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.

Quality Evaluation of Temporomandibular Joint Images from 3 High-resolution Dynamic Sequences / 中国医学科学院学报

Objective To compare the image quality of three high-resolution dynamic MRI methods for evaluating the motion of temporomandibular joint disc and condyle. Methods Twenty-five patients with suspected temporomandibular joint disorders were examined by single-shot fast spin-echo (SSFSE),fast imaging employing steady-state acquisition (FIESTA),and spoiled gradient echo (SPGR) on the oblique sagittal position.Two radiologists performed subjective and objective evaluation on the images with double-blind method.The subjective evaluation included the signal intensity of mandibular condyle,articular disc,soft tissue around articular disc,and lateral pterygoid muscle,the contrast between articular disc and condyle,the contrast between articular disc and surrounding soft tissue,condylar motion,and disc movement.The objective evaluation indexes included image signal intensity,signal-to-noise ratio (SNR),and contrast-to-noise ratio (CNR).The subjective and objective indexes of the image quality were compared between the three sequences. Results The SSFSE sequence had lower signal intensity of articular disc and higher signal intensity of condyle and surrounding soft tissue than FIESTA and SPGR sequences (all P<0.001).The SPGR sequence showed higher signal intensity of lateral pterygoid muscle than the SSFSE and FIESTA sequences (P=0.017,P<0.001).Among the three sequences,SSFSE sequence showed the clearest articular disc structure (χ2=41.952,P<0.001),the strongest contrast between articular disc and condyle (χ2=35.379,P<0.001),the strongest contrast between articular disc and surrounding soft tissue (χ2=27.324,P<0.001),and the clearest movement of articular disc (χ2=44.655,P<0.001).SSFSE and FIESTA sequences showed higher proportion of disc displacement and reduction than SPGR sequence (all P<0.001).The CNR (χ2=21.400,P<0.001),SNR (χ2=34.880,P<0.001),and condyle signal intensity (F=337.151,P<0.001) demonstrated differences among SSFSE,FIESTA,and SPGR sequences.The CNR of SSFSE sequence was higher than that of FIESTA sequence (P<0.001),while it had no significant difference between SSFSE and SPGR sequences (P=0.472).In addition,the SSFSE sequence had higher SNR and signal intensity than FIESTA and SPGR sequences (all P<0.001). Conclusion The best image quality can be observed from SSFSE sequence where both the structure and movement of temporomandibular joint are well displayed.Therefore,SSFSE is preferred for the examination of temporomandibular joint movement.

CBCT analysis of condylar and occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry / 口腔医学

Objective@#To analyze the condylar and inclination of the occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry by using cone beam computed tomography(CBCT).@* Methods@#Forty eligible patients with Angle Class Ⅲ malocclusion were enrolled. All individuals were classified based on the distance from Me point to median sagittal plane. The left and right angles between OP and FH plane, the position and morphology of the condyle were measured in both groups.Then the data collected were statistically analyzed. @* Results@#Compared to the opposite side, there was a statistically significant difference(P<0.05) in angle between OP and FH plane, the anterior joint space, superior joint space, lateral joint space and condylar mediolateral diameter, with a higher proportion of joint posteriority in deviated side. Mandibular deviations were positively correlated with both the anterior joint space of the deviated side and the angle between OP and FH plane of the opposite side(P<0.01). There was no statistical difference between the left and right side of angles between OP and FH plane, the position and morphology of the condyle in skeletal Class Ⅲ patients without mandibular deviation(P>0.05); the joint was predominantly in anterior and middle position. @*Conclusion@#There is asymmetry on the left and right sides of the inclination ofocclusal plane, the position and morphology of the condyle of skeletal Class Ⅲ malocclusion patients with mandibular asymmetry. Compared with the opposite side, the deviated side has smaller angle between OP and FH plane and smaller condylar mediolateral diameter, and the condyle shows generally more posterior, inferior and inward movement in glenoid fossa. The inclination of the occlusal plane and the position of condyle are significantly and positively correlated with the distance from Me point to median sagittal plane.

