Reconstruction of Temporomandibular Joint and Skull Base Defect Following Osteosarcoma Resection.

ABSTRACT: Osteosarcoma of the jaw is uncommon, occurring in about 6% to 8% of cases. The authors present the case report of a (woman 72-year-old) with osteosarcoma involving the temporomandibular joint (TMJ). Radical surgery was chosen with resection of the tumor together with the condyle, the coronoid process, the zygomatic arch and eroded bone of the skull base at the site of the joint cavity. Contact of the tumor with the dura mater was not confirmed perioperatively.Reconstruction of the TMJ was 24 months after resection. The fossa component was concurrently formed in such a way as to cover the defect in the skull base and allow the reconstruction of the fossa and resected zygomatic arch. Four years after tumor resection there are no signs of local recurrence or metastases. Two years after TMJ reconstruction, the patient is symptom-free-occlusion is satisfactory, jaw movement is within normal range.

The Manifestations of Covid-19 Infection. Manifestations in Patients with Temporomandibular Joint Disorders.

The authors present a group of patients who were treated for exacerbation of temporomandibular joint disorders (TMD) following Covid-19 infection and who in the past had successfully undergone surgery of the temporomandibular joint (TMJ). The group consisted in total of 21 patients who relapsed after contracting Covid-19. There were 4 men and 17 women, the average age was 45.6 years (28-63). The most common complaint was pain. In all cases, the pain was located in the preauricular area, 4 patients had pain in the lateral side of the neck, 1 patient had pain of the nasal alae. During clinical examination, pain was present on palpation of the masseter muscle (19 patients), temporal muscle (4 patients) and the TMJ area (4 patients). In 4 cases, pain on palpation was present in the area of the nape and sternocleidomastoid muscles. Treatment in all cases was the same: thermotherapy, muscle relaxation massage and non-steroidal anti-inflammatory drugs. Symptoms subsided in all cases within 2 weeks. In light of the Covid-19 pandemic, it is also necessary to expect an increased number of patients with TMD. The authors recommend targeted patient histories regarding Covid-19 infection when examining patients with TMD symptoms - this will certainly facilitate determining the etiology of the pain.

A Complex Evaluation of the In-Vivo Biocompatibility and Degradation of an Extruded ZnMgSr Absorbable Alloy Implanted into Rabbit Bones for 360 Days.

The increasing incidence of trauma in medicine brings with it new demands on the materials used for the surgical treatment of bone fractures. Titanium, its alloys, and steel are used worldwide in the treatment of skeletal injuries. These metallic materials, although inert, are often removed after the injured bone has healed. The second-stage procedure-the removal of the plates and screws-can overwhelm patients and overload healthcare systems. The development of suitable absorbable metallic materials would help us to overcome these issues. In this experimental study, we analyzed an extruded Zn-0.8Mg-0.2Sr (wt.%) alloy on a rabbit model. From this alloy we developed screws which were implanted into the rabbit tibia. After 120, 240, and 360 days, we tested the toxicity at the site of implantation and also within the vital organs: the liver, kidneys, and brain. The results were compared with a control group, implanted with a Ti-based screw and sacrificed after 360 days. The samples were analyzed using X-ray, micro-CT, and a scanning electron microscope. Chemical analysis revealed only small concentrations of zinc, strontium, and magnesium in the liver, kidneys, and brain. Histologically, the alloy was verified to possess very good biocompatibility after 360 days, without any signs of toxicity at the site of implantation. We did not observe raised levels of Sr, Zn, or Mg in any of the vital organs when compared with the Ti group at 360 days. The material was found to slowly degrade in vivo, forming solid corrosion products on its surface.

Evaluating the Effect of Conservative Therapy in Patients with Wilkes Stage III Temporomandibular Joint Derangement.

The authors evaluated effects of physiotherapy in patients experiencing Wilkes III temporomandibular joint (TMJ) derangement with clinically limited joint mobility, but no pain. The group consisted of 31 patients with unilateral temporomandibular joint involvement, 3 men and 28 women (average age was 30.93, ranging from age 12 to 61). None of the patients in the group had experienced any previous TMJ therapy. The patients underwent conservative therapy in the form of home exercise (mobilisation and isometric exercises) as the first step in treatment. The authors evaluated the improvement in jaw movement (maximal interincisal opening - MIO) and the patients' subjective assessments of their condition. Disc position before and after two months of exercise was also evaluated using ultrasound examination. The average MIO value in patients before starting the exercises was 33.5 mm, and after two months of exercises, 42.4 mm. Subjective assessment by patients: 26 patients (83%) described their condition as completely satisfactory, not requiring further therapy. Of these patients, ultrasound examination showed 10 patients with complete disc reduction, 9 patients with a change in disc displacement with reduction, and 7 patients with a continuing (unchanged) state of disc displacement. Results of our study show the effect of conservative therapy in patients with painless TMJ due to disc displacement (WIII). Effect of home exercises which were easy to perform, simple and acceptable to the patient were demonstrated.

