Comparison of unilateral rostral, middle and caudal segmental mandibulectomies as an alternative treatment for unilateral temporomandibular joint ankylosis in cats: an ex vivo study

2020 ◽  
pp. 1098612X2097713
Author(s):  
Lenin A Villamizar-Martinez ◽  
Han Chia ◽  
James B Robertson ◽  
Cristian M Villegas ◽  
Alexander M Reiter
Keyword(s):  
Temporomandibular Joint ◽  
Ex Vivo ◽  
Surgical Techniques ◽  
Mouth Opening ◽  
Bony Tissue ◽  
Temporomandibular Joint Ankylosis ◽  
Vertical Range ◽  
Mandibular Body ◽  
Segmental Mandibulectomy ◽  
Joint Ankylosis

Objectives Temporomandibular joint ankylosis (TMJA) is the partial or complete inability to open the mouth due to intra- or extra-articular fibrous, bony or fibro-osseous tissue proliferation. Surgical procedures such as gap arthroplasty, condylectomy or wide extra-articular osteotomy have been recommended to treat this condition; these techniques are challenging, time-consuming and have been occasionally associated with postoperative recurrence, severe periarticular neurovascular iatrogenic trauma and death. Segmental mandibulectomy had previously been recommended as an alternative option for unilateral TMJA, but the location of mandibulectomy and extent of bone removal from the mandible region have not been mentioned in the literature. This study aimed to validate the area of the mandibular body (rostral, middle or caudal) and amount of bony tissue that should be osteotomized during a segmental mandibulectomy for treatment of unilateral TMJA in cats. Methods In this block study, 30 cadaver heads of domestic shorthair cats were randomly divided into three groups of 10 specimens each based on the mandibular region that would undergo segmental mandibulectomy (rostral, middle and caudal). The size of the removed mandibular segment and pre- and postoperative vertical range of mandibular motion were compared for statistical purposes. Results A significant statistical difference was observed between the pre- and postoperative vertical range of mandibular motion between the rostral, middle and caudal segmental mandibulectomies ( P <0.001). The mean postoperative recovered range of mandibular motion for the rostral, middle and caudal segmental mandibulectomies was 50.4%, 81.9% and 90.4%, respectively. Conclusions and relevance The caudal segmental mandibulectomy showed the highest postoperative vertical range of mandibular motion. The removal of a minimum of 1.2 cm of the caudal mandibular body was required to achieve nearly full recovery of presurgical mouth opening in the specimens of this study. The caudal segmental mandibulectomy may eliminate the risk of iatrogenic periarticular neurovascular damage inherent to more invasive surgeries performed at the temporomandibular joint area. When performed unilaterally, the caudal segmental mandibulectomy is a viable surgical alternative that may show a similar outcome to other surgical techniques.

scholarly journals Management of temporomandibular joint ankylosis with combination of gap arthroplasty surgery and physiotherapy

2016 ◽  
Vol 28 (1) ◽  
Author(s):  
Nurul Ramadhanty ◽  
Alwin Kasim ◽  
Abel Tasman ◽  
Seto Adiantoro ◽  
Dikki Drajat
Keyword(s):  
Temporomandibular Joint ◽  
Maxillofacial Surgery ◽  
Surgical Techniques ◽  
Mouth Opening ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Post Surgery ◽  
Gap Arthroplasty ◽  
Intensive Physiotherapy ◽  
Joint Ankylosis

