scholarly journals A Protocol for the Use of a Combined Microvascular Free Flap with Custom-Made 3D-Printed Total Temporomandibular Joint (TMJ) Prosthesis for Mandible Reconstruction in Children

2021 ◽  
Vol 11 (5) ◽  
pp. 2176
Author(s):  
Krzysztof Dowgierd ◽  
Rafal Pokrowiecki ◽  
Maciej Borowiec ◽  
Marcin Kozakiewicz ◽  
Dominika Smyczek ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Soft Tissues ◽  
Total Joint Replacement ◽  
Speech Development ◽  
Functional Requirements ◽  
Immediate Reconstruction ◽  
Congenital Deformities ◽  
Custom Made ◽  
Masticatory System

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes.

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1056
Author(s):  
Giovanni Beltrami ◽  
Gabriele Ristori ◽  
Anna Maria Nucci ◽  
Alberto Galeotti ◽  
Angela Tamburini ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Host Bone ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

scholarly journals Custom-made Total Joint Replacement After Segmental Resection of Recurrent Follicular Ameloblastoma

2021 ◽  
Vol 6 ◽  
pp. 247275122199297
Author(s):  
Ismael Vejar Alba ◽  
Guadalupe Jacinto Arias ◽  
Emmanuel Guerrero Soto ◽  
Sara Itzel López Zenteno
Keyword(s):  
Joint Replacement ◽  
Clinical Presentation ◽  
Slow Growth ◽  
Total Joint Replacement ◽  
Segmental Resection ◽  
Slow Growth Rate ◽  
Safety Margins ◽  
Custom Made

Design: Clinical case report. Objective: To present custom-made total joint replacement as a suitable option after resection of extensive odontogenic tumors. Background: Ameloblastoma is the most common odontogenic tumor. Clinical presentation is characteristic as it presents with a slow growth rate, but highly expansive and recurrent. Ample resection with safety margins is imperative to allow for a functional and predictable reconstruction. Methods: We present the case of a 51-year-old male diagnosed with a recurrent follicular ameloblastoma and was treated with segmental resection and subsequent reconstruction with custom-made total joint replacement. Results: Follow-up at 14 months after surgery showed satisfactory quality of life and proper functionality. Conclusions: Total custom joint replacement is an ideal option after extensive resections involving the articular region.

scholarly journals The Value of SPECT CT in Patient Management of Osteoarthritis of the Temporomandibular Joint

2018 ◽  
Vol 1 (1) ◽  
pp. 18-22
Author(s):  
Bernard Bonte ◽  
Kristoff Muylle ◽  
Nigel Shaun Matthews
Keyword(s):  
Temporomandibular Joint ◽  
Total Joint Replacement ◽  
Mouth Opening ◽  
Stage Iv ◽  
Stage Disease ◽  
Diagnostic Arthroscopy ◽  
Custom Made ◽  
The Right ◽  
End Stage ◽  
Masseter Muscles

A 30 year old female patient presented in 2009 with severe bilateral temporomandibular joint (TMJ) pain, restricted mouth opening and tenderness over the masseter muscles. She was initially diagnosed with Wilkes Stage IV of the right and left TMJ. A diagnostic arthroscopy performed bilaterally failed to releave her pain. She was diagnosed with an isolated spondyloarthropathy of TMJ based on a positive test for HLA B. Further medicamentous treatment was unsuccesfull over subsequent months and years. CBCT of the TMJ showed discrete sclerosis of the right TMJ. Based on an additional SPECT-CT with 99 Tcm hydroxymetylene diphosphonate with significant increased uptake of the tracer in the right TMJ, the right TMJ was considered as end stage disease and a right total joint replacement (TJR) using a Zimmer Biomet custom made prosthesis was performed. A left TJR was performed 3 years.

scholarly journals Retrospective Study of Facial Nerve Function following Temporomandibular Joint Arthroplasty Using the Endaural Approach

2015 ◽  
Vol 8 (2) ◽  
pp. 88-93 ◽  
Author(s):  
Frederick Liu ◽  
Helen Giannakopoulos ◽  
Peter D. Quinn ◽  
Eric J. Granquist
Keyword(s):  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Nerve Injury ◽  
Total Joint Replacement ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Retrospective Case ◽  
Facial Nerve Injury ◽  
Nerve Dysfunction

