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-32901906

RESUMEN

BACKGROUND: Temporomandibular joint (TMJ) dislocation can be categorized into three groups: acute, habitual or recurrent, and long-standing. Long-standing TMJ dislocation refers to a condition that persists for more than one month without reduction. Long-standing dislocation of the TMJ is rare and the most challenging and difficult to treat of the three. CASE REPORT: The present case study relates to a 53-year-old woman with long-standing TMJ dislocation of a year's duration who presented for treatment. Due to this condition, she was unable to take food orally, and nutrition was managed by gastrostomy tube feeding. She also suffered from schizophrenia and had been admitted to a closed hospital. Bilateral mandibular condylectomy was performed, restoring oral function. However, post-reduction, an open bite remained, restricting the types of food that she could eat. Additional intermaxillary fixation and intermaxillary traction would have been required for an optimal outcome, but they were not possible for this patient. CONCLUSION: Despite an inability to provide comprehensive treatment, due to patient-related factors, occlusal and masticatory functions were restored to adequate levels following bilateral condylectomy alone. This enabled oral feeding and improved her quality of life.


Asunto(s)
Ingestión de Alimentos , Luxaciones Articulares/cirugía , Cóndilo Mandibular/cirugía , Masticación , Boca/fisiopatología , Recuperación de la Función , Articulación Temporomandibular/cirugía , Femenino , Humanos , Luxaciones Articulares/fisiopatología , Persona de Mediana Edad , Calidad de Vida , Articulación Temporomandibular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
15.
J Vet Dent ; 37(2): 94-99, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32815477

RESUMEN

A 15-year-old Thoroughbred gelding was presented for investigation of fever, right temporomandibular region swelling, and progressive pain when opening the mouth. Right temporomandibular joint (TMJ) sepsis was diagnosed based on synovial fluid analysis, sonographic imaging, and standing robotic cone-beam computed tomography. Concurrent otitis media and temporohyoid osteoarthropathy (THO) were also noted. The horse was treated with arthroscopic debridement and lavage during standing sedation followed by local and systemic antimicrobial therapy. There were no complications associated with the surgical procedure and the gelding's clinical signs resolved. Arthroscopy of the TMJ can be accomplished in the standing horse and should be considered when arthroscopic exploration or debridement of this joint is indicated. This is also the first case report of concurrent otitis media, TMJ sepsis, and THO; due to their close anatomic relationship, it is possible that septic otitis media could lead to pathology in the TMJ and temporohyoid joint, as described in humans.


Asunto(s)
Enfermedades de los Caballos , Sepsis , Trastornos de la Articulación Temporomandibular , Animales , Artroscopía/veterinaria , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/cirugía , Caballos , Humanos , Masculino , Sepsis/diagnóstico , Sepsis/veterinaria , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/veterinaria , Irrigación Terapéutica/veterinaria
17.
J Oral Maxillofac Surg ; 78(10): 1692-1703, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32610046

RESUMEN

PURPOSE: The purpose of the present study was to report the temporomandibular joint (TMJ) alloplastic reconstruction (TMJR) revision and/or replacement rates and associated complication outcomes data gathered from experienced TMJ surgeons and to review the recent relevant data. MATERIALS AND METHODS: A 21-question anonymous on-line survey was sent to all Commission on Dental Accreditation-approved oral and maxillofacial surgery program directors and to members of the European Society of TMJ Surgeons and the American Society of Temporomandibular Joint Surgeons. RESULTS: Of the surgeons sent the survey, 22% completed the full questionnaire. Most responses were from surgeons who routinely perform TMJR surgery (93.5%). Of the respondents, 28.3% had more than 30 years of experience and 73.9% were full-time academic faculty. A total of 4638 TMJR procedures were recorded and analyzed. The incidence of TMJR revision (keeping the same device) was 3% and that of replacement (placing a new device) was 4.9%. The most common reason for revision was heterotopic ossification (27.5%). The most common reason for replacement was infection (21.1%). Revision was successful in 86.7% and replacement in 94.6% of the patients at the longest follow-up reported. CONCLUSIONS: The data from the present study have shown that the incidence is low and the success rate is high for TMJR revision and replacement.


