Tratamiento de la anquilosis temporomandibular en niños con materiales aloplásticos / Treatment of temporomandibular ankilosis in children with alloplastic materials

La anquilosis de la articulación temporomandibular en niños continúa siendo una patología presente a pesar de los avances médicos y sociales. El tratamiento de esta patología en niños tiene como objetivos restablecer la apertura bucal y mejorar la estética facial cuando se presentan hipoplasias o micrognatias asociadas. El uso de materiales aloplásticos para el tratamiento de la anquilosis temporomandibular en niños es evitar la reanquilosis y disminuir riesgos, molestias y costos que ocasionan la toma y aplicación de injertos, siendo utilizados con buenos resultados en niños en otras especialidades como la Traumatología y Ortopedia. Estos procedimientos pueden llevarse a cabo de manera segura y predecible. En este artículo se reportan dos casos de anquilosis temporomandibular en niños, tratados con materiales aloplásticos, llevados a cabo en la Unidad Médica de Alta Especialidad No. 71 del Instituto Mexicano del Seguro Social, Torreón, Coahuila, México, con un seguimiento de 11 y 16 años de postoperatorio, demostrando que se trata de una buena opción de tratamiento sin presentar alteraciones al crecimiento y desarrollo de los pacientes (AU)

Temporomandibular ankilosis in children is pathology still present despite the medical and social advances. The treatment of this pathology in children aims to restore mouth opening and improve facial aesthetics when hypoplasia or micrognatia are present. The use of alloplastic materials to treat temporomandibular ankilosis in children is to prevent the re ankilosis and reduce discomfort, risks, and cost causing by the take and application of graft, alloplastic materials being used with good results in children in other specialties such as Traumatology and Orthopedics. These procedures can be made safely and predictably. This article describes two cases of temporomandibular ankilosis in children, treated with alloplastic materials, carried out in the Medical Unit of High Specialty, number 71, of the Mexican Institute Social Security, Torreon, Coahuila, Mexico, with follow up of cases 11 and 16 years of postoperative, prove that is a good option of treatment, without presenting any alterations in growth and development of patients (AU)

Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision.

Background and purpose - The incidence of manipulation under anesthesia (MUA) after knee arthroplasty surgery has been reported to vary between 0.5% and 10%. We evaluated the incidence of MUA after primary knee arthroplasty in Sweden, the demographics of the patients and the risk of revision. Patients and methods - Between 2009 and 2013, 64,840 primary total and unicompartmental knee arthroplasties (TKA and UKA) were registered in the Swedish Knee Arthroplasty Register (SKAR). MUAs performed between 2009 and 2014 were identified through the in- and outpatient registers of the Swedish National Board of Health and Welfare. Pertinent data were verified through medical records and patient demographics and revisions were obtained from the SKAR. Results - 1,258 MUAs were identified. Of these, 1,078 were 1st-time MUAs, performed within 1 year after the primary knee arthroplasty. The incidence of MUA was 1.7% and the incidence varied between hospitals from 0% to 5%. The majority were performed after TKA (98%), in younger patients (65% < 65 years), women (64%), and relatively healthy persons (88% had ASA ≤ 2). The cumulative risk of revision at 10 years was 10% (95% CI 8.6-12), similar for men and women. Interpretation - In Sweden, MUA is a rather uncommon measure after knee arthroplasty, especially after UKA. The CRR at 10 years was doubled compared to the general knee arthroplasty population. The frequency of the procedure varies between hospitals but in general it is performed more frequently in healthier and younger patients.

Retrograde intubation in a dog with severe temporomandibular joint ankylosis: case report.

BACKGROUND: Orotracheal intubation in dogs is a common and easily-performed procedure that provides a patent airway during anaesthesia. In dogs with temporomandibular joint ankylosis or pseudo-ankylosis, airway management can be a challenging procedure since these dogs have a limited ability to open their mouth. Methods to provide safe, uneventful intubation in such patients may include minimally invasive techniques such as retrograde intubation using a guide wire and fibre-optic-aided laryngoscopy. CASE PRESENTATION: We report a case of a 16-month-old, intact female Bull Terrier weighing 17 kg, admitted to the hospital for surgical treatment of bilateral ankylosis of the temporomandibular joint. Intubation was achieved, without direct observation of the larynx, by retrograde intubation using a vascular access catheter and a vascular wire guide through cricothyroid membrane. Bilateral condylectomy was performed and the dog recovered uneventfully. CONCLUSIONS: In conclusion, retrograde intubation was relatively simple to perform with the guide wire technique and no specific training or equipment were necessary.