Discectomy with Subsequent Free Fat Flap Insertion in Disc Perforation Therapy of Temporomandibular Joint. Assessment of Results 24 Months after Operation.

Discectomy with replacement of disc is one possibility for treating disc perforation where conservative, mini-invasive therapy and arthroscopy has had no effect. Allogenic or autologous materials are used to replace the disc. The authors assess the use of a free fat flap (FFF) in 19 patients who in 2015-2016 underwent a unilateral discectomy with disc replacement. In the retrospective 24-month follow-up study a total of 16 patients (84%) were free of difficulties. 24 months after the operation mouth opening was on average 39.3 mm, pain (VAS - visual analog scale (0-10) was assessed on average at 0.3). Crepitus was present after 24 months in 37.5% of patients (6 patients). An assessment of changes in joint structures on cone beam computed tomography (CBCT) for these patients 24 months after the operation showed the progression of flattening of the joint head, in one case unevenness of the joint head. In 3 cases (16%) there was a recurrence of the state within 24 months - in all cases with clinical manifestations of pain and limited mobility, for these patients on the CBCT significant unevennesses of the joint head, subchondral cysts were noted. The authors find discectomy with use of FFF to be an effective method of treatment with a minimum of complications. However, one should take into account the relatively short time of monitoring after the operation (2 years) and limited number of patients in the cohort (19 patients).

Evaluation of Complications Following a Trans-masseteric Antero-parotid Approach for Patients with Sub-condylar Fractures of Their Temporomandibular Joint. A Retrospective Study.

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.

Osteoarthrosis of Temporomandibular Joint Related to the Defects of Posterior Dentition: A Retrospective Study.

Osteoarthrosis (OA) of temporomandibular joint (TMJ) is a progressive degenerative disease, gradually affecting cartilage, synovial membrane and bone structures. OA of TMJ clinically manifests with joint noises, pain and restricted mouth opening. In late stages, it results in severe damage of TMJ structures and development of ankylosis. Osteoarthrosis is a multifactorial disease; the occurrence is associated with TMJ overloading. The cohort included 619 patients [538 women (87%) and 81 men (13%), with average age 40.6 years (age range 8-89 years)] with TMJ disorder, who were examined in the year 2014 in Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic. The aim of this retrospective study was to analyse, if the lack of posterior teeth (supporting teeth zones) is the main etiologic factor of osteoarthrosis of TMJ. Diagnosis of OA was established on the clinical signs and the panoramic X-ray signs. Simultaneously other etiologic factors of OA were assessed. The presence of OA changes on X-ray had 171 patients (i.e. 27.6% of the total number of 619). 17.5% from these patients with OA had defect in posterior dentition. Other aetiological factors (stress, skeletal or vertebrogenous disorders) showed higher incidence of OA changes on X-ray. Defect of posterior dentition is not negligible, but it is not the main aetiological factor for osteoarthrosis of TMJ.

Keratocystic Odontogenic Tumour with Extraosseal Spread: Evaluation of the Effect Carnoy's Solution.

Keratocystic odontogenic tumour is relatively rare benign tumour. It is characterized by its fast aggressive growth and high risk of recurrence. Treatment is always surgical: conservative (enucleation, marsupialization) or aggressive (enucleation followed by application of Carnoy's solution, cryotherapy; peripheral ostectomy or en block resection of the jaw). Authors analysed retrospectively 22 patients who fulfilled inclusion criteria, i.e. had odontogenic keratocystic tumour of mandible, wherein antero-posterior dimension was at least 30 mm, and the tumour penetrated into the surrounding soft tissues. All patients underwent tumour enucleation, in 11 patients Carnoy's solution was given into the bone cavity after enucleation. The recurrence rate in the evaluation at least 36 months after surgery was both patient groups the same: 45.4%.

The neuromuscular approach towards interdisciplinary cooperation in medicine.

