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>

The sequential management of recurrent temporomandibular joint ankylosis in a growing child: a case report / 대한악안면성형재건외과학회지

BACKGROUND: Temporomandibular joint (TMJ) ankylosis in children often leads to facial deformity, functional deficit, and negative influence of the psychosocial development, which worsens with growth. The treatment of TMJ ankylosis in the pediatric patient is much more challenging than in adults because of a high incidence of recurrence and unfavorable growth of the mandible. CASE REPORT: This is a case report describing sequential management of the left TMJ ankylosis resulted from trauma in early childhood. The multiple surgeries including a costochondral graft and gap arthroplasty using interpositional silicone block were performed, but re-ankylosis of the TMJ occurred after surgery. Alloplastic TMJ prosthesis was conducted to prevent another ankylosis, and signs or symptoms of re-ankylosis were not found. Additional reconstruction surgery was performed to compensate mandibular growth after confirming growth completion. During the first 3 years of long-term follow-up, satisfactory functional and esthetic results were observed. CONCLUSIONS: This is to review the sequential management for the recurrent TMJ ankylosis in a growing child. Even though proper healing was expected after reconstruction of the left TMJ with costal cartilage graft, additional surgical interventions, including interpositional arthroplasty, were performed due to re-ankylosis of the affected site. In this case, alloplastic prosthesis could be an option to prevent TMJ re-ankylosis for growing pediatric patients with TMJ ankylosis in the beginning.

Role of coronoid process in reconstruction of temporomandibular joint.

This article reports the role of coronoid process as a free graft and pedicled graft in reconstruction of temporomandibular joint in ankylosis cases. The cases treated were observed clinic-radiologically over a period of 12 months. Various autogenous and alloplastic materials used for reconstruction of TMJ were considered with their advantages and limitations. The use of coronid process for reconstruction of the nose, orbital floor, alveolar ridge and paranasal augmentation has been reported by various authors. Due to its shape and size coronoid process is not a popular option for TMJ reconstruction. The advantage of using coronoid graft is autogenous bone of intramembranous origin harvested through same surgical site. Possibility of graft resorption can be minimized when used as pedicled graft. Postoperative radiograph revealed complete uptake and remodeling of the graft when used both as free and pedicled graft. There was no failure of treatment in terms of reankylosis. Therefore, coronoid process may be a suitable bone resource for condylar reconstruction in patients with TMJ ankylosis.

Anquilosis de ATM: riesgos anatómicos y potencialidad del sistema piezoeléctrico / TMJ ankylosis: anatomical risk and piezoelectric system potentiality

El objetivo de este trabajo es presentar los riesgos anatómicos en el abordaje de la anquilosis de la articulación temporo mandibular (ATM) y el uso del sistema piezoeléctrico para realizar la resección de la misma. La paciente sexo femenino, 12 años, presento una anquilosis de la ATM derecha, previamente operada en base a reconstrucción con un injerto costocondral. Luego de 4 años de realizada la primera reconstrucción se presentó con una nueva anquilosis del área presentando una masa de tejido óseo de 31 mm en sentido latero-medial, que abarcaba hasta el foramen oval en la base de cráneo y de 28 mm en sentido anteroposterior. La lesión fue abordada con un acceso preauricular y posterior resección con sistema piezoeléctrico, utilizando una técnica de resección en bloque. Se presenta la técnica y se discute la potencialidad de realizar este procedimientos con los nuevos sistemas piezoeléctrico.

The aim of this report is to present the anatomical risk for to treat the temporo mandibular joint (TMJ) ankylosis and the use of the piezoelectric system for to make the bone resection. Female patient, 12 years old, presented a right TMJ ankylosis, that was previously operated with a costocondral graft reconstruction. After 4 year from these reconstructive surgery the patient was involved in a new TMJ anklylosis of the same side showing a bone mass with 31mm in an meddle-lateral direction, with compromise until to oval foramen in the skull base and 28mm in the anterior-posterior direction. The lesion was operated by a preauricular approach and then a bone resection with the piezoelectric system, using a block resection technique. In this report it´s present the technique and is discusses the potentiality of the new piezoelectric system for these procedures.

Distracção osteogênica mandibular: experiência do INTO-RJ / Mandibular distraction osteogenesis: experience of the INTO-RJ

