Artroplastia em Gap com Interposição de Fáscia de Temporal para o Tratamento de Anquilose de Articulação Temporomandibular: Relato de Caso / Gap Arthroplasty with Temporalis Fascia Interposition for the Treatment of Temporomandibular

A anquilose da articulação temporomandibular (ATM) é caracterizada pela união intracapsular do complexo disco-côndilo à superfície do osso temporal, podendo gerar restrição dos movimentos mandibulares e limitação de abertura bucal. São descritas ainda alterações como restrição da capacidade mastigatória, dificuldade de fonação e de uma adequada higiene bucal, além de dificuldade de interação social. O presente caso retrata um paciente feminino, 27 anos, com histórico de fratura de parassínfise e côndilo mandibular bilateral após trauma em 2014, evoluindo com anquilose da ATM direita, com abertura máxima de 13,27 mm. Para o tratamento do caso descrito, foi utilizado o acesso de Al-Kayat, coronoidectomia ipsilateral e ressecção de massa anquilótica em gap com interposição de retalho da fáscia do músculo temporal no lado direito. Após seis meses do procedimento cirúrgico, foi realizada uma nova tomografia da face na qual se observa ausência de lesões e de sinais de recidiva da anquilose e também foi observada a manutenção do espaço de lacuna feita pela ressecção óssea. O resultado satisfatório da técnica foi atribuído pela obtenção e estabilização de uma abertura bucal adequada, melhora da capacidade mastigatória e da fonação. Além do sucesso clínico, uma vantagem da técnica utilizada foi o baixo custo do procedimento por utilizar apenas interposição do músculo temporal sem uso de materiais aloplásticos. Além disso, a coronoidectomia ipsilateral associada foi suficiente para auxiliar na manutenção da abertura alcançada, não sendo necessária a coronoidectomia contralateral, o que minimizou o tempo operatório e a morbidade de mais um sítio cirúrgico acessado.

Ankylosis of the temporomandibular joint (TMJ) is characterized by the intracapsular union of the condyle- disc complex to the surface of the temporal bone, which can cause restriction of the mandibular movements and a limitation of a mouth opening. Alterations are also described as a restriction of masticatory capacity, difficulty in phonation and suitable oral hygiene, as well as difficulty in social interaction. A 27-year-old female patient with a bilateral history of parasymphysis and mandibular condyle fracture after a trauma in 2014, which evolved to an ankylosis of the right TMJ, with a maximum mouth opening of 13.27 mm. For the treatment of the described case, it was used the Al- Kayat approach, ipsilateral coronoidectomy and resection of the ankylotic mass in gap with interposition of temporalis muscle fascia flap on the right side. After six months of the surgical procedure, it was made a new computed tomography of the face in which it was possible to notice the absence of lesions and signs of recurrence of the ankylosis. It was also observed the maintenance of the gap space made by the bone resection. The satisfactory result of the technique was attributed to the achievement and stabilization of an adequate mouth opening, improved chewing ability and phonation. Besides the clinical success, an advantage of the technique used was the low cost of the procedure by using only temporal muscle interposition without the use of alloplastic materials. In addition, the associated ipsilateral coronoidectomy was sufficient to help maintaining the achieved mouth opening, and the contralateral coronoidectomy was not necessary, as a result it was minimized the surgical time and morbidity of one more accessed surgical site.

Research progress on ankylosis of primary molars / 口腔疾病防治

@#Ankylosis of primary molars is a kind of eruption abnormality of the teeth, where the periodontal membrane disappears, owing to a bony union between bone and root. Studies have shown that the common proportion of ankylosed primary molars is 1.3%~8.9% with an equal occurrence. In the primary dentition, the mandibular first primary molar is the most commonly affected tooth, while in the middle mixed dentition stage of development, the second primary molar is more affected. Its etiology may be related to genetics, signaling pathways of mineralization metabolism of local alveolar bone or cementum, cytokines secreted by epithelial rest cells of Malassez, and enhanced inflammatory reactions during physiological absorption of roots. Ankylosis of primary molars can be diagnosed by clinical symptoms and imaging and is classified as mild, moderate and severe according to the degree of infraocclusion. As it may cause a series of complications, such as occlusal disturbances, delayed exfoliation and incomplete alveolar process development, multidisciplinary treatment, including in the departments of pediatric dentistry, orthodontics, periodontics and prosthodontics, should be adopted, and long-term treatment is determined based on the patient's age, severity of infraocclusion, and presence of permanent teeth. This review summarizes the etiology, diagnosis, complications and treatment of ankylosed primary molars to provide a reference for the clinical diagnosis and treatment of decidual molar fixation.

