1/22. Functional rehabilitation of ankylosed temporomandibular joints.Successful chrome-cobalt prostheses have been used to replace the condyle and glenoid fossa in six young macaca irus monkeys. In one group of two animals the left temporomandibular joint was replaced; in the second group the right joint and in the third group both temporomandibular joints were replaced. Neither masticatory function nor ability to open or close the mouth was affected, and all the animals remained in excellent health, living in the colony for 9 to 10 months. A similar surgical procedure was carried out for treatment of three human patients with ankylosed temporomandibular joints.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/22. Using three-dimensional-computerized tomography as a diagnostic tool for temporo-mandibular joint ankylosis: a case report.Roentgenographic examination has long been a useful diagnostic tool for temporo-mandibular joint (TMJ) disease. The methods include TMJ tomography, panoramic radiography and computerized tomography (CT) scan with or without injection of contrast media. Recently, three-dimensional CT (3D-CT), reconstructed from the two-dimensional image of a CT scan to simulate the soft tissue or bony structure of the real target, was proposed. In this report, a case of TMJ ankylosis due to traumatic injury is presented. 3D-CT was employed as one of the presurgical roentgenographic diagnostic tools. The conventional radiographic examination including panoramic radiography and tomography showed lesions in both sides of the mandible. CT scanning further suggested that the right-sided lesion was more severe than that on the left. With 3D-CT image reconstruction the size and extent of the lesions were clearly observable. The decision was made to proceed with an initial surgical approach on the right side. With condylectomy and condylar replacement using an autogenous costochondral graft on the right side, the range of mouth opening improved significantly. In this case report, 3D-CT demonstrates its advantages as a tool for the correct and precise diagnosis of TMJ ankylosis.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
3/22. Coronal approach for the replacement of the condylar head in bilateral temporomandibular joint ankylosis: report of three cases.Limitation of mouth opening has long been the chief complaint for patients who suffer from temporomandibular joint (TMJ) ankylosis. For surgical treatment of this disease, several ways have been employed for access to the condylar fossa, including the preauricular, postauricular, perimeatal, endaural and Risdon approaches. In this article, we report three patients with bilateral TMJ ankylosis who underwent replacement of both condylar heads using the bicoronal approach. The advantages demonstrated with this surgical technique are ease of access to the condylar head, ideal surgical exposure field, utility of temporalis muscle and fascia and minimal risk of facial paralysis.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
4/22. ankylosis of the temporomandibular joint as a complication of forceps delivery: report of a case.A two and half years old girl presented with severe limitation of mouth opening, facial asymmetry, inability to masticate, and proclination of the anterior maxillary and mandibular teeth. There was no history of facial trauma, infection or neonatal fevers. A diagnosis of bony ankylosis of the TMJ was made following a confirmation of delivery by means of obstetrics forceps during a difficult labour. The causes of TMJ ankylosis and the sequaele are highlighted.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
5/22. Mandibular distraction in temporomandibular joint ankylosis.Condylar damage during childhood can produce ankylosis and alteration of the mandibular growth. In case of unilateral ankylosis occurring in early childhood, a mandibular hypoplasia of the affected side may develop. The patients have limitation of mouth opening, facial asymmetry, and chin deviation toward the affected side. The aims of this study are to show the use of distraction osteogenesis in mandibular hypoplasia associated with ankylosis and to present our experience with a new therapeutic option for the treatment of mandibular hypoplasia with unilateral ankylosis in the childhood consisting of the association of arthroplasty to treat the ankylosis and mandibular distraction to correct the facial asymmetry, both accomplished in the same surgical procedure. From November of 1996 to November of 1997, three male patients aged 2, 7, and 13 years with mandibular hypoplasia and ankylosis were treated by distraction osteogenesis. An arthroplasty consisting of the resection of the ankylotic block and interposition of a temporalis muscle flap, plus coronoidectomy was done in two of them and mandibular distraction was done in all three patients. Articular functional rehabilitation began on the first postoperative day. Mandibular distraction began on the fifth postoperative day with a rate of 1 mm per day, ending when the facial symmetry was achieved. From the first postoperative day, an increase in the mouth opening was achieved; this increase continued until ending the distraction. The average duration of distraction was 22 days. Average duration of consolidation was 6 weeks. Oral opening increased from 10 mm to 35 mm in the 7-year-old patient, from 9 mm to 27 mm in the 2-year-old patient, and from 14 mm to 38 mm in the 13-year-old patient. To date, oral opening and facial symmetry persist. Osseous mandibular distraction together with arthroplasty offers an excellent new alternative for treatment of patients with mandibular hypoplasia and associated ankylosis, with minimal morbidity and complications.- - - - - - - - - - ranking = 2keywords = mouth (Clic here for more details about this article) |
