Surgical treatment of temporomandibular joint ankylosis: Follow-up of 15 cases and literature review

Introduction: Ankylosis may be defined as the fusion of the articular surfaces with bony or fibrous tissue. The treatment oftemporomandibular joint ankylosis poses a significant challenge because of the high incidence of recurrence.Purpose: To report 15 cases treated by either gap arthroplasty, or the articular reconstruction technique using costochondralgrafts, coronoid process grafts or alloplastic condylar implants; evaluate the results of these surgeries and make a literaturereview.Methods: The sample was obtained from the records of the Oswaldo Cruz University Hospital (HUOC-UPE) of patientssubmitted to ankylosis treatment by alloplastic or autogenous graft between March 2000 and October 2006. Pre- and postoperativeassessment included a thorough history and physical examination to determine the cause of ankylosis, the maximalincisal opening, etiology and type of the ankylosis, recurrence rate and presence of facial nerve paralysis.Results: The mean maximal incisal opening in the preoperative period was 8.71 + 6.97 mm and in the postoperative periodit was 28.50 + 8.10 mm, the recurrence rate was 20% (n=3), and always occurred in ankylosis type IV.Conclusion: The articular reconstruction with alloplastic or autogenous grafts, or gap arthroplasty for the treatment of ankylosisis shown to be efficient in relation to the post-operative maximal incisal opening, recurrence and articular function (AU)

Herida de nervio facial seguida de cirugía para el tratamiento de anquilosis de la articulación temporomandibular / Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint

Objetivo: El propósito de este trabajo fue realizar un estudio longitudinal de una serie de casos, en los cuales se observó disfunción del nervio facial subsecuente a cirugía para el tratamiento de anquilosis temporomandibular.Diseño del estudio: La muestra estuvo compuesta por 13 pacientes de ambos géneros, en los cuales fueron realizados 18 abordajes quirúrgicos. Fue realizada una evaluación postoperatoria de la actividad motora del nervio facial, de acuerdo con la escala de House-Brackmann. Todos los pacientes fueron fotografiados y evaluados para los periodos de tiempo: 24 horas, 1 semana, 1 mes y 3 meses.Resultados: Los resultados mostraron que el porcentaje de casos de disfunción del nervio facial fue de 31%. Fue observado un aumento en la frecuencia de lesión nerviosa en los casos donde fue usada la técnica de artroplastia interposicional, asi como también que el 75% de los pacientes habían sido sometidos al menos a una intervención quirúrgica previa al estudio. Después de 3 meses todos los pacientes presentaban actividad normal del nervio facial.Conclusión: La frecuencia de lesión del nervio facial se relaciona al grado de dificultad quirúrgica determinda por el tipo de anquilosis. Las lesiones nerviosas mostraron un caracter temporal

Objective: The purpose of the present paper was to carry out a longitudinal study of a series of cases in which injury of the facial nerve was observed following surgery for the treatment of temporomandibular ankylosis.Study design: The sample was composed of 13 patients, both male and female, in whom 18 surgical approaches were made. A postoperative assessment of the motor function of the facial nerve was made in accordance with the House-Brackmann grading system. All the patients were photographed and assessed at the following postoperative times: 24 hours, one week, one month and three months.Results: The results showed that injury of the facial nerve occurred in 31% of the cases. An increase in the frequency of nerve injury was observed in the cases in which the interpositional arthroplasty technique was employed, as well as the fact that 75% of the patients had undergone at least one surgical intervention prior to the study. After three months all the patients displayed normal function of the facial nerve.Conclusion: The frequency of facial nerve injury is related to the degree of difficulty involved in the surgery determined by the type of ankylosis. The nerve lesions were shown to be of a temporary nature

Facial nerve paralysis after impacted lower third molar surgery: A literature review and case report

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Facial nerve paralisys (FNP) is the most commom cranial nerve disorders and it results in a characteristic facial distortion that is determined in part by the nerves branches involved. With multiples etiologies, these included trauma, tumor formation, idiopathic conditions, cerebral infarct, pseudobulbar palsy and viruses. FNP during dental treatment is very rare and can be associated with the injection of local anesthetic, prolonged attempt to remove a mandibular third molar and subsequent infection. We report a case of a 21 years-old black woman who developed a Bell’s palsy after an impacted third molar surgery under local anaesthesia, present a FNP classificated like a grade IV by the House-Brackmann’s grading system. The treatment was based of prescription of a citidine and uridine complex (NÚCLEO CMP tm) one tablet twice per day and a close follow up. Three months later that had begining the treatment, the patient recovery her normal facial muscle activity

Tratamiento de la anquilosis de la articulación temporomandibular por artroplastia simple / Treatment of temporomandibular joint ankylosis by gap arthroplasty

Objetivo: El propósito de este trabajo es mostrar que la artroplastia simple mejora la apertura bucal al tratar la anquilosis temporomandibular. Pacientes y métodos: Fueron tratados ocho pacientes con anquilosis de la articulación temporomandibular por medio de artroplastia simple. Los pacientes fueron evaluados en el postoperatorio por un periodo por lo menos de veinticuatro meses (mínimo 24 y máximo 48 meses). Resultados: De los ocho pacientes (once articulaciones), cinco (62,5%) presentaron afectación unilateral y tres pacientes (37.5%) afectación bilateral de la ATM. La edad media fue de 20 años ± 9 (rango de 3 a 30 años). La máxima apertura bucal en el período preoperatorio fue de 9,25 ± 6,41 mm, mientras en el período postoperatorio fue de 29,88 ± 4,16 mm (p = 0.011). Se observó parálisis del nervio facial en dos pacientes (25%) la cual fue de carácter temporal. No se observó ninguna recurrenciaen nuestra serie. Conclusiones: El trauma fue la mayor causa de la anquilosis tempomandibular en nuestra muestra. La artroplastia simple mostró buenos resultados para el tratamiento de la anquilosis de la ATM

Purpose: The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating TMJ ankylosis.Patients and methods: Eight patients with TMJ ankylosis were treated by gap arthroplasty. The patients were evaluated by at least twenty-four months (minimum 24 and maximum 48 months).Results: Of the eight patients (eleven joints), five (62.5%) had unilateral involvement and three patients (37.5%) had bilateral involvement. The mean age was 20 years ± 9 (range 3 to 30 years). The mean maximal incisal opening (MIO) in the preoperativeperiod was 9.25 ± 6.41 mm and in the postoperative period it was 29.88± 4.16 mm. The complication of temporary facial nerve paresis was encountered in two patients (25%). No recurrence was observed in our series. Conclusions: Trauma was the major cause of tempomandibular joint ankylosis in our sample. Gap arthroplasty showed good results when treating TMJ ankylosis