Management of ankylosed teeth using the decoronation technique: integrative literature review and case report

ABSTRACT Introduction: The decoronation technique has been described in literature since 1984 and, based on the available results, it can lead to considerable benefits for the repair and rehabilitation of ankylosed teeth. Based on these reports, one could expect that this procedure would be well known by the dental community. However, this fact does not seem to be true, and this procedure is not widely used. Methods: The objective of this paper is to present appropriate literature that discusses decoronation and evaluate the perspectives of the procedure, both in relation to the technique and the long-term benefits for the patient. An integrative literature review at PubMed, ScieELO, and Lilacs databases was performed using the keywords "decoronation", "ridge preservation decoronation", "decoronation ankylosis". In addition, a case report will be presented to demonstrate the technique in a systematic and detailed manner. Results: Considering the inclusion criteria, 27 articles that present consistency regarding decoronation were selected. Conclusion: There is scarce availability of scientific works related to the topic, to corroborate and discuss the technique. The present paper reinforces the benefits of this procedure, and revisit decoronation, attempting to provide a possible treatment for ankylosed teeth in growing patients.

RESUMO Introdução: A técnica de decoronação é descrita na literatura desde 1984 e, com base nos resultados disponíveis, pode trazer benefícios consideráveis para o reparo e reabilitação de dentes anquilosados. Com base nesses relatos, seria esperado que esse procedimento fosse bem conhecido pela comunidade odontológica. No entanto, isto não parece ser verdadeiro e esse procedimento não é amplamente utilizado. Objetivo: O objetivo deste artigo é apresentar literatura adequada que discuta a decoronação e avalie as perspectivas do procedimento, tanto em relação à técnica quanto aos benefícios em longo prazo para o paciente. Métodos: Foi realizada revisão integrativa da literatura nas bases de dados PubMed, SciELO e Lilacs, utilizando as seguintes palavras-chave: "decoronation", "ridge preservation decoronation", "decoronation ankylosis". Além disso, um relato de caso demonstrará a técnica de maneira sistemática e detalhada. Resultados: Considerando os critérios de inclusão, foram selecionados 27 artigos que apresentam consistência quanto à decoronação. Conclusão: Há escassa disponibilidade de trabalhos científicos relacionados ao tema para corroborar e discutir a técnica. Esse artigo reforça os benefícios desse procedimento e revisa a decoronação na tentativa de fornecer um possível tratamento para dentes anquilosados em pacientes em crescimento.

A retrospective research of combined anterior and posterior approach in total hip arthroplasty for fused/ankylosed hips / 中华骨科杂志