Morphology of Mandibular Condyle in The Population of Sarawak: A Retrospective Cross-sectional Study Using Digital Panoramic Radiograph

@#Introduction: The morphology of the condyles changes naturally with age, gender, face type, occlusal force, functional load, malocclusion type, and the right and left sides. Although condylar shape and size differ throughout populations, there have been few investigations on condylar morphology, particularly in the Malaysian population. Methods: This retrospective, observational, cross-sectional survey was conducted at the Oral and Maxillofacial Surgery Clinic of Sarawak General Hospital from September 2021 to March 2022, involving radiographic assessment of condylar morphology from 893 panoramic radiographs. Age, gender, ethnicity and dentition status using Eichner index were extracted from the data. Descriptive statistics were used. Pearson’s chi-square test was used to determine the association between the independent variables (age, gender, ethnicity and dentition status) and the shape of the mandibular condyle. A p-value of < 0.05 was considered statistically significant. Results: Only 450 panoramic radiographs were included in this study. The condyles were outlined and grouped into four categories, namely pointed (40.2%), round (32.8), angled (18.8), and flat (8.2%). Condylar morphology was found to be significantly associated with gender (p<0.005) and insignificant with other independent variables. Conclusion: The findings suggest that the most prevalent condylar morphology among the Sarawak population is the pointed shape, in contrast with other previous studies that reported the round shape condylar morphology as the majority shape.

Relationship between the condyle morphology and clinical findings in terms of gender, age, and remaining teeth on cone beam computed tomography images

Aim: This study aimed to evaluate the relationship between clinical findings and some factors such as age, gender, and remaining teeth on the anatomy of the temporomandibular joint in order to diagnose normal variations from abnormal cases. Methods: In this cross-sectional study, cone-beam computed tomography (CBCT) images of 144 patients referring to Tabriz Dental School for various reasons were selected and evaluated. The different aspects of the clinical parameters and the morphology of the condyle were evaluated on coronal, axial, and sagittal views. The CBCT prepared using the axial cross-sections had been 0.5 mm in thickness. The sagittal cross-sections had been evaluated perpendicular to the lengthy axis of the condyle at a thickness of 1 mm and the coronal cross-sections had been evaluated parallel to the lengthy axis of the condyle at a thickness of 1 mm. Data were analyzed with descriptive statistical methods and t-test, chi-squared test, using SPSS 20. The significance level of the study was p < 0.05. Results: There was a significant relationship between the condyle morphology, number of the teeth, and mastication side (p = 0.040). There were significant relationships between the condyle morphology, age between 20-40, and occlusion class I on the all the three views (coronal, axial, sagittal) (p = 0.04), (p = 0.006), (p = 0.006). Also, significant relationships were found in the condyle morphology and location of pain according to age, the number of remaining teeth, and gender. (p = 0.046) (p = 0.027) (p = 0.035). Conclusion:There are significant relationships between the clinical symptoms and condyle morphology based on age, gender, and the number of remaining teeth. The clinical finding that has the most significant relationship between the condyle morphology, remaining teeth (9-16 teeth), all of the age range (20-80 year), and gender was mastication side

Cone-beam computed tomography analysis of degenerative changes, condylar excursions and positioning and possible correlations with temporomandibular disorder signs and symptoms

Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms

Management of diacapitular mandibular condyle fracture using a single lag screw fixation: case report / Manejo de fractura de cóndilo mandibular diacapitular mediante fijación con tornillo de tracción único: reporte de caso

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Introducción: Las fracturas mandibulares son las fracturas faciales más comunes que afectan a diversos sitios anatómicos de la mandíbula. Entre las diversas fracturas mandibulares, el manejo de las fracturas condilares sigue siendo una tarea desafiante para los cirujanos. Reporte del Caso: Presentamos el caso de un paciente masculino de 28 años que consultó por dolor en el mentón y restricción de la apertura de la boca. La tomografía computarizada reveló una fractura sagital de la cabeza condilar derecha con desplazamiento medial de los fragmentos fracturados. El tratamiento de las fracturas diacapitulares incluye la reducción abierta y la fijación interna del cóndilo derecho con un solo tirafondo. Resultados: Los resultados postoperatorios fueron favorables, donde se establecieron los movimientos mandibulares normales, la oclusión dentaria deseada y el posicionamiento exacto del cóndilo con fijación rígida manteniendo así la forma del cóndilo. Conclusión: Se recomienda encarecidamente el uso de una fijación con un solo tornillo de tracción, ya que soporta en gran medida los fragmentos de fractura estabilizados y también ayuda a prevenir la rotación medial de los fragmentos de fractura.