Introdução: O desenvolvimento das técnicas de distracção do esqueleto craniofacial representou um grande avanço na prática da cirurgia craniofacial. A distracção é uma técnica menos invasiva, mais rápida e com uma morbidade aparentemente menor comparada com as técnicas tradicionais de reconstrução craniofacial. No ano de 2013, o serviço de Cirurgia Crânio Maxilo Facial do INTO realizou uma série de casos de distracção mandibular. Este trabalho objetiva apresentar nossa experiência. Métodos: De janeiro a março de 2013, sete pacientes realizaram cirurgia de distracção mandibular. Todos os pacientes operados apresentavam hipoplasia mandibular uni ou bilateral em decorrência de anquilose de ATM ou microssomia craniofacial. Em alguns pacientes com anquilose de ATM foi realizada também a ressecção do bloco anquilótico no mesmo tempo da distracção. Resultados: No pós-operatório houve melhora de todas as funções estomatognáticas, ganho de peso, decanulação da paciente traqueostomizada e melhora na qualidade do sono. Houve melhora nos perfis faciais, as laterognatias foram amenizadas e a abertura oral aumentou na maioria dos pacientes. A abertura oral aumentou de maneira mais significativa naqueles pacientes onde a cirurgia de anquilose foi realizada em conjunto com a distracção. A complicação mais comum foi dor à ativação, relato de cinco pacientes (71%).Conclusão: A distracção osteogênica da mandíbula é uma boa alternativa para o tratamento das hipoplasias mandibulares, muitas vezes sendo a primeira indicação em algumas situações clínicas. Aparentemente tem morbidade menor do que as reconstruções clássicas de mandíbula e possui o bônus de alongar também os tecidos moles.

Introduction: The introduction of distraction of the craniofacial skeleton represented a great advancement in the practice of craniofacial surgery. Distraction is a less invasive technique that is faster and with an apparently lower morbidity than the traditional craniofacial reconstruction techniques. In 2013, the craniomaxillofacial surgery service of the Institute of Traumatology and Orthopaedics performed a series of mandibular distraction surgeries. In this article, we aim to present our experience. Methods: From January to March 2013, seven patients underwent mandibular distraction surgery. All patients exhibited unilateral or bilateral mandibular hypoplasia due to ankylosis of the temporomandibular joint (TMJ), or craniofacial microsomia. In some patients with ankylosis of the TMJ, resection of the anlylotic block was also performed concomitantly with the distraction. Results: Postoperative improvement was noted in all the stomatognathic functions: weight gain, decannulation of a tracheostomized patient, and improved quality of sleep. There was an improvement in facial profiles: the laterognathism was eased and the mouth opening increased in most patients. The mouth opening increased more significantly in patients in whom ankylosis surgery was done in conjunction with the distraction. The most common complication was pain upon distraction, reported by five patients (71%). Conclusion: Mandibular distraction osteogenesis is a good alternative for the treatment of mandibular hypoplasia, often being the first indication in some clinical situations. It apparently has a lower morbidity than the classic mandible reconstructions and has the added benefit of also lengthening the soft tissues.

A clinical study on temporalis myofascial flap for adult temporomandibular joint ankylosis

Fourteen Years Follow-up of Ohara Condylar Prosthesis for the Treatment of Bilateral Temporomandibular Joint Ankylosis

Temporomandibular joint(TMJ) ankylosis is a serious and disabling condition. It results in the inability of the patient to open the mouth, impairment of the speech, difficulty in mastication, poor oral hygiene, facial asymmetry, mandibular micrognathia and psychologic disability. The causes of TMJ ankylosis can be diverse, traumatic, septic, autoimmune and rarely neoplastic. Traumas and particularly mandibular condyle fracture represent the most frequent cause of TMJ ankylosis. The interposition of muscle and fascia between the bones and many other materials like cartilage, muscle and dermis, fat or fascia was suggested.1 In addition, numerous alloplastic materials have been used for partial or total reconstruction of the TMJ. The current authors report 14 years follow-up results of Ohara condylar prosthesis for the treatment of bilateral temporomandibular joint ankylosis in a 35-year-old male. The patient had a bilateral TMJ ankylosis and micrognathia resulted from rheumatoid arthritis and the TMJ reconstruction with Ohara condylar prosthesis was performed. Four years later, right Ohara prosthesis was removed due to the penetration of the prosthesis into the middle cranial fossa and right TMJ was reconstructed with vascularized calvarial bone graft and costo-chondral graft. At 13 years after the first operation, reankylosis occurred bilaterally, and gap arthroplasty with interpositional silicon block was performed. Now he is being encouraged to exercise to open the mouth and opening up to 30mm is possible.

Comparison of different osteotomies in the operation for temporomandibular joint ankylosis treatment / 实用口腔医学杂志

0.05).Conclusion:Modified osteotomy can not improve operative effect.

INTERPOSITIONAL ARTHROPLASTY OF TEMPOROMANDIBULAR JOINT ANKYLOSIS WITH TEMPORALIS MYOFASCIAL FLAP

The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and high incidence of recurrence. TMJ ankylosis has been treated by excision and total joint reconstruction with alloplastic, allogeneic, autogenous materials as interpositional materials. The temporalis myofascial flap had been considered to be a successful interpositional material, due to its anatomical, topographical, and functional properties. This study evaluated the efficacy of the temporalis myofascial flap for nine TMJs (five patients) through the preauricular approach and coronoidectomy. Radiographic and physiologic long term result was investigated in this study. The result reveals that the temporalis myofascial flap is a good autogenous tissue satisfying the criteria of an ideal interpositional material, which offers a material that fulfills the physiological function of the disc. In spite of favorable functional outcome, mild postoperative openbite tendency remains another challenge.