Objective:To investigate the safety and efficacy of a combined anterior and posterior approach in total hip arthroplasty (THA) for fused/ankylosed hip.Methods:37 patients who underwent THA for fused/ankylosed hip from January 2015 to December 2020 were retrospectively analyzed, including 28 males and 9 females, with an average age of 47.9±12.0 years (range, 26-72 years). Etiologies included 23 cases of ankylosing spondylitis, 9 cases of infectious arthritis of the hip in youth, and 5 cases of traumatic arthritis after acetabulum or femoral neck fracture. All patients underwent THA with combined anterior and posterior approach. These factors include operation time, blood loss, amount of transfused blood, blood transfusion rate, preoperative and postoperative Harris score, postoperative range of motion of the hip, and perioperative complications, etc. were evaluated. Postoperative radiography of the hip was performed to evaluate acetabular abduction angle, anterior inclination angle, the prosthesis fixation, osteolysis and heterotopic ossification around the hip.Results:A total of 37 patients were enrolled. The mean operative time was 147.6±16.8 min (range, 129-190 min); the mean estimated blood loss (EBL) was 850.0±10.8 ml (range, 600-1,200 ml); the blood transfusion rate was 59% (22/37), and the mean blood transfusion was 420±45.0 ml (range, 0-800 ml). All patients were followed up for 4.2±0.9 years (range, 1.2-7.2 years). The average abductor angle of the acetabular was 43.7°±5.4° (range, 31°-55°), and the average inclination angle was 20.9°±6.7° (range, 10°-35°); the preoperative Harris score was 47.1±9.9 (range, 40-55) and the mean Harris score at the last follow-up was 83.4±12.4 (range, 75-90). The preoperative range of motion of the hip in all directions was 0°. Postoperative hip range of motion was good, with a mean hip flexion of 95.5°±12.2° (range, 80°-110°), mean extension of 10.5°±3.4° (range, -10°-25°), and mean abduction of 38.0°±8.2° (range, 10°-50°). Postoperative complications were minor, including 2 case with poor wound healing, 2 cases with paresthesia or tingling sensation in the anterior or anterolateral thigh, which returned to normal within 3 months after surgery, and no deep infection or dislocation occurred. The acetabular cup was in poor position in 2 cases and the femoral stem was varus in 1 case, but the prosthesis was stable and no treatment was needed. All the acetabular cups and femur stems were confirmed with bone ingrowth on the last follow-up radiographs, and one patient had heterotopic ossification (Brooker grade 1). No osteolysis or wear of the acetabular liner was observed.Conclusion:Combined anterior and posterior approach (Gibson posterolateral approach + modified Hardinge approach) in THA for fusion/ankylosed hip can fully expose the operative field and sufficiently release the soft tissue, and the function of hip recovered well postopratively.

Hydrocephalus, Ankylosis and Brachygnathism in an Non-descript Indigenous Calf: A Case Report

The present finding of a case reports revealed successful management of per-vaginal delivery of an indigenous male calf with multiple congenital anomalies like hydrocephalus, ankylosis and brachygnathism.

A Review of Intubation Techniques in Anaesthetic Management of Temporomandibular Joint Ankylosis

Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision

ABSTRACT Objective: This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline. Conclusion: This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

RESUMO Objetivo: O presente artigo tem como objetivo discutir a abordagem multidisciplinar necessária no tratamento de casos de impacção e anquilose de dentes permanentes, associados a histórico de trauma, considerando o estado psicológico da criança e da família diante de situações traumáticas de bullying, por meio do relato do tratamento complexo de um incisivo central que precisava ser movido ortodonticamente através da linha média. Conclusão: Esse caso foi um grande desafio, que incluiu procedimentos multidisciplinares complexos. Os resultados e a estabilidade após 26 meses de contenção indicaram fechamento ortodôntico bem-sucedido do espaço de dois dentes superiores, sem o uso de implantes ou próteses, em uma paciente adolescente que apresentava histórico de trauma dentário, perda de osso alveolar e prognóstico inicial incerto.

Classification for treatment of adult temporomandibular joint ankylosis and its secondary malformations / 口腔疾病防治

Objective@#To generate a new classification for adult temporomandibular joint ankylosis (TMJA), which could effectively guide treatment strategies for adult TMJA patients with various clinical features. @* Methods@# We developed a new "CD" classification system according to the preservation of the condyle (C) and the severity of dentofacial bone deformity (D). From January 2016 to April 2020, 56 TMJ patients (with 73 ankylosed joints) in our department were classified into 4 subgroups by ‘CD’ classification: condylar head preservation but no dentofacial deformities (C+D-), no condylar head preservation and no dentofacial deformities (C-D-), condylar head preservation and dentofacial deformities (C+ D+), and no condylar head preservation but dentofacial deformities (C-D+). Different strategies were used according to the clinical features of each subgroup. The clinical outcomes of these patients were analyzed. Different treatment strategies of temporomandibular joint reconstruction were adopted for different subclasses of patients and were followed. "C +": lateral arthroplasty (LAP) was used to remove the rigidity and preserve the medial residual condyle. "C-": if the ankylosing bone ball is small and the loss of ascending branch height is not obvious, arthroplasty should be performed to relieve ankylosis; however, if the ankylosing bone ball is large and the ascending branch height decreases significantly, joint reconstruction should be carried out after the ankylosis is relieved. "D +": surgical treatment of secondary dental and maxillofacial malformations at the same time or over stages. "D-": orthodontic treatment after operation to improve occlusal relationship and symptomatic treatment of oral diseases. @*Results@#After treatment, all 73 ankylosed joints were completely released, and the average maximal interincisal opening increased from (3.6±3.2 )to (32.8 ± 5.4) mm (P<0.001), with no recurrence of ankylosis found during the 12-48 month follow-up period.@*Conclusion @#The generation and elaboration of a ‘CD’ classification system is intended to help as a TMJA reconstruction guide for adult TMJA treatment and be widely used in more hospitals.