Modificación de la actividad metabólica por medio de un dispositivo intraoral en pacientes con hiperplasia condilar confirmada por SPECT / Metabolic activity modification by means of an intraoral device in patients with condylar hyperplasia confirmed by SPECT

Objetivo: Evaluar los efectos de la aplicación de un dispositivo intraoral de uso permanente en el comportamien- to de los cóndilos con hiperplasia condilar (HC) confirmada por tomografía computarizada de emisión por fotón único (SPECT), estableciendo una comparación con un grupo de pacientes con HC que no utilizó el dispositivo. Materiales y métodos: 30 pacientes con una edad promedio de 21,7 años (+/-5,56) con HC confirmada con SPECT fueron asignados al azar a dos grupos: a los del grupo I (n=18) se les colocó un dispositivo intraoral de uso perma- nente para modificar la posición de la mandíbula, mientras que a los del grupo II (n=12) no se les colocó ningún dispo- sitivo. Se realizaron evaluaciones de dolor, del desvío de la línea media, de la apertura máxima y del disconfort al inicio del estudio y a los 2, 4, 6, 10, 12 y 14 meses. A los 19 meses promedio, la actividad osteoblástica (AO) fue reevaluada me- diante SPECT. Resultados: En el grupo I, la AO en los cortes coro- nales y transversales cesó o disminuyó (p<0,001) respecto a la condición inicial, mientras que en el grupo II la AO au- mentó (p<0,001). Los datos fueron analizados utilizando el test de Wilcoxon de rangos signados. Al ajustar un modelo de ANCOVA robusto utilizando el valor inicial como covariable también se observa que el efecto del grupo fue estadística- mente significativo en ambos cortes (p<0,001). Conclusiones: La aplicación de un dispositivo intrao- ral de uso permanente mejora la evolución de la hiperplasia condilar, lo que lo puede convertir en un tratamiento de uti- lidad para el tiempo que se aguarda para realizar una condi- lectomía alta de cuello de cóndilo, o incluso para evitar este procedimiento (AU)

Objective: To evaluate the effects of the application of an intraoral device for permanent use on the behavior of con- dyles with condylar hyperplasia (CH) confirmed by single photon emission computed tomography (SPECT), establish- ing a comparison with a group of patients with CH that did not use the device. Materials and methods: Thirty patients with an aver- age age of 21.7 years (+/-5.56) with CH confirmed by SPECT were randomly divided into two groups: the ones in group I (n=18) received an intraoral device for permanent use to align the mandible, while those in group II (n=12) did not get any device. Pain, midline shift, maximum opening, and discomfort were evaluated at the beginning of the study and at 2, 4, 6, 10, 12, and 14 months. At an average of 19 months, osteoblastic activity (AO) was reassessed by SPECT. Results: In group I, the AO in the coronal and trans- verse sections ceased or decreased (p<0.001) in comparison to the initial condition, while in group II the AO increased (p<0.001). The data was analyzed by the Wilcoxon signed rank test. Adjusting a robust ANCOVA model using the ini-tial value as a covariate made it possible to observe that the effect of the group was statistically significant in both cuts (p<0.001). Conclusions: The application of an intraoral device for permanent use improves the evolution of condylar hyperpla- sia, which can make it a useful treatment until a high condylectomy of the neck of the condyle is performed, or even to avoid this procedure (AU)

Factores de riesgo que inciden en la reabsorción condilar posterior a cirugía ortognática. Revisión bibliográfica / Risk factors that affect condylar resorption after orthognathic surgery. Literature reviewRisk factors that affect condylar resorption after orthognathic surgery. Literature review

La reabsorción condilar (RC) después de una cirugía ortognática (CO) es una consecuencia no deseada y en ocasiones con complicaciones irreversibles. El propósito de la investigación fue determinar los factores de riesgo que inciden en la RC posterior a una CO, mediante una revisión bibliográfica. Para lo cual se planteó un estudio exploratorio y documental, se realizó una revisión de literatura de los artículos desde el periodo de 2000 hasta el 2020, sin restricción de idioma, se excluyeron las investigaciones en animales e in vitro, resúmenes de congresos, publicaciones de RC relacionadas por enfermedad sistémica y estudios sobre remodelación condilar sin especificar RC posquirúrgica. La búsqueda de información se efectuó entre julio-agosto del 2021, en las bases de datos de Pubmed, Embase y SciELO, inicialmente fue con los términos de RC, CO, reabsorción condilar progresiva, "RC y CO", reportando 1346 artículos iniciales, después se hizo una selección de los estudios en función de los factores de riesgo, identificando 53 artículos, siguiendo los lineamientos de PRISMA. Se incluyeron 23 artículos, el análisis de los mismos demostró que los principales factores de riesgo implicados en la RC posquirúrgica son el sexo femenino de los pacientes, entre 14 y 58 años, con maloclusión clase Angle II, con ángulos del plano mandibular alto (24º- 50º), expuestos a una cirugía bimaxilar, avance mandibular (AM) mayor a 5 mm en sentido antihorario, utilizar una fijación intermaxilar rígida y que la recaída posquirúrgica se puede relacionar con la RC.

