Résumé
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.
Résumé
Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the temporomandibular joint (TMJ) is replaced by scar tissue. Most frequently reported complications after surgical treatment are limited mouth opening and re-ankylosis. Reankylosis happens due to inadequate bone removal, lack of sufficient interpositional material, fibrous tissue adhesions and elongation of coronoid process and regrowth of bone in the sigmoid notch area. In gap arthroplasty treatment chances to recurrence is 53% than interpositional arthroplasy. We treated a case of right sided TMJ reankylosis by interpositional arthroplasty with temporomyofacial flap and physiotherapy was started 3 days after surgery and maintained for 6 months. In 2 years follow-up, no signs of recurrence and maximum mouth opening 45 mm were observed. The success in preventing reankylosis after TMJ interpositional arthroplasty with temporomyofacial flap is relatively better than gap arthroplasty alone.
Sujets)
Ankylose/épidémiologie , Ankylose/chirurgie , Arthroplastie/méthodes , Enfant , Fascia/transplantation , Humains , Mâle , Techniques de physiothérapie , Lambeaux chirurgicaux/instrumentation , Lambeaux chirurgicaux/méthodes , Os temporal/chirurgie , Muscle temporal/transplantation , Articulation temporomandibulaire/chirurgie , Troubles de l'articulation temporomandibulaire/épidémiologie , Troubles de l'articulation temporomandibulaire/chirurgieRésumé
Management of temporomandibular joint (TMJ) ankylosis is challenging for the oral and maxillofacial surgeon because it involves the mouth opening, dentofacial deformity, diet problem, and quality of life. Although surgical techniques to treat TMJ ankylosis have improved, reankylosis is a persistent problem. The temporalis myofascial flap provides good material for interpositional arthroplasty, because of its good vascular supply, anatomic proximity, and adequate thickness. This case report examines the efficacy of submandibular anchorage to prevent reankylosis by inhibiting flap dislocation.
Sujets)
Ankylose , Arthroplastie , Difformités dento-faciales , Régime alimentaire , Luxations , Bouche , Qualité de vie , Articulation temporomandibulaireRésumé
Controversies exist regarding the treatment options for the end-stage arthritic change in the lateral tarsometatarsal joints. Arthrodesis has been frequently performed, but has a disadvantage of sacrificing a mobile joint. Resection arthroplasty also gained its popularity, especially in the patients with Rheumatoid arthritis, but possible hypermobility can lead to deformity. We report a successful clinical outcome of a patient with Rheumatoid arthritis in the 4th, 5th tarsometatarsal joints treated with tendon interpositional arthroplasties.
Sujets)
Humains , Polyarthrite rhumatoïde , Arthrodèse , Arthroplastie , Malformations , Articulations , TendonsRésumé
Temporo-mandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Ankylosis may be corrected surgically by an array of procedures like gap arthroplasty, joint reconstruction and interpositional arthroplasty. Though many types of autogenous grafts and alloplastic materials are available for the interpositioning, the temporalis muscle graft offers significant advantages like ease of harvesting, minimal donor site morbidity and effective coverage of the arthroplasty site. The efficacy of the same is highlighted in this article by its application in four cases of TMJ ankylosis.
Sujets)
Ankylose dentaire , Articulation temporomandibulaire , Procédures de chirurgie opératoireRésumé
Sujets)
Adulte , Humains , Ankylose , Arthroplastie , Études de suivi , Tête , Artère maxillaire , Bouche , Pelvispondylite rhumatismale , Articulation temporomandibulaireRésumé
Two types of elbow arthroplasties are used in current clinial practice:interpositional and implant arthroplasty.Interposition elbow arthroplasty neither completely eliminates pain nor restores full function.It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis,especially those with limited elbow motion.Current implant arthroplasty has come a long way in the past three decades.Elbow implant survival data nearly approach those of knee arthroplasty.The majority of patients have significant improvement in function and marked pain relief after total elbow replacement.However,the complication rate is higher than that for total hip and knee arthroplasty,is likely inherent in the anatomic uniqueness of the elbow itself.Greater caution must be paid to prevention of the complications of total elbow replacement.This article reviews the types,indications,contraindications and results of elbow arthroplasty.
Résumé
Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.