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)

Two Airway Management Techniques in a Pediatric Patient with Temporomandibular Joint Ankylosis: Two-stage Fiberoptic Scope Intubation Technique and Video Laryngoscope-guided Conversion from Nasotracheal to Orotracheal Intubation -- A Case Report

@#<p style="text-align: justify;">Ankyloblepharon-ectodermal dysplasia-clefting (AEC) syndrome is an ectodermal dysplasia presenting with cleft lip or palate and congenital filiform eyelid fusion. This is a case report of a 1-year and 6-month-old girl with AEC syndrome presenting with temporomandibular joint ankylosis who underwent release of temporomandibular joint ankylosis, coronoidectomy, bilateral cheiloplasty, Tajima rhinoplasty, and repair of lower lip pits under general anesthesia. Fiberoptic nasotracheal intubation was done successfully using a two-stage technique originally described by Stiles. As necessitated by the surgical plan, video laryngoscope guidance was subsequently used to facilitate the conversion from nasotracheal to orotracheal intubation.</p>

Cirugía de la anquilosis temporomandibular en pacientes pediátricos / Temporo mandibular joint ankylosis surgery in pediatric patients

Introducción: la anquilosis temporomandibular se caracteriza por la limitación en la apertura bucal, lo que conlleva alteraciones estéticas, de la masticación, el lenguaje y respiratorias. El objetivo del reporte es describir las características clínicas de los pacientes y evaluar resultados del tratamiento quirúrgico para la anquilosis temporomandibular. Materiales y métodos: presentamos un estudio observacional, descriptivo y retrospectivo en el que se revisaron las historias clínicas e imágenes de todos los pacientes operados de anquilosis de la articulación temporomandibular desde enero 2008 a diciembre de 2016. Resultados: se intervinieron 44 casos, cuya etiología principal eran los traumatismos (70,5 %), con predominio femenino en el 77,3 % de los casos y la presentación unilateral como la más frecuente con el 70,5 % del total. La edad de mayor frecuencia de presentación fue entre 6 a 10 años con el 47,7 % de los casos. La cirugía más realizada fue la condilectomía con coronoidectomía en el 79,5 % de los casos. Como complicación más frecuente se encontró la parálisis de la rama palpebral en el 13,7 %, y obteniendo un 6 % de recidiva. Discusión: los resultados presentados son similares a otras publicaciones, ya que se reprodujo el tratamiento protocolizado mundialmente y no se encontraron diferencias significativas en cuanto a etiología, edad, tratamiento realizado y complicaciones. Conclusiones: la anquilosis temporomandibular es una patología que requiere de un tratamiento quirúrgico que logre la resección del bloque anquilótico, así como la asociación de otras técnicas quirúrgicas como la realización de un colgajo para disminuir la posibilidad de recidiva y distracción ósea para restablecer la anatomía mandibular.

Introduction: Temporomandibular ankylosis limits the mandibular function, decreasing the buccal opening, with aesthetic alterations as well as chewing language and even respiratory disfunction. Objective: To describe the patients clinical paticularities and evaluate the surgical treatment results for this pathology. Design: Observacional, descriptive and retrospective study. Methods: We reviewed the medical histories and images of all the patients who underwent temporomandibular ankylosis release from January 2008 to December 2016. Results: It involved 44 cases, being the main etiology injuries in a 70.5%, with predominance of the female sex in the 77.3% and the unilateral presentation with the 70.5% of the cases. Ages between 6 to 10 years were the most frequent ones with 47.7%. The surgery most performed was the condilectomia with coronoidectomy in 79.5% of the cases. The most frequent complication was the palpebral branch paralysis in 13.7% and we had a 6% of ankylosis recurrence. Discussion: Our results are similar to other publications when reproducing the worldwide protocolized treatment, without finding significant differences in terms of etiology, age of presentation, treatment carried out and complications. Conclusions: Temporomandibular ankylosis is a condition that requires surgical treatment, which is aimed to anatomical and functional restoration. Wide bone resection complemented with other surgical techniques such as flap interposition to minimize the relapse possibility and bone distraction to restore the mandibular anatomy.

