Ankylosis Patients Research Articles

The importance of the occipitocervical area in patients with ankylosing spondylitis analysis of a cohort of 86 cervical fractures in surgically treated patients.

Study Design:This was a retrospective analysis of prospectively collected data.Objective:The effect of C0-C1-C2 cervical ankylosis in patients with ankylosing spondylitis (AS) is not documented. The objective of this study is to describe the radiological characteristics of the occipitocervical junction in patients with AS operated for a cervical fracture and to correlate them with their clinical evolution.Materials and Methods:Analysis of patients with ankylosing spondylitis (AS) treated in a single institution of a cervical vertebral fracture between 2007 and 2014 who were prospectively followed through the SWESPINE registry. The integrity of the C0–C1–C2 joints was determined and classified into fused and nonfused joints. By determining the angle between C0–C1 and C1–C2 joints in the coronal view of the computed tomography scan (X-angle), the progressive degeneration of these joints was described. Intra- and inter-observer reliability of this test was determined. The instruments of health-related quality of life (QOL) and disability were EQ5D and Oswestry disability index (ODI), respectively.Results:A total of 86 patients with AS treated surgically for cervical fracture had complete facet ankylosis between C3 and T1 due to their pathology. Mean age 69.2 years (standard deviation [SD]: 11.7). The most common level of fracture was in C5–C6. In 24 patients, the C0–C1 joint was fused, and in 15 patients, C1–C2 joint was fused. The intra- and inter-class reliabilities for X-angle measurement were very high (intraclass correlation coefficients = 0.94; 0.92). The mean X-angle was 125° (SD: 12) in nonfused patients and 136° (SD: 14) in fused patients (P < 0.001). There were no differences in QOL and disability at 2 years between the two groups: EQ5D-index of 0.54 and 0.55 (P = 0.5), ODI of 26.4 and 24, (P = 0.35) respectively.Conclusions:X-angle is a reliable measure for joint integrity C0–C1–C2 in patients with AS. Total cervical ankylosis including the C0-C1-C2 segments is not related to poorer QOL and disability in these patients.

Use of Temporalis Fascia Flap in the Treatment of Temporomandibular Joint Ankylosis: A Clinical Audit of 5 Years.

Aim:Restoration of normal function and jaw movements in patients with temporomandibular joint (TMJ) ankylosis has been a challenge. Various techniques have been provided for its treatment; but the results have been variable. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis and to decrease postoperative complications such as reankylosis.Materials and Methods:This paper is a review of surgical outcome of interposition arthroplasty with temporalis fascia in 17 patients of unilateral TMJ ankylosis who underwent the above procedure. The review is based on the pre-, intra- and post-operative evaluation of these seventeen patients who were treated between 2008 and 2013. The follow-up time was 1–5 years.Results:Reankylosis was seen in only one of the patients; the remaining patients had satisfactory mouth openings.Conclusion:Surgical treatment of TMJ ankylosis with interposition of temporal fascia is an effective and easy procedure for prevention for reankylosis. The autogeneous nature and proximity to the joint are the main advantages of the temporal fascia flap when compared with other interpositional materials.

Correlation between hemoglobin concentration and hematocrit values in patients with temporomandibular joint ankylosis and nonankylosed patients

