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1.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(1): 113-118, 2020 Feb 18.
Artículo en Chino | MEDLINE | ID: mdl-32071473

RESUMEN

OBJECTIVE: To investigate the effect of preoperative condylar condition for mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis on the stability of the jaw after orthognathic surgery and on the postoperative condylar volume changes. METHODS: In this retrospective study, from 2014 to 2019, 37 patients including 1 male and 36 female, aged between 21 to 34 years old with an average age of (28.03±6.52) years, were diagnosed with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis by Peking University School and Hospital of Stomatology and received orthognathic surgery, meeting the inclusion criteria were included. According to the preoperative condylar condition. There were divided into smooth group and non-smooth group, the lateral cephalometric films 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery were used to establish the coordinate system and cephalometric analysis to determine the stability of the jaw after operation. The three-dimensional model of the condyle was segmented by cone beam computed tomography (CBCT) 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery and the volume was obtained to evaluate the change of the condyle volume after surgery. CBCT image data was used to evaluate the changes of the condylar condition after surgery, and to clarify the correlation between the postoperative condylar condition and jaw stability. SPSS 20.0 statistical software was used for statistical analysis, Fisher's exact probability methods were used to compare whether there were statistically significant differences in the stability of the mandibular joint at stages T1, T2 and T3 with different preoperative condylar condition.Spearman correlation coefficient analysis and Mann-Whitney test were used to compare whether there were statistically significant differences in the volume changes at stages T1, T2 and T3 after surgery between the two groups. RESULTS: The recurrence rates of the mandible in the condylar smooth group were T1 36.85%, T2 47.37% and T3 42.11%, respectively. The recurrence rates in the non-smooth condylar group were T1 27.78%, T2 44.44% and T3 55.56%, respectively. There was no statistical difference in the recurrence rates between the two groups at different time points. There was no significant difference in the condylar volume change between smooth group and non-smooth group. CONCLUSION: For patients with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis and no significant changes in the condyle observed for one year before surgery, there is no difference in the influence of the preoperative condylar condition on the stability of jaw after operation, and no definite influence on the volume of the condyle after operation. Condylar resorption 3 months after surgery can cause instability of the jaw after orthognathic surgery.


Asunto(s)
Cirugía Ortognática , Osteoartritis , Articulación Temporomandibular/cirugía , Adulto , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Mandíbula , Cóndilo Mandibular , Osteoartritis/cirugía , Estudios Retrospectivos , Adulto Joven
2.
J Craniomaxillofac Surg ; 47(12): 1913-1917, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810846

RESUMEN

This report aims to present the concept of reestablishing lateral pterygoid muscle function during total temporomandibular joint (TMJ) replacement surgery. The key feature is a lattice structure (scaffold) located in the condylar neck of a titanium, three-dimensionally (3D)-printed mandibular component that houses morselized autologous bone from the resected condyle and osteogenic stem cells from iliac bone marrow aspirate, and to which the fibrous enthesis component (collagen attachments to a bone fragment) is fixed via suture cerclage prior to the development of the bony union. Five TMJs were replaced using enthesis reconstruction in three patients who were followed for 1 year and more. Laterotrusion to the contralateral side measured on average 6.4 mm preoperatively, 2.3 mm at 1 month, 3 mm at 3 months, 4 mm at 6 months, and at 1-1.5 years (62,5% of the preoperative laterotrusion/40% of a normal laterotrusion). Subjective normalization of mastication after 1 year was present in all patients. A successful reattachment of the enthesis to an alloplastic endoprosthesis suggests that patients will not only be able to open and close their mouths properly with reduced pain but will also be able to actually chew. The technique has potential applications in orthopedic alloplastic reconstruction.


Asunto(s)
Artroplastia de Reemplazo , Músculos Pterigoideos/fisiología , Articulación Temporomandibular/fisiología , Articulación Temporomandibular/cirugía , Humanos , Imagenología Tridimensional/métodos , Cóndilo Mandibular/fisiología , Tendones
3.
Prague Med Rep ; 120(2-3): 64-73, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31586505

RESUMEN

Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients' status and any complications of using TMAP from the years 2013-2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% - in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.


