Influence of the lateral pterygoid muscle on traumatic temporomandibular joint bony ankylosis.

BACKGROUND: The pathogenesis of traumatic TMJ ankylosis remains unclear. This study aimed to verify the role of the lateral pterygoid muscle in the pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis. METHODS: Eight 6-month-old male sheep were used in this study. Bilateral TMJ osteotomies were performed to induce sagittal fractures of the mandibular condyle. The lateral one-fourth segment of the disc was removed to establish a model of TMJ bony ankylosis. Subsequently, the function of the left and right lateral pterygoid muscles was blocked (experimental group) or maintained (control group), respectively. At 12 weeks postoperatively, animals were sacrificed and TMJ complex samples were evaluated by gross observation, spiral computed tomography (CT), micro-CT, and histological examinations. RESULTS: Gross observation revealed bony ankylosis in the control TMJs and fibrous adhesions in the experimental TMJs. Spiral CT and micro-CT demonstrated that, compared to the experimental group, the control group showed calcified callus formation in the joint space and roughened articular surfaces after new bone formation, which protruded into the joint space. Maximum mediolateral and anteroposterior condylar diameters were significantly larger in the control group than in the experimental group. Micro-CT also showed that the primary growth orientation of new trabeculae was consistent with the direction of lateral pterygoid traction in the control group, but not in the experimental group. Histological examination showed fibro-osseous ankylosis in the control group, but not in the experimental group. CONCLUSIONS: The lateral pterygoid simulates the effects of distraction osteogenesis, which is an important factor in the pathogenesis of TMJ bony ankylosis during the healing of sagittal condylar fractures.

Observational Study of Surgical Treatment of Sagittal Fractures of Mandibular Condyle.

OBJECTIVE: This study was conducted to investigate the complications that occur after surgical treatment of sagittal fracture of the mandibular condyle (SFMC). METHODS: A retrospective study was conducted on patients in whom SFMC was treated using surgical methods (87 patients, 105 sides) between January 1995 and December 2011 (79 sides were treated by rigid internal fixation and the remaining 26 sides were removed the condylar fragments). The longest follow-up was 17 years, and the shortest was 2 years. Follow-ups were conducted to assess mandibular activity, mouth opening, and computed tomography scans of condylar morphologic alterations. The postoperative complications were evaluated and the causes were analyzed. RESULTS: We observed 3 patients with joint ankylosis (all of them were removed the condylar fragments); 8, mouth opening less than 30 mm; 23, deviation on mouth opening at 6 months. At 4 weeks, 19 patients had facial nerve weakness, which was resolved within 6 months. The radiological investigation showed complete remodeling in 56.2% of the condyles (in the 59 sides, 57 sides were treated by rigid internal fixation and 2 sides were removed the condylar fragments); partial remodeling 27.6% condyles (in the 29 sides, 20 sides were treated by rigid internal fixation and 9 sides were removed the condylar fragments); poor remodeling, 16.2% condyles (in the 17 sides, 2 sides were treated by rigid internal fixation and 15 sides were removed the condylar fragments). CONCLUSIONS: Surgical treatment of SFMC is not perfect. There were some complications that occurred after the surgical treatment of SFMC. The findings also indicate that condylar anatomic reduction is the basis for functional recovery and, therefore, rigid fixation should be implemented. Furthermore, the removal of condylar fragments should be performed with caution, and if used, the fragments should be removed entirely.

[Comparative efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle].

OBJECTIVE: To compare the efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle. METHODS: From January 1985 to December 2010, our department treated 67 cases (82 sides) sagittal fractures of mandibular condyle with occlusal splint at a height of 1-2 mm in molar region for six months or other non-surgical treatment. Their clinical and radiological remodeling of affected condyles after treatment were reviewed at six mouths, one year and each year after treatment. They were divided into 2 groups according to age. There were 28 patients (34 sides) aged over 12 years and 39 patients (48 sides) under 12 years. During a follow-up period of 2-25 years, mandibular activity, mouth opening and parallel CT scan of condylar morphological alterations were examined. RESULTS: Under 12-year-old group:good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months.Only 11 of 39 patients had deviation on mouth opening at 6 months.Radiological studies showed that 32 condyles were complete remodeling and 16 condyles were partial remodeling. Poor remodeling was not observed. Over 12-year-old group:Ankylosis occurred in 4 joints. And 15 of 28 patients had deviation on mouth opening at 6 months.Radiological studies showed the remodeling of condyles was complete (n = 6), partial (n = 16) and poor (n = 12) respectively. CONCLUSION: Mandibular functional recovery and condylar remodeling are better in children with more powerful healing and reconstructing capacities.

[Analysis of human mandible and temporomandibular joint using three-dimensional finite element method under different mechanical models].

