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.

Functional Restoration by Interpositional Arthroplasty with Temporalis Myofascial Flap in Temporomandibular Joint Ankylosis - A Clinical Study

Purpose: The purpose of this clinical study was to evaluate the functional restoration by interpositional arthroplasty with temporalis myofascial flap in temporomandibular joint ankylosis. Methods: After obtaining consent, the procedure were explained to the patient and each of the patients who met the inclusion criteria of the present study were randomly selected. Preoperatively all required investigations were done, fitness opinion for surgery and general anaesthesia was obtained, preoperative mouth opening / interincisal distance was measured with calliper, occlusion recorded, and midline shift was assessed. Surgical procedure (interpositional arthroplasty with temporalis myofascial flap) was carried out under general anaesthesia with endotracheal intubation. And patient was followed for about six months and following parameters were recorded. Mouth opening / interincisal distance, occlusion, Midline shift, Pain and Diet (solid/liquid). Results: In the present study, the temporalis myofascial flap was evaluated to be efficient in preventing the reankylosis. Preoperatively the mean interincisal opening was 6.93mm and post-operatively after a period of 6 months follow-up it remained as 34.93mm. Conclusion: The temporalis myofascial flap is an efficient interpositional material. It is a biologic, autogenous tissue, so there is no question of any rejection. The results of this study indicate that the use of temporalis muscle and fascia flap is effective in treating TMJ ankylosis.

Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis

OBJECTIVES: The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (≥35 mm) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle. RESULTS: With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed. CONCLUSION: Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.

Temporomandibular Joint Ankylosis in Young Adult: A Case Report.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition. It involves the mouth opening, dentofacial deformity, diet problem, and quality of life. When it occurs in a child, it can have devastating effects on the future growth and development of the jaws and teeth. Furthermore, in many cases it has a profoundly negative influence on the psychosocial development of the patient, because of the obvious facial deformity, which worsens with growth. TMJ ankylosis results in a limitation of the mouth opening. This disorder can result in an array of problems with diet, facial deformity, and poor oral hygiene. Three main surgical modalities described in the literature for its management are gap arthroplasty, interpositional arthroplasty and total joint replacement. Recurrence remains the main problem after surgery. Aggressive resection and intensive postoperative physiotherapy are recommended to prevent re-ankylosis.

Post-traumatic-Zygomaticocoronoid Ankylosis: A Rare Clinical Case Report.

Fusion of the zygomatic bone to the coronoid process of the mandible is a rare phenomenon reported in the literature and commonly called as zygomaticocoronoid ankylosis. It can be sequel of trauma or infection in the midfacial region, mimicking a wide range of problems including the common temporomandibular joint ankylosis and dysfunction. Maxillofacial trauma involving the displaced fracture of zygoma can obstruct the movement of coronoid and if not treated can cause ankylosis between both bones. It is very diffi cult to identify zygomaticocoronoid ankylosis on conventional radiographs and requires the through clinical and advanced radiological evaluation like cone-beam computed tomographic (CBCT) to diagnose it. CBCT can be a great help to identify the size and extension of ankylotic mass and decide the approach to remove it. Zygomaticocoronoid ankylosis can be approached intraorally by Keen’s incision, and extraorally through a hemicoronal approach we have approached intraorally. Here, we present surgical management of post-traumatic zygomaticocoronoid ankylosis in 42-year-old male patient who had trismus for 18 years.

Treatment of Unilateral TMJ Ankylosis in a Pediatric Patient with Temporalis Fascia Flap A Case Report.

The definite cause of temporomandibular joint (TMJ) ankylosis is still an unknown fact. TMJ ankylosis may result from, infection, trauma or insufficient surgical treatment of the mandibular condyle region. Different techniques have been described so far for the treatment of TMJ ankylosis, but no technique has successfully given uniform results. Relapse causing limited mouth opening, infection, open bite, reankylosis are the complications. Many authors agree that aggressive physiotherapy immediately after the surgical procedure, interpositional graft as spacer and wide bone resection are the basic principles in treating TMJ ankylosis. In this article, we discussed a case of unilateral TMJ ankylosis, in a 9-year-old boy, treated with the intre-positional gap arthroplasty with superficial temporalis fascia flap.

Facial nerve injury following surgery for temporomandibular joint ankylosis: A prospective clinical study.

Objective: The purpose of this prospective study was to evaluate the incidence and degree of facial nerve damage and time taken for its recovery following surgery for temporomandibular joint (TMJ) ankylosis. Materials and Methods: A total of 30 subjects with the TMJ ankylosis with or without history of previous surgery were included in this prospective study. House-Brackmann grading system was used to assess the function of the facial nerve post-operatively. Results: Most of the subjects were in the age range of 13-15 years. Eight subjects had bilateral ankylosis and remaining 22 had unilateral ankylosis. Out of 32 joints in which gap arthroplasty was performed, 4 had Grade 1 injury, 14 had Grade 2 injury, 12 had Grade 3, and 2 with the Grade 4 injury 24 h post-operatively. Whereas, out of 6 cases of interpositional arthroplasty 4 had Grade 1 injury and 2 had Grade 4 injury. According to House-Brackmann grading system, at 24 h, 78.9% patients had different grades of facial nerve injury, which gradually improved and came to normal limits within 1-3 months post-operatively. Comparison of change in the Grade of injury at 3 months follow-up as compared to baseline (24 h) showed full recovery in all the cases (100%) showing a statistically significant difference from baseline (P < 0.001). Conclusion: When proper care is taken during surgery for TMJ ankylosis, permanent facial nerve injury is rare. However, the incidence and degree of temporary nerve injury could be either due to the heavy retraction causing compression and or stretching of nerve fiber resulting in neuropraxia.

Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report

Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.

O côndilo mandibular bífido (BMC) é uma entidade incomum descrita na literatura e de etiologia controversa. Apesar da ausência de sintomatologia clínica, o radiologista deve estar alerta e deve ter conhecimento a respeito desta anormalidade, bem como suas implicações funcionais e mudanças morfológicas. A anquilose de articulação temporomandibular é uma patologia incapacitante com envolvimento do côndilo mandibular, fossa articular e base do crânio. A associação entre côndilo mandibular bífido e anquilose temporomandibular é rara e deve ser avaliada cuidadosamente. O objetivo deste artigo é relatar um caso simultâneo de côndilo mandibular bífido (BMC) e anquilose temporomandibular e descrever seus achados em tomografia computadorizada (CT).

Fiberoptic Nasotracheal Intubation in Pediatric Patients with Difficult Mouth Opening: A case report / 대한마취과학회지

We present two pediatric patients, one with Pierre Robin syndrome and one with temporomandibular joint ankylosis with limited mouth opening. They had historical and physical evidence of airway obstruction, difficult feeding, and sleep disturbance. They were scheduled for oromaxillofacial surgery. In each case, two different-sized fiberoptic bronchoscopes were used for nasotracheal intubation. After loss of consciousness following an IV injection of ketamine or inhalation of sevoflurane while maintaining spontaneous respiration, 10% lidocaine was sprayed into one nostril. Following insertion of a 60 cm Olympus LF-2 fiberoptic bronchoscope (OD: 3.8 mm) through the same nostril without tube placement, the vocal cords were visualized and topical anesthesia of the larynx was achieved by spraying 2% lidocaine through the biopsy channel. Thirty seconds later, the bronchoscope was passed into the trachea and 2% lidocaine was sprayed intratracheally. Then, the bronchoscope was withdrawn. An endotracheal tube was advanced through the same nostril and positioned in the nasopharynx and the ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded through the tube. There was neither a cough nor laryngeal spasm during advancement of the tube into the trachea. Extubation was performed without compromise in the operating room. The patients were discharged uneventfully.

Simultaneous Correction of Unilateral Temporomandibular Joint Ankylosis and Mandibular Hypoplasia Using Combined Arthroplasty and Mandibular Distraction

Damage of temporomandibular joints in infancy may result in ankylosis and alteration of the mandibular growth. In case of unilateral ankylosis occurring in early childhood, a mandibular hypoplasia of the affected side usually follows. The patients have limitation of mouth opening, poor oral hygiene, facial and mandibular growth disturbances, and rarely, upper airway obstruction in the form of either night snoring or obstruction sleep apnea. The objective of this study is to show the use of distraction osteogenesis in mandibular hypoplasia associated with ankylosis and to present our technique for the treatment of mandibular hypoplasia with unilateral ankylosis in infancy consisting of simultaneous arthroplasty which treats the ankylosis and mandibular distraction and enables to correct the facial asymmetry in the same procedure. Between November 1999 and May 2000, three girl patients (42, 44, and 48 months old) who had mandibular hypoplasia associated with ankylosis were treated with simulatneous arthroplasty and distraction osteogenesis. Two kinds of arthroplasties, consisting of gap arthroplasty for one patient and interpositional arthroplasty using a temporal fascia turn-over flap for the other two patients, were executed and mandibular distraction in all three patients. Mouth-opening exercises began on the first day following the operation. Mandibular distraction began on the fifth day after the operation at a rate of 1 mm per day (0.5 mm twice a day) and continued to achieve a slight overcorrection of deviated chin. From the first day after the operation, an increase in the mouth opening was achieved. The average duration of distraction was 20 days. Average duration of consolidation was 6 weeks. Oral opening increased from 2 to 20 mm in case of the first patient, from 4 to 28 mm in the second patient, and from 5 to 24 mm in the third patient. The follow-up period was from 5 to 12 months (mean 8 months). At the time of final evaluation, oral opening and a more normal facial contour persist. It is believed that mandibular distraction combined with arthroplasty offers a new therapeutic option for the treatment of mandibular hypoplasia associated ankylosis, with minimal morbidity and complications.

Relationship between coronoid process hyperplasia and temporomandibular joint ankylosis / 实用口腔医学杂志

Objectives:To investigate the relationship between coronoid process hyperplasia(CPH)and temporomandibular joint ankylosis(TMJA) and to analyze its pathologic mechanism and clinical meaning.Methods:28 patients with TMJA from 1984 to 2004 were retrospectively studied.The length of coronoid process and the mouth-opening degree were measured on their depicting map of panoramic radiographs.106 subjects with normal TMJ were enrolled as the controls.The relationship between CPH and case history of TMJA was statistically analysed.Results:Coronoid process in TMJA subjects was longer than that in the controls(P