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1.
Dentomaxillofac Radiol ; 49(3): 20190364, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31674794

RESUMEN

OBJECTIVES: Three-dimensional models of mandibular condyles provide a way for condylar remodeling follow-up. The overall aim was to develop and validate a user-friendly workflow for cone beam CT (CBCT)-based semi-automatic condylar registration and segmentation. METHODS: A rigid voxel-based registration (VBR) technique for registration of two post-operative CBCT-scans was tested. Two modified mandibular rami, with or without gonial angle, were investigated as the volume of interest for registration. Inter- and intraoperator reproducibility of this technique was tested on 10 mandibular rami of orthognathic patients by means of intraclass correlation coefficients (ICC's) and descriptive statistics of the transformation values from the VBR. The difference in reproducibility between the two modified rami was evaluated using a paired t-test (p < 0.05). For the segmentation, eight fresh frozen cadaver heads were scanned with CBCT and micro-CT. These data were used to test the inter- and intraoperator reproducibility (ICC's) and accuracy (Bland-Altman plot) of a newly designed workflow based on semi-automated contour enhancement. RESULTS: Excellent ICC's (0.94-0.99) were obtained for the voxel-based registration technique using both modified rami. If the gonial angle was not included in the volume of interest, there was a trend of increased operator error suggested by significant higher interoperator differences in translation values (p = 0,0036). The segmentation workflow proved to be highly reproducible with excellent ICC's (0.99), low absolute mean volume differences between operators (23.19 mm3), within operators (28.93 mm3) and low surface distances between models of different operators (<0.20 mm). Regarding the accuracy, CBCT-models slightly overestimate the condylar volume compared to micro-CT. CONCLUSIONS: This study provides a validated user-friendly and reproducible method of creating three-dimensional-surface models of mandibular condyles out of longitudinal CBCT-scans.


Asunto(s)
Cóndilo Mandibular , Tomografía Computarizada de Haz Cónico Espiral , Tomografía Computarizada de Haz Cónico , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Reproducibilidad de los Resultados
2.
Oral Maxillofac Surg Clin North Am ; 32(1): 105-116, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31685348

RESUMEN

Idiopathic condylar resorption (ICR), alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in adolescent and young women. ICR occurring before the completion of growth results in a shorter mandibular condyloid process, ramus and body, compensatory growth at the gonial angle and coronoid process, as well as an increase in anterior facial vertical dimension. Management options discussed include oral appliances, orthodontics, medical management, orthognathic surgery with and without disc repositioning, and alloplastic temporomandibular joint replacement.


Asunto(s)
Resorción Ósea , Cóndilo Mandibular/cirugía , Ortodoncia Correctiva , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Resorción Ósea/etiología , Femenino , Humanos , Cóndilo Mandibular/patología , Aparatos Ortopédicos , Articulación Temporomandibular
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.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
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.
Medicine (Baltimore) ; 98(37): e16814, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31517812

RESUMEN

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.


Asunto(s)
Fijación Interna de Fracturas , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Reducción Abierta , Adulto , Comorbilidad , Estudios Transversales , Femenino , Fijación Interna de Fracturas/economía , Costos de la Atención en Salud , Hematoma/epidemiología , Hematoma/etiología , Humanos , Pacientes Internos , Tiempo de Internación/economía , Masculino , Fracturas Mandibulares/economía , Fracturas Mandibulares/epidemiología , Reducción Abierta/economía , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Resultado del Tratamiento
8.
J Craniofac Surg ; 30(7): 2045-2047, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31369504