6/22. Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis.ankylosis of the temporomandibular joint has been a daunting problem in oral and maxillofacial surgery. Condylectomy with gap arthroplasty is the basic technique for treatment of the fully grown patient. In the past, reconstruction has primarily been accomplished with alloplastic materials or with autogenous tissue harvested from the patient. joints reconstructed with alloplastic materials have been subject to complications such as acute infection and chronic inflammatory problems as a result of foreign-body reaction with the immune system. Biologic reconstruction with autogenous materials does expose the patient to the risk of complications at the donor site. In the last 4 years, we have treated seven patients between the ages of 20 and 42 years who had complete temporomandibular joint ankylosis. In each patient, the affected joint was exposed through an extended preauricular incision. The ankylosed mandibular condyle with the surrounding abnormal bone, together with the coronoid process, was resected and removed. The ankylosed area was resected until an improvement of at least 15 mm in the interincisal opening distance was obtained. A solvent-preserved homologous cartilage graft was sculpted according to the size and shape of the gap and was then placed in it as interpositional material. Physical therapy, including active and passive mouth-opening exercises, began on the second postoperative day and continued for 6 months. patients were observed for 6 months to 4 years. During this period, no major complications were noted, and satisfactory results were obtained. The initial mean interincisal opening distance was 15.2 mm after surgery, and the final mean interincisal opening distance was 32 mm after completion of physiotherapy. No recurrence was seen during the 4 years of follow-up. This technique seems to be an effective, time-saving, and simple alternative to other methods of joint reconstruction in adults who have fairly extensive ankylosis of the temporomandibular joint. In this article, a description of the surgical technique, a review of all cases, and recommendations for the use of this type of graft material are discussed. Our clinical experience over the past 4 years with the use of preserved homologous costal cartilage grafts as interpositional material has been encouraging.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
7/22. Transpalatal excision of the odontoid process.A patient with platybasia of the skull and temporomandibular joint ankylosis is presented. Relief of brain stem compression by the impingement of the odontoid through a soft, hypoplastic clivus was done by first doing a mandibular condylectomy to open the mouth. A transoral-transpharyngeal route was then employed to excise the odontoid process.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
8/22. An unusual case of sub-condylar bilateral fracture and bilateral post-traumatic temporomandibular ankylosis.A case of bilateral sub-condylar fracture with wide stump dislocation associated with a central facial trauma, fracture-intrusion of the rhino-orbital-maxillary complex and a parasymphyseal mandibular fracture, is reported. After surgery and inter-maxillary fixation an unusual temporo-mandibular ankylosis developed. Maximum mouth opening, lateral and protrusive movements were severely limited. Surgical treatment of ankylosis was requested and performed. The originality of this case lies in the atypical lateral dislocation of condylar neck fractured stumps to the zygomatic arches and in the later appearance of ankylosis between the glenoid fossa, zygomatic arch, condylar neck stump, and the condylar process displaced anteromedially. The ankylosed blocks were resected, displaced condyles were also removed due to the strong adhesion with the ankylotic tissue and the lack of any anatomical continuity or connection with the glenoid fossa. Functional therapy allowed the resolution of the functional limitation.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
9/22. Combined surgical therapy of temporomandibular joint ankylosis and secondary deformity using intraoral distraction.temporomandibular joint (TMJ) ankylosis is a pathological process caused by damage of the mandibular condyle. When this event takes place in subjects during the developmental age, it results in an alteration of the entire maxillofacial complex. Therefore, surgical methods able to remove the temporomandibular ankylosis also include necessary operations to correct the secondary maxillofacial deformity. The distraction osteogenesis has induced our center to modify the surgical protocol for the therapy of patients who have developed TMJ ankylosis and secondary maxillomandibular deformity. We have treated four patients with monolateral ankylosis of the TMJ and serious deformities of the maxillomandibular complex secondary to functional limitation. During the same operation, arthroplasty was performed with the removal of the ankylotic block and the interposition of a temporal muscle flap in the new articular space; an intraoral osteodistractor was also positioned to lengthen the mandible. All patients showed recovery of the eurhythmy of the face and good re-establishment of the symmetry. An average 12-month follow-up showed the average opening of the mouth to be at least 35 mm. The combination of TMJ arthroplasty and intraoral osteodistraction provides good functional and aesthetic results in patients affected by ankylosis who have developed secondary maxillofacial deformities.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
10/22. ankylosis of the temporomandibular joint developing shortly after multiple facial fractures.A 41-year-old male patient was referred for treatment of extensive facial fractures and lateral condylar dislocations. The patient underwent open reduction and fixation under general anaesthesia. Intermaxillary fixation was released in 2 weeks and mouth opening was 21 mm. Despite postoperative physical exercises, the range of motion decreased to 10 mm at 5 weeks after the surgery. MR arthrography revealed a fibrous ankylosis in the bilateral TMJs. Coronal CT scans depicted a bony outgrowth of the left TMJ tuber. The patient underwent surgery for the ankylosis including discectomy and coronoidectomy, and removal of the bony outgrowth. An interincisal distance of 30 mm on maximal mouth opening has been maintained for 14 postoperative months. The importance of imaging assessment was emphasized for diagnosing the precise pathologic state of the ankylosis and selecting an appropriate surgical treatment of choice.- - - - - - - - - - ranking = 2keywords = mouth (Clic here for more details about this article) |
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