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.

Anquilose da articulação temporomandibular em criança: relato de caso / Ankylosis of temporomandibular joint in child: case report

A anquilose da Articulação Têmporo-Mandibular (ATM) é a fusão entre o côndilo mandibular e a cavidade glenóide, restringindo os movimentos articulares, limitando a mastigação e induzindo a problemas estéticos, nutricionais, psicológicos, sociais, e alterações funcionais que influenciam no crescimento facial, quando acomete pacientes infantis.Objetivo: apresentar um caso clínico de anquilose da ATM em uma criança com hipótese diagnóstica de anquilose fibrosa, intra-articular, unilateral, completa, verdadeira, tipo I de Sawhney, da articulação temporomandibular direita, com retro-láterognatia, com etiologia provavelmente congênita ou idiopática, com limitação da abertura bucal e dificuldade à mastigação, sendo indicada a cirurgia e posteriores tratamentos ortopédico funcional dos maxilares, fisioterapêutico e fonoaudiológico.Conclusão: a anquilose da ATM em crianças de baixa idade pode levar a distúrbios no crescimento. Uma descrição detalhada dos achados clínicos, funcionais e radiográficos é necessária para estabelecer o correto diagnóstico...

Temporomandibular joint ankylosis (TMJ) is the fusion of the mandibular condyle and the glenoid cavity, restricting joint movement, limiting chewing and inducing aesthetic, nutritional, psychological and social problems, and functional changes that influence facial growth, when it affects children.Aim: this paper aims to present a clinical case of TMJ ankylosis in a child with a possible diagnostic of fibrous ankylosis, intra-articular, unilateral, complete, true, type I Sawhney, of the right temporomandibular joint, with retro-laterognatia, probably with congenital or idiopathic etiology, with limitation of mouth opening and chewing difficulties, with indication of surgery and subsequent functional orthopedic treatment of the jaws, physical therapy and speech therapy.Conclusion: an ankylosis of the temporomandibular joint (TMJ) in early childhood may lead to growth disturbances. Detailed descriptions of clinical, functional and radiographic findings are necessary in order to establish a correct diagnosis...

Anquilosis condilar mandibular unilateral - relato de caso clínico / Unilateral mandibular condylar ankylosis - a case report

La anquilosis de la  A.T.M. es  una patología clasificada conforme el local donde ocurre, el tipo de tejido envuelto y su extensión. El tratamiento debe ser quirúrgico, con remoción del cóndilo e interposición de algún tipo de material autógeno o alo plástico en el espacio formado

The anquilose of TMJ it is a pathology classified the place where happens accordingly, type of involved fabric and her extension. The treatment should be surgical, with removal of the condyle and interference of some type of autogenous material or aloplastic in the formed space

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report / Anquilosis no-sindrómica, verdaderamente congénita de la articulación temporomandibular reporte de un caso

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

Ankylosing spondylitis in patients attending Baghdad Teaching Hospital

Fifty patients with definite diagnosis of Ankylosing Spondylitis [AS] [49 males and one female] are included in this prospective study. The patients were classified according to age at onset into juvenile and adult groups. Eight patients [16%] who developed the disease between 10-19 years were considered as juvenile and 42 [84%] patients between 20-49 years as adults. Spinal involvement was seen in 38 [76%] patients, whilst peripheral arthropathy in 8 [16%] patients and in 4 [8%] patients axial as well as peripheral arthropathy were noticed. Peripheral arthropathy occurred in 62.5% of juveniles and 7.14% of adults, whilst axial occurred in 37.5% of the former and 83.3% of the latter. A positive family history was recorded in 10 patients. All patients remain gainfully employed despite their severe disease. Chest expansion was limited in 80%. All patients were having enthesiopathy and were negative for Rheumatoid factor. Pulmonary involvement of restrictive pattern was reported, significantly more in patients compared to control group. The values of Forced Vital Capacity [FVC], Forced Expiratory Volume in first second [FEV1] and Maximum Voluntary Ventilatory Ventilation [MVV] were reduced whilst the ratio of FEV1/FVC remained unchanged. Apical fibrosis and pleural thickening were seen in 12 [24%] patients of adult group. Radiological sacroilitis was reported in all patients whilst dorsolumbar spines were invovled in 43 patients and the cervical spines were spared in the juvenile group. We were interested in identifying the pattern of joint involvement according to age of onset and systemic manifestation of AS

Artoplastia del codo / Elbow artroplasty

Fueron revisados 12 casos con artroplastia de codo, durante los años 1977 y 1989 ambos inclusive, en el Hospital San Juan de Dios, Caracas. Después de una descripción anatómica de la articulación del codo y de la etiología, estudiamos los diferentes métodos empleados para la artroplastia. Presentamos 7 pacientes con fracturas de codo (58%), 4 con A.R.J. (38%), y 1 caso con Osteomielitis (8%). Se obtuvieron excelentes resultados en dos casos y buenos resultados en tres y regulares en cuatro. En los nueve se utilizó Fascia Lata