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1.
J Oral Maxillofac Surg ; 79(1): 90.e1-90.e7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33010216

RESUMO

PURPOSE: To investigate the application and value of intraoperative computed tomography (CT) in the surgical management of temporomandibular joint (TMJ) ankylosis. PATIENTS AND METHODS: Patients who underwent surgery of TMJ ankylosis with the aid of intraoperative CT scan from July 2016 to December 2018 were retrospectively studied. Demographics, type of ankylosis, surgical method, intraoperative CT scan time, radiographic evidence, the CT-directed revision rate, and clinical outcomes were analyzed. RESULTS: Four patients (5 sides) were successfully operated with the aid of intraoperative CT imaging, and CT-directed revisions were made in 3 of them during surgery. The average time spent in CT scanning was (10.2 ± 3.3) minutes. No surgical complications were noted, and a good satisfaction rate (with an average maximum mouth opening of 38.8 mm and no recurrence during the follow-up period) was obtained. CONCLUSIONS: Intraoperative CT scanning is a helpful tool in the evaluation of the radiographic result of TMJ ankylosis, and a real-time revision could be made. It increased the precision and safety of the surgery of TMJ ankylosis.


Assuntos
Anquilose , Anquilose/diagnóstico por imagem , Anquilose/cirurgia , Humanos , Estudos Retrospectivos , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular , Tomografia Computadorizada por Raios X
2.
J Oral Maxillofac Surg ; 79(1): 75-87, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32866483

RESUMO

PURPOSE: Adult temporomandibular joint ankylosis (TMJA) lacks a uniform management protocol. The purpose of the study was to evaluate the outcome of stock total joint replacement (TJR) along with fat grafting around the joint in adult TMJA patients. Specific aim was to find out whether TJR can be a definitive management for adult TMJA. METHODS: The investigators implemented a prospective study on adult TMJA patients treated with ostearthrectomy of ankylosis and stock temporomandibular joint (TMJ) TJR with fat grafting. Concomitant orthognathic correction of facial asymmetry was performed in some unilateral cases. Follow-up was carried out at regular intervals for assessing primary outcome variable of maximal incisal opening (MIO) and reankylosis. Secondary outcome variable included demographic data, etiology, duration of ankylosis (DOA), correlation between DOA and preoperative and postoperative MIO, occlusion and complications of hemorrhage, facial nerve paresis, periprosthetic joint infection, dislocation, and implant failure. RESULTS: The study sample was composed of 41 patients (54 joints) (bilateral, n = 13; unilateral, n = 28 [right side, n = 12; left side, n = 16]). The number of recurrent cases was 15. Trauma as etiology of ankylosis was seen in n = 30 (73.2%), infection in n = 7 (17.1%), unknown in n = 3 (7.3%), and ankylosing spondylitis in n = 1 (2.4%) cases. Mean DOA was 11.95 years. Paired t test revealed a statistically significant difference between preoperative and follow-up MIO (P < .001). None of the cases showed reankylosis in the follow-up period. Pearson correlation revealed statistically negative correlation between DOA and postoperative MIO. CONCLUSIONS: The result of this study suggests that stock TMJ TJR along with fat grafting around the joints provides adequate mouth opening without any sign and symptoms of reankylosis. Stock TMJ TJR with fat grafting can be considered as a definitive treatment modality in adult TMJA with minimum comorbidity.


Assuntos
Anquilose , Artroplastia de Substituição , Tecido Adiposo , Adulto , Anquilose/cirurgia , Humanos , Estudos Prospectivos , Articulação Temporomandibular/cirurgia , Resultado do Tratamento
3.
J Oral Maxillofac Surg ; 79(1): 109-132.e6, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32800758