Condylar resorption (CR) after orthognathic surgery (OS) is an undesirable consequence and sometimes with irreversible complications. The purpose of the research was to determine the risk factors that affect CR after OS by means of a literature review. For which an exploratory and documentary study was proposed, a literature review of the articles from 2000 to 2020 was carried out, without language restriction, excluding animal and in vitro research, conference abstracts, CR publications related to systemic disease and studies on condylar remodeling without specifying postoperative CR. The search for information was performed between July-August 2021, in Pubmed, Embase and SciELO databases, initially it was with the terms of CR, OS, progressive condylar resorption, "CR and OS", reporting 1346 initial articles, then a selection of studies was made according to risk factors, identifying 53 articles, following the PRISMA guidelines. Twenty-three articles were included, the analysis of which showed that the main risk factors involved in postoperative CR are the female sex of the patients, between 14 and 58 years old, with Angle II class malocclusion, with high mandibular plane angles (24º - 50º), exposed to bimaxillar surgery, mandibular advancement (MA) greater than 5 mm counterclockwise, use of rigid intermaxillary fixation and that postoperative relapse can be related to CR.

Fractura de Hoffa medial: reporte de un caso / Medial Hoffa fracture: a case report

Resumen: Introducción: Las fracturas del cóndilo femoral en el plano coronal o fracturas de Hoffa se encuentran entre las fracturas más raras del miembro pélvico, pero son aún más raras las del cóndilo medial. El éxito en el manejo de estos pacientes radica en el diagnóstico oportuno y la consecuente reducción anatómica de la superficie articular del fémur. Caso clínico: El objetivo de este reporte es presentar a un paciente con el diagnóstico de fractura de Hoffa medial derecha, registrado como caso único en los archivos de nuestro hospital. El paciente acudió referido en Noviembre de 2011, con evolución de 10 días tras sufrir caída de caballo, presentando mecanismo de varo forzado y contusión directa de la rodilla derecha. Mostró radiografías anteroposterior y lateral de rodilla derecha, donde se observó de forma sutil solución de la continuidad en el plano coronal de la base del cóndilo medial, corroborado por resonancia magnética y asociado a lesiones parciales no quirúrgicas de ambos meniscos y del ligamento cruzado anterior. Se intervino quirúrgicamente el día 27 de Noviembre de 2011 mediante reducción abierta con abordaje medial y fijación interna con dos tornillos canulados de 7.0 mm. Se egresó al paciente indicando la movilización temprana y continua de la rodilla, difiriendo el apoyo y rehabilitación hasta la sexta semana. Actualmente el paciente se encuentra con posibilidad de deambulación, asintomático y con arcos de movilidad completos. El respeto del aparato extensor mediante un abordaje medial y la superficie articular con tornillos canulados se refleja en la adecuada evolución de nuestro paciente, pudiendo regresar a sus actividades diarias, incluso el montar.

Abstract: Introduction: Knee femoral condyle coronal fractures or Hoffa fractures are among the rarest fractures of the pelvic limb, being even more rare those of the medial condyle. The success in the management of these patients lies in the timely diagnosis and the consequent anatomical reduction of the femoral articular surface. Clinical case: The objective of this article is to present a patient with right medial Hoffa fracture, registered as a single case in the archives of our hospital. The patient was referred to us on November 2011, with a 10-day course after suffering a fall from horse ridding, presenting a forced varus mechanism and direct contusion of the right knee. He shows an anteroposterior and lateral knee X-rays showing a subtle solution of continuity in the coronal plane of the base of the medial condyle, corroborated with magnetic resonance imaging and was also associated with a non-surgical partial injury of both menisci and the anterior cruciate ligament. Surgical intervention was performed on 27th/11/2011, through open reduction with a medial approach and internal fixation with 7.0 mm (x2) cannulated screws. The patient was discharged with early and continuous mobilization of the knee, deferring support and rehabilitation until the 6th week. He is currently a wandering patient, asymptomatic, with complete range of motion. Because respecting the extensor apparatus through a medial approach and the articular surface with cannulated screws, it was observed in consequence an adequate evolution of our patient, being able to return to his daily activities, even remount.