New progress in the pathogenesis of traumatic temporomandibular joint ankylosis / 口腔疾病防治

@#Traumatic temporomandibular joint ankylosis refers to fibrous or bony fusion between the condyle and the glenoid fossa. It can cause problems with mouth-opening limitations, mastication difficulties, obstructive sleep apnea and hypopnea syndrome. When traumatic temporomandibular joint ankylosis occurs during childhood, it can cause facial asymmetry, micrognathia, and malocclusion, which significantly affect the physical and mental health. Once temporomandibular joint ankylosis occurs, it will be refractory and recurrent. The pathogenesis of temporomandibular joint ankylosis has not been completely elucidated and has always been a research hotspot in the oral and maxillofacial fields. In this paper, worldwide research was conducted, and the pathogenesis of traumatic temporomandibular joint ankylosis was clarified, such as “damage of condyle”,“disc displacement or rupture”,“damage to the glenoid fossa” and “lateral pterygoid muscle distraction”. The relative pathogenesis hypotheses were summarized, such as “hematoma organization” and “lateral pterygoid muscle distraction osteogenesis”. The related pathogenesis of traumatic temporomandibular joint ankylosis was discussed based on the latest cytology and molecular biology research.

Research progress on factors related to the difficulty of orthodontic tooth movement / 口腔疾病防治

@#Orthodontic tooth movement is a complex physiological process based on periodontal tissue remodeling. Numerous factors, such as the anatomical characteristics of oral and maxillofacial complications, occlusal interference, mechanical factors and systematic factors, may play critical roles in orthodontic tooth movement, leading to tooth movement difficulty. In recent years, many scholars have focused on factors related to tooth movement difficulty, but current research mostly involves animal experiments and retrospective studies. Clinical trials of high-quality and evidence-based medicine studies are required. Although no sound theory system is available that is universally recognized and the mechanism of many factors remains debatable, alveolar bone defects, the maxillary sinus, the gingiva, tooth ankylosis, bone islands and friction may cause orthodontic tooth movement. Understanding the factors related to the difficulty of orthodontic tooth movement is advantageous to develop a more comprehensive personalized treatment plan for patients and achieve more efficient and safer tooth movement. In this paper, the current factors related to orthodontic tooth movement are reviewed to provide references for clinical orthodontic treatment.

Efficacy of Baxian Xiaoyaotang Against Ankylosis of Wind-Cold-Dampness Obstruction Syndrome After Acute Achilles Tendon Rupture Surgery and Its Influences on TGF-β1， IGF-1， and EGF / 中国实验方剂学杂志