RESUMO

PURPOSE: Several animal models of temporomandibular joint ankylosis (TMJA) have been described for more than the past 2 decades. The aim of this study was 2-fold: 1) to compile and summarize the evidence of animal studies that compare different forms to induce, treat (disease already established), or prevent (after trauma) TMJA; and 2) to address the following focused question: what is the quality of reporting in these studies? MATERIALS AND METHODS: A systematic review was conducted. Animal studies conducted up to October 2019 comparing at least 2 procedures to induce, treat (disease already established), or prevent (after trauma) TMJA were considered. Compliance with the Animal Research Reporting In Vivo Experiments guidelines was checked for all studies. Studies evaluating treatment of TMJA or preventive measures also were evaluated using the SYstematic Review Center for Laboratory animal Experimentation's risk of bias tool for animal studies. RESULTS: A total of 24 studies were included. The studies were evaluated for feasibility regarding data synthesis, and a meta-analysis was not suitable because of methodological differences, mainly regarding the animal model chosen and surgical procedures performed to induce TMJA. In 17 articles, authors aimed to investigate different procedures to induce TMJA (fibrous, fibro-osseous, or bony). In 7 articles, different treatment or preventive strategies were compared. The sheep was the most used animal in models of TMJA. Only 25% (6 of 24) of studies reported some step to minimize bias (ie, blinding of investigators, randomization procedures, or allocation concealment). Approximately 54% (13 of 24) of articles clearly commented on study limitations and potential sources of bias. Further animal studies on TMJA should consider improving their reporting standards to increase their validity and improve the reproducibility of animal experiments.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Animais , Anquilose/prevenção & controle , Anquilose/cirurgia , Artroplastia , Reprodutibilidade dos Testes , Ovinos , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/prevenção & controle , Transtornos da Articulação Temporomandibular/cirurgia
4.
Res Vet Sci ; 132: 328-331, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32738728

RESUMO

Resection of the distal interphalangeal joint (DIJ) is a claw-preserving method for treatment of septic arthritis. This study presents the radiographic and histological findings of the surgically-treated area after resection of the DIJ using a plantar approach in seven German Holstein cows. Histological postmortem evaluation 439 to 710 days after surgery showed that there was extensive proliferation of connective tissue rich in collagen fibres in the space left after resection in three cows; this was classified as fibrous ankylosis. In the remaining four cows, histological evaluation 1010 to 1756 days after surgery showed extensive new bone formation in the joint cavity consistent with osseous ankylosis. Radiographs of the resected DIJ region obtained at the time of histological examination revealed no osseous ankylosis in two cows, partial ankylosis in one cow and complete osseous ankylosis in four cows. Formation of complete osseous ankylosis after resection of the DIJ did take longer than 1-2 years in three of our specimens indicating a longer time span compared to earlier studies.


Assuntos
Anquilose/veterinária , Artrite Infecciosa/veterinária , Doenças dos Bovinos/cirurgia , Coxeadura Animal/cirurgia , Animais , Anquilose/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Feminino , Seguimentos , Casco e Garras/diagnóstico por imagem
5.
Atlas Oral Maxillofac Surg Clin North Am ; 28(2): 111-118, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32741508

RESUMO

Temporomandibular joint ankyloses are a fusion of the mandibular condyle to the base of skull. Surgical advances have stemmed from innovation in computer planning, guidance, and intraoperative navigation, allowing surgeons to restore form and function with greater precision, predictability, and safety. Preoperative computer virtual surgical planning used the computed tomography scan data to render a 3-dimensional image that can be used for surgical simulations and fabrication of intraoperative aids. Temporomandibular joint reconstruction should be considered as a predictable option in the management of temporomandibular joint ankylosis. Intraoperative navigation allows for continuous real-time 3-dimensional positioning of instruments.


Assuntos
Anquilose , Cirurgia Assistida por Computador , Transtornos da Articulação Temporomandibular , Humanos , Côndilo Mandibular , Articulação Temporomandibular
6.
Indian J Dent Res ; 31(3): 350-353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32769265