OBJECTIVE: Analysis the result of human mandible and temporomandibular joint using two different three-dimensional finite element method under different mechanical models. METHODS: The 3-dimensional model including cortical and cancellous bone for human mandible was obtained through computed tomography (CT) scan. Then the model was meshed in the software ICEM CFD. The passive and active muscle-force loadings were separately applied on the FE model to simulate the anterior clenching. Stress distributions in two models were compared. RESULTS: The stress distributions of two models were apparently different. In the passive muscle-force model, high stress was mainly distributed in mandibular angle, retromolar trigone, notch and bite point on crown. In the active muscle-force model, high stress was mainly distributed in condylar vertex and neck, mandibular angle, retromolar trigone and bite point on crown. There were some similarities between passive and active muscle loadings. However, large difference existed in condylar region due to the vertices reaction force disparity. CONCLUSION: Closer to actual stressing state of human mandible and temporomandibular joint, the active muscle-force model is a proper biomechanical model for human mandible under anterior clenching.

[Applied anatomy of the stylomastoid foramina and its relation to the surrounding bone structures].

PURPOSE: To study the relationship between the stylomastoid foramen and surrounding bony structures, enrich anatomical data and provide reference for clinical surgery. METHODS: A total of 62 intact and dry adult skulls were selected. The shape of the stylomastoid foramen was observed, the diameter of the stylomastoid foramen, the distances from the posterolateral point and the anterior medial point to the surrounding bony structures were measured with a vernier caliper. SPSS 25.0 software package was used to analyze the data. RESULTS: There were four shapes of stylomastoid foramen, i.e., circular (61.29%), oval (29.84%), irregular (8.06%) and triangular (0.81%). The circular diameter was (2.80±0.61) mm, the oval long and short diameters were (4.43±0.96) and (2.79±0.60) mm. Distances from the posterolateral and anterior medial points of the stylomastoid foramen to the posterolateral point of the external opening of the carotid canal, the anterior medial point of the jugular foramen, the midline, the most anterior point of the foramen magnum, the posterior point of the great palatine foramen, the posterolateral point of the foramen lacerated, the foramen ovale, the posterolateral point of the foramen spinosum, the anterior point of the styloid process root, the outermost point of the tympanomastoid fissure and the tip of the mastoid process were (16.10±2.81), (24.01±2.65), (44.95±3.24), (45.10±2.71), (61.66±4.14), (35.56±4.35), (32.26±2.85), (29.12±3.40), (10.39±3.25), (9.49±2.24) and (12.01±2.79) mm; (12.80±2.41), (21.56±2.51), (42.96±3.97), (42.91±2.76), (58.97±3.97), (32.98±4.14), (29.20±2.77), (25.80±2.87), (7.37±2.33), (11.42±2.00) and (15.41±2.57) mm, respectively. Statistical analysis showed that there was no significant difference in the apertures and distances between the left and right side(P＞0.05). CONCLUSIONS: Most of the stylomastoid foramen are round and oval, understanding the distance between the foramen and surrounding bony structures is helpful for guiding clinical operations and enriching anatomical knowledge.

[Clinical analysis of 12 cases of orthognathic surgery with digital computer-assisted technique].

PURPOSE: This study was to investigate the effect of the digital computer-assisted technique in orthognathic surgery. METHODS: Twelve patients from January 2008 to December 2011 with jaw malformation were treated in our department. With the help of CT and three-dimensional reconstruction technique, 12 patients underwent surgical treatment and the results were evaluated after surgery. RESULTS: Digital computer-assisted technique could clearly show the status of the jaw deformity and assist virtual surgery. After surgery all patients were satisfied with the results. CONCLUSIONS: Digital orthognathic surgery can improve the predictability of the surgical procedure, and to facilitate patients' communication, shorten operative time, and reduce patients' pain.

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.

Zinc ion implantation-deposition modification of titanium for enhanced adhesion of focal plaques of osteoblast-like cells.

BACKGROUND: Surface modification by ion implantation-deposition is well established in materials science and can be an effective way to improve biocompatibility. The aim of this study is to evaluate the chemical composition of a modified titanium (Ti) surface after zinc (Zn) ion implantation and deposition and examine the effect of the modification on the formation of cellular focal adhesion plaques in vitro. METHODS: cp-Ti discs were modified with Zn ion implantation and deposition via PIIID. The chemical composition of the surface modification was characterized by X-ray photoelectron spectroscopy (XPS). The formation of focal adhesion plaques on the modified Ti was investigated with human osteoblast-like MG-63 cells that were seeded onto the Ti surfaces and quantified by morphometric analysis under a confocal microscope. RESULTS: XPS data revealed that the modified Zn-Ti surface consisted of Ti, oxygen, Zn, and carbon. In addition, Gaussian fitting of the spectra indicated that the modified surface contained titanium dioxide and zinc oxide. After 6 hours of MG-63 cell culture, there were significantly more focal adhesion plaques on the modified surfaces than observed on the nonmodified Ti (P < 0.05). CONCLUSION: Zn ion implantation and deposition greatly improved the biocompatibility of Ti for the growth of MG-63 cells.

[Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

OBJECTIVE: To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. METHODS: Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. RESULTS: Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. CONCLUSIONS: Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.