Background: Temporomandibular joint (TMJ) ankylosis causes distortion of the anatomy of the upper airway resulting in some form of airway obstruction. Aim: The aim of this study was to determine the relationship between TMJ ankylosis and hemoglobin and hematocrit levels. Settings and Design: This was a prospective comparative study of all consecutive patients with TMJ ankylosis who presented to the Oral and Maxillofacial Unit of the Teaching Hospital from January 2010 to December 2012. Materials and Methods: Information obtained included age, gender, types of ankylosis, etiology, duration of ankylosis as well as the hemoglobin and hematocrit values which were compared with age- and sex-matched nonankylosed patients. P ≤ 0.05 was considered statistically significant. Results: Twenty patients aged 10–35 years (mean 20.8 ± 5.53) comprising 55.0% males and 45.0% females participated in the study. Bony ankylosis was the most common presentation (75.0%) while trauma (55.0%) was the most common etiologic factor. The mean duration of ankylosis was 9.05 ± 5.43. The mean hemoglobin concentration was 13.49 ± 1.67 and the mean hematocrit was 39.35 ± 5.63. There was a positive correlation between the duration of ankylosis and the hemoglobin concentration (r = 0.471, df = 17, P= 0.042) as well as the hematocrit values (r = 0.457, df = 17, P= 0.049). Both hematological parameters were found to be significantly higher than the values in the nonankylosed patients with a mean difference of 1.57 g/dl (P = 0.001) and 6.28% (P = 0.0001) for hemoglobin concentration and hematocrit values, respectively. Conclusion: Patients with TMJ ankylosis have higher values of hemoglobin concentration and hematocrit values than the nonankylosed individuals and these findings can be explored for the clinical benefit of patients.

Re-Assessment of Coronoid as a Graft for Condylar Reconstruction in TMJ Ankylosis Patients: A Prospective Study and Literature Review

Treatment for TMJ ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. To rebuild a structurally and functionally satisfactory neocondyle is a challenging problem. Aim of this study is to re-assess the coronoid as a graft for condyle reconstruction. Twenty patients of TMJ ankylosis without involvement of the coronoid process in ankylotic mass, coming in age group elder than 14years were selected for the study over a period 3years from 2011 to 2014. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. After osteoarthrectomy coronoid process was detached and fixed with a 4 hole L-shaped titanium miniplate to form neo condyle. No donor site morbidity was observed as reported with other autogenous grafts. Satisfactory mouth opening was observed during follow up period with mean mouth opening 37.33±4.20mm except one case which required graft removal due to postoperative infection. Radiographically moderate amount of resorption of grafted coronoid process was observed in nearly all the cases however satisfactory mandibular function and occlusion was observed.

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

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.

Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis

The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty. A retrospective analysis of temporomandibular joint ankylosis patients (n=15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared. Significant (all p<0.05) differences were recorded in temporomandibular joint ankylosis patients treated with interpositional arthroplasty with autogenous tissue (53.3%) versus Matthews device arthroplasty (46.7%) according to intermediate (25±7 vs. 34±5mm) and late (19±8 vs. 33±5mm) postoperative maximal incisal opening, intermediate (31% vs. 7%) and late (47% vs. 12%) postoperative relapse, and reoperation rate (38% vs. 0%). There was similarity (all p>0.05) in preoperative (4.8±2.9 vs. 4.9±2.9mm) and recent (35±4 vs. 37±4mm) postoperative maximal incisal opening, hospital stay (3.5±0.8 vs. 3.6±0.8 days), and surgery-related complications (13% vs. 14%). Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse.

Lack of Evidence for Nonotosclerotic Stapes Fixation in Human Temporal Bone Histopathology.

Nonotosclerotic stapes fixation does not represent a significant cause of stapes ankylosis in patients undergoing stapedectomy; the vast majority have otosclerosis. Nonotosclerotic stapes fixation has been proposed as the diagnosis in 30 to 40% of patients undergoing stapedectomy (after excluding rare congenital, systemic, and syndromic causes of stapes fixation and tympanosclerosis). This finding was based on the histopathologic evaluation of total stapedectomy surgical specimens. Since these specimens do not include the surrounding otic capsule, the histopathologic evidence of otosclerosis may be missed. Human temporal bone specimens from patients who underwent stapes mobilization, stapedotomy, or stapedectomy during life were evaluated for histologic evidence of otosclerosis. Patients with a history of temporal bone trauma, tympanosclerosis, and congenital, systemic, or syndromic causes of stapes fixation were excluded. Therefore, most temporal bone donors carried a clinical diagnosis of otosclerosis. Two hundred ten specimens from three temporal bone collections were independently evaluated. Otosclerosis was found on histology in 99% (207/210). Therefore, the incidence of nonotosclerotic stapes fixation was 1% (3/210). In two of the three patients who did not have otosclerosis, the contralateral temporal bone had otosclerosis on histopathologic evaluation. These patients may have had otosclerosis in the footplate only (which was removed at the time of surgery and not available for review). Nonotosclerotic stapes fixation is not likely a distinct pathologic classification from otosclerosis. Most patients diagnosed with nonotosclerotic stapes fixation likely have otosclerosis, but do not have otosclerotic foci in the stapes itself.

Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases.

Aim:The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients.Settings and Design:A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications.Materials and Methods:Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded.Results:Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat.Conclusion:In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

Total hip arthroplasty for postoperative ankylosis in patients with hip peripheral fracture

Objective To discussion the feasibility and effect of total hip arthroplasty (THA) of postoperative ankylosis in patients with hip peripheral fracture. Methods From January 2008 to October 2013, cementless THA was performed in 23 patients with ankylosis after internal fixation of hip peripheral fracture. There were 16 males and 7 females, aged 23 to 67 years (mean, 43 years). Interval between internal fixation and THA was 12 to 73 months (mean, 38 months). Results Mean follow-up was 28 months (range, 3 to 60 months). All patients presented good press-fit prostheses with mean acetabular valgus of 43.3°, mean acetabular anteversion of 22.5°, and mean femoral anteversion of 16.4°. Primary wound healing was detected with no occurrence of infection, prosthetic loosening or dislocation, and periprosthetic fracture. Femoral vein incomplete embolism was diagnosed in one patient with limb swelling 2 months after operation, but swelling subsided after 3 months of bed rest, elevation of the affected limb and anticoagulant therapy. Length of the bilateral limbs was almost equal in 19 patients with the difference within 0.5 cm, but the affected limb was 0.8-1.4 cm shorter in 3 patients and was 0.8 cm longer in 1 patient. Harris hip score improved from (42.16 ± 3.03)points before operation to (93.08±5.23)points at the last follow-up (P<0.05). Conclusion THA is associated with good hip function recovery and improved quality of life during the treatment of postoperative ankylosis in patients with hip peripheral fracture. Key words: Ankylosis; Hip fractures; Arthroplasty, replacement, hip

Assessment of facial nerve injury with "House and Brackmann facial nerve grading system" in patients of temporomandibular joint ankylosis operated using deep subfascial approach.

Background:Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery. In spite of the development of a myriad of surgical approaches to the TMJ, FN remains at risk. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury.Objectives:To assess FN injury following TMJ surgery using deep subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS).Materials and Methods:Twenty TMJs in 18 patients were operated for TMJ ankylosis, using “the deep subfascial approach.” FN function was assessed postoperatively at 24 h, 1 week, 1 month, 3 months, 6 months using HBFNGS. Statistical analysis was done using SPSS 16.0.Results:Of 20 surgical sites 3 sites showed Grade III (moderate) FN injury and 17 sites showed Grade II (mild) FN injury at 24 h. The condition improved with time with full recovery of FN at all surgical sites at 6 months.Conclusion:The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is the safest method to avoid injury to FN.

Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis.

Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary step in this pathway. We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate regression analyses focused first on identifying significant MRI predictors of new backfill and fat metaplasia. We then assessed the role of backfill and fat metaplasia in the development of new ankylosis. All analyses were adjusted for demographic features, treatment, and baseline and 2-year change in SSS values for parameters of inflammation and MRI structural lesions. Resolution of inflammation and reduction of erosions were each independently associated with the development of new backfill and fat metaplasia at 2 years on multivariate analyses. Multivariate regression analysis that included demographic features, baseline and 2-year change in parameters of inflammation and MRI structural lesion showed that reduction in erosions (P = 0.0005) and increase in fat metaplasia (P = 0.002) at 2 years was each independently associated with the development of new ankylosis. Our data support a disease model whereby ankylosis develops following repair of erosions, and fat metaplasia and backfill are key intermediary steps in this pathway.