Observation of the growth and development of subchondral bone in rat condyles exposed to fluoride at the level of bone microarchitecture / 中华地方病学杂志

Objective:To observe the effect of fluoride on growth and development of bone microstructure of rats condyle subchondral bone (RCSB).Methods:Forty two 3-week-old SD rats (half male and half female) were fed adaptively for 1 week, and 3 females and 3 males were sacrificed and recorded as 0 month. The remaining rats were randomly divided into control group ( n = 18) and fluoride exposed group ( n = 18) according to their body weight (55 - 70 g), half male and half female. The fluoride exposed group was fed with 150 mg/L sodium fluoride (NaF) aqueous solution, and the control group was fed with tap water. The two groups of experimental animals were sacrificed at 3, 5 and 7 month, respectively, 6 rats in each group, half male and half female. The right mandibular condyle was separated, and Micro CT scanning was performed to detect the microstructure parameters of RCSB. Results:In fluoride exposed group (3 month), bone surface/tissue volume (BS/TV), bone surface/bone volume (BS/BV), trabecular thickness (Tb.Th), trabecular number (Tb.N), structure model index (SMI), connectivity, connectivity density (Conn.D) and total porosity of female rats were significantly different from those of male rats ( t = - 5.10, - 5.58, 4.52, - 4.32, - 4.03, - 2.81, - 6.71, - 3.32, P < 0.05). There was no significant difference in each index between female and male rats in fluoride exposed group (5, 7 month, P > 0.05). Conclusion:In chronic fluorine exposure bone environment, the RCSB bone microarchitecture of male and female rats is different with time, showing the tendency of fluoride injury that the bone changes of female rats are slowed and the bone changes of male rats are active.

Morphometric assessment methods for estimation of sexual dimorphism from cranial occipital condyles / Métodos de evaluación morfométrica para la estimación del dimorfismo sexual de los cóndilos occipitales craneales

SUMMARY: Identification of fragmentary human remains is an integral par of medico legal investigations. Occipital region is commonly not affected in traumatic injuries and accidents due to its secluded position which makes it the integral part in determination of sex in the absence of entire skeleton. Occipital condylar region is also the most common area for degenerative and neoplastic diseases. So thorough knowledge of anatomy of occipital condyle is very essential during surgical interventions. 86 skulls were studied from osteological collections of Department of Anatomy, Yenepoya Medical College. Maximum length and breadth of the occipital condyle, anterior intercondylar distance and posterior intercondylar distance was measured with the help of vernier callipers. Descriptive statistics was calculated for the parameters considered. Metric data of right and left sides were compared with student t test and p value was calculated.All data obtained was subjected for discriminant function analysis to derive the statistical model. All the measurements were significantly high in males compared to females. Condylar length and width, anterior and posterior intercondylar distance can be used to derive formula for determination of sex in south Indian population with an accuracy of 66.3 %.

RESUMEN: La identificación de restos humanos fragmentarios es una parte integral de las investigaciones médico legales. La región occipital comúnmente no se ve afectada en lesiones traumáticas y accidentes debido a su posición apartada que la convierte en parte integral en la determinación del sexo en ausencia de un esqueleto completo. La región condilar occipital es también el área más común de enfermedades degenerativas y neoplásicas. Por lo tanto, el conocimiento integral de la anatomía del cóndilo occipital es esencial durante las intervenciones quirúrgicas. Se estudiaron 86 cráneos de colecciones osteológicas del Departamento de Anatomía, Facultad de Medicina de Yenepoya. Se midió el largo y ancho máximo del cóndilo occipital, la distancia intercondilar anterior y la distancia intercondilar posterior con la ayuda de un calibrador vernier. Se calculó la estadística descriptiva para los parámetros considerados. Los datos métricos de los lados derecho e izquierdo se compararon con la prueba t de Student y se calculó el valor de p. Todos los datos obtenidos se sometieron a análisis de función discriminante para derivar el modelo estadístico. Todas las medidas fueron significativamente altas en los hombres en comparación con las mujeres. La longitud y el ancho del cóndilo, la distancia intercondilar anterior y posterior se pueden utilizar para derivar la fórmula para determinar el sexo en la población del sur de la India con una precisión del 66,3 %.