Asunto(s)
Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Músculo Masetero , Glándula Parótida , Complicaciones Posoperatorias , Articulación Temporomandibular/cirugía , Humanos , Fracturas Mandibulares/complicaciones , Músculo Masetero/cirugía , Glándula Parótida/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
4.
J Craniofac Surg ; 30(7): 2253-2256, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31513037

RESUMEN

This paper describes the application of a modified digital surgical guide, an occlusal template and a pre-formed reconstruction titanium plate in the open reduction and internal fixation of a bilateral mandibular fracture. Bilateral mandibular fracture is a commonly encountered simple type of fracture. However, even for an experience surgeon, achieving precise treatment remains a challenge due to the movable temporomandibular joint, unstable fractured segments, the difficulty in forming a reconstruction plate, and the lack of an effective stabilizing and locating device. In this case, the surgeon used a specially-designed modified guide together with a reconstruction plate and an occlusal template to treat a bilateral mandible fracture, effectively improving the accuracy and the medical outcome of the operation, saving operation time and reducing postoperative complications.


Asunto(s)
Fracturas Mandibulares/cirugía , Reconstrucción Mandibular , Adulto , Placas Óseas , Fijación Interna de Fracturas , Humanos , Masculino , Fracturas Mandibulares/diagnóstico , Reconstrucción Mandibular/instrumentación , Tempo Operativo , Complicaciones Posoperatorias , Cirugía Asistida por Computador , Articulación Temporomandibular/cirugía , Titanio
5.
Shanghai Kou Qiang Yi Xue ; 28(3): 275-278, 2019 Jun.
Artículo en Chino | MEDLINE | ID: mdl-31489415

RESUMEN

PURPOSE: To explore the correlation between increased vertical dimensions and temporomandibular joint (TMJ) spaces of patients with severe tooth wear after occlusal reconstruction treatment. METHODS: The TMJ spaces and the condylar positions of 30 patients were measured by cone-beam CT (CBCT) before and after treatment. SPSS 19.0 software package was used to analyze the anterior, superior and posterior space of TMJ. Independent sample t test was utilized to evaluate the correlation between vertical dimension and TMJ spaces. RESULTS: There was no significant difference between TMJ spaces of two sides, the data of two sides were combined for further analysis. The mean anterior interspace, superior interspace, posterior interspace was (2.01±0.52)mm, (3.15±0.94)mm, (2.70±0.98)mm before treatment, and (2.03±0.35)mm, (3.46±0.74)mm, (2.79±0.58)mm after treatment, respectively. Based on calculating the In(P/A) and linear ratio(LR), condylar position moved backward for 52% patients before treatment. After occlusal reconstruction, the reduction rate of anterior displacement of condyle was 86.7%. CONCLUSIONS: In addition to restoring its vertical dimensions of patients with severe tooth wear, the condyle should be induced to appropriate position to prevent TMJ symptoms.


Asunto(s)
Cóndilo Mandibular , Articulación Temporomandibular , Desgaste de los Dientes , Tomografía Computarizada de Haz Cónico , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Dimensión Vertical
6.
J Craniofac Surg ; 30(7): 2257-2260, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31490446

RESUMEN

One of the indications of the surgical approach of the temporomandibular joint is the presence of foreign body in its interior. However, joint handling offers risks, especially bleeding. In these cases, angiography and embolization of the arteries involved with the projectile play an important role in the prevention of complications. In this report, the authors describe a case of a 23-year-old male victim of firearm attack with comminuted fracture of the right mandibular condyle. The patient underwent angiography and prophylactic embolization of the arteries adjacent to the foreign body. A surgical procedure was performed to remove the projectile and bone fragments with the aid of the X-ray image intensifier, which resulted in the restoration of mandibular function, absence of joint pain, and satisfactory dental occlusion. This case shows the importance of auxiliary imaging methods for performing a safe surgical procedure for removal of ballistic and bony fragments from the interior of the temporomandibular joint.