Costochondral Graft as Interpositional material for TMJ Ankylosis in Children: A Clinical Study.

TMJ ankylosis is one of the most disruptive anomaly that affects the masticatory system. The inability to move the mandible has significant functional ramification, such as the inability to eat a normal diet. Additionally, speech is affected, making it difficult for some individuals to communicate and express themselves to others. As there are several biologic and anatomic similarities to the mandibular condyles, autogenous costochondral grafts have been considered to be the most acceptable tissue for temporomandibular joint reconstruction. In addition donor site complications are infrequent and regeneration of the rib usually occurs within a year post operatively in children. The aim of this study was to evaluate the function of costochondral grafts to replace the mandibular condyles and to assess the position, growth, overgrowth, function, success, failure and resorption of costochondral grafts. Ten TMJ ankylosis patients were operated in the Department of Oral and Maxillofacial Surgery at Institute of Dental Sciences, Bareilly. Out of the 10 cases 6 were male patients and 4 female patients in age group of ≤14years; of which 8 patients were of unilateral TMJ ankylosis and 2 were of bilateral TMJ ankylosis. All ten patients underwent interpositional gap arthroplasty with reconstruction of the condyle by costochondral graft. All patients with costochondral grafts had improved mandibular symmetry and growth with adequate mouth opening. This study indicates that using costochondral grafts to reconstruct TMJ ankylosis in children provides a good result.

THU0104 Risk Factors of Advanced Spinal Disease And/Or Bamboo Disease in Patients with Ankylosing Sponylitis during TNFI Treatments: HÜR-BİO REAL Life Results

BackgroundSpinal ankylosis is most important reason of functional impairment in ankylosing spondylitis (AS). In routine practice, all patients who learned diseases's name ask ankylosing posture and risk factors for ankylosis....

OP0018 Epigenetic Study of Advanced Ankylosis in Patients with Ankylosing Spondylitis

BackgroundAnkylosing spondylitis (AS) is an inflammatory spinal disease characterized by ankylosis of the spine. A subset of patients develops significant ankylosis resulting in mobility issues.ObjectivesTo determine if epigenetic modifications may...

Factors Influencing Treatment Plan and Post Operative Compliance in TMJ Ankylosis Patients: A Retrospective Analysis of Long Term Post Surgical Evaluation.

Ankylosis of the temporomandibular joint is a clinical entity significant for a maxillofacial surgeon. Since time immemorial humanity is battling with this condition which is not just disfiguring the normal anatomy of the face but severely hampers the function of mastication. In this study we have tried to evaluate and correlate various factors leading to causation of ankylosis of TM Joint along with clinical manifestation and treatment planning as well as outcomes. This is a retrospective study, records of 60 patients were selected out of which 28 patients reported for recall. Based on a predefined format, patients were evaluated and correlation was looked up on various accounts such as age of occurrence and age of reporting to the surgeon, probable etiology, sex distribution, treatment modality and postoperative outcome. The mean age of onset or occurrence was 4-7years of age whereas age of reporting to the clinic was 16-17years. Highest percentage of patients had trauma as an etiology (64%) and the lowest percentage had congenital deformity (21%). Three surgical techniques were evaluated and compared for their post surgical mouthopening, gap arthroplasty was done in 61%, interpositional arthroplasty in 39% and low ramus osteotomy in 21%. This study was aimed at analyzing the clinical form and function of the post surgical patient reviewing the recent radiographs to analyze the surgical site. The data collected was (1) Age of occurrence and age of reporting with the deformity (2) Etiological history (3) Sex and Side predisposition (4) Procedure used for correction of deformity (5) Recall (follow up) data especially recurrence and physiotherapy. We arrived at a conclusion that mean age of occurrence of deformity was approximately 4.7years and age at which patient reported to clinic was 16.2years. The main etiological factor was trauma (51%) and ear infection (21%). 57% patients presented with unilateral deformity, with both the sides equally effected. The effectiveness of gap arthroplasty, interpositional arthroplasty and low ramus osteotomy procedures was evaluated. Gap arthroplasty and interpositional arthroplasty were found to be effective procedures. The importance of post operative physiotherapy was emphasised yet again through this study.