Eminectomía bilateral como tratamiento para luxación crónica de articulación temporomandibular. Reporte de caso / Bilateral eminectomy as a treatment for chronic temporomandibular joint dislocation. Case report

Introducción: la luxación de la articulación temporomandibular es un desplazamiento del cóndilo fuera de sus posiciones funcionales dentro de la fosa articular y la eminencia articular, la cual ocasiona una pérdida completa de la función articular. La luxación crónica es toda luxación aguda que progresa sin un tratamiento específico y que puede ser de carácter recurrente. La eminectomía es un tratamiento quirúrgico definitivo contra la luxación crónica de articulación temporomandibular. Objetivo: reportar el caso clínico de un paciente masculino, de la tercera década de su vida, con diagnóstico de luxación crónica de la articulación temporomandibular de cinco meses de evolución y presentar una revisión actualizada de la literatura sobre este procedimiento quirúrgico. Caso clínico: el paciente fue tratado quirúrgicamente con eminectomía bilateral. Discusión: la eminectomía es un procedimiento quirúrgico controversial; sin embargo, recientes investigaciones lo catalogan como seguro y efectivo. Conclusión: el caso clínico presentado muestra un buen resultado.

Background: Temporo-mandibular joint dislocation is a displacement of the condyle, out of its functional positions within the articular fossa and articular eminence, causing a complete loss of joint function. Chronic dislocation is any acute dislocation that progresses without specific treatment and that can be recurrent. Eminectomy is a definitive surgical treatment for chronic temporomandibular joint dislocation. Objective: To report the clinical case of a male patient in the third decade of his life with a diagnosis of chronic dislocation of the temporomandibular joint of 5 months of evolution and to carry out an updated review of the literature on this surgical procedure. Case Report: The patient was treated surgically with bilateral eminectomy. Discussion: Eminectomy is a controversial surgical procedure; recent research classifies it as safe and effective. Conclusion: The presented clinical case shows a good result.

Condylar Dislocation for Intracranial Fossa: a Review of the Last 10 Years

The displacement of the mandibular condyle into the cranial fossa is an uncommon event; when it occurs, there is a need for immediate and multidisciplinary surgical intervention. Due to its rare advent, there is still no consolidated service dynamics, as this condition has not yet been described in a sedimented way in the literature databases. In the present article, we performed a literature review of condylar dislocation for the intracranial fossa described in the past 10 years in the PubMed and Lilacs search databases.

Posición condilar y espacio articular témporomandibular valorado con tomografía Cone beam / Condylar position and Temporomandibular Joint Space analysis with Cone-beam tomography

Resumen Objetivo. Comparar posición condilar y espacio articular en articulación témporo-mandibular, en pacientes con y sin disfunción témporo-mandibular mediante tomografía Cone Beam. Métodos. Criterios diagnósticos de investigación para trastornos témporo-mandibulares Eje II, n=50 pacientes ambos sexos, edad comprendida 18 - 27 años. Muestra aleatoria n= 50 pacientes equivalente a 100 articulaciones, se obtuvo: n=25 pacientes sin disfunción témporo-mandibular, considerados asintomáticos 25 con y sin disfunción témporo-mandibulares, considerados sintomáticos. Mediante tomografía Cone Beam de articulación témporo-mandibular boca abierta - boca cerrada se avaluó de forma manual los espacios interarticulares. Resultados. El espacio condilar anterior en pacientes con y sin disfunción témporo-mandibular no presentó diferencia significativa, p=0,30. La posición condilar tampoco mostró diferencia significativa p=0,58. En pacientes con y sin disfunción témporo-mandibular (sintomáticos) la posición central y posterior del cóndilo (35,2%), pacientes con y sin disfunción témporo-mandibular (asintomáticos) la posición anterior y central fue más significativa (37,0%); seguido de la posición posterior del cóndilo (26,1%). Conclusión. No existe diferencia significativa en la posición condilar y el espacio interarticular en pacientes sintomáticos y asintomáticos.

Abstract Aim. To compare the condylar position and joint space of the temporomandibular join in individuals with and without temporomandibular dysfunction, using cone beam computed tomography (CBCT). Methods. Research Diagnostic Criteria for Temporomandibular Disorders Axis II (n= 50) patients both sexes, age 18 - 27 years. Random sample (n=50) patients equivalent to 100 joints, obtaining: n-25 patients without temporomandibular dysfunction, considered asymptomatic and 25 patients with and without temporomandibular dysfunction, considered symptomatic. By tomography Cone Beam of open mouth temporomandibular joint - closed mouth was manually evaluated the interarticular spaces. Results. The anterior condylar position space and condylar position not significantly different in induvials with and without temporomandibular dysfunction temporomandibular disorders p=0,30 and p=0,58, respectively. Conclusions. There is no significant difference in the condylar position and intraarticular.

