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1.
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
2.
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
3.
Bratisl Lek Listy ; 122(3): 184-189, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33618526

RESUMEN

AIM: Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fixation (ORIF) of condylar­base and low condylar­neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar­base and low condylar­neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS: In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar­base and low condylar­neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS: The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fixation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fistulae complications during a 12­month follow­up period. CONCLUSION: The periangular infraparotid transmasseteric approach to ORIF of condylar­base and low condylar­neck fractures is an effective and safe approach allowing accurate anatomic reposition and fixation of the fragments with minimum surgical complications (Tab. 1, Fig. 12, Ref. 21).


Asunto(s)
Traumatismos del Nervio Facial , Fracturas Mandibulares , Fijación Interna de Fracturas , Humanos , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
4.
Braz Oral Res ; 35: e27, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33605357

RESUMEN

The aim of the present overview was to evaluate the outcomes of systematic reviews to determine the incidence of condylar resorption in patients submitted to orthognathic surgery and analyze whether the risk of developing this condition is related to a specific type of surgery. Searches were conducted in the PubMed/MEDLINE, Embase, and Cochrane electronic databases for systematic reviews with quantitative data on condylar resorption due to any type of orthognathic surgery for dentoskeletal deformities published up to May 25, 2019. The AMSTAR 2 and Glenny tools were applied for the quality appraisal. Five systematic reviews were included for analysis. Only one article was considered to have high quality. Among a total of 5128 patients, 12.32% developed condylar resorption. From those patients, 70.1% had double jaw surgery, 23.4% had mandibular surgery alone, and in 6.5% a Lefort I technique was used. Based on these findings, bimaxillary surgery could be considered a risk factor for condylar resorption. However, these results should be interpreted with caution, since other factors, such as pre-operative skeletal deformities, type of movement, and type of fixation, can contribute to the development of this condition. Further studies should consider reporting main cephalometric data, temporomandibular diagnosis, hormonal levels, and tomographic measures before and after the surgery at least every 6 months during the firsts two years to identify accurately risk factors for condylar resorption.


Asunto(s)
Resorción Ósea , Procedimientos Quirúrgicos Ortognáticos , Resorción Ósea/epidemiología , Resorción Ósea/etiología , Cefalometría , Humanos , Incidencia , Cóndilo Mandibular/cirugía , Revisiones Sistemáticas como Asunto
5.
J Craniomaxillofac Surg ; 49(4): 251-255, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33589333

RESUMEN

The merits of surgical treatment of fractures of the mandibular condyle versus non-surgical management remains highly controversial, despite a large volume of literature dedicated to this topic. One reason the controversy remains, is because most of the outcomes in the literature are not directly comparable. The disparate range of condylar fracture classifications used is one of the reasons that studies are not comparable. We sought to review classification systems for condylar fractures used in the recent scientific literature. Review of the literature from 2016 to 2019, looking for papers relating to fractures of the mandibular condyle. Papers identified were assessed for type of study, focus of study, classification system used. 88 studies were identified, including prospective and retrospective cohort studies, randomised and non-randomised prospective studies, randomised controlled trials and case series. More studies focussed on epidemiological factors than surgical access, fixation or outcomes. 31 used no classification system, whilst 17 used unique classification systems and 40 used previously referenced classification systems. Classification systems are used to help separate clinical problems into distinguishable groups, where there is a difference in management or outcome depending on the distinguishing features. There is currently a wide diversity of classification systems used for condyle fractures, and as a result, comparisons of surgical access, fixation and outcomes are difficult to make. Having a single classification system across the published literature would allow easier comparison and the classification proposed by the AO group is recommended for future use.


Asunto(s)
Cóndilo Mandibular , Fracturas Mandibulares , Consenso , Fijación Interna de Fracturas , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/cirugía , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento
6.
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
7.
J Craniomaxillofac Surg ; 49(2): 126-134, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33451941

RESUMEN

This study aims to show our institute's experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13-34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of -144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.