Temporomandibular Joint Ankylosis:Evaluation of surgical outcomes

The study reviews surgical outcomes of 45 temporomandibular joint (TMJ) ankylosis patients that were treated in the maxillofacial and oral surgery unit of the University of the Western Cape, in South Africa.The aim of the study was to evaluate the outcomes of our protocol and to compare the outcomes unilateral and bilateral TMJ ankylosiscases. In this study the outcomes of TMJ ankylosiswere evaluated by using the following three parameters; preoperative maximal interincisal opening (preop MIO), intraoperative maximal interincisal opening (OP MIO) and the outcome Maximal interincisal opening (outcome MIO). The patient progress since surgery is calculated by subtracting Op MIO from the outcome MIO, and parameter is called postoperative change (Pop MIO). While the overall change is measured by subtracting preop MIO from the outcome MIO, and variable is called Overall change in MIO (OC MIO). The study showed that surgical release of TMJ ankylosis improved mouth opening by a mean OC MIO of 18.5mm. The study also showed that there was no difference in outcomes between unilateral and bilateral cases. Gap arthroplasty showed better outcomes than reconstruction with costochondral graft.

Role of coronoidectomy in increasing mouth opening.

Aim:To evaluate the effectiveness of coronoidectomy in advanced (stage III-IV) oral submucous fibrosis (OSMF) and temporomandibular joint (TMJ) ankylosis.Materials and Methods:Five patients clinically diagnosed as grade III/IV OSMF (group 1) and seven patients clinically and radiographically confirmed as TMJ ankylosis (group 2) underwent surgery entailing coronoidectomy in addition to conventional surgical procedures required in both the conditions followed by vigorous mouth opening exercises. The results were evaluated using the interincisal distance at maximum mouth opening as the objective outcome over a follow-up period of 2 months.Results:OSMF patients (group I) showed a mean preoperative interincisal opening of 14.40 mm which increased to 24.60 mm after conventional procedures and showed further increment to 35 and 44.80 mm after unilateral and bilateral coronoidectomy, respectively; which was statistically significant (P = 0.043). Follow-up of 2 months showed a gradual increase in mean mouth opening compared to baseline which was also found to be statistically significant (P = 0.043). In TMJ ankylosis patients (group II), preoperative mean mouth opening of 6.71 mm increased to 24.29 mm after conventional procedures, and further to 37.29 mm after unilateral coronoidectomy which was statistically significant (P = 0.018). On subsequent follow-up of 2 months, a gradual increase in mean mouth opening compared to baseline was observed which was statistically significant (P = 0.018).Conclusion:Coronoidectomy is an effective adjunct in increasing intraoperative and stabilizing postoperative mouth opening.

Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome

This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via ‘lazy-S’ incision. A gap arthroplasty was performed, followed by a ‘reverse L’ osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13–27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients.

Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint

AimTo evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. MethodsFifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea–hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan.TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. ResultsPost distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea–hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. ConclusionDistraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea.

OP0261 Genetic and functional evidence for a role of the bone morphogenetic protein type 1B receptor in ankylosis in mice

BackgroundProgression of ankylosis in patients with ankylosing spondylitis is highly variable, suggesting that ankylosis is at least partially due to genetic factors. We used a murine ankylosing enthesitis mouse model...