Abordaje intraoral con asistencia endoscópica para las fracturas de cóndilo mandibular: descripción de una serie de casos / Intraoral approach with endoscopic assistance for mandibular condyle fractures: a case series

Objetivo: Describir una serie de casos de fracturas de cóndilo mandibular resueltas por abordaje intraoral y asistencia video-endoscópica. Casos clínicos: Se presentan 3 casos de pacientes con fracturas de cóndilo mandibular unilateral. Dos casos presen- tan un segundo trazo de fractura parasinfisiaria asociada. El tratamiento realizado fue la reducción abierta y la fijación in- terna de todas las fracturas por abordaje oral. Se realizaron controles clínicos y tomográficos mediatos y a distancia (AU)

Aim: To present the experience with a series of cases re- solved by an intraoral approach and video-endoscopic assis- tance for the management of mandibular condyle fractures. Clinical cases: Three cases of patients with unilater- al mandibular condyle fractures are presented. Two of the cases presented a second line of associated parasymphyseal fracture. The treatment performed was open reduction and internal fixation of all fractures by oral approach. Mid-term and long-term clinical and tomographic follow-ups were per- formed, with favorable results (AU)

Posición condílea según biotipo facial en tomografía de haz de cono / Condylar position according to facial biotype in cone beam tomography / Posição condilar de acordo com a biótipo facial em tomografia feixe cone

Resumen Introducción y objetivo: La posición condilar, como el biotipo facial es importante para mantener una oclusión y un sistema estomatognático equilibrado. El objetivo del presente artículo es relacionar el biotipo facial con la posición condílea en tomografía de haz de cono, en pacientes sin reporte de trastornos temporomandibulares. Materiales y métodos: Se estudiaron 59 tomografías de pacientes 23 de sexo masculino y 36 femenino, con edades entre 14 y 59 años, se clasificaron en dolicofacial, mesofacial y braquifacial. Con el fin de evaluar la posición condilar se estudió la dimensión de los espacios articulares. Las tomografías fueron medidas con I-Cat vision y para el análisis estadístico se utilizó STATA 14, fue avalado por el comité de ética de la Universidad del Valle. Resultados: Se realizó correlación interobservador obteniendo un Kappa promedio de 0,85. 45 pacientes corresponden al biotipo braquifacial, 8 dolicofacial y 6 mesofacial. En todos los espacios articulares, los braquifaciales presentaron valores de mayor dimensión y el dolicofacial menor dimensión. Se encontró que los espacios mediales (CMS) presentaron valores similares en cuanto a lateralidad dentro de cada biotipo, teniendo diferencias de 0,02 a 0,09 sin embargo, para los espacios articulares centrales (CCS) y laterales (CLS) se observaron mayores diferencias entre un lado y otro, teniendo diferencias 0,15 hasta 0,62 lo cual es estadísticamente significativo. CLS fue el espacio articular de menor dimensión en todos los biotipos. Evaluando los espacios articulares por cada biotipo se encontraron diferencias significativas (P < 0,05) en CMS derecho, CCS derecho y muy cercano a la significancia CLS izquierdo. En todos los espacios articulares se observaron valores mayores en el sexo masculino de los cuales todos son braquifaciales siendo estadísticamente significativa (P < 0,05) para el espacio articular en CCS derecho, CLS Derecho y CLS Izquierdo. Conclusiones: Las dimensiones de los espacios articulares están relacionados con el biotipo facial, las medidas tomográficas de corte coronal son un insumo necesario como parte del análisis y diagnóstico anidado al biotipo facial.