BACKGROUND: The contemporary approach of dentistry towards interdisciplinary cooperation is based on the neuromuscular concept. In recent years many authors have pointed out a correlation between orthopaedic and dental findings. Furthermore, there is an intimate biomechanical interrelationship of occlusion with cerebral fluid circulation, left and right equilibrium, gaze stabilisation and headache. The influence of a dental occlusion and temporomandibular joint (TMJ) status on general health has been widely analysed in the current scientific literature. AIM: The aim of this analytic study was to display the deep relationship between dentistry and other fields of medicine, and to show the necessity of wide cooperation between dentists and physicians. CONCLUSIONS: This study was based on a review of 41 sources, including specialised articles and books. The significance of different anatomical and physiological preconditions (occlusion, muscles and TMJ status) was considered and evaluated separately. However, as a result of modern concepts of general body health, extending cooperation between different fields of medicine is essential. The practical application of the principles of neuromuscular dentistry enables one to increase greatly the treatment efficiency of aches in muscles, headaches, postural dysfunctions as well as of many other diseases. However, the dentist's contribution to the development of an interdisciplinary approach is underestimated. Many theoretical aspects of the interdisciplinary relationship have not been sufficiently examined, hence the practical consequences remain unclear. Further research in the field is urgently needed.

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.

Evaluation of complications following stock replacement of the temporomandibular joint performed between the years 2006 and 2015: a retrospective study.

PURPOSE: Alloplastic total temporomandibular joint replacement (TMJR) is now considered to be a standard procedure for temporomandibular joint (TMJ) reconstruction. TMJR can improve mandibular mobility, restore the dental occlusion and improve facial aesthetics. The purpose was to assess the presence of intraoperative and post-operative complications, including the presence of post-operative chronic pain. METHODS: This retrospective study evaluated the use of 62 stock TMJR devices implanted in 45 patients who underwent surgery between the years 2006 and 2015 by the same surgeon at the Department of Oral and Maxillofacial Surgery, Stomatology Clinic, General Teaching Hospital (VFN) Charles University, Prague, Czech Republic. RESULTS: Intraoperative and post-operative complications recorded were facial nerve dysfunction (14-22%), open bite/malocclusion (2-3.2%), condylar component dislocation (1-1.6%), infection requiring revision surgery (1-1.6%) and (27-43%) reported chronic pain 24 months after surgery. CONCLUSIONS: As with any surgical procedure, TMJR can have complications. The results of this study demonstrate that the most common post-operative complication was continued pain. Chronic pain after TMJR was more common in patients with a preoperative diagnosis of degenerative joint disease. Also, the incidence of post-operative TMJR pain increased with the duration of symptoms prior to TMJR, leading to a question of the best timing for TMJR.

Autologous blood injection for the treatment of chronic recurrent temporomandibular joint dislocation.

PURPOSE: Many different surgical techniques for the treatment of chronic recurrent temporomandibular joint (TMJ) dislocation have been described. This article discusses a technique of autologous blood injection to the TMJ for treatment of chronic recurrent TMJ dislocation. MATERIALS AND METHODS: Twenty-five patients diagnosed with chronic recurrent TMJ dislocation were treated by bilateral injections of autologous blood into the upper joint space and around the TMJ capsules bilaterally. RESULTS: Eighty percent had a successful outcome and required no further treatment at their 1-year follow-up. CONCLUSION: This procedure has proven to be safe, simple, and cost effective for the treatment of chronic recurrent TMJ dislocation.

Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report.

PURPOSE: The purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF). MATERIALS AND METHODS: 26 patients (29 joints) were diagnosed in period of 5 years (2011-2015) with CHF, 5 patients had concomitant mandibular fracture. Fractures were diagnosed on basis of conventional orthopantomogram (OPG) and computed tomography (CT). RESULTS: Intraoperative arthroscopy revealed hyperemia and hypervascularity in all 29 joints, anterior disc dislocation in 26 joints, cartilage erosion in 21 joints and hemorrhagic clots were present in 10 joints. Major hemarthrosis or tear of the posterior band, as often described in MRI, could not be shown in our patients. Data from the study further the understanding of intraarticular pathology of the TMJ after acute trauma in a group with CHF. CONCLUSION: Intraoperative arthroscopy is useful for direct evaluation and accurate diagnosis of the extent of soft tissue damage to TMJ in CHF. Larger and more long-term studies including comparison to MRI findings should be helpful to refine the treatment and postoperative management of patients after CHF.

A prospective assessment of outcomes following the use of autologous blood for the management of recurrent temporomandibular joint dislocation.

PURPOSE: The objective of the study was to compare results of treatment for chronic recurrent temporomandibular joint dislocation (CRTMD) by autologous blood injection (ABI) using two different methods of administration (combination intra- and peri-articular, and peri-articular alone). MATERIALS AND METHODS: Forty patients diagnosed with CRTMD were randomly divided into two groups of 20 each (A and B). Group A were treated by intra- and peri-articular blood injection, group B were treated by peri-articular injection alone. The follow-up was done at 1, 3, 6, and 12 months. The study assessed presence of dislocations, pain (VAS, 0-10), interincisal mouth opening (IMO), and the presence of sound phenomena. The treatment was considered successful in patients without the persistence of CRTMD symptoms, as well as with a VAS of 0-1. RESULT: After 12 months, a beneficial therapeutic effect in group B was seen in 11 patients, while 16 patients from group A had a therapeutic effect. CONCLUSION: Intra- and peri-articular ABI is more effective than peri-articular blood application alone in the treatment of CRTMD, although the difference was not statistically significant.