RESUMO

Background: Long term effectiveness of surgical management of chronically restricted mouth opening in OSMF or TMJ ankylosis depends largely on postoperative physiotherapy. This in turn is dependent on patient's compliance. Use of adjunctive aids besides pharmacotherapy that reduces patients pain and improves compliance with exercise is warranted. Aims: To evaluate the role of TENS and structured rehabilitation programme in postoperative physiotherapy in OSMF and TMJ ankylosis patients. Methods and Materials: A pilot study was conducted in which 6 patients of restricted mouth opening were put on a structured rehabilitation protocol in which TENS, heat and cold therapy with structured mouth opening exercise regimes. Interincisal opening, VAS score and a subjective assessment of post surgical discomfort was evaluated. Results and Conclusions: Results revealed an improved compliance and cooperation by patients. Pain on VAS scale also reduced from mean of 7.8 on day 1 to 3.6 on day 5 in this group. The mean discomfort on day 3 was reported as mild to moderate. An early attainment of passive mouth opening closest to intraoperative mouth opening was also reported on day 5 which is usually not achievable without any physiotherapy intervention.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Humanos , Boca , Cooperação do Paciente , Projetos Piloto
7.
J Oral Maxillofac Surg ; 78(12): 2235-2246, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32649895

RESUMO

Ankylosis of the temporomandibular joint (TMJ) is defined as the emergence of a bony or fibrous compound between the condyle and the cranial base. It can result in divergent craniofacial characteristics. The aim of this study was to present an orthodontic-surgical approach in a case series of 4 patients with a diagnosis of TMJ ankylosis as a complication of otomastoiditis. The patient characteristics of 4 patients in whom TMJ ankylosis was diagnosed as a complication of otomastoiditis were described. All patients were treated with gap arthroplasty with costochondral graft, physiotherapy, and orthodontic therapy to achieve acceptable mouth opening and function. All reacted differently to this therapy, and additional interventions were required during childhood. In early-onset ankylosis, however, guiding the mandibular growth orthodontically can prevent increasing facial asymmetry and canting of the occlusal plane. After the pubertal growth spurt is finished, orthodontic treatment combined with surgical intervention may be considered to correct facial asymmetry and provide good dental occlusion. Orthodontic and surgical treatments showed themselves to be fundamental for patients with TMJ ankylosis as a complication of otomastoiditis, although continual monitoring until the end of growth is necessary to achieve the most functional recovery possible.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Anquilose/etiologia , Anquilose/cirurgia , Artroplastia/efeitos adversos , Criança , Humanos , Mandíbula , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/etiologia , Transtornos da Articulação Temporomandibular/cirurgia
9.
J Craniomaxillofac Surg ; 48(8): 779-785, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32709503

RESUMO

The patient-reported outcome measures are endorsed for better evaluation of disease impact and treatment outcomes. Temporomandibular joint (TMJ) ankylosis has been observed to adversely impact the quality of life (QoL) of the patients, affecting both the physical and psychosocial aspects of their lives. The study was conducted to develop and validate a TMJ ankylosis specific QoL questionnaire (TMJAQoL). It had two phases. Phase 1 was associated with the development of the questionnaire while phase 2 examined its psychometric properties and validated the instrument. In phase 1, a 65 item pool was generated and was eventually reduced to a 37 item pool after sequential evaluation by two expert groups. The 37 item draft was subjected to item reduction by the impact method, resulting in a 12 item draft divided into 4 domains, which formed the TMJAQoL questionnaire. In phase 2, the TMJAQoL was completed by 51 TMJ ankylosis patients and was found to have optimum validity, reliability and internal consistency. 44 of these patients completed the TMJAQoL again after the surgery. A significant change in mean cumulative TMJAQoL scores (pre-op = 14.10, post op = 4.05, p = .001) was found after the surgery. This change was significantly correlated to the improvement in the maximal incisal opening and the right and left lateral movements (r > .30). Amongst the TMJAQoL domains, significant improvement was seen in functional limitation (p = .026), psychological well being (p = .017) and social wellbeing domains (p = .038). Overall, improved QoL was observed after the TMJ surgery. The TMJAQoL demonstrated optimum psychometric properties and promises to be an effective QoL instrument for the TMJ ankylosis patients.


