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.

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.

Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.

Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.