Management of Bilateral Temporomandibular Joint Ankylosis and Class 2 Malocclusion in a Patient With Nager Syndrome

FACE ◽  
2021 ◽  
pp. 273250162110557
Author(s):  
Andrew M. Ferry ◽  
Han Zhuang Beh ◽  
Lauren A. Truong ◽  
Rami P. Dibbs ◽  
Lesley W. Davies ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Standard Treatment ◽  
Facial Asymmetry ◽  
Facial Growth ◽  
Tmj Ankylosis ◽  
Mandibular Distraction Osteogenesis ◽  
Nager Syndrome ◽  
No Gold Standard ◽  
Joint Ankylosis ◽  
Pierre Robin

Nager syndrome is a rare hereditary syndrome characterized by severe mandibulofacial and pre-axial upper limb anomalies. Patients with Nager syndrome often exhibit syndromic Pierre-Robin sequence secondary to their hypoplastic mandible and require mandibular distraction osteogenesis to prevent dependence on a tracheostomy or gastric tube. This procedure, however, has been associated with temporomandibular joint (TMJ) ankylosis. TMJ ankylosis is a highly debilitating condition that dramatically impairs patients’ function and can result in facial asymmetry in affected children during periods of rapid facial growth. Surgical intervention is warranted in patients who fail physiotherapy; however, there is no gold standard treatment for surgically correcting TMJ ankylosis in patients with Nager syndrome. Herein, we detail the surgical management of TMJ ankylosis and class 2 malocclusion in a patient with Nager syndrome.

scholarly journals FIBROUS ANKYLOSIS OF TEMPOROMANDIBULAR JOINT: PRESENTING WITH SUDDEN ONSET COMPLETE INABILITY TO OPEN MOUTH.

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Rupesh Kumar Namdev
Keyword(s):  
Ct Scan ◽  
Temporomandibular Joint ◽  
Facial Asymmetry ◽  
Sudden Onset ◽  
Complete Fusion ◽  
Tmj Ankylosis ◽  
Mandibular Movements ◽  
Joint Ankylosis ◽  
Underlying Pathology

The temporomandibular joint makes it possible to open and close your mouth, as involving chewing, swallowing, speaking, and yawning activity.  Ankylosis of the Temporomandibular joint which includes partial or complete fusion of the joint with resulting restricted opening of mouth, restricted mandibular movements (hypomobility) with deviation to the affected side on opening of the mouth.  The pathology is multifactorial and restoration of function usually involves surgical intervention and dependence on the exact pathology situated at the root of pons.  It is essential to evaluate the underlying pathology, its degree for proper planning of surgery and follow-up.  3-D CT scan of facial bones provide a reliable and consistent diagnosis and evaluation for temporomandibular joint ankylosis.  Keywords: TMJ, ankylosis, 3-D CT scan, facial asymmetry.

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.

scholarly journals The Use of a Bioadhesive (BioGlue®) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

2013 ◽  
Vol 6 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Joseph Kamal Muhammad ◽  
Bader Abdulla Al Hashimi ◽  
Abu Bakr Al Mansoor ◽  
Iqbal Ali
Keyword(s):  
Temporomandibular Joint ◽  
Distraction Osteogenesis ◽  
Facial Asymmetry ◽  
Psychological Needs ◽  
Form And Function ◽  
Temporomandibular Joint Ankylosis ◽  
Mandibular Distraction Osteogenesis ◽  
Permanent Implants ◽  
And Function ◽  
Joint Ankylosis

The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue®; CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood.

scholarly journals Custom-Made Alloplastic Prosthetic Implant to Treat Temporomandibular Joint Ankylosis in Pediatric Patients: A Case Study

2021 ◽  
Vol 12 (1) ◽  
pp. 142
Author(s):  
Andrea Lazzarotto ◽  
Alessandro Tel ◽  
Riccardo Nocini ◽  
Luca Raccampo ◽  
Salvatore Sembronio ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Open Bite ◽  
Facial Growth ◽  
Anterior Open Bite ◽  
Tmj Ankylosis ◽  
Custom Made ◽  
Prosthetic Implant ◽  
Previously Treated ◽  
Joint Ankylosis