Objective:To investigate the efficacy of Baxian Xiaoyaotang （BXT） in treating ankylosis of wind-cold-dampness obstruction syndrome after acute Achilles tendon rupture surgery and its effects on transforming growth factor-<italic>β</italic>₁ （TGF-<italic>β</italic>₁）， insulin-like growth factor-1 （IGF-1）， and epidermal growth factor （EGF）. Method:According to the visiting sequence， 66 patients with fresh closed Achilles tendon rupture were included and randomly divided into a treatment group （<italic>n</italic>=33） and a control group （<italic>n</italic>=33）. Patients in both groups underwent surgical repair， followed by immobilization in long-leg brace， which was then replaced by the boot brace in the fourth week， with the plantar-flexion angle adjusted correspondingly. Six weeks later， the brace was removed for accelerated functional rehabilitation training. On this basis， patients in the treatment group were further instructed to fumigate and wash the affected Achilles tendon with BXT， twice a day， for 45 d. The Leppilahti Achilles tendon performance scores and American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot scores between the two groups were compared at the time of brace removal and the third， sixth， and twelfth months after surgery. The strength of triceps surae on the affected side was evaluated at the last follow-up visit. The serum TGF-<italic>β</italic>₁， IGF-1， and EGF levels were detected before and after treatment. The wind-cold-dampness obstruction syndrome scores， symptom scores， the changes in foot dorsiflexion angle， and the overall clinical efficacy were compared. Result:The changes in scores of patients receiving different treatment measures did not synchronize. After the removal of brace， the Leppilahti Achilles tendon performance score and AOFAS ankle-hindfoot score determined at three time points in the treatment group were higher than those in the control group （<italic>P</italic><0.05）. At the last follow-up visit， the good-to-excellent rate of muscle strength in the treatment group was 93.94% （31/33）， higher than 72.73% （24/33） in the control group （χ²=0.031，<italic>P</italic><0.05）， implying that the strength of triceps surae in the treatment group was better recovered. After treatment， the serum TGF-<italic>β</italic>₁， IGF-1， and EGF levels in both groups were increased in contrast to those before treatment （<italic>P</italic><0.05）， and these levels in the treatment group were all higher than those in the control group （<italic>P</italic><0.05）. The foot dorsiflexion angle and the wind-cold-dampness obstruction syndrome score in the treatment group were superior to those in the control group （<italic>P</italic><0.05）. The overall response rate of the treatment group was 90.91% （30/33）， higher than 75.76% （25/33） of the control group （<italic>χ</italic>²=6.981， <italic>P</italic><0.05）. No adverse reactions occurred during the treatment. Conclusion:The external fumigation and washing with BXT alleviates both the clinical symptoms and traditional Chinese medicine （TCM） syndrome， improves the joint function score， triceps surae strength， and other indicators， elevates the serum TGF-<italic>β</italic>₁， IGF-1， and EGF levels， and enhances the strength and toughness of Achilles tendon of patients with ankylosis due to wind-cold-dampness obstruction after the acute Achilles tendon rupture surgery. Its clinical efficacy is better than that of functional rehabilitation training.

Research Advances of Human Homologue of Mouse Progressive Ankylosis Protein and Bone and Joint Diseases / 中国医学科学院学报

The human homologue of mouse progressive ankylosis protein(ANKH)is an inorganic pyrophosphate transport regulator,which regulates tissue mineralization by controlling the level of inorganic pyrophosphate.It plays an important role in the pathogenesis and development of bone and joint diseases,such as ankylosing spondylitis,craniometaphyseal dysplasia,and articular cartilage calcification.This review summarizes the progress of research on ANKH and the above-mentioned diseases.

Diagnosis of alveolodental ankylosis in unerupted canines: one of the answers to why the canine does not come

ABSTRACT Introduction: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. Objective: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. Conclusions: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

RESUMO Introdução: Muitas vezes, a erupção falha, e ocorrem situações que impedem que os caninos cheguem até o plano oclusal. Objetivos: Discorrer sobre quais as três situações nas quais o canino não chega até o plano oclusal, permanecendo não irrompido e, ao mesmo tempo, destacar como se diagnosticar com segurança uma dessas três causas, a anquilose alveolodentária, a partir da tomografia. Conclusões: A anquilose em dentes não irrompidos ocorre pela atrofia do ligamento periodontal, incluindo os Restos Epiteliais de Malassez. Os sinais tomográficos de uma anquilose alveolodentária em caninos não irrompidos são a interrupção do espaço periodontal hipodenso, a descontinuidade da lâmina dura e a sua continuidade com a superfície radicular, que, gradativamente, perde sua regularidade.

Planejamento virtual em cirurgia ortognática para tratamento de assimetria: relato de caso / Virtual planning in orthognathicsurgey for assimetrytreatment: case report

Introdução: Os casos de assimetria facial são um desafio para tratamento no âmbito da cirurgia Bucomaxilofacial, devido a alteração craniofaciais nos três planos do espaço (Pitch,Yaw e Roll). Estes termos são utilizados para o planejamento da cirurgia ortognática e são essenciais para o planejamento virtual, A utilização da tecnologia neste sentido vem sendo cada vez mais empregada devido a sua previsibilidade de resultado tanto nos casos convencionais como nos mais desafiadores como os das assimetrias faciais. Este artigo visa relatar o planejamento virtual para a correção de um caso de assimetria através da cirurgia ortognática. Relato de caso: Paciente pediátrico leucoderma, do sexo masculino com 5 anos, possui limitação na abertura de boca, desvio da mandíbula para o lado direito com tempo de evolução de 5 meses. O procedimento consistiu na remoção da massa fibrótica através do acesso de Al Kayat. Após o procedimento cirúrgico o paciente foi submetido a uma série de sessões de fisioterapia agressiva. Considerações finais: A associação da remoção da massa fibrótica ou do bloco anquilótico e a fisioterapia intensa no pósoperatório propiciaram um resultado satisfatório, devolvendo a função mandibular do paciente... (AU)