Assuntos
Anquilose , Qualidade de Vida , Humanos , Reprodutibilidade dos Testes , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular
10.
Oral Maxillofac Surg ; 24(4): 509-514, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32572708

RESUMO

The temporomandibular joint (TMJ) ankylosis describes the bone or fibrous adhesion of the TMJ components, with functional impairment. The present report shows the surgical correction the TMJ ankylosis due to a condyle fracture in a child. A 12-year-old patient, female, attended to the Oral and Maxillofacial Surgery Department of the Clinical Hospital/Federal University of Uberlândia, showing severe mouth opening limitation (9 mm) and history of bilateral condyle fracture and symphysis fracture. The right TMJ ankylosis was diagnosed, removed, reshaped, and repositioned to form the reshaped condyle, by the sliding reconstruction of the condyle using posterior border of mandibular ramus and myofascial interposition of the temporal fascia. Five months of follow-up showed mouth opening of 44 mm maintained after 2 years, without complaints. The surgical treatment of the TMJ ankylosis is needed for the reestablishment of the immediate function; however, the patient must be watched until the end of development.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Anquilose/diagnóstico por imagem , Anquilose/cirurgia , Criança , Feminino , Humanos , Mandíbula , Côndilo Mandibular , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia
11.
Br J Oral Maxillofac Surg ; 58(8): 947-952, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32534812

RESUMO

The purpose of this study was to assess the efficacy of 3-dimensional, printed, patient-specific guides to direct virtual gap arthroplasties that were designed for five patients with advanced unilateral ankylosis of the temporomandibular joint. The guides were used to mimic the intraoperative creation of five preplanned osteotomies, as well as simulating the width and depth of the bone cleavage. The accuracy of the devices in guiding the surgical simulation was assessed by superimposing the preoperative and postoperative computed tomographic scans. The devices were easily put in place with smooth uniform surgical bone cleavage, and favourable postoperative outcomes. The statistical analysis between the planned and surgical gaps, showed that the difference in dimensions was not significant (p=0.1018). The patient-specific gap arthroplasty was neither too near the skull base nor did it jeopardise the height of the mandibular ramus.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Anquilose Dental , Anquilose/diagnóstico por imagem , Anquilose/cirurgia , Artroplastia , Computadores , Humanos , Osteotomia , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia
12.
J Contemp Dent Pract ; 21(3): 337-349, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32434984

RESUMO

AIM: Temporomandibular joint ankylosis (TMJA) management involves many surgical treatment modalities depending on the experience of the operator. A lot of literature has been published on various treatment modalities. Many systematic reviews (SRs) were published without any published prior protocol. So, the study aimed to evaluate the quality of SRs with meta-analysis of TMJA management. MATERIALS AND METHODS: Systematic reviews with meta-analysis were included for the quality assessment using AMSTAR (assessment of multiple SRs) and Glenny et al. checklist by two independent teams. The search was limited to the Medline database archival (from January 1980 to December 2018). RESULTS: The primary search identified 1,507 related articles. After activation of different filters, abstracts screening, and cross-referencing, finally, a total of six studies were assessed to make the overview up-to-date. CONCLUSION: The articles scored 8 to 11 with AMSTAR and 7 to 13 with the Glenny et al. checklist. None of the published reviews received maximum scores. The methodology and heterogeneity are essential factors to assess the quality of the published literature. CLINICAL SIGNIFICANCE: None of the included meta-analysis was registered or published protocol with Prospero or Cochrane before publication for better validity of the studies. The authors are advised to follow reporting criteria so that in the future it is possible to provide the standards of care for TMJA with the highest quality of evidence.


Assuntos
Anquilose , Lista de Checagem , Humanos , Articulação Temporomandibular , Resultado do Tratamento
13.
Br J Oral Maxillofac Surg ; 58(8): 970-974, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32456996

RESUMO

The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p=0.013) and at one year (p=0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Anquilose Dental , Anquilose/cirurgia , Artroplastia , Derme , Humanos , Estudos Prospectivos , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia
14.
J Oral Maxillofac Surg ; 78(7): 1100-1110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32283078