The aim of this retrospective case–control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. A total of 39 approaches were performed through an endaural incision. Patients undergoing total joint replacement and/or with preexisting facial nerve dysfunction were excluded from the study. Five patients were lost to follow-up and were excluded from the study. Facial nerve function of all patients was clinically evaluated by resident physicians preoperatively, postoperatively, and at follow-up appointments. Facial nerve injury was determined to have occurred if the patient was unable to raise the eyebrow or wrinkle the forehead (temporalis branch), completely close the eyelids (zygomatic branch), or frown (marginal mandibular branch). Twenty-one of the 36 patients or 22 of the 39 approaches showed signs of facial nerve dysfunction following TMJ arthroplasty. This included 12 of the 21 patients who had undergone previous TMJ surgery. The most common facial nerve branch injured was the temporal branch, which was dysfunctional in all patients either as the only branch injured or in combination with other branches. By the 18th postoperative month, normal function had returned in 19 of the 22 TMJ approaches. Three of the 22 TMJ approaches resulted in persistent signs of facial nerve weakness 6 months after the surgery. This epidemiological study revealed a low incidence of permanent facial nerve dysfunction. A high incidence of temporary facial nerve dysfunction was seen with TMJ arthroplasty using the endaural approach. Current literature reveals that the incidence of facial nerve injury associated with open TMJ surgery ranges from 12.5 to 32%. The temporal branch of the facial nerve was most commonly affected, followed by 4 of the 22 approaches with temporary zygomatic branch weakness. Having undergone previous TMJ surgery did not increase the incidence of facial nerve injury using the endaural approach. This information is important for patients and surgeons in the postoperative period, as a majority of patients will experience recovery of nerve function.

Asociación entre hábitos parafuncionales de la cavidad bucal y los transtornos temporomandibulares en adolescentes

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Gabriel Muñoz Quintana
Keyword(s):  
Oral Cavity ◽  
Temporomandibular Joint ◽  
Temporomandibular Disorders ◽  
Temporomandibular Disorder ◽  
Neuromuscular System ◽  
Jaw Movements ◽  
Nail Biting ◽  
Palabras Clave ◽  
Masticatory System ◽  
Objective Being

La musculatura del sistema masticatorio y la articulación temporomandibular (ATM) están protegidos por reflejos nerviosos básicos y sistema neuromuscular a través de la coordinación de fuerzas musculares, todo lo que produce sobrecarga muscular repetitiva como los hábitos parafuncionales (HPF) pueden ocasionar trastornos temporomandibulares (TTM)1. Los HPF se caracterizan por movimientos anormales a la función mandibular normal sin objetivo funcional, al estar alterados constituyen una fuente productora de fuerzas traumáticas caracterizadas por dirección anormal, intensidad excesiva y repetición frecuente y duradera (Rolando Castillo Hernández, 2001)4. El objetivo del estudio fue identificar la asociación entre la presencia de hábitos parafuncionales de la cavidad bucal y los TTM en adolescentes de la ciudad de Puebla. Estudio observacional descriptivo. Se incluyeron 258 adolescentes, 132 (51.2%) mujeres y 126 (48.8%) hombres, con una edad promedio de 12.5±.73 y quienes fueron diagnosticados con los CDI/TTM y los HPF fueron auto-reportados por los pacientes. Se encontró una prevalencia de los TTM del 39.9% y una prevalencia de HPF del 86%. Los HPF más frecuentemente reportados fueron la succión labial y la onicofagia. Se encontró una asociación significativa (x2=7.31, p=0.007) entre los hábitos parafuncionales y los TTM en adolescentes. Palabras clave: Trastornos temporomandibulares, hábitos parafuncionales, adolescentes, articulación temporomandibular. Abstract The muscles of the masticatory system and temporomandibular joint (TMJ) are protected by basic nerve reflex and neuromuscular system through the coordination of muscle forces, all that repetitive muscle overload occurs as habit parafunctional (HPF) can cause temporomandibular disorder TMD)1. The characteristics of HPF are abnormal jaw movements without a functional objective. Being the jaw movements altered, they constitute a source of traumatic forces with an abnormal direction, excessive intensity and long-lasting and frequent duration. (Rolando Hernandez Castillo 2001)4. Objective: was to identify the association between the presences of parafunctional habits of the oral cavity and TMD in adolescents in the Puebla city in Mexico. Material and methods: Is a observational study, we included 258 adolescents 132 (51%) females and 126 (48.8%) were men, mean age 12.5±.73 and who were diagnosed with CDI/TTM and HPF were self- reported by patients. Results: The prevalence of TMD was 39.9% and a prevalence of 86% HPF. The most frequently reported HPF were lip sucking and nail biting. We found a significant association (x2= 7.31, p = 0,007) between HPF and TMD in adolescents. Key words: Parafunctional habits of oral cavity, temporomandibular disorders, temporomandibular joint. (Odontol Pediatr 2011;10(2): 90-94).

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

2021 ◽  
pp. 152660282098527
Author(s):  
Jan Stana ◽  
Carlota Fernandes Prendes ◽  
Ramin Banafsche ◽  
Nikolaos Konstantinou ◽  
Barbara Rantner ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Emergency Setting ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Custom Made ◽  
Descending Aortic Aneurysm ◽  
Type A Dissection ◽  
Open Surgical Approach

Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

Sign in / Sign up

Export Citation Format

Share Document