Temporomandibular Joint (TMJ) ankylosis represents a fairly common condition which surgeons need to face. According to Rowe, it can be defined as a restricted functional capacity of the jaw with limited movements owing to bony or fibrous adhesions between the condyle and either glenoid fossa, disc or eminence (or both). It can become a disease which impacts patients’ daily life, who suffer from limited mandibular excursion with reduced intercisal opening, anterior open bite, inability to swallow, sleep disorders, and speech problems. In children this may also result in abnormal mandibular and facial growth. In this paper, we deal with the case of a child with an important momolateral ankylosis, previously treated surgically with Costochondral Grafting arthroplasty without success and subsequently treated with a custom-made prosthesis.

scholarly journals Temporomandibular Joint Ankylosis with Maxillary Extension: Proposal for Modification of Sawhney's Classification

2018 ◽  
Vol 2 (1) ◽  
pp. s-0038-1666852
Author(s):  
Ramat Oyebunmi Braimah ◽  
Abdurrazaq Olanrewaju Taiwo ◽  
Adebayo Aremu Ibikunle ◽  
Taoheed Oladejo ◽  
Mike Adeyemi ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Poor Quality ◽  
Age Group ◽  
Loss Of Function ◽  
Female Ratio ◽  
Tmj Ankylosis ◽  
Cancrum Oris ◽  
Temporomandibular Joint Ankylosis ◽  
Joint Pathology ◽  
Joint Ankylosis

Temporomandibular joint (TMJ) is a unique joint in which both jaws must open synchronously for function. Any pathology in one or both joints results in functional problems with associated poor quality of life. TMJ ankylosis (TMJA) is a joint pathology as a result of bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. This is a retrospective study from two tertiary referral centers in northwest region of Nigeria from 2012 to 2016. Data retrieved include gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, interpositional materials used, and complications. Data were analyzed using SPSS for Window version 20.0 (IBM Corp.). Results were presented as simple frequencies and descriptive statistics. A total of 36 patients with TMJA were seen during the study period; out of which 7 (19.4%) patients had maxillary extension of the ankylotic mass. There was a male: female ratio of 1.3:1. Four (57.1%) patients were within the age group between 5 and 10 years, two (28.6%) within the age group between 11 and 15 years, while only one (14.3%) was within the age group between 31 and 35 years. All the cases (7 [100%]) of maxillary extension were secondary to cancrum oris (noma). Cheek scarring as a result of management of cancrum oris was observed. In addition, intraoral fibrosis eliminating the upper and lower buccal sulci extending to the molar regions was also noted. With the involvement of the maxilla in the ankylotic mass, the authors have proposed modification of Sawhney's classification by the addition of Class V. The authors have suggested a name for the new classification to be “Modified Sawhney's Classification of Temporomandibular Joint Ankylosis”. Aggressive postoperative physiotherapy for a sufficient period of time (minimum of 6 months) is paramount.

Technique of Dual Distraction for Correction of Unilateral Temporomandibular Joint Ankylosis With Facial Asymmetry: A Case Series

2019 ◽  
Vol 77 (12) ◽  
pp. 2555.e1-2555.e12
Author(s):  
Dhirendra Srivastava ◽  
Payal Luthra ◽  
Sonal Mishra ◽  
Lokesh Chandra ◽  
Sarang Sharma ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Case Series ◽  
Facial Asymmetry ◽  
Temporomandibular Joint Ankylosis ◽  
Joint Ankylosis

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 Experience with Blind Nasotracheal Intubation for Temporomandibular Joint Ankylosis at Mayo Hospital, Lahore