Asunto(s)
Cóndilo Mandibular , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Estética Dental , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/patología , Asimetría Facial/cirugía , Femenino , Humanos , Hiperplasia/patología , Hiperplasia/cirugía , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Adulto Joven
8.
Angle Orthod ; 91(3): 399-415, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33373430

RESUMEN

Treatment of skeletal Class II patients with dual bite and idiopathic condylar resorption (ICR) is challenging for orthodontists because of the unstable position of the mandible as well as skeletal relapse attributed to improper seating of the mandibular condyles. This case report describes the successful treatment of an 18-year-old Mongolian man diagnosed with centric relation-maximum intercuspation discrepancy and ICR. After making a definitive diagnosis from verified centric relation using bilateral manipulation, orthodontic treatment was initiated followed by three-dimensional computer-aided design/computer-aided manufacturing prebent titanium plate-guided sagittal split ramus osteotomy and genioplasty. Postoperative 3D superimposition demonstrated that this surgical guide approach provided accurate repositioning of the condyles, which were well positioned in the fossae. Complete orthodontic and surgical treatment time was 24 months. The patient's facial appearance and occlusion improved significantly, and a stable result was obtained with a 1-year follow-up.


Asunto(s)
Maloclusión de Angle Clase III , Maloclusión de Angle Clase II , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Cefalometría , Humanos , Masculino , Maloclusión de Angle Clase II/complicaciones , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/cirugía , Mandíbula , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Osteotomía Sagital de Rama Mandibular
9.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(5): 519-524, 2020 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-33085235

RESUMEN

OBJECTIVE: To investigate the effect of bilateral sagittal split ramus osteotomy (BSSRO) on temporomandibular joint (TMJ) symptom and condylar position in patients with skeletal class Ⅲ malocclusion treated with orthodontic-orthognathic surgical treatment. METHODS: Twenty-four patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment were included in the study. Their cone-beam computed tomography scans and TMJ symptom were evaluated, and their Helkimo index before BSSRO, 1 month after BSSRO, and 12 months after BSSRO was recorded. The maximum diameter of the horizontal and coronal sections, short axis diameters, neck width, height, joint space widths at different angles (45°, 90°, and 135°) of the condylar joint, bilateral condylar spacing, and different condylar angles (horizontal angle, vertical angle, and stress angle) in three dimensions were measured. Then, the changes in TMJ symptom and bone structure at different periods were analyzed. RESULTS: The Helkimo index was anamnestic (Ai) or dysfunctional (Di) levels 0 or 1 before and after BSSRO, and no difference in Helkimo index was observed. The horizontal angle and joint space widths at 45° and 90° increased whereas the joint space width at 135° decreased at 1 month after BSSRO compared with before BSSRO (P<0.05). Except for the increase in condylar horizontal angle (P<0.05), no significant difference in other measurement items was noted (P>0.05) 12 month after BSSRO. CONCLUSIONS: BSSRO would not have a remarkable effect on the TMJ symptom and condylar position of patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment procedure and whose Helkimo index ranked Ai0, Ai1, Di0, and Di1.


Asunto(s)
Maloclusión de Angle Clase III , Osteotomía Sagital de Rama Mandibular , Tomografía Computarizada de Haz Cónico , Humanos , Maloclusión de Angle Clase III/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Articulación Temporomandibular/diagnóstico por imagen
10.
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
11.
J Craniomaxillofac Surg ; 48(10): 933-941, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32919835