RESUMEN

INTRODUCTION: Mandibular condyle fractures are a common type of facial fracture in children. The authors aimed to examine the demographics, etiology, treatment, and outcomes of these fractures managed in a single pediatric trauma unit. MATERIALS AND METHODS: A retrospective review was performed of patients presenting to a pediatric hospital between 2003 and 2016 with mandibular condyle fractures. Initial data was extracted from a dedicated trauma database. Included patient's medical records and imaging were then reviewed. Data on demographics, etiology, fracture type, and treatment were recorded. Univariate statistical analysis was performed. RESULTS: Forty-four patients with 49 condyle fractures were included. The average age of patients was 11.4 years (range 3-15 years). A fall from a bicycle/scooter was the most common mechanism. Twenty-six fractures were isolated and 23 involved a further fracture of the mandibular arch. The condylar neck was the most common site of fracture (55%). There was no statistical significance between age (0-10 years, 10-16 years) and site of fracture or the presence of an associated arch fracture. The majority of isolated fractures (73%) were treated conservatively without inter-maxillary fixation. Thirty-nine patients attended the follow-up and the median follow-up period was 196 days (interquartile range 21-165 days). Two patients had a malocclusion at follow-up that required intervention. CONCLUSION: There was a broad range of presentations in our cohort. Conservative management in isolated fractures resulted in stable outcomes and this large case series supports the consensus that management of pediatric condyle fractures should be as conservative as possible.


Asunto(s)
Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Accidentes por Caídas , Adolescente , Niño , Preescolar , Tratamiento Conservador , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Maloclusión , Estudios Retrospectivos
9.
Cir Cir ; 87(5): 587-594, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31448782

RESUMEN

Background: Over the years, the treatment to be chosen for the resolution of condylar fractures has been discussed with great concern. Treatment depends on the type and location of the fracture, as well as other associated factors such as facial injuries and concurrent diseases. Aim of the study: The aim of the study was to make a review of the different criteria to establish a diagnosis and treatment to resolve mandibular condyle fractures, according to the evolution of the years and what this entails. Discussion: Management of condylar fractures remains controversial among surgeons. However, as time goes by and as comparative and analytical studies are carried out within the issue, parameters and criteria are established to facilitate the decisions taken regarding the management and treatment of condylar fractures. Conclusion: Condylar fractures must be managed according to the clinical and case presentation.


Asunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Factores de Edad , Niño , Toma de Decisiones Clínicas , Humanos , Maloclusión/prevención & control , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Estudios Retrospectivos
10.
J Craniofac Surg ; 30(8): 2555-2559, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449207

RESUMEN

The objective was to validate a semi-automated segmentation method for 3-dimensional (3D) reconstruction of the mandibular condyle from cone beam computed tomography (CBCT) data and illustrate its application in volumetric analysis of the condyle.Ten CBCT datasets were used to validate the proposed semi-automatic method for 3D rendering of mandibular condyles. First, a standardized orientation protocol of the skull was applied. After defining the volume of interest, a grey-scale cut-off value was selected to allow an automatic reconstruction of the condyle's surface. Subsequently, condylar contour was optimized manually. The whole process was repeated twice by 2 independent investigators. Volumetric measurements of the condyle were used as a measure of conformity between both investigators. The reproducibility of condylar volume reconstruction was excellent for intra-examiner measurements (CV = 3.65%, intraclass correlation coefficient = 0.97) and good for inter-examiner measurements (CV = 7.15%, ICC = 0.89). The overall mean time required for the segmentation process was 6.31 + 2.78 minutes. The proposed protocol provides an accurate and reproducible tool for 3D reconstruction of the mandibular condyle using CBCT data. Its implementation will enable adequate follow-up of morphological changes in bone tissue with a Hounsfield unit-based imaging segmentation method.