Abstract Introduction and objective: The condylar position, as well as the facial biotype, are important to maintain an occlusion and a balanced stomatognathic system. The objective of this article is to relate the facial biotype with the condylar position in cone beam tomography in patients without temporomandibular disorders. Materials and methods: 59 Cone Beam Computer Tomography (CBCT) of 23 male and 36 female patients, with age between 14 and 59 years, were classified into dolichofacial, mesofacial and braquifacial biotypes. In order to evaluate the condylar position, the dimension of the joint spaces is evaluated. CBCT were measured with I-Cat vision and STATA 14 was used for statistical analysis, it was endorsed by the ethics committee of the Universidad del Valle. Results: The interobserver correlation was performed, obtaining a Kappa of 0.85. 45 patients correspond to the braquifacial biotype, 8 dolichofacial and 6 mesofacial. In all the joint spaces, the braquifacial ones presented values ​​of greater dimension and the dolichofacial smaller dimension. It was found that the medial spaces (CMS) present similar values ​​in terms of laterality within each biotype, having differences of 0.02 to 0.09, however, for the central (CCS) and lateral (CLS) joint spaces greater differences between one side and the other, having differences 0.15 to 0.62 which is significant. CLS was the joint space with the smallest dimension in all biotypes. Evaluating the joint spaces for each biotype, significant differences (P <0.05) were found in right CMS, right CCS and very close to the left CLS significance. Higher values ​​were observed in all the joint spaces in males, all of which are braquifacial, being statistically significant (P <0.05) for the joint space in the right CCS, Right CLS and Left CLS. Conclusions: The dimensions of the joint spaces are related to the facial biotype, the coronal section tomographic measurements are a necessary input as part of the analysis and diagnosis related to the facial biotype.

Resumo Introdução e objetivo: A posição condilar, assim como o biótipo facial, são importantes para manter uma oclusão e um sistema estomatognático equilibrado. O objetivo deste artigo é relacionar o biótipo facial com a posição condilar na tomografia de feixe cônico em pacientes sem disfunção temporomandibular. Materiais e métodos: 59 tomografias de pacientes 23 do sexo masculino e 36 do feminino, com idades entre 14 e 59 anos, foram classificadas em dolicofacial, mesofacial e braquifacial. Para avaliar a posição condilar, a dimensão dos espaços articulares foi é estudada. As tomografias foram medidas com o I-Cat Vision e o STATA 14 foi usado para a análise estatística, endossada pelo comitê de ética da Universidad del Valle. Resultados: Foi realizada a correlação interobservador, obtendo-se o Kappa de 0,85. 45 pacientes correspondem ao biótipo braquifacial, 8 dolicofaciais e 6 mesofaciais. Em todos os espaços articulares, os braquifaciais apresentaram valores de maior dimensão e os dolicofaciais de menor dimensão. Verificou-se que os espaços mediais (CMS) apresentam valores semelhantes em termos de lateralidade dentro de cada biótipo, havendo diferenças de 0,02 a 0,09, porém, para os espaços articulares central (CCS) e lateral (CLS) maiores. diferenças entre um lado e o outro, tendo diferenças de 0,15 a 0,62 o que é significativo. CLS foi o espaço comum com a menor dimensão em todos os biótipos. Avaliando os espaços articulares para cada biótipo, foram encontradas diferenças significativas (P <0,05) no CMS direito, CCS direito e muito próximas à significância do CLS esquerdo. Valores mais elevados foram observados em todos os espaços articulares do sexo masculino, todos braquifaciais, sendo estatisticamente significantes (P <0,05) para o espaço articular do CCS direito, CLS direito e CLS esquerdo. Conclusões: As dimensões dos espaços articulares estão relacionadas ao biótipo facial, as medidas tomográficas em corte coronal são um insumo necessário como parte da análise e diagnóstico relacionado ao biótipo facial.

The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle: our clinical experience

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey's syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection

Morphological Variations of the Condylar Head among Children Aged 4–15 Years A Panoramic Study

Background: Growth and development of dentocraniofacial complex occurs during various stage of development of dentition with TMJ as one of its centres of growth. The condition of temporomandibular joint can be visible from its condylar head form; therefore, it is crucial to recognize the normal morphology of condylar head during different stages of development of dentition. Aims: The aim of the study is to view the morphological appearance of condylar head during primary dentition, mixed dentition and permenant dentition. Subject and Methods: 400 panoramic images of 194 boys and 296 girls were collected and were divided into three groups bases on the stage of dentition. Shape of the condylar head were determined by tracing the print out of the panoramic image on an X ray viewer. Results: The study showed that during primary dentition stage shape of the conylar head was dominated by round shape and as growth and development occurs the condylar head shape changes to convex. Conclusion: The study describes the normal morphology of mandibular condyles in a child population attending The dentition status as well as growth of craniofacial has a significant role in determining condylar morphology.

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)