ABSTRACT
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)
Subject(s)
Humans , Male , Child , Biocompatible Materials , Temporomandibular Joint Disorders/therapy , Ankylosis/therapy , Maxillofacial Prosthesis , Titanium , Follow-Up Studies , Chromium Alloys , Genioplasty , Mandibular Condyle/injuriesABSTRACT
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 objetivo del uso de materiales aloplásticos para el tratamiento de esta patología en niños es evitar la morbilidad y los gastos que ocasiona la toma y aplicación de injertos, para esto, durante 15 años, en la Unidad Médica de Alta Especialidad del Instituto Mexicano del Seguro Social, Torreón, Coahuila, México, Departamento de Cirugía Maxilofacial, se ha establecido el protocolo de tratar esta patología en niños con el uso de prótesis metálicas de cavidad glenoidea, en lugar de injertos costales o de otro tipo, además de tratar las hipoplasias o micrognatias en un mismo tiempo quirúrgico con el uso de aparatos distractores óseos, teniendo excelentes resultados a mediano plazo, sin daño a estructuras anatómicas ni a los procesos de crecimiento y desarrollo de los pacientes. Se utilizan prótesis prediseñadas de cromo, cobalto, molibdeno, que se adaptan adecuadamente a las estructuras óseas, siendo un material utilizado ya en otras áreas de la ortopedia en niños, concluyendo que se trata de una buena opción de tratamiento que disminuye el riesgo, frecuencia y costos de cirugías de mayor complejidad y que puede llevarse a cabo de manera segura y predecible. En este artículo se reportan tres casos de niños con anquilosis temporomandibular tratados con este método con buenos resultados (AU)
Temporomandibular joint ankylosis in children is actually a pathology still present despite the medical and social advances. The treatment of this pathology in children has restored the buccal opening and improve the facial aesthetics when hypoplasia and micrognathia are present. The purpose of using alloplastic material for treatment of this disease in children is to prevent morbidity and expenses related to making and implementing grafts, for this, for 15 years in the Medical Unit of High Specialty the Mexican Institute of Social Security, Torreon, Coahuila, Mexico, Department of Maxillofacial Surgery, has been established protocol to treatment this pathology in children with the use of metal glenoid prosthesis instead of rib grafts or otherwise in addition to treating hypoplasias or micrognatias in the same surgical time with the use of distracting devices bone, having excellent results in the medium term without damage to anatomical structures or processes of growth and development of patients. The prosthesis used predesigned chromium, cobalt, molybdenum, which are suitably adapted to the bone structures, with a material already used in other areas of orthopedics in children, concluding that this is a good treatment option that reduces the risk, and surgeries often cost more complex and can be performed safely and predictably. In this paper, three cases of children with temporomandibular ankylosis treated with this method with good results are reported (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Ankylosis , Biocompatible Materials , Maxillofacial Prosthesis , Micrognathism , Temporomandibular Joint Disorders , Chromium Alloys , Dental Prosthesis Design , Mexico , Molybdenum , Osteogenesis, DistractionABSTRACT
Aim: This study aimed to evaluate temporomandibular joint reconstruction in Yemeni children with metatarsal bone graft after release of ankylosis. Methodology: Ten patients ≤12 years of age, comprising eight unilateral and two bilaterally TMJ ankylosis, were selected for this study. These patients underwent reconstruction with 10 non-vascularized metatarsal grafts. The reconstructed joints were then followed for an average of 1 year. Measures of opening, symmetry, and clinical symptoms relating to the reconstructed joints were assessed. Results: Mean pre-operative interincisal aperture was 8.2mm, and immediate post-operative aperture 23.4mm. At the end of the follow-up period, acceptable results were achieved in 8 out of 10 cases, with adequate mouth opening of 35.6mm in 8 out of 10 patients and overall interincisal aperture of 30.3mm. Re-ankylosis occurred in two bilaterally-treated patients at the end of follow-up. Subjectively, 80 percent of the patients rated their function as satisfactory and were able to occlude and masticate without any difficulty. Conclusion: Reconstruction of TMJ after release of ankylosis utilizing metatarsal bone graft shows a satisfactory interincisal aperture in 80 percent of patients.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Temporomandibular Joint Disorders/surgery , Bone Transplantation , Plastic Surgery Procedures , Ankylosis/surgery , Yemen , Metatarsus , Follow-Up Studies , Range of Motion, Articular , Treatment Outcome , Recovery of Function , MasticationABSTRACT
A bent lighted stylet has demonstrated effectiveness for intubating patients with difficult airways. We report a case of successful intubation using a lighted stylet that was bent to configure the upper airway passage in a patient with ankylosis of the temporo-mandibualr joint and a small inter-incisor gap with diffuse submandibular abscesses. We suppose that lighted stylets with different bends can be used in difficult airway cases. The usefulness of a bent lighted stylet to fit the upper airway passage needs further evaluation for additional clinical application.