Asunto(s)
Imagenología Tridimensional , Procedimientos Quirúrgicos Reconstructivos , Automatización , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Masculino , Cóndilo Mandibular/cirugía , Reproducibilidad de los Resultados , Cráneo
11.
J Craniofac Surg ; 30(8): 2601-2603, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449227

RESUMEN

Correction of facial asymmetry caused by active unilateral condylar hyperplasia (CH) requires proper diagnosis, arrested ongoing condylar growth, and ultimately orthognathic surgery. Traditionally, prior to performing orthognathic surgery, active CH is addressed either by: awaiting natural cessation of condylar overgrowth, or performing an interval high condylectomy (to stop growth). However, these strategies both add to the total treatment time, by either waiting and confirming no active growth, or performing a first stage growth-arresting procedure. In this report, the authors describe concurrent high condylectomy, and 3-jaw orthognathic surgery, to address the root of the problem and provide aesthetic correction in the same setting. This clinical series illustrates a detailed description of this approach, highlighting operative order, and an analysis of outcomes.


Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Femenino , Humanos , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto Joven
12.
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
13.
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
14.
J Craniofac Surg ; 30(8): e707-e710, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31261325

RESUMEN

Unilateral condylar hyperplasia (UCH) is characterized by an overgrowth of the mandibular condyle responsible for a facial and dental asymmetry associated with temporomandibular joint function and maxillary growth consequences. The diagnosis is based on a body of clinical, radiological and histological arguments. A 38 years old woman with a reactivation of UCH after a latency period of 16 years following an orthognathic surgery performed for facial asymmetry normalization is presented. She was addressed to our department for a facial progressive asymmetry relapse and dental prosthetic consequences.The radiological images and the planar scintigraphy combined with single-photon emission computed tomography scans showed an active left unilateral condylar hyperplasia. A left proportional condylectomy was performed.The case presented highlights the possibility for the UCH to be reactivated after a long period of latency, leading to a relapse of the occlusal and facial disorders and so advocates the need for first condylectomy or at least a long-term follow-up if condylectomy is not performed as a first-line treatment.


Asunto(s)
Hiperplasia/diagnóstico por imagen , Cóndilo Mandibular/diagnóstico por imagen , Adulto , Asimetría Facial/cirugía , Femenino , Humanos , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos , Articulación Temporomandibular/diagnóstico por imagen
15.
Ann Ital Chir ; 90: 244-251, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31354151

RESUMEN

AIM: We evaluated the safety and efficacy using a mini-retromandibular transparotid approach to reduce and rigidly fix displaced mandibular condylar neck fractures. MATERIAL OF STUDY: Retrospective evaluation of patients who underwent surgical reduction of condylar fracture from January 2012 to December 2014 at the Department of Cranio Maxillo-Facial Surgery of the University Hospital of Catanzaro, Italy. All the patients were clinically assessed for signs/symptoms of infection, signs of Frey's syndrome or salivary fistula, facial nerve palsy ,postoperative scar, TMJ function, and occlusion with range of mouth opening and deviation. RESULTS: The sample was composed of 15 patients. Good results were achieved in all patients and with an average follow- up of 20 months. No major intraoperative or postoperative complication remained at 6 months of postoperative follow- up. DISCUSSION: Management of condylar fractures is still one of the most controversial topics in maxillofacial surgery. Regarding our experience with the mini-retromandibular approach, we evaluate the advantages in comparison with other extra-oral approaches. Advantages include the shorter working distance from the skin incision to the condyle with direct alignment of the fractured segments, less conspicuous facial surgical scarring with good cosmetic result, short operation time, with a low risk of postoperative complications and possible injuries of the facial nerve. CONCLUSIONS: According to our results, we believe that the mini-retro-mandibular approach is a viable and safe approach for the surgical treatment of condylar fractures, with a relatively low risk of postoperative complications. KEY WORDS: Condylar fracture, Extraoral approach, Mini-retromandibular access.