Background. Temporomandibular joint (TMJ) ankylosis is a union of the articular surface of the temporal bone to the disc-condyle complex that restricts mandibular movements due to either a fibrous or bony union between the head of the condyle and the glenoid fossa. Common etiological factors are trauma, infection, and pathology in the joint or systemic diseases. The diagnosis of TMJ ankylosis is established through physical and clinical evaluation, and imaging examination. Currently, the surgical techniques used to treat TMJ ankylosis are gap arthroplasty, interpositional arthroplasty, joint reconstruction, and distraction osteogenesis. Purpose. To provide overview about management of temporomandibular joint ankylosis with gap arthroplasty combined with physiotherapy post surgery. Case. A 12-year-old female patient came to Department of Oral and Maxillofacial Surgery with complaint of opening mouth restriction, which occured since one year prior to admission. After complete physical and radiographic examination, patient then was diagnosed with TMJ ankylosis due to neglected odontogenic infection. The treatment was performed with gap arthroplasty under general anesthesia. Patient then underwent physiotherapy after the surgery, including application of heat on the affected region and exercises to open and close mouth. Discussion. Ankylosis of TMJ is an uncommon case that results in chronic and severe limited mouth opening. The critical factor of successful treatment of TMJ ankylosis is early detection, correct surgery approach, implementation of an intensive physiotherapy program, and a good post-operative conduct. Therefore on this patient, gap arthroplasty was the chosen surgery approach followed by intensive physiotherapy. Conclusion.Management goal in TMJ ankylosis is  to increase the patient’s mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Careful surgical technique and subsequent atten­tion to physiotherapy are both considered essential to achieve a satisfactory result.

scholarly journals Gap Arthroplasty of Bilateral Temporomandibular Joint Ankylosis

2014 ◽  
Vol 29 (2) ◽  
pp. 28-31
Author(s):  
Ferdinand Z. Guintu ◽  
Alexander T. Laoag ◽  
Joselito F. David
Keyword(s):  
Temporomandibular Joint ◽  
Mouth Opening ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Gap Arthroplasty ◽  
Long Term Follow Up ◽  
Preauricular Approach ◽  
Temporal Bones ◽  
Joint Ankylosis

Objective: To present a case of bilateral temporomandibular joint ankylosis that was managed successfully through gap arthroplasty. Methods: Design:   Case report Setting:   Tertiary Government Hospital Patient:   One Results: A 25-year-old man presented with inability to open his mouth for 18 years after direct trauma to his chin.  CT scan showed bilateral bony fusion of condyles to glenoid fossae, hypertrophic sclerosis and fusion of the condylar heads to the temporal bones. He underwent bilateral gap arthroplasty via preauricular approach with creation of a 15 mm space on the mandibular fossa. As of latest follow up, the patient maintained an inter-alveolar distance of 30 mm for 5 months postoperatively, through continuous aggressive mouth opening exercises. Conclusion:      Gap arthroplasty may be an efficient procedure for temporomandibular joint ankylosis in achieving satisfactory post-operative inter-alveolar opening and articular function. Early and meticulous rehabilitation is required to prevent relapse. Long-term follow up is recommended to document possible recurrence.   Keywords: temporomandibular joint ankylosis, gap arthroplasty, TMJ ankylosis, ankylosis

scholarly journals Interpositional Arthroplasty for Treatment of ATM Ankylosis

2020 ◽  
Vol 6 (6) ◽  
Author(s):  
Dos Santos FDB ◽  
Braz E ◽  
Matos MR ◽  
Schmitz MO ◽  
Tomazi FHS ◽  
...  
Keyword(s):  
Literature Review ◽  
Temporomandibular Joint ◽  
Temporal Bone ◽  
Mouth Opening ◽  
Functional Disorders ◽  
Condylar Fracture ◽  
Temporomandibular Joint Ankylosis ◽  
Articular Disk ◽  
Image Test ◽  
Joint Ankylosis

Introduction: The temporomandibular joint ankylosis is the union between the surface of the temporal bone in its articular portion and the complex made out of articular disk and the condyle. Its etiology is multifactorial being the trauma with condylar fracture most cited. This alteration causes several functional disorders to the patient, among them the main one is the limitation of mouth opening, which causes difficulty eating, speaking, hygiene, speech and others. The diagnosis is made through a clinic image test. The goal is to show a report of case of ankylosis as well as a literature review.