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Khalid Javed ◽  
Ambrin Amjad ◽  
Muhammad Abdul Aziz
Keyword(s):  
Temporomandibular Joint ◽  
Nasotracheal Intubation ◽  
Fiberoptic Intubation ◽  
Nasal Intubation ◽  
Corrective Surgery ◽  
Tmj Ankylosis ◽  
Airway Control ◽  
Temporomandibular Joint Ankylosis ◽  
Retrograde Intubation ◽  
Joint Ankylosis

Temporomandibular joint ankylosis presents a serious problem for airway management. Alternate or additional technique of airway control are required in this condition. Different options include blind nasotracheal intubation, fiberoptic intubation, retrograde intubation or tracheostomy. Moreover, the patient could be awake or asleep. The purpose of our study was to describe our experience with blind nasotracheal intubation after induction of general anesthesia with spontaneous ventilation in patients of temporomandibular ankylosis presenting for corrective surgery. This experience was gained on all the patients of temporomandibular joint ankylosis presenting to fasciomaxillary department at Mayo Hospital, Lahore over a period of 1 1/2 years. The surgery done was gap arthroplasty with genioplasty. Thirty six patients (male:24, female: 12) with age ranging between 3 years to 25 years with a mean of 12.56 years were studied. All the patients received premedication with atropine 10mg/kg body weight to dry up secretion. Patients were deeply anaesthetized with Halothane, Nitrous oxide with 50% oxygen. Thirty four patients were successfully intubated. Blind nasal intubation failed in 2 patients. The successful blind nasotracheal intubation for surgery for TMJ ankylosis needs adequately and deeply anaesthetized patients, relatively small well lubricated endotracheal tube passed through patent naris with atropine as premedication.

scholarly journals Evaluation of Hemoglobin Concentration and Hematocrit Values in Temporomandibular Joint Ankylosis Patients in Comparison to Nonankylosed Patients

2018 ◽  
Vol 19 (2) ◽  
pp. 210-213 ◽  
Author(s):  
Jasjit Sahota ◽  
Dipanshu Bakshi ◽  
Guneet Kaur ◽  
Deepinder Singh ◽  
Ambika Thakur ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Hematological Parameters ◽  
Autologous Blood ◽  
Hemoglobin Concentration ◽  
Well Being ◽  
Blood Transfusions ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Group I ◽  
Joint Ankylosis

ABSTRACT Aim The aim of this study is to find if there is any correlation between the hematological parameters and temporomandibular joint (TMJ) ankylosis and severity of the disease in such patients when compared with the nonankylosed patients. Materials and methods A total of 70 patients with age ranging from 10 to 40 years were included in the study after excluding the subjects according to the inclusion criteria. We categorized the subjects into two major groups: group I: control (nonankylosed/healthy subjects) and group II: study group (ankylosed subjects) with each group containing 35 subjects (n = 35) respectively. A detailed personal and medical history was obtained. The pharynx diameter was also recorded for each patient, and blood investigations using venous blood were done, which included hemoglobin concentration and hematocrit values. Results The results of study population showed a mean age of 22 ± 2.2 years. The most common etiology reported was trauma (65.7%) followed by infections, in which Noma was the most common one (80%). The difference of the mean values for hemoglobin and hematocrit concentration, between both the groups, was found to be statistically significant (p < 0.0001). Furthermore, a positive correlation was observed between the hemoglobin concentration and duration of ankylosis. Conclusion This study was an attempt to find a relation between the hemoglobin and hematocrit values in TMJ ankylosis patients so that the clinical treatment and management of such patients during surgeries be improved and may be beneficial for the patient. Clinical significance Temporomandibular joint ankylosis patients have to undergo complex surgical treatment, where the risk of excessive blood loss is high. Therefore, considering the complications of blood transfusions, such as infections and other risk factors, these patients can be good subjects for autologous blood transfusions, which help in improvement of the overall well-being of the patient. How to cite this article Singh D, Kaur G, Bakshi D, Sahota J, Thakur A, Grover S. Evaluation of Hemoglobin Concentration and Hematocrit Values in Temporomandibular Joint Ankylosis Patients in Comparison to Nonankylosed Patients. J Contemp Dent Pract 2018;19(2):210-213.

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