Anquilose da articulação têmporo-mandibular em criança: relato de caso clínico / Temporomandibular joint ankylosis in children: case report

Anquilose da articulação temporo mandibular (ATM) pode ser definida como a fusão das superfícies articulares da mandíbula com o crânio, resultando em severos problemas para seus portadores. Os fatores causais mais comuns são: trauma, infecção e doença sistêmica. Diversos sistemas de classificação têm sido propostos, dentre eles o estabelecido por Sawhney (1986), que divide essa patologia em 4 estágios. Diversas formas de tratamento têm sido empregadas, tais como artroplastia em gap, artroplastia interposicional e reconstrução articular. Kaban estabeleceu um protocolo de tratamento para pacientes pediátricos, muito utilizado na atualidade, apresentando boas taxas de sucesso. O objetivo do trabalho foi relatar um caso de uma criança com anquilose bilateral da ATM, tratada seguindo esse protocolo, com sucesso em seu objetivo de restaurar a função mandibular, apesar da possibilidade de procedimentos complementares futuros para finalização do caso.

Ankylosis can be defined as a fusion of the articular surfaces of the jaw to the skull, resulting in severe problems for its sufferers. The most common causal factors are trauma, infection and systemic disease. Several classification systems have been proposed, among them established by Sawhney (1986), which divides this disease into four stages. Several forms of treatment have been employed, such as gap arthroplasty, interpositional arthroplasty and joint reconstruction. Kaban established a treatment protocol for pediatric patients widely used today with good success rates. The aim of the study was to report a case of a child with bilateral ankylosis, treated according to this protocol with success in the goal to restore jaw function despite the possibility of future additional procedures for completion of the case.

Late treatment of a mandibular gunshot wound.

Mandibular gunshot injuries are esthetically and functionally devastating, causing comminuted fractures and adjacent tissue destruction depending on the weapon gauge, projectile shape, impact kinetic energy, and density of the injured structures. If the mandibular fracture is not adequate or promptly treated, the broken fragments will fail to heal. In case of a treatment delay, progressive bone loss and fracture contracture will require a customized approach, which includes open reduction, removal of fibrous tissue between the bony stumps, and fixation of the fracture with a reconstruction plate and autogenous graft. The authors report the case of a 34-year-old man wounded on the mandible 15 years ago. With the aid of computed tomography and a prototype, a surgical plan was designed including open reduction and internal fixation of the segmental mandibular defect with a reconstruction plate and bone graft harvested from the iliac crest. The postoperative follow-up was uneventful and the 12-month follow up showed a positive aesthetic and functional result.