Subject(s)
Humans , Abscess , Ankylosis , Decompression Sickness , Intubation , Intubation, Intratracheal , Joints , Temporomandibular JointABSTRACT
Management of temporomandibular joint (TMJ) ankylosis is challenging for the oral and maxillofacial surgeon because it involves the mouth opening, dentofacial deformity, diet problem, and quality of life. Although surgical techniques to treat TMJ ankylosis have improved, reankylosis is a persistent problem. The temporalis myofascial flap provides good material for interpositional arthroplasty, because of its good vascular supply, anatomic proximity, and adequate thickness. This case report examines the efficacy of submandibular anchorage to prevent reankylosis by inhibiting flap dislocation.
Subject(s)
Ankylosis , Arthroplasty , Dentofacial Deformities , Diet , Joint Dislocations , Mouth , Quality of Life , Temporomandibular JointABSTRACT
Introducción: el manejo terapéutico de la anquilosis temporomandibular ha incluido diferentes modalidades quirúrgicas. Objetivo: se realizó este estudio con el objetivo de caracterizar la muestra tratada de anquilosis socio-demográficamente, identificar causas asociadas a la anquilosis, clasificarlas topográficamente y según la clasificación de Shawhney, determinar los valores de máxima apertura bucal y excursiones mandibulares pretratamiento y evolutivos. Material y métodos: se ejecutó un estudio de casos en 14 pacientes del total de pacientes con anquilosis temporomandibular quienes acudieron a los servicios de Cirugía Maxilofacial de los Hospitales Universitarios «Miguel Enríquez¼ , "Salvador Allende" y la Facultad "Raúl González Sánchez", 2005-2012. Se realizó artrólisis e interposición de colgajo de fascia temporal. Se valoraron variables sociodemográficas, causas, tipos de anquilosis, máxima apertura bucal y excursiones mandibulares pretratamiento y evolutivas. Resultados: predominaron pacientes con edades entre 22-31 años (57,2%) y el sexo masculino (71,4%); la etiología traumática por fractura condilar (71,4%) y las anquilosis bilaterales (71,4%). El valor promedio de máxima apertura bucal pretratamiento fue de 8 milímetros, con un valor a los 12 meses de 39 milímetros. Conclusiones: la artroplastia interposicional con fascia temporal restituyó a los pacientes valores normales de excursiones mandibulares manteniéndose estables durante el año de observación.
Introduction: the therapeutic handling of the temporomandibular ankylosis has included different surgical modalities. Objective: this study was done with the objectives: to characterize the treated sample social- demographically, to identify associated causes, to classify ankylosis topographically and according to Shawhney´s Classification, to determine the values of maximum buccal opening and mandibular trajectories before and after treatment. Material and methods: a case series study was carried out in 14 patients of the total of patients with ankylosis diagnosis who attended to the Maxillofacial Departament, in the University Hospitals "Miguel Enríquez", "Salvador Allende" and Dentistry College "Raul González Sánchez", between 2002-2011. The sample was subjected to surgical treatment with arthrolysis, and interposition of temporalis fascial flap. The studied variables were: demographical, causes, types of ankylosis, maximum buccal opening and mandibular trajectories, accidents and complications. Results: patients among 22-31 years (57,2%), masculine sex (71,4%), traumatic causes with condylar fractures (71,4%), and bilateral ankylosis(71,4%). The average value of maximum buccal opening was before treatment (8 mms) and after 12 months (39 mms). Conclusions: the Interpositional arthroplasty with temporalis fascial flap restored the normal values of mandibular movements in the totality of the studied sample, with stable results.