RESUMO

PURPOSE: There is limited evidence in the literature about fat grafting in the management of temporomandibular joint ankylosis (TMJA). The purpose was to investigate which interpositional fat grafting technique is superior in the operative management of TMJA. The specific aim was to compare the volumetric change and maximal mouth opening (MIO) when pedicled buccal fat or abdominal fat is interposed in patients being treated for TMJA. PATIENTS AND METHODS: A randomized controlled trial was conducted on TMJA patients divided into 2 groups: Pedicled buccal fat pad was used for interposition in group A, whereas abdominal fat was used in group B. At the end of 1 year, the volumetric change in fat was analyzed by comparing immediate postoperative and 1-year follow-up magnetic resonance imaging (MRI). MIO and re-ankylosis were recorded. Categorical variables were analyzed by the χ2 test or Fisher exact test. Continuous variables were compared using the t test and Wilcoxon signed rank test. Linear regression analysis was performed. RESULTS: A total of 36 patients (51 joints [15 bilateral and 21 unilateral]) were included, comprising 18 in group A and 18 in group B. The mean preoperative MIO measured 6.8 mm in group A and 4.2 mm in group B. The mean immediate postoperative MRI fat volume was 4.3 cm3 in group A and 10.8 cm3 in group B. One-year follow-up MRI showed a fat retention rate of 32.44% in group A and 58.17% in group B. The rate of volumetric shrinkage was 67.5% in group A and 41.9% in group B (P < .001). Analysis of variance showed a statistically significant difference between volumetric shrinkage and both treatment groups (P < .001). MIO improved to 30.6 mm in the pedicled buccal fat pad group (group A) and 41.9 mm in the abdominal fat group (group B) (P < .001). No re-ankylosis occurred in either group at 1-year follow-up. CONCLUSIONS: Our study results suggest that the percentage of retention of interposed abdominal fat at 1 year is more than that of pedicled buccal fat pad. Volumetric shrinkage is greater with buccal fat pad, which is a paradox considering the pedicled blood supply. Abdominal fat is better than pedicled buccal fat pad when used for interposition in TMJA treatment.


Assuntos
Anquilose/cirurgia , Articulação Temporomandibular , Gordura Abdominal , Tecido Adiposo/transplante , Artroplastia , Humanos , Boca , Articulação Temporomandibular/cirurgia
15.
J Craniofac Surg ; 31(5): 1390-1394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310874

RESUMO

Mandibular condylar osteochondroma (OC) can result in facial asymmetry, malocclusion, and temporomandibular joint dysfunction. The authors have previously demonstrated a novel method for conservative condylectomy and simultaneous orthognathic surgery for treatment of mandibular condylar OC. The purpose of this study was to evaluate the immediate improvement and long-term stability of mandibular symmetry in the treatment of condylar OC. Fifty-six patients with unilateral mandibular condylar OC combined with secondary facial asymmetry and malocclusion were enrolled in this retrospective study. The computerized tomography (CT) scans were acquired with the mandible in centric relation (CR) before surgery, 1 week and 12 to 18 months after surgery. The images were reconstructed and processed for the analysis with ProPlan CMF 2.1 software. After defining the skeletal landmarks and the reference planes, the chin deviation, chin rotation and mandibular asymmetry index were calculated. The operations and healing were uneventful and the patients showed no signs of recurrence or temporomandibular joint ankylosis during the follow-up. Facial symmetry was greatly improved right after the surgery in the chin deviation (from 9.2 to 1.7 mm, P < 0.01), chin rotation (from 11.2 to 2.3, P < 0.01) and the asymmetry index of three mandibular landmarks (Go, MF and Sg, all P < 0.01). It also showed a stable result after 12 to 18 months follow-up. We also established a novel measurement method, which showed that the combination of conservative condylectomy via the intraoral approach based on intraoperative navigation and simultaneous orthognathic surgery is effective for improving the facial symmetry when treat the mandibular condylar OC.