Asunto(s)
Artroplastia de Reemplazo , Prótesis Articulares , Trastornos de la Articulación Temporomandibular , Humanos , Encuestas y Cuestionarios , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía
18.
J Oral Maxillofac Surg ; 78(10): 1759-1765, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32544471

RESUMEN

Synovial chondromatosis (SC) is an infrequent, benign condition of unknown etiology affecting the synovium within articular joints. Often considered a metaplastic process, multiple cartilaginous nodules develop in the confines of the synovial membrane. In time, these cartilage nodules develop into fragments, sometimes detaching from the synovium and, thus, become loose in an adjacent synovial cavity. The temporomandibular joint (TMJ) is an unusual site of involvement, with the extracapsular compromise of the cranial base exceedingly rare. A 68-year-old woman presented with a tender mass to the left TMJ that later proved to be SC. Computed tomography illustrated a rare extension of the lesion into the middle cranial fossa. The multidisciplinary effort to remove the mass in its entirety included both oral and maxillofacial surgical and neurosurgical teams. We have reviewed the presentation, diagnosis, surgical treatment, and outcomes of the present case, with diagnostic images and photomicrographs of the lesion included. We also briefly reviewed the reported studies.


Asunto(s)
Condromatosis Sinovial , Trastornos de la Articulación Temporomandibular , Anciano , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Fosa Craneal Media , Femenino , Humanos , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía
19.
Ann R Coll Surg Engl ; 102(8): e213-e215, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32588651

RESUMEN

Synovial chondromatosis is a rare benign condition. It most commonly affects the large joints. Presentation in the temporomandibular joint is rare. Our case was an incidental radiological finding and not diagnosed immediately, highlighting the ease with which conditions such as this can be missed, particularly in asymptomatic patients. Only 45% of patients with synovial chondromatosis show radiographic changes. Findings as significant as ours are unusual. An increased professional awareness of the radiological signs of synovial chondromatosis would be beneficial to improve diagnosis and prognosis for patients.


Asunto(s)
Condromatosis Sinovial , Articulación Temporomandibular , Humanos , Masculino , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Articulación Temporomandibular/cirugía
20.
J Oral Maxillofac Surg ; 78(9): 1492-1498, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32540323

RESUMEN

PURPOSE: The purpose of this study was to assess the efficacy of alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) in patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: All patients with a formal diagnosis of JIA requiring a TMJ patient-specific TJR between 2010 and 2018 at The University of Texas-Health at San Antonio were retrospectively analyzed. To be included, patients must have had a formal diagnosis of JIA, complete records, and TMJ reconstruction with the TMJ Concepts patient-specific total joint prosthesis (TMJ Concepts, Ventura, CA). Clinical data acquisition was required at a minimum of 12 months after surgery (longest follow-up [LFU]). Subjective and objective analyses were performed using a 10-point visual analog scale at the preoperative and LFU time points. Surgical data at the perioperative and LFU time points were recorded for comparison. RESULTS: Twenty patients with JIA met the inclusion criteria. The mean visual analog scale measurements for facial pain, TMJ pain, jaw function, diet, and disability were all significantly reduced at LFU. The maximal interincisal opening with pain was increased from 33.5 mm preoperatively to 44 mm at LFU, and the mean maximal interincisal opening without pain was increased from 31.1 mm preoperatively to 43 mm at LFU. None of the patients had complications from their TMJ TJR. CONCLUSIONS: Alloplastic TMJ reconstruction is a safe and efficacious treatment option for the surgical management of end-stage TMJ disease in JIA patients.


Asunto(s)
Artritis Juvenil , Artroplastia de Reemplazo , Prótesis Articulares , Artritis Juvenil/cirugía , Humanos , Estudios Retrospectivos , Articulación Temporomandibular/cirugía
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