RESUMEN

AIM: The results of conservative treatment of pediatric dislocated (luxative) condyle fractures are usually unsatisfactory. We therefore decided to present and analyze the results of surgical treatment of these fractures. PATIENTS AND METHODS: Children with dislocated condyle fractures were treated surgically, with the approach always including opening the temporomandibular joint (TMJ). Postoperatively, patients had regular controls at 1 week, 1 month, 3 months, and 6 months, and then yearly thereafter. At each control visit, facial symmetry, maximal mouth opening, lateral chin deflection upon mouth opening, TMJ pain, condylar motion, palpable pathological phenomena, and occlusion were all checked clinically. Healing of the fracture site, condylar height, shape and growth were assessed on panoramic radiographs. Possible surgical complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, intraoperative bleeding, postoperative hematoma formation, infection, and reoperation due to fragment malposition. The postoperative scars were assessed. RESULTS: Over the 6-year period from 2013 until the end of 2018, seven children with dislocated condyle fractures were treated surgically. Six of the seven patients were treated with open reduction and internal fixation, and the plates and screws were deliberately not removed. The age range of the patients was 1.5-14 years (average 6.1 years). Follow-up time was 15 months to 6 years. No growth disturbances or facial asymmetries were seen over this follow-up period, with all patients maintaining proper occlusion, joint movement, and mouth opening. Fracture healing and condylar growth were clearly demonstrated with serial control panoramic radiographs. Condylar height asymmetry was observed only in one case, in which only reduction of the fracture with no fixation was performed. In all other cases, condylar height was symmetric. None of the children presented with chewing difficulties or joint pain. No intra- or postoperative surgical complications were noted. The preauricular scars were all very discreet, and none of the patients or parents complained about them. CONCLUSION: Surgical treatment in cases of dislocated (luxative) condylar fractures in children and small infants restores anatomy and thus securely enables further symmetric growth of the condyles, mandible, and the entire facial skeleton.


Asunto(s)
Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/cirugía , Luxaciones Articulares/terapia , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/cirugía , Adolescente , Niño , Preescolar , Tratamiento Conservador , Estudios de Seguimiento , Fijación Interna de Fracturas , Humanos , Lactante , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Resultado del Tratamiento
12.
J Craniomaxillofac Surg ; 48(10): 956-961, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32773219

RESUMEN

INTRODUCTION: Camel-hump condylo-mandibular dysplasia is a specific form of condyle dysostosis, first described by Delaire. The aim of this study was to describe the clinical and radiographic phenotype of the disease, and to discuss therapeutic options. CASE SERIES: Twenty-one patients were analyzed retrospectively. They exhibited the same unilateral facial asymmetry, which was of mandibular origin, with an elevated commissural line and occlusal cant, and a deviated chin on the side of the deformity. The soft tissues and the ears were always normal in terms of their physical appearance. Radiographic analysis generally revealed a short, curved, and anteriorly displaced condyle, with a high and sharp coronoid process. CT scans revealed that the glenoid fossa was empty. Twelve patients exhibited dental abnormalities, consisting mainly of dental inclusions affecting the lower first and/or second molars (10 patients). A good response to functional orthodontic treatment was achieved in eight patients, while 13 patients required a surgical mandibular lengthening procedure. CONCLUSION: Condylo-mandibular dysplasia is a congenital condyle deformity that needs to be recognized and differentiated from craniofacial microsomia in order to be able to provide patient-specific treatments.


Asunto(s)
Asimetría Facial/diagnóstico por imagen , Asimetría Facial/cirugía , Síndrome de Goldenhar , Mentón , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Estudios Retrospectivos
13.
Artículo en Inglés | MEDLINE | ID: mdl-32807713