Introduction: The temporomandibular ankylosis consists in mandibular movements limitation and is characterized as complete fusion of mandibular condyle to articular fossa or as a formation of a fibrotic mass in the region. Case Report: Pediatric male patient, white, 5 year-old, had a mouth opening limitation, mandibular deviation to the right side with 5 mouths of evolution. The procedure consisted in the removal of the fibrotic mass through the Al-Kayat approach. After the surgical procedure the patient was submitted to a series of aggressive physiotherapy sessions. Final considerations: The association of the removal of the fibrotic mass or the ankylotic bloc to intense physiotherapy in the post operatory provides a satisfactory result, restoring patient´s mandibular function... (AU)

A rare case of symphalangism of bilateral interphalangial joint of thumbs: a case report

Symphalangism is rare congenital disorder characterised by ankylosis of interphalangeal joints of hands and feet. The fusion can involve the proximal or the distal joints; however, involvement of the proximal interphalangeal joints is more common. There may other associated skeletol and non-skeletol abnormalities. Here the author reports a 14 year old girl with symphalangism involving the interphalangeal joints of the thumbs of bilateral hand. She did not have any functional impairment and hence no medical or surgical intervention was performed. As involvement of thumbs is very rare condition, author would like to report it.

Interpositional arthroplasty with temporalis myofascial flap reconstruction in a case of temporomandibular joint bony ankylosis: a case report and review of literature

The report describes the treatment of a 30 year old female patient having unilateral right temporomandibular joint (TMJ) bony ankylosis whose mouth opening was restricted to 5 mm and had additional mandibular retrognathism causing severe mastication problems besides speech difficulties and low morale. The ankylosis had resulted in facial asymmetry due to bony hard swelling in front of right tragus. The patient was taken up for right interpositional arthroplasty with temporalis myofascial flap reconstruction by pre auricular approach and left coronoidectomy by intraoral approach as a preferred technique. A satisfactory mouth opening of 33 mm was achieved in immediate post-operative. Patient was followed up with aggressive mouth opening exercises in postoperative period.

Long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint ankylosis and reconstructed mandibular condyle / 华西口腔医学杂志

OBJECTIVE@#Mandibular condyle injury usually results in malocclusion and disharmony of facial growth in growing children. This study aimed to evaluate the long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint (TMJ) ankylosis who underwent mandibular condyle reconstruction.@*METHODS@#Ten growing patients with unilateral bony TMJ ankylosis admitted in West China Hospital of Stomatology, Sichuan University between January 1st, 2008 and December 31st, 2016 were followed up and evaluated. These patients include three males and seven females with ages ranging from 5 years to 12 years at the time of surgery. Each patient underwent gap arthroplasty, condyle reconstruction with ipsilateral coronoid, and interposition of the pedicled temporalis fascial flap in a single operation. The postoperative follow-up ranged from 3 years to 8 years with an average of 4.9 years. Postoperative panoramic radiographs determined the growth of the mandibular height and length on the affected side and compared it with those of the healthy side.@*RESULTS@#All patients recovered uneventfully after surgery. At the end of follow-up period, the maximal mouth opening ranged from 32 mm to 41 mm with an average of 35.6 mm. Mandibular height and length continued to grow after the successful treatment of ankylosis using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The final ramus height and mandibular length of the affected side at the end of follow-up increased by 25.3% (P<0.05) and 26.1% (P<0.05), respectively, compared with the initial values measured immediately after surgery. Growth rates of ramus height and mandibular length of the affected side were 47.1% and 27.2% lower (P<0.05) than those of the healthy side, respectively.@*CONCLUSIONS@#Mandibular height and length continued to grow after the successful treatment of ankylosis by using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The growth rate of the affected mandible was reduced compared with that of the undisturbed side even after treatment of ankylosis.