Case Of Temporomandibular Joint Ankylosis Research Articles

Can concurrent use of king vision video laryngoscope and fiberoptic bronchoscope improve efficacy and safety of awake intubation in patients with limited mouth opening? - A case report

Securing the airway by endotracheal intubation in a patient with a restrictive mouth opening poses a challenge to anesthesiologists. Awake tracheal intubation using flexible fiberoptic bronchoscopy is the gold standard in the anesthetic management of patients with restricted mouth openings. Awake video laryngoscopy (VL) is being increasingly used for the management of the anticipated difficult airways. We report a case of temporomandibular joint ankylosis with restrictive mouth opening posted for laparoscopic nephrectomy managed by awake intubation with the combined use of king vision VL (KVVL) and fiberoptic bronchoscope (FOB). KVVL provided an improved and clear view of the airway structures and FOB helped in guiding and maneuvering the tube safely into the larynx. The combined use of KVVL and FOB enhanced the effectiveness and safety of the procedure.

Retrospective comparative evaluation of airway management with different techniques of fiberoptic intubation in patients undergoing surgery for temporomandibular joint ankylosis

Background: Temporomandibular fusion has devastating effects on the growth and development of an individual's jaws. Thus, surgical modality is seen as a last resort to its correction. Surgical management of temporomandibular ankylosis cases presents significant challenges to an anesthetist in maintaining airway patency. Thus, this retrospective study evaluated the techniques for combating airway management challenges, emphasizing developing an institutional protocol that effectively minimizes errors. Methods: This retrospective study was conducted in the RUHS College of Dental Sciences and attached to the RUHS College of Medical Sciences, Jaipur, Rajasthan, India, for a period of three years. The records of 94 patients who had undergone surgical correction of TMJ ankylosis and were intubated with fiberoptic intubation were compiled. The cases were divided into groups, Group General anesthesia (GA) and Group Regional anesthesia (RA), and analyzed for demographics, successful intubation, and complications. Results: In Group GA, 98 % of cases were successfully intubated. Patient movements were 0 in Group GA and 25% in Group RA. Coughing was present in 1.61% of cases of group GA and 98.38% of Group RA. Epistaxis occurred in 35% of cases, and 29% of cases suffered from sore throat after extubation in Group GA. Conclusion: The anesthetist dilemma of intubating awake or anesthetized always exists. However, a careful preoperative evaluation and assessment of the patient for mask ventilation helps in the successful anesthetic management of temporomandibular joint ankylosis cases. For the anticipated difficult airway awake, fiberoptic intubation is still the ‘gold standard’ technique.

In-house three-dimensional printing for surgical planning: learning curve from a case series of temporomandibular joint and related disorders.

Three-dimensional (3D) printed models can improve the understanding of the structural anatomic changes in cases of temporomandibular joint ankylosis and pseudoankylosis leading to closed jaw locking. Their use in pre-surgical planning and intraoperative guidance has been reported, contributing to the predictability and success of these surgery procedures, which can be quite complex, especially in small animal patients. The use and production of 3D tools and models remain challenging and are so far limited to institutions with high (economical and human) resources. This study aims to propose simplified workflows using open-source software to facilitate an in-house 3D printing process. To illustrate this, three cases of temporomandibular joint ankylosis and one of pseudoankylosis were reviewed, where in-house 3D printed models were used for client communication and surgical management. The 3D models were segmented from computed tomography and printed via stereolithography. They were used to support discussion with clients (n = 4), to allow surgeons to pre-surgical plan and practice (n = 4) and for intraoperative guidance during surgery (n = 2). Surgical cutting guides were produced in one case to improve precision and define more accurately osteotomy lines. It is essential to consider the initial time and financial investment required for establishing an in-house 3D printing production, particularly when there is a need to produce biocompatible tools, such as surgical cutting guides. However, efficient and streamlined workflows encourage the integration of this technology, by accelerating the printing process and reducing the steep learning curves, while open-source software enhances accessibility to these resources.

An evaluation of clinical outcome of total alloplastic temporomandibular joint replacement and costochondral graft in temporomandibular joint ankylosis cases – A retrospective study