A preliminary study of effects of low-intensity pulsed ultrasound (LIPUS) irradiation on dentoalveolar ankylosis.

The purpose of this experiment was to investigate whether low-intensity pulsed ultrasound (LIPUS) irradiation can inhibit dentoalveolar ankylosis in transplanted rat teeth. LIPUS irradiation (the pulsed ultrasound signal had a frequency of 3.0 MHz, a spatial average intensity of 30 mW/cm2, and a pulse ratio of 1:4) was performed on the face over the re-planted teeth of rats for 4 weeks. After the rats were euthanized, we measured mobility (Periotest value [PTV]) of the transplanted and control teeth using a Periotest. Finally, we performed histological evaluation to detect ankylosis. PTVs tended to be significantly lower for re-planted teeth than for control teeth. Histological evaluation revealed that the roots of all re-planted teeth were coalescent with alveolar bone. Furthermore, no ankylosis was observed in three-fifths of the re-planted teeth following LIPUS irradiation. These results indicate the potential efficacy of LIPUS to inhibit dentoalveolar ankylosis.

"Closed Reduction" Principles Can Manage Diverse Conditions of Temporomandibular Joint Vertical Height Loss: From Displaced Condylar Fractures to Idiopathic Condylar Resorption.

PURPOSE: The aim of this case series was to describe a modification of the classic "closed reduction" technique to manage unilateral or anterior open bite owing to a loss in vertical height (LVH) caused by several disorders and pathologies other than displaced condylar fractures. MATERIALS AND METHODS: The protocol included insertion of an occlusal appliance to increase the height of the premature contact and the width of the open bite, stabilization of the dental arches by rigid arches, and the use, during sleep, of rubber bands in the open bite region to pull the mandible cranially. In addition, when awake, the patient performed physiotherapy exercises to guide the mandible into maximum intercuspation. The increased open bite enhanced the effect of the rubber bands in guiding the mandible into the original habitual occlusion and the rigid arches served to minimize tooth eruption. RESULTS: The present cases showed the favorable outcome of this low-risk treatment in the re-establishment of the original habitual occlusion within 1 to 4 weeks and without reconstruction of the LVH. CONCLUSION: The efficacy of this complication-free approach to correct occlusion in various conditions of LVH suggests that this protocol should be applied before venturing into surgical intervention.

Transport distraction osteogenesis combined with orthodontic treatment in a patient with unilateral temporomandibular joint ankylosis.

Temporomandibular joint ankylosis manifests a range of clinical characteristics dependent upon the age of onset, the affected side, and the severity. When it occurs during development, mandibular growth is affected, resulting in severe retrusion or asymmetry as well as limitation of mandibular movements. Progressive asymmetric mandibular growth in unilateral ankylosis causes canting of the occlusal plane. In this case report, we present a successful temporomandibular joint reconstruction using transport distraction osteogenesis combined with camouflage orthodontic treatment for occlusal canting correction of a patient with unilateral temporomandibular joint ankylosis and severe facial asymmetry.

Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. METHODS: Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. RESULTS: Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. CONCLUSIONS: Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.

Use of Ultrasonography for Assessing Treatment Efficacy in a Case With Ankylosis of the Temporomandibular Joint.

The patient was a 32-year-old university lecturer with limited mouth opening for 15 years. The patient was diagnosed with right temporomandibular joint ankylosis 10 years prior. Ultrasonography was employed to assess capsule-condyle distance before and after physical therapy. A treatment plan aiming at mobilizations and exercises was implemented, and the patient reported improvements in eating and speaking.

Brisement force in fibrous ankylosis: A technique revisited.

Fibrous ankylosis is a common complication of trauma to the temporomandibular joint (TMJ) in children. Proper treatment and regular follow-up is necessary for its successful management. This report highlights a case of posttraumatic fibrous ankylosis successfully managed with brisement force-gradual tractional forces applied to the TMJ under local anesthesia without any associated complications. Mouth opening increased significantly from 15 to 35 mm. The patient was advised to perform rigorous physiotherapy at home, to maintain interincisal opening of 35 mm. The case was followed up for 6 months with no decrease in mouth opening.