scholarly journals Interposition arthroplasty in post-traumatic temporomandibular joint ankylosis: A retrospective study

2009 ◽  
Vol 42 (02) ◽  
pp. 182-187
Author(s):  
Satyaswarup Tripathy ◽  
Mohd Yaseen ◽  
Nitya N. Singh ◽  
L. M. Bariar
Keyword(s):  
Temporomandibular Joint ◽  
Full Range ◽  
Mouth Opening ◽  
Temporalis Fascia ◽  
Female Ratio ◽  
Temporomandibular Joint Ankylosis ◽  
Temporal Fascia ◽  
Post Traumatic ◽  
Joint Ankylosis

ABSTRACTTemporomandibular joint ankylosis which is most frequently caused by trauma, presents with restriction in mouth opening in early stages and if children are the victim and not treated early, it presents with growth retardation of the involved mandibular side. Various methods are available for surgical correction. We have reviewed our experience with the efficacy of different interpositional materials in post-traumatic cases in our set up with special reference to temporal fascia over last three years. Twenty seven patients with history of trauma, mostly fall from height, have been studied. They were evaluated clinically and by computed tomography (CT) scan, orthopantogram and x- ray lateral oblique view. The most common age group was 10-15 years with mean 12.5 years and male to female ratio 1:2. Preoperative mouth opening (inter incisor distance) was 1-2 mm in 17 cases and 2-4 mm in 10 cases. We have used temporalis fascia in nine, costochondral graft in seven, silastic sheets in five and T-plates in six cases. Post-operatively, adequate mouth opening of 30-50 mm was observed in six months follow-up and more than 50 mm at one year follow up in 21 cases out of which nine cases have interpositional material as temporalis fascia alone. The postoperative period was uneventful in all cases and none required re-operation for recurrences. We conclude that interpositional arthroplasty, especially with pedicled temporal fascia, is the best method to prevent recurrences and establish good mouth opening and full range of jaw movements.

Coronoidoplasty in TMJ ankylosis treatment

2020 ◽  
Vol 13 (8) ◽  
pp. e235698
Author(s):  
Daniel Sathiya Sundaram Selvaraj ◽  
Ajish George Ommen ◽  
Jagadish Ebenezer
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Protocol ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Open Bite ◽  
Surgical Removal ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
The Past ◽  
Joint Ankylosis

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a ‘coronoidoplasty’ after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, ‘coronoidoplasty’, as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Concomitant Temporomandibular Joint Ankylosis and Maxillomandibular Fusion in a Child with Klippel- Feil Syndrome: A Case Report

2018 ◽  
Vol 42 (5) ◽  
pp. 386-390
Author(s):  
Deepika Pai ◽  
Abhay T Kamath ◽  
Pushpa Kini ◽  
Manish Bhagania ◽  
Saurabh Kumar
Keyword(s):  
Oral Health ◽  
Temporomandibular Joint ◽  
Cervical Vertebrae ◽  
Clinical Signs ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Limited Mouth Opening ◽  
Oral Manifestation ◽  
Temporomandibular Joint Ankylosis ◽  
Joint Ankylosis

Klippel-Feil syndrome (KFS) is classically characterized by fusion of any of the two of seven cervical vertebrae. It is identified by the presence of a triad of clinical signs including short neck, limitation of head and neck movements and low posterior hairline. Unusual bony malformations leading to facial asymmetry is the most common oral manifestation associated with KFS. Such maxillomandibular fusion can also result in restricted mouth opening in children. It's a challenge to provide complete rehabilitation in such children. This paper presents a report of a type II KFS with both maxillomandibular fusion and temporomandibular joint ankylosis which led to the limited mouth opening in a six-year-old child. Also, the child showed an inadequate development of speech, facial asymmetry and compromised oral health owing to the restricted mouth opening. After thorough investigations, surgery was done which restored limited mouth opening which led to normalizing of speech and oral health.

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