Treatment of Dentofacial Deformity Associated with Temporomandibular Joint Ankylosis Through Vertical and Sagittal Osteotomies of the Mandibular Ramus.

ABSTRACT: Ankylosis of the temporomandibular joint is a disorder resulting from fibrous, osseous, or fibro-osseous adhesion that directly affects the quality of life of the individual. The authors present a case of unilateral temporomandibular joint ankylosis treated by condilectomy and ipsilateral sliding vertical ramus osteotomy associated with contralateral sagittal osteotomy aiming to restore function and to correct dentofacial deformity class II. A 31-year-old female patient presented with a history of facial trauma and major complaint of oral opening limitation. Physical examination revealed hypoplasia of the lower third of the face, facial pattern type II, anterior open bite, and maximum mouth opening of 22.5 mm. Computed tomography showed an ankylotic mass in the right mandibular condyle with deformity of the condylar structure and fusion to the right zygomatic arch and a contralateral condylar fracture sequel. It was proposed to perform a condilectomy of the right mandibular condyle for the removal of the bone mass concomitant to the sliding vertical ramus osteotomy of the mandibular ramus for condylar reconstruction by rhytidectomy approach and the sagittal osteotomy of the left mandibular aiming the reestablishment of occlusion and the correction of dentofacial deformity. The condylar fracture was not operated because the condyle was remodeled. The patient is in her fourth year postoperative presenting satisfactory esthetic-functional re-stabilization, without clinical signs of recurrence. In conclusion, the authors believe that combined sliding vertical ramus osteotomy and sagittal osteotomy can bring satisfactory results in complex cases.

Conservative treatment of bilateral temporalis muscle hypertrophy in a pregnant woman.

BACKGROUND: Hypertrophy of the masticatory muscles may affect the temporalis, masseter, and pterygoid muscles in several different combinations. METHODS: A case of bilateral temporalis muscle hypertrophy, with masseter and pterygoid involvement, in a 26-year-old white woman in the fourth month of gestation is reported. Magnetic resonance imaging and physical examination were used for diagnosis. Hypertrophy was considered to be of acquired nature. The patient was managed using alternative, noninvasive methods. RESULTS: After 2 months, visible reduction was observed. Clinical symptoms of muscle discomfort were also reported. CONCLUSIONS: In the presented case, we were able to use an alternative, noninvasive form of treatment, which provided our patient with an overall improvement in physical and psychologic aspects.