Assuntos
Assimetria Facial , Côndilo Mandibular/diagnóstico por imagem , Neoplasias Mandibulares/diagnóstico por imagem , Procedimentos Cirúrgicos Ortognáticos , Osteocondroma/diagnóstico por imagem , Adolescente , Adulto , Anquilose/diagnóstico por imagem , Feminino , Humanos , Masculino , Côndilo Mandibular/cirurgia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteocondroma/cirurgia , Recidiva , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Int J Oral Maxillofac Surg ; 49(11): 1449-1458, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32247547

RESUMO

Temporomandibular joint ankylosis (TMJA) is a complicated condition that affects not only the condyle, but also the maxillofacial complex. Thus, it is often challenging to find a standardized treatment strategy for TMJA. This study was performed to analyse our experience with 95 TMJA patients over a 4-year period and develop a new classification system ('CDA'). The CDA classification system divides TMJA patients into eight different groups according to the preservability of the condyle (C), severity of the dentofacial bone deformity (D), and skeletal age (A). The 95 patients (129 ankylosed joints) were treated using different strategies based on this CDA classification. Treatment options included preserving or reconstructing the condylar head, surgical correction of jaw deformities, and close follow-up of mandibular growth. After treatment, all 129 ankylosed joints were completely released and the average maximum inter-incisal opening (MIO) increased from 3.6 ± 3.2 mm to 32.8 ± 5.4 mm, with no recurrence of ankylosis found during follow-up. In conclusion, this new CDA classification can effectively guide treatment strategies for TMJA patients. Using particular strategies for patients based on specific CDA classifications could provide optimal management to the benefit of TMJA patients.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Anquilose/diagnóstico por imagem , Anquilose/cirurgia , Artroplastia , Humanos , Mandíbula , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia
17.
J Oral Maxillofac Surg ; 78(6): 916-926, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32171600

RESUMO

PURPOSE: The aim of the present study was to determine the effect of intramuscular injection of botulinum toxin A (BTX-A) into the masticatory muscles on the physiotherapy pain and mouth opening outcomes after surgical intervention of temporomandibular joint (TMJ) ankylosis and to verify the effects using electromyographic studies. PATIENTS AND METHODS: The study included 20 patients with TMJ ankylosis. The patients were further subdivided into control and interventional groups. The interventional group was given intramuscular injections of BTX-A in the masticator muscles before surgery. Only saline injections were given to the control group. All 20 patients were evaluated for pain and ease of active physiotherapy at the 1-week and 1-, 3-, and 6-month follow-up visits using a questionnaire. Intergroup comparisons were performed for both groups. Electromyographic (EMG) studies were also performed in the intervention group for each patient. EMG recordings were performed of the individual masticator muscle in each patient before injection and at 1 and 3 months after injection. RESULTS: The intervention group showed better results with respect to pain during the mouth opening exercises and improvements in mouth opening. All the interventional group patients showed a transient decrease in the microvolt value on the EMG studies of their masticator muscles on injection of BTX-A. CONCLUSIONS: BTX-A injection can be a straightforward and useful adjunct to surgical treatment of TMJ ankylosis for the reduction of pain during postoperative physiotherapy.


Assuntos
Anquilose , Toxinas Botulínicas Tipo A , Humanos , Injeções Intramusculares , Boca , Dor , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular
18.
J Craniomaxillofac Surg ; 48(5): 494-500, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32209271

RESUMO

PURPOSE: This study aimed to evaluate the remodeling of condyles reconstructed by transport distraction osteogenesis (DO) in patients with temporomandibular joint (TMJ) ankylosis. PATIENTS AND METHODS: Twenty-one patients with 26 affected joints were followed up for 34.1 ± 13.3 months. Patients who had undergone gap arthroplasty and TMJ reconstruction by DO were included. Maximal mouth opening (MMO) and occlusion were recorded. Computed tomography images were obtained preoperatively (T0), upon completing distraction (T1), upon removal of the distraction device (T2), and >2 years postoperatively (T3). The following were measured: mandibular ramus height, distance between gonion and Frankfurt plane (Go-FN), condylar width, and condyle-ramus angulation. RESULTS: Of the 21 patients, one showed re-ankylosis, while five exhibited anterior open bite. From T1 to T3, the total amount of resorption of ramus height reached up to 8.2 ± 4.6 mm (p < 0.001), in comparison with a total distraction length of 13.8 ± 4.1 mm; the mean resorption rate was 59.4%. Similarly, Go-FN decreased by 6.2 ± 4.0 mm (p < 0.001). CONCLUSION: Our findings indicated that DO combined with gap arthroplasty was an effective method for the treatment of TMJ ankylosis to improve MMO. The reconstructed condyle exhibited a high frequency of resorption in height.


