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

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

Rapid-prototype titanium bone forms for vertical alveolar augmentation using bone morphogenetic protein-2: design and treatment planning objectives.

Reconstruction of complex maxillofacial defects where the use of bone morphogenetic protein-2 composite grafts may be preferred can be done using perforated titanium shells or forms that confine the graft material and simultaneously establish the desired shape of the augmentation without resorting to autogenous block bone grafting. Reported here is a method for creation of rapid-prototype titanium bone forms, which was developed from a software program, to reproduce bone morphology precisely. The technique and treatment planning objectives are elucidated, especially with regard to complex vertical augmentations.

Fabrication of printed titanium shells for containment of BMP-2 composite graft materials for alveolar bone reconstruction.

The engineering, design, manufacture, and rationale for use of printed titanium shells for alveolar bone reconstruction using BMP-2/ACS/allograft are described. This is proposed as a possible improvement to the current hand-configured mesh graft technique in common use today.

Removal of an extensive mandibular odontoma using an intraoral approach.

Odontomas, the most common odontogenic tumors, occur more frequently in the maxilla and are rarely larger than a tooth. They are usually found incidentally on routine dental radiographs during the second decade of life. The treatment of choice is surgical removal, and large tumors are challenging as damage may occur to surrounding anatomic structures. In this article we describe a "giant" compound odontoma occupying the entire body of the mandible and ramus in a 7-year-old girl. A conservative intraoral enucleation was used to avoid facial scarring and preserve mandibular continuity and function. The huge bony defect healed completely without a bone graft or further intervention. This case report emphasizes the importance of the early diagnosis of these lesions and a conservative surgical approach as well as the extraordinary healing potential of young patients.

Is entire removal of a post-traumatic temporomandibular joint ankylotic site necessary for an optimal outcome?

PURPOSE: Temporomandibular joint (TMJ) ankylosis that occurs after TMJ condylar fracture constitutes a treatment challenge. The purpose of the present study is shed light on an alternative treatment approach for certain such cases where the displaced condylar head or part of it can be detected in computed tomography. The leading principle of this protocol is accurate removal of the ankylotic mass only, leaving the condyle-disc apparatus un-touched. PATIENTS AND METHODS: The study is based on such cases of post trauma ankylosis where the displace condyle was detected. Thirteen cases are reported (10 unilateral and 3 bilateral) age ranged from 8 to 51 years (mean 20). All patients were treated according to the presented protocol that emphasizes the significance of preserving the condyle-disc apparatus while accurately removing the ankylotic mass. To achieve the required precision, 3-dimensional computed tomography was used. An integral part of the treatment plan is intensive guided physiotherapy, which is intended to re-establish normal joint function, the original occlusion and facial symmetry (in growing individuals). RESULTS: The patients were followed up for 6 to more than 60 months. After guided physiotherapy, all patients had significant postoperative improvement in maximal mouth opening from a mean of 18.4 mm (range 8 to 28) to a mean of 41.2 mm (range 35 to 50). All patients had returned to their original occlusion. In all the growing patients, a marked improvement in facial symmetry was observed. CONCLUSIONS: In post trauma ankylosis the displaced head of the condyle and disc should be searched for using computed tomography. If detected we recommend its preservation while accurately remove only the ankylotic mass. Using this approach, in addition to achieving adequate mandibular motion, good occlusion, and normal facial growth, major surgery, with all its inconveniences and potential complications, is avoided.

Primary lymphoma of the mandible masquerading as bisphosphonate-related osteonecrosis of jaws.

A 66-year-old osteoporotic woman suffered from long-term mental paresthesia (numbness), facial swelling, and a nonhealing extraction site. Fulfilling the three clinical diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ; exposed bone for at least 8 weeks, current bisphosphonate [risedronate] treatment, and no history of head and neck radiation therapy), she was diagnosed and treated accordingly. Nevertheless, a later histopathologic examination revealed malignant lymphoproliferative infiltration of large and intermediate cells. Based on immunostaining and positron-emission tomography, she was diagnosed as having primary diffuse large B-cell lymphoma. This case demonstrates the limitation of the current diagnostic method of BRONJ. Thus, the clinician should be particularly cautious and aware of the differential diagnosis, including malignancy, especially when lesions are accompanied by (mental nerve) neuropathy and long-standing swelling/expansion, and even when plain radiography is not a contributing factor.

Sunitinib related osteonecrosis of jaw: a case report.

A 58-year-old woman presented to the Oral and Maxillofacial Surgery Clinic experiencing severe limited mouth opening and exposed bone in the socket of the right mandibular third molar 8 months following the extraction of the tooth. The patient had been treated during the year before her presentation with sunitinib, an antiangiogenic drug, for renal cell carcinoma. The clinical, radiographic, and histologic picture of a chronic nonhealing extraction socket was consistent with osteonecrosis of the jaw (ONJ), although she had never been treated with bisphosphonates or corticosteroids. The treatment with sunitinib was discontinued and the patient was treated with antibiotics and physiotherapy for 12 weeks with complete recovery. Sunitinib may cause osteonecrosis of the jaw after oral surgical interventions with no previous exposure to bisphosphonates. The pathogenesis may be related to its antiangiogenic mechanism and impaired wound healing. Full recovery may require long-term cessation of the insulting drug combined with prolonged antibiotic treatment.