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the level of evidence in the literature on etiology and management of idiopathic condylar resorption (ICR) of the mandible. STUDY DESIGN: A systematic search of articles published from 1982 to 2019 was conducted via PubMed, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. English language reports of human studies that addressed the etiology or management of ICR were included. Case reports, opinion or perspective articles, and nonhuman or non-English language articles were excluded. The quality of the included studies was assessed by using the Oxford Center for Evidence-Based Medicine criteria. RESULTS: The search yielded 230 studies, and 40 met the criteria for inclusion. The etiology of ICR was the focus of 33 studies; the remaining 8 assessed its management. The total number of patients in the included studies was 1399. The level of evidence assessing the etiology of ICR averaged 3.16 (range 2b-to 3b). Proposed etiologies and contributing factors included female gender, 17ß-estradiol levels, condylar anatomy, and history of orthognathic surgery. The level of evidence of studies assessing the management of ICR was 3.7 (range 2b-4). Treatment strategies included disk repositioning, autologous condylar reconstruction (costochondral graft), and alloplastic total joint reconstruction. Average follow-up was 46.8 ± 38.2 months. CONCLUSIONS: The proposed etiology and management of ICR, as reported in the literature, vary considerably. Condylectomy with autogenous or alloplastic reconstruction appears to be the most stable management strategy. The levels of evidence regarding the etiology and management of ICR are low.


Asunto(s)
Resorción Ósea , Cóndilo Mandibular/cirugía , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Femenino , Humanos , Mandíbula
14.
PLoS One ; 15(7): e0236425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32726330

RESUMEN

Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.


Asunto(s)
Actinina/genética , Deformidades Dentofaciales/genética , Predisposición Genética a la Enfermedad , Hidrolasas Diéster Fosfóricas/genética , Pirofosfatasas/genética , Trastornos de la Articulación Temporomandibular/genética , Adulto , Mentón/diagnóstico por imagen , Modelos Dentales , Deformidades Dentofaciales/diagnóstico por imagen , Deformidades Dentofaciales/patología , Deformidades Dentofaciales/cirugía , Cara/diagnóstico por imagen , Femenino , Estudios de Asociación Genética , Humanos , Maxilares/diagnóstico por imagen , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/genética , Maloclusión/patología , Maloclusión/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos , Polimorfismo de Nucleótido Simple/genética , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/cirugía
15.
Int J Oral Maxillofac Surg ; 49(11): 1435-1438, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32653260

RESUMEN

The aim of this study was to describe the steps of a minimally invasive surgical technique used to perform a proportional intraoral condylectomy with a three-dimensionally (3D) printed cutting guide. The technique consists of two steps: virtual surgical planning and intraoral condylectomy. During virtual surgical planning, the mandibular ramus was measured bilaterally, the height of the proportional condylectomy was planned virtually, and a cutting guide was 3D printed. In the intraoral condylectomy, the mandibular condyle was approached intraorally, the 3D printed cutting guide was positioned in the sigmoid notch, and the proportional condylectomy was performed. The protocol reported in this technical note is the sum of knowledge acquired from a series of studies published previously by the authors, who have jointly developed a surgical technique that is both minimally invasive and accurate for the treatment of condylar hyperplasia.


Asunto(s)
Cóndilo Mandibular , Osteotomía , Asimetría Facial/patología , Humanos , Hiperplasia/patología , Mandíbula , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Impresión Tridimensional
16.
J Oral Maxillofac Surg ; 78(11): 2072.e1-2072.e12, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32621806

RESUMEN

PURPOSE: Facial asymmetry associated with unilateral condylar hyperplasia can benefit from condylectomy, which aims to arrest the pathologic condylar growth and restore an appropriate posterior height. However, there are several cases in which condylar hyperplasia is combined with various dentofacial deformities, for which joint surgery has to be accompanied by concomitant orthognathic surgery. The literature is relatively poor of examples in which virtual planning for orthognathic surgery includes the evaluation of condylectomy, which is often manually performed. The aim of this study was to present and discuss a workflow for 1-stage computer-guided customized management of skeletal asymmetry by simultaneous condylectomy and orthognathic surgery. MATERIALS AND METHODS: Five patients were enrolled in this study from 2018 to 2019. All patients underwent combined virtual planning of orthognathic surgery and condylectomy. Virtual surgery was translated into real surgical coordinates using patient-specific surgical guides and custom-designed osteosynthesis plates. RESULTS: All surgical procedures were uneventful, and in all patients, virtual planning was successfully brought into the operating room with high accuracy, as confirmed by superimposition analyses. Symmetrization of the face and achievement of correct occlusion were observed in all cases. CONCLUSIONS: The presented protocol is a reliable solution for the combined planning of orthognathic surgery and condylectomy. Virtual planning, surgical guides, and custom-designed plates allow computerized simulations to be replicated in the real patient.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/patología , Asimetría Facial/cirugía , Humanos , Hiperplasia/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía
17.
Artículo en Inglés | MEDLINE | ID: mdl-32595061