ABSTRACT
Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.
Subject(s)
Female , Humans , Male , Middle Aged , Young Adult , Arthroplasty, Replacement , Follow-Up Studies , Maxillofacial Prosthesis , Osteochondroma , Prostheses and Implants , Skull Base , Temporomandibular Joint Disorders , Temporomandibular Joint , Transplants , United States Food and Drug AdministrationABSTRACT
Antecedentes: Los trastornos de la articulación temporomandibular (DTM) abarcan ungran número de condiciones clínicas que involucran los músculos de la masticación, laoclusión, la articulación temporomandibular (ATM) y otras estructuras relacionadas, lo queresulta en dolor y disfunción mandibular. Muchos casos de DTM pueden ser manejadoscon tratamiento no quirúrgico; sin embargo, pacientes con daño irreversible de la ATM y enun estadio final de la patología articular necesitan reparación o reconstrucción quirúrgica,procedimiento realizado tradicionalmente con tejidos autógenos, principalmente injertocostocondral. El uso de tejidos autógenos para la reconstrucción de la ATM tiene mayoresdesventajas y un alta tasa de complicaciones. Estas desventajas incluyen morbilidad del sitiodonante y largo tiempo quirúrgico. Las complicaciones comprenden reabsorción del injerto yanquilosis. Las indicaciones para la reconstrucción total de la ATM con prótesis aloplásticasincluyen anquilosis, fractura condilar irreparable, necrosis avascular, reconstrucciones previasfallidas, condiciones inflamatorias y degenerativas, reabsorción condilar idiopática y ciertostrastornos congénitos. Objetivo: Proporcionar al lector una técnica ilustrada para la reconstrucciónaloplástica de la ATM, estableciendo criterios mínimos indispensables para sureconstrucción en situaciones clínicas específicas. Métodos: Guía de práctica clínica basadaen la evidencia científica, con una propuesta de protocolo para la planificación preoperatoria,el manejo quirúrgico y los cuidados postoperatorios en la reconstrucción aloplásticade la ATM con prótesis estándar. Conclusión: Los implantes protésicos estándar para lareconstrucción aloplástica de la ATM proporcionan un método eficaz, seguro, predecible,eficiente y rentable para la reconstrucción en pacientes con patología articular avanzada...
Background: Temporomandibular Joint Disorder (TMD) is a collective term embracing anumber of clinical conditions that involve the masticatory musculature, occlusion, thetemporomandibular joint (TMJ) and other associated structures, resulting in pain andlimitation of mandibular function. Many patients suffering from TMDs can be managedwith non-surgical therapies, but some end-stage TMJ patients require surgical TMJ repairor reconstruction. The most widely used autogenous graft for TMJ reconstruction is thecostochondral graft. The use of autogenous tissue for TMJ reconstruction presents severaldisadvantages and a high rate of complications. These disadvantages include donormorbidity and increased intraoperative surgical time. The complications include graft resorptionand ankylosis. Indications for TMJ total reconstruction with alloplastic prosthesisinclude ankylosis, condylar fracture irreparable, avascular necrosis, failed previous jointreconstruction, inflammatory and degenerative conditions, idiopathic condylar resorptionand certain congenital deformities. Purpose: To provide the practitioner with an illustratedtechnique for alloplastic reconstruction of the TMJ, establishing minimum criteria necessaryfor reconstruction in specific clinical situations. Methods: Evidence-based clinical practiceguidelines, with a proposed protocol for perioperative management, surgical management,and postoperative care in alloplastic reconstruction of the TMJ with prosthesis stock.Conclusion: Stock prosthetic TMJ implants provide a safe, predictable, efficient, and costeffective means for joint reconstruction in patients with advanced joint disease...