Asunto(s)
Articulación Temporomandibular/cirugía , Heridas por Arma de Fuego/cirugía , Oclusión Dental , Armas de Fuego , Cuerpos Extraños/cirugía , Fracturas Conminutas/cirugía , Humanos , Masculino , Cóndilo Mandibular/cirugía , Adulto Joven
7.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(8): 510-514, 2019 Aug 09.
Artículo en Chino | MEDLINE | ID: mdl-31378027

RESUMEN

Orthognathic surgery and temporomandibular joint (TMJ) surgery are two relatively independent disciplines in oral and maxillofacial surgery. Dentofacial deformities and TMJ diseases commonly coexist. The diagnosis and treatment of the diseases with coexisting dentofacial deformities and TMJ disorders is complex. Thus it is very important to comprehensively understand the common characteristics of orthognathic and TMJ surgery, which places a greater demand on oral and maxillofacial surgeons. The present work focuses on our thinking on common characteristics of TMJ and orthognathic surgery based on the managements of these diseases.


Asunto(s)
Deformidades Dentofaciales , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Trastornos de la Articulación Temporomandibular , Humanos , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía
8.
J Craniofac Surg ; 30(8): 2549-2550, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31403507

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the efficiency of inhaled nitrous oxide (N2O) for manual reduction of acute nontraumatic temporomandibular joint (TMJ) dislocation in the supine position technique. METHODS: This clinical trial included a total of 51 patients presenting with acute nontraumatic TMJ dislocation. The patients were grouped randomly. The supine position technique was applied in both N2O group (experimental group) and control group (without N2O). The visual analogue scale scores (VAS scores) of the pain perception and the operation time were recorded. RESULTS: All patients with dislocated mandible were successfully managed. The VAS scores of pain perception were significantly reduced in N2O group. It was 1.63 compared to 4.00 in control group. The average operation time was also significantly reduced in N2O group (Supplemental Digital Content, Table 2, http://links.lww.com/SCS/A716). It was 129.92 seconds compared to 170.04 seconds in control group. CONCLUSION: Inhalation of N2O helps to reduce the pain perception and the operation time of manual reduction of acute nontraumatic TMJ dislocation using the supine position technique. It is beneficial to both patients and doctors.


Asunto(s)
Luxaciones Articulares/cirugía , Óxido Nitroso/uso terapéutico , Articulación Temporomandibular/cirugía , Administración por Inhalación , Femenino , Humanos , Masculino , Percepción del Dolor
9.
J Craniomaxillofac Surg ; 47(11): 1739-1751, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31439411

RESUMEN

OBJECTIVES: Clinical and experimental studies show that the etiology of traumatic temporomandibular joint (TMJ) fibrous ankylosis and bony ankylosis are associated with the severity of trauma. However, how the injury severity affects the tissue differentiation is not clear. We tested the hypothesis that angiogenesis affects the outcomes of TMJ trauma, and that enhanced neovascularization after severe TMJ trauma would promote the development of bony ankylosis. METHODS: Bilateral condylar sagittal fracture and discectomy were performed for each sheep, with the glenoid fossa receiving either severe trauma to induce bony ankylosis or minor trauma to induce fibrous ankylosis. At days 7, 14, 28, and 56 after surgery, total RNA was extracted from the ankylosed callus. Temporal gene expressions of several molecules functionally important for blood vessel formation were studied by real-time PCR. RESULTS: Histological examination revealed a prolonged hematoma phase and a lack of cartilage formation in fibrous ankylosis. mRNA expression levels of HIF-1α, VEGF, VEGFR2, SDF1, Ang1, Tie2, vWF, CYR61, FGF2, TIMP1, MMP2, and MMP9 were distinctly lower in fibrous ankylosis compared with bony ankylosis at several time points. CONCLUSIONS: Our study indicates that inhibition of angiogenesis after TMJ trauma might be a promising strategy for preventing bony ankylosis in the future.


Asunto(s)
Anquilosis/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/lesiones , Animales , Anquilosis/etiología , Fibrosis , Cóndilo Mandibular , Ovinos , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/etiología
10.
Br J Oral Maxillofac Surg ; 57(9): 929-931, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31445774

RESUMEN

Arthroscopy is a diagnostic-therapeutic technique used in the treatment of disorders of the temporomandibular joint (TMJ). The difficulties of arthroscopy lie in the manipulation of the tools, which is why training in the technique of triangulation in artificial models is essential. We developed a training system based on the techniques of arthroscopy in the TMJ, using simulators. The first simulator was a metal box containing three holes for insertion of the instruments, and the second was a human artificial model made of polymers. We found that they facilitated training in the techniques of arthroscopy, which subsequently reduced operating time and led to a better execution of skills in reality.