A porcine model: surgical anatomy of the orbit for maxillofacial surgery.

Due to its similarity to humans, the pig has proven to be a suitable biomodel for both research purposes and for training medical professionals, particularly in surgical specializations. For example, new implant materials have been tested on pig jaws and pigs have also been used in the development of new surgical techniques. For optimizing the effectiveness of such research or training, detailed data on the anatomy of their particular features are needed. At present, however, only limited information related to surgical and imaging anatomy of the facial and orbital areas of the pig and its comparison to human structures from the experimental surgery point of view is available in the literature. The aim of this study was to obtain such data and to compare the morphological structures of the porcine and human orbital regions and to lay down the foundation for practical use in experimental surgery. Ten pig heads were examined using computed tomography (CT) and magnetic resonance imaging (MRI) and, subsequently, a dissection of the orbit was carried out. Attention was focused on the structure of the orbit (floor, rim and nerves) frequently affected by pathological processes in humans (such as trauma, infection or tumours) and which consequently are frequently the subject of maxillofacial surgery. The porcine orbit is suitable for use in experimental medicine. However, if used in experiments, its anatomical peculiarities must be taken into consideration. Our study presents a foundation of basic knowledge for researchers who plan to use the pig as a biomedical model to investigate alternative treatments in the head region.

Open bite as a complication of total temporomandibular joint replacement: a case report.

Temporomandibular joint total joint replacement, like any surgery, can be associated with either intraoperative or postoperative complications. Intraoperative complications may include injuries to local anatomical structures (e.g., blood vessels, nerves, middle ear, and external auditory canal), or poor positioning and/or adaptation of the prosthesis components to the host bone. Postoperative complications may include infection, hematoma, heterotopic bone formation, implant failure, pain, salivary fistula, foreign body or allergic reactions, and malocclusion. This article reports the occurrence of a postoperative open-bite malocclusion complication, the result of maxillary artery hemorrhage.

Therapy of the osteoarthritis of the temporomandibular joint.

Osteoarthritis is a common condition of the mandible. The treatment of osteoarthritis primarily consists of rest therapy (restricting jaw movements), the use of pharmaceuticals (analgesics, antiinflammatories), splint therapy, thermotherapy or mini-invasive therapy. Our study investigated the effectiveness of the various therapeutic options in the treatment of osteoarthritis. We compared the effectiveness of rest therapy (restricting mouth opening, analgesic therapy), splints, arthrocentesis of the upper joint space, and arthrocentesis in combination with splint therapy. We looked at 80 patients diagnosed with osteoarthritis of the temporomandibular joint. We only included patients with symptoms in one temporomandibular joint (TMJ). This 3 months long-term study shows that arthrocentesis combined with the use of a splint is an effective first-stage treatment method for patients with osteoarthritis of the TMJ (80% patients with good outcome 3 months after commencement of therapy).

Laryngotracheal stenosis in critically ill patients.

CONCLUSIONS: Prolonged artificial pulmonary ventilation by tracheostomy tube (>30 days) doubled the risk of stenosis (relative risk, RR = 2.04, p = 0.002). Critically ill patients with repeated tracheotomies were more than six times likely to experience stenosis (RR = 6.44, p< 0.001) than other critically ill patients. OBJECTIVE: In this retrospective study, we describe the occurrence of laryngotracheal stenosis (LTS) in critically ill patients after elective tracheostomy who had undergone treatment for LTS at the Na Homolce Hospital in Prague, Czech Republic. METHODS: We studied 28 patients who were diagnosed with symptomatic LTS. Basic major demographic data, duration of mechanical ventilation, onset of tracheal stenosis after decannulation, and tracheostomy type (percutaneous dilatational or surgical tracheostomy) were recorded. The number of patients requiring repeated tracheostomies was also recorded. RESULTS: Neither the demographic data nor the type of tracheostomy represented statistically significant risk factors. The risk factors for LTS were prolonged artificial pulmonary ventilation using the tracheostomy tube (p = 0.005) and repeated tracheostomy (p< 0.001). The mean onset of stenosis symptoms was 53.7 days (range 2-300 days), with a median of 58 days. Stenosis involved the trachea in 20 patients, subglottis in five cases, and glottis and subglottis in three cases. Seven patients (25%) underwent a tracheal resection and primary end-to-end reconstruction. One patient underwent laryngotracheoplasty with dilatation. The procedure was endoscopic in 18 patients (64.3%). Two patients (7.1%) received permanent tracheostomies.