RESUMEN

OBJECTIVE: Condylar remodeling is crucial in retrognathic adolescents with anterior disk displacement without reduction (ADDwoR). This study aimed to evaluate the efficacy of functional orthodontics after arthroscopic disk repositioning surgery in improving condylar remodeling. STUDY DESIGN: A retrospective cohort study was performed to evaluate the condylar remodeling in patients with retrognathic unilateral ADDwoR who received arthroscopic disk repositioning surgery from March 2013 to December 2017. The primary predictor variable was functional orthodontics, based on which patients were divided into group A and group B. The outcome variables were condylar remodeling on both the affected side and the unaffected side measured by using the 3-circle method. The independent-sample t test was performed to test the difference between the 2 groups. A P value less than 0.05 was considered significant. RESULTS: In total, 117 patients (28 males and 109 females) were included in our study, with 75 cases in group A (follow-up: 7.48 months) and 62 cases in group B (follow-up: 7.95 months). Group A showed better condylar remodeling on the affected side compared with group B, but there was no significant difference on the unaffected side. CONCLUSIONS: Functional orthodontics after arthroscopic disk positioning leads to improved condylar remodeling in patients under 17 years of age with ADDwoR and mandibular retrusion.


Asunto(s)
Ortodoncia , Retrognatismo , Trastornos de la Articulación Temporomandibular , Adolescente , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Estudios Retrospectivos , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/cirugía
18.
J Oral Maxillofac Surg ; 78(10): 1795-1810, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32554064

RESUMEN

PURPOSE: The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS: To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS: The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS: The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.


Asunto(s)
Fracturas Mandibulares , Adulto , Fijación de Fractura , Fijación Interna de Fracturas , Humanos , Mandíbula , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Reducción Abierta , Rango del Movimiento Articular , Resultado del Tratamiento
19.
Bratisl Lek Listy ; 121(6): 379-385, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32484700

RESUMEN

AIM: The purpose of this retrospective study was to perform an evaluation of postoperative positional changes of the condyle and mandibular function after bilateral sagittal split osteotomy (BSSO) with manual proximal segment positioning. PATIENTS: 45 patients were divided into the 2 groups ‒ G1 (advancement ‒ 14 patients) and G2 (setback - 31 patients). Rigid internal fixation screws were utilized in all cases. Inclusion criteria were only BSSO, no TMJ symptoms preoperatively and age 18 or older. RESULTS: The differences between pre- and postoperative condyle position were evaluated using measurements taken from preoperative CT scans and compared to CT scans made a minimum of 6 months postoperatively. The positional changes in both the axial and sagittal planes were measured and compared. The recovery of mandibular function was evaluated by measuring maximal interincisal opening (MIO). The results revealed that condylar positional changes after BSSO in both groups were minimal and not significantly different for all three dimensions measured. The recovery of mandibular function was faster in the group G2 than in the group G1. Mandibular function reached almost preoperative level in 6-12 months postoperatively in both groups. CONCLUSION: The results demonstrated that following BSSO, only insignificant condylar displacement and functional changes occurred within 6 to 12 months postoperatively (Tab. 4, Fig. 2, Ref. 47).


Asunto(s)
Mandíbula , Cóndilo Mandibular , Osteotomía , Humanos , Cóndilo Mandibular/cirugía , Osteotomía/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
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