Assuntos
Anquilose/cirurgia , Osteogênese por Distração , Transtornos da Articulação Temporomandibular/cirurgia , Artroplastia , Humanos , Côndilo Mandibular/cirurgia , Articulação Temporomandibular
19.
J Craniofac Surg ; 31(5): 1343-1347, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32176014

RESUMO

BACKGROUND: The authors present an institutional experience treating congenital and acquired temporomandibular joint (TMJ) ankylosis, detailing outcomes and potential risk factors of recurrence. METHODS: Retrospective chart review identified patients with TMJ ankylosis (1976-2019). Clinical records, operative reports, and imaging studies were reviewed for demographics, surgical operations, and ankylosis including maximal interincisal opening (MIO) and re-ankylosis. RESULTS: Forty-four TMJs with bony ankylosis were identified in 28 patients (mean age at any initial mandibular surgery: 3.7; range:0-14 years). Follow-up was 13.7 ±â€Š5.9 years. Sixteen (57.1%) patients had bilateral ankylosis; 27(96.4%) had syndromes. Nine patients had congenital ankylosis, 16 had iatrogenic ankylosis (4.5 ±â€Š3.7 years from initial distraction osteogenesis or autologous mandibular reconstruction) referred from outside institutions in 6 instances, and 3 had post-infectious ankylosis. Patients having their first mandibular operation at a younger age had more frequent reoperations for recurrent TMJ ankylosis, although this did not reach statistical significance. Mean improvement in MIO was 21.4 ±â€Š7.3 mm. Ankylosis recurred in 21 (75%) patients. Five patients with congenital TMJ ankylosis required gastrostomy and remained at least partially dependent. Five patients had tracheostomy at the time of TMJ ankylosis surgery: 2 were eventually decannulated and 3 required repeat tracheostomy after ankylosis recurrence and remained tracheostomy-dependent. CONCLUSION: The clinical course of TMJ ankylosis in children affected by craniofacial differences is complex and typically involves a high rate of recurrence and multiple reoperations despite initial improvement in postoperative MIO. Younger age at initial mandibular surgery and number of operations require further investigation as potential predictors of recurrent TMJ ankylosis as well as tracheostomy and gastrostomy dependence.


Assuntos
Anquilose/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/cirurgia , Adolescente , Anquilose/diagnóstico por imagem , Artroplastia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Reconstrução Mandibular , Osteogênese por Distração , Recidiva , Estudos Retrospectivos , Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Traqueostomia , Resultado do Tratamento
20.
J Comp Pathol ; 175: 39-48, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32138841

RESUMO

Temporomandibular joint (TMJ) ankylosis is an uncommon clinical entity in human and veterinary medicine. However, the condition is severely debilitating and is life-limiting if not treated. This study sought to characterize the intra- and extra-articular features of naturally occurring TMJ ankylosis in cats. TMJs from client-owned cats (n = 5) that underwent bilateral TMJ gap arthroplasty were examined and compared with TMJs from healthy, age-matched feline cadavers (n = 2) by cone-beam computed tomography (CBCT), micro-computed tomography (µCT) and histologically. Features of bilateral intra- and extra-articular ankylosis compounded by degenerative joint lesions were identified radiographically and histologically in all affected cats. Features of TMJ 'true' ankylosis included variable intracapsular fibro-osseous bridging, degeneration of the disc and the articular surfaces, narrowing of the joint space and flattening of the condylar process of the mandible. Extra-articular features of TMJ ankylosis included periarticular bone formation and fibro-osseous bridging between the mandible, zygomatic arch and coronoid process. In addition, subchondral bone loss or sclerosis, irregular and altered joint contours and irregularly increased density of the medullary bone characterized the degenerative changes of the osseous components of the TMJ. Complex radiological and histological features of both ankylosis and pseudoankylosis were identified that clinically manifested in complete inability to open the mouth.


Assuntos
Anquilose/veterinária , Doenças do Gato/patologia , Transtornos da Articulação Temporomandibular/veterinária , Animais , Gatos , Feminino , Masculino
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