Two typical cases of pseudoankylosis of the jaw: same treatment, different outcome.

Pseudoankylosis of the temporomandibular joint is a rare, extra-articular form of ankylosis of the jaw. It is characterised by limited mandibular movement caused by an extrinsic condition of the joint leading to fusion between the coronoid process and temporal, zygomatic or maxillary bone. Pseudoankylosis is less frequent than the intracapsular form. Extracapsular ankylosis can be congenital or acquired; approximately 70% of cases are associated with trauma. A CT scan is usually requested to achieve a diagnosis. CT can detect bony fusion, thus differentiating pseudoankylosis from true ankylosis. Once symptomatic bone ankylosis is diagnosed, surgery with postoperative physiotherapy is the recommended treatment. The ankylotic bone is removed together with the coronoid process and the mouth is forced open under general anaesthesia. Two cases of post-traumatic pseudoankylosis of the jaw treated with bilateral coronoidectomy and postoperative physiotherapy are described.

Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: A systematic review and meta-analysis.

BACKGROUND: Interpositional arthroplasty (IA) and reconstruction arthroplasty (RA) are widely used in treating temporomandibular joint ankylosis (TMJA). But the reported clinical outcomes are controversial, the debate over which one is better remains. METHODS: The Pubmed, EMBASE, OVID EBM Reviews, and Web of science were searched up to Oct 11 2014 without limitation on year, language. Only randomized controlled trials and observational cohort studies with a follow-up of at least 12 months were included. RESULTS: A total of 8 retrospective cohort studies with 234 patients with TMJA were included in metaanalysis. Pooled analysis showed no significant differences in reankylosis (RD: -0.00; 95% CI: -0.08, 0.07; Z=0.06; P =0.95; I(2) =0%), and maximum incisal opening (MD=0.99; 95% CI: -1.43, 3.4, Z=0.8, p=0.42; I(2) =74%) between the IA and RA groups. CONCLUSIONS: IA and RA could produce similar outcomes in treating TMJA regarding to rankylosis and maximum incisal opening. Other postoperative complications, such as overgrowth of cartilage, malocclusion and the status of facial development should be evaluated more thoroughly.

Bony fusion in a chronic cervical bilateral facet dislocation.

BACKGROUND: Cervical facet dislocation injuries typically present shortly after occurrence due to the pain and neurologic deficit that can be associated with this injury. Bilateral dislocations of the facet joint require prompt evaluation, reduction, and surgical intervention. Rare case reports present bilateral dislocations presenting in a delayed fashion. CASE REPORT: We report the case of a 60-year-old male who presented with mild neck pain 1 year after initial injury. Computed topography of the cervical spine showed healing with bony fusion of a bilateral C6-7 facet dislocation. Given the chronic healed nature of the injury and minimal symptoms, the patient is being followed without intervention. CONCLUSIONS: Although most bilateral facet dislocations present and are treated immediately after injury; this case illustrates that some may be missed during initial evaluation. Once healed, these injuries may be stable without surgical intervention.

Early treatment of unilateral temporomandibular joint ankylosis: a multidisciplinary approach.

Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

Bony ankylosis of the knee secondary to heterotopic ossification after total knee arthroplasty: a case report.

We report a case of bony ankylosis of the knee secondary to severe and extensive heterotopic ossification over 9 years after primary total knee arthroplasty in a 71-year-old woman.

Ankylosing pelvitrochanteric heterotopic ossification in a patient with spinal cord injury.

Heterotopic ossification is a frequent complication after spinal cord injury. It usually develops around major weight bearing joints. However, ankylosing hip is a rare presentation. Various treatment methods have been reported and advocated as efficacious methods for management of heterotopic ossification. We report a case of ankylosing pelvitrochanteric heterotopic ossification treated with surgical excision before full maturation, postoperative radiation therapy and indomethacine without recurrence after 1 year. Treatment options are discussed in this particular case.

How do I manage restricted mouth opening secondary to problems with the temporomandibular joint?

Restricted mouth opening is a common problem that presents to secondary care, and management depends on the primary cause. The most common differential diagnoses related to the temporomandibular joint (TMJ) include muscle spasm secondary to pain, anchored disc phenomenon, irreducible anterior disc displacement, rheumatoid diseases, and ankylosis. In this paper each is considered in turn.