Asunto(s)
Artroscopía , Cirujanos Oromaxilofaciales/educación , Artroscopía/métodos , Competencia Clínica , Simulación por Computador , Humanos , Cirujanos Oromaxilofaciales/normas , Articulación Temporomandibular/cirugía
11.
Br J Oral Maxillofac Surg ; 57(8): 793-795, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31375300

RESUMEN

We present a 16-year-old boy with a history of ankylosis of the temporomandibular joint (TMJ) who had been treated with a costochondral graft and mandibular distraction. The distraction seems to have caused pulp canal obliteration of the lower right second premolar and lower right first molar on radiographic examination. To our knowledge this is the only reported instance of such damage related to mandibular distraction. We aim to highlight the risks of this complication and the importance of discussing it with patients as part of the process of informed consent.


Asunto(s)
Anquilosis , Cavidad Pulpar/patología , Osteogénesis por Distracción , Articulación Temporomandibular , Anquilosis del Diente , Adolescente , Anquilosis/cirugía , Humanos , Masculino , Mandíbula , Osteogénesis por Distracción/efectos adversos , Articulación Temporomandibular/cirugía
12.
Am J Orthod Dentofacial Orthop ; 156(1): 125-136, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256825

RESUMEN

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.


Asunto(s)
Tirantes , Prótesis Articulares , Cóndilo Mandibular/cirugía , Mordida Abierta/cirugía , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Puntos Anatómicos de Referencia , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Resorción Ósea/terapia , Cefalometría , Estética Dental , Femenino , Humanos , Imagenología Tridimensional , Mandíbula/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Maxilar/cirugía , Mordida Abierta/diagnóstico por imagen , Aparatos Ortodóncicos , Aparatos Ortodóncicos Fijos , Ortodoncia Correctiva/instrumentación , Osteotomía , Planificación de Atención al Paciente , Radiografía Panorámica , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento
13.
World Neurosurg ; 130: 259-263, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31295609

RESUMEN

BACKGROUND: Dislocation of the mandibular condyle into the middle cranial fossa is a rare injury that can be seen after facial trauma. Early identification of condyle dislocation into the middle cranial fossa was difficult until the development of computed tomography, and diagnosis was often significantly delayed after the initial trauma. CASE DESCRIPTION: We present a rare case of a young woman who presents after a mechanical fall resulting in facial trauma with an avulsion condyle fracture with dislocation of the mandibular condyle into the middle cranial fossa. CONCLUSIONS: To our knowledge, this complete avulsion of the condyle into the middle cranial fossa requiring an intracranial approach for condylectomy is extremely rare. We discuss the surgical management options for reduction and fixation accomplished in a multidisciplinary approach involving neurosurgery and oral maxillofacial surgery.


Asunto(s)
Fosa Craneal Media/cirugía , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Procedimientos Quirúrgicos Reconstructivos , Adulto , Fosa Craneal Media/diagnóstico por imagen , Femenino , Humanos , Luxaciones Articulares/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico , Articulación Temporomandibular/cirugía
14.
Ann R Coll Surg Engl ; 101(6): 415-421, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31155887

RESUMEN

INTRODUCTION: We discuss our findings on the retention of the medially displaced residual condyle during the treatment of type III temporomandibular joint ankylosis, as well as the postoperative results observed during follow-up. MATERIALS AND METHODS: Thirty-two patients with type III temporomandibular joint ankylosis that met the inclusion criteria of the study were included as subjects. The morphological integrity of the medially displaced residual condyle was verified in all of the participating patients through the use of cone beam computed tomography. The duration of the ankylosis ranged from 2 to 12 years. The maximum length that patients were able to open their mouths ranged from 6 mm to 14 mm. The surgical treatments used in this report included the separation of bony fusions between the condyle and the glenoid fossa, resection of the ankylosed sites, preservation of the displaced condyles in their medial position and suturing the remains of the disc to its typical position or taking the temporalis myofascial flap instead. The long-term results were evaluated by computed tomography and clinical follow-up examinations. RESULTS: Three-year postoperative follow-up examinations were performed for all of the patients included in this study. No recurrences were observed in the patients who adhered to the postoperative therapeutic advice. Patients had an average maximal mouth opening distance of 34.50 ± 5.75 mm as recorded during the final follow-up examination. CONCLUSIONS: The released medially residual condyle can still function normally in temporomandibular joint movement and without reankylosis after a bone fusion resection. The displaced condyle should thus be preserved instead of being removed during the treatment of type III temporomandibular joint ankylosis.