Asunto(s)
Fijación de Fractura/métodos , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida , Estudios Retrospectivos , Adulto Joven
16.
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
17.
BMC Surg ; 19(1): 67, 2019 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-31242878

RESUMEN

BACKGROUND: Reconstruction of mandibular continuity and function after tumor resection is challenging, particularly in cases including the mandibular condyle. Various approaches for reconstruction after disarticulation resection have been reported. However, the scapula flap has received little attention as a treatment option in these cases. PATIENTS AND METHODS: Three cases of computer aided design and computer aided manufacturing (CAD/CAM) assisted reconstruction after disarticulation resection using a vascularized scapula and latissimus dorsi flap are reported. All cases required reconstruction of the mandibular ramus and condyle in combination with the reconstruction of large and complex soft tissue defects. RESULTS: The surgical procedure was deemed successful in all cases. The scapula flap could be placed as preoperatively planned and patients regained their preoperative occlusion pattern and satisfying mouth opening-ranges. The large soft tissue defects could reliably be reconstructed using a latissimus dorsi flap. CONCLUSIONS: The scapula and latissimus dorsi flap can be considered a suitable option for the reconstruction of mandibular disarticulation resection defects in combination with large soft tissue defects.


Asunto(s)
Diseño Asistido por Computadora , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Escápula , Músculos Superficiales de la Espalda , Colgajos Quirúrgicos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
18.
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
19.
BMC Surg ; 19(1): 28, 2019 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-30832641

RESUMEN

BACKGROUND: The purpose of this study was to compare the outcomes and effectiveness between intraoral approach and retromandibular approach for treatment of subcondylar fracture of mandible. METHODS: Between March 2011 and October 2013, 24 patients with subcondylar fractures of the mandible were treated by a single surgeon with an intraoral approach using an angulated screwdriver (n = 14) or by another surgeon using a retromandibular approach (n = 10). The interincisal distance was measured 1 week (T0), 6 weeks (T1), 3 months (T2), and 6 months (T3) postoperatively. We also compare the average operation time and the cost of operation between the two groups. RESULTS: At 6 months postoperatively, all 24 patients achieved satisfactory ranges of temporomandibular joint movement, with an interincisal distance > 40 mm without deviation and with stable centric occlusion. The intraoral group had the median interincisal distance of 14 mm at T0, 38 mm at T1, 42.5 mm at T2, and 43 mm at T3, while the retromandibular group had that of 15, 29, 35, and 42.5 mm respectively. There was no statistically significant difference between the intraoral and the retromandibular group at T0 and T4. However, significant differences were noted T1 and T2 (p < 0.01). The differences of average operation time between the intraoral (81 min) and retromandibular group (45 min) were statistically significant (p < 0.01). The cost of an operation was 369.96 ± 8.14 (United States dollar [USD]) in intraoral group and was 345.48 ± 0.0 (USD) in retromandibular group. The differences between the two groups were statistically significant (p < 0.01). CONCLUSION: In open reduction of a subcondylar fracture of the mandible, a intraoral approach using an angulated screwdriver is superior to the retromandibular approach in terms of interincisal distance, although the operation time is longer.


Asunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Reducción Abierta/métodos , Adulto , Femenino , Fijación Interna de Fracturas/economía , Fijación Interna de Fracturas/instrumentación , Costos de Hospital , Humanos , Masculino , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Reducción Abierta/economía , Reducción Abierta/instrumentación , Tempo Operativo , Resultado del Tratamiento
20.
BMJ Case Rep ; 12(2)2019 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-30737324

RESUMEN

Unilateral condylar hyperplasia is characterised by slow progressive growth of the different parts of mandible, the aetiology of which is still unclear. It is a self-limiting condition mostly seen between the age of 11-30 years causing facial asymmetry and its progression ceases after a certain time. In literature until now very few cases have been reported and every case that is being reported adds to its features or the aetiology. Previously, it has been classified into two types that is, hemimandibular hyperplasia and hemimandibular elongation. Here, we report a similar case with a few features distinct from those reported earlier.


Asunto(s)
Asimetría Facial/cirugía , Hiperplasia/diagnóstico por imagen , Maloclusión/patología , Mandíbula/anomalías , Cóndilo Mandibular/patología , Osteotomía/métodos , Adulto , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Mandíbula/crecimiento & desarrollo , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Orales/métodos , Resultado del Tratamiento
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