Asunto(s)
Anquilosis/cirugía , Artroplastia/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Adulto , Anquilosis/diagnóstico por imagen , Niño , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Cóndilo Mandibular/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
15.
J Craniofac Surg ; 30(4): 1033-1038, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31163568

RESUMEN

INTRODUCTION: While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction. METHODS: A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications. RESULTS: Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions. CONCLUSIONS: Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.


Asunto(s)
Anquilosis/cirugía , Artroplastia/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Niño , Femenino , Humanos , Masculino , Recurrencia
16.
Am J Otolaryngol ; 40(5): 691-695, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31227259

RESUMEN

OBJECTIVE: To determine how current temporomandibular joint (TMJ) reconstruction methods affect functional outcomes. METHODS: Retrospective review from January 2006 to July 2017 at a single tertiary care center. All patients who underwent mandibulectomy with subsequent reconstruction with vascularized free tissue were included in the study. Condylar segments were reconstructed with vascularized free tissue flap in conjunction with autologous tissue or allograft in the joint space. Preoperative, 3 month, 1 year, and 2 year postoperative records were assessed for trismus, need for tube feeds, and Functional Oral Intake Scale (FOIS). RESULTS: Joint space was reconstructed with autologous tissue (n = 10), allograft (n = 15) or both (n = 9). At three months, FOIS scores significantly decreased from 5.4 preoperatively to 4.8 post operatively (P = .024) and need for tube feeds significantly increased from 15.8% preoperatively to 35.1% (P ≤0.027). Trismus significantly decreased from 63.2% to 27% (P = .006). At one-year, there were no significant changes in functional status compared to pre-operative state. Patients who had previous RT had significantly worse FOIS scores preoperatively (p = .002), at three months (p < .001), one year (p < .001), and two years (p = .008). There was no significant difference in postoperative functional status of patients based on the method of TMJ reconstruction. CONCLUSION: Reconstruction of the TMJ with vascularized free tissue is a viable option and yields acceptable long-term outcomes. While functional status may improve or worsen in the immediate postoperative period, long term results mirror preoperative function. Preoperative trismus will likely improve. LEVEL OF EVIDENCE: Level 3; Retrospective Comparative Study.


Asunto(s)
Trasplante Óseo/métodos , Osteotomía Mandibular/métodos , Neoplasias de la Boca/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos/trasplante , Articulación Temporomandibular/cirugía , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Centros de Atención Terciaria , Resultado del Tratamiento
17.
J Craniofac Surg ; 30(3): e265-e267, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31048623

RESUMEN

Dislocation of the temporomandibular joint (TMJ) is the displacement of the head of the condyle from its normal position in the glenoid fossa. Anterior dislocations are the most common type of TMJ dislocations. Prognathism of the lower jaw, anterior crossbite, and open bite are the classic features in bilateral TMJ dislocations.The treatment of acute TMJ dislocation involves manual reduction with or without general anesthesia. The use of maxillomandibular fixation is reserved for chronic, more complex dislocations. Determining the presence of a predisposing factor is very important in guiding the correct treatment and management for this condition.The authors present a case of acute spontaneous temporomandibular joint dislocation where multiple predisposing factors were recognized, requiring treatment with maxillomandibular fixation after manual reduction.


Asunto(s)
Luxaciones Articulares/terapia , Articulación Temporomandibular/lesiones , Accidentes de Tránsito , Adulto , Vértebras Cervicales/lesiones , Femenino , Humanos , Técnicas de Fijación de Maxilares , Manipulación Ortopédica , Respiración Artificial , Traumatismos de la Médula Espinal/complicaciones , Articulación Temporomandibular/cirugía , Traqueostomía , Trismo/complicaciones
18.
Med Eng Phys ; 68: 11-16, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30979582

RESUMEN

The aim of this study is to analyse the biomechanical effects of bilateral sagittal split ramus osteotomy (BSSRO) on temporomandibular joints (TMJs) of a patient with mandibular prognathism. Two three-dimensional models of the maxilla, mandible, and articular disc were constructed based on pre- and postoperative cone-beam computed tomography (CBCT) images of the patient's head. Meanwhile, based on the preoperative model, numerical surgery of BSSRO was performed to predict the optimized postoperative model (named Num-post). Contact elements were used to simulate the interactions between the discs and articular cartilages and between the upper and lower dentitions. Muscle forces and boundary conditions corresponding to centric occlusion were applied on the models. Stresses on the disc, condylar, and temporal cartilages were significantly reduced after the optimized numerical surgery. Meanwhile, the stress distributions in the TMJ in the Num-post-operative model were uniform without stress concentration compared to Pre-operative model and Post-operative model, which suggests that the optimized numerical surgery can be beneficial to orthognathic surgeries.


Asunto(s)
Fenómenos Mecánicos , Cirugía Ortognática , Articulación Temporomandibular/cirugía , Fenómenos Biomecánicos , Tomografía Computarizada de Haz Cónico , Femenino , Análisis de Elementos Finitos , Humanos , Estrés Mecánico , Articulación Temporomandibular/diagnóstico por imagen , Adulto Joven
19.
Eur Arch Otorhinolaryngol ; 276(8): 2141-2148, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31004197

RESUMEN

PURPOSE: The tympanic membrane (TM) belongs to the ear. Despite its place in the ear anatomy, can we give it also a different anatomic classification? The main objective is to clarify the nature of TM, tympanic bone and malleus to propose a new anatomic classification. METHODS: This cadaveric study was performed in two human heads and six fresh temporal bones. A study of the temporomandibular joint, external acoustic meatus (EAM), TM and middle ear structures was conducted. A medical literature review englobing anatomy, embryology, histology and phylogeny of the ear was performed and the results were compared with the results of the dissection. RESULTS: The external ear is constituted by the auricle and the EAM. This last segment is made by a cartilaginous and an osseous portion. The osseous portion of the EAM is constituted mainly by tympanic bone. The external ear is separated from the middle ear by the TM. Inside the middle ear, there are three ossicles: malleus, incus and stapes, which allow the conduction of sound to the cochlea. Based on the anatomic dissection and medical literature review of the tympanic bone, malleus and TM, we propose that these structures are interconnected like a joint, and named it "Tympanicomalleal joint". CONCLUSIONS: It seems that the TM can be part of a joint that evolved to improve sound transmission and middle ear protection. Thinking TM has part of a joint may help in the development of more efficient reconstructive surgical techniques.


Asunto(s)
Anatomía Regional/métodos , Martillo/anatomía & histología , Hueso Temporal/anatomía & histología , Articulación Temporomandibular , Membrana Timpánica , Timpanoplastia/métodos , Cadáver , Oído Medio/anatomía & histología , Humanos , Modelos Anatómicos , Articulación Temporomandibular/anatomía & histología , Articulación Temporomandibular/cirugía , Membrana Timpánica/anatomía & histología , Membrana Timpánica/fisiopatología , Membrana Timpánica/cirugía
20.
J Craniofac Surg ; 30(4): 1272-1274, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30839462

RESUMEN

PROPOSE: This paper aims to describe a modification of the Wolford technique by replacing the Mitek anchors with bone screws. TECHNICAL DESCRIPTION: Two intermaxillary fixation screws locking screws, with 2.0 mm in diameter and 8 mm in length, are used in each temporomandibular joint, one of which is fixed to the root of the zygomatic arch and another to the lateral pole of the mandibular condyle. Ethibond 2-0 thread is passed through the holes in the 2 ipsilateral screws, thus acting as an artificial ligament limiting the range of the mouth opening. CONCLUSION: The technique described was effective in preventing mandibular dislocation while allowing satisfactory mouth opening range. This technique has easy handling and low cost.


Asunto(s)
Tornillos Óseos , Luxaciones Articulares/cirugía , Traumatismos Mandibulares/cirugía , Humanos , Mandíbula/cirugía , Cóndilo Mandibular/cirugía , Recurrencia , Articulación Temporomandibular/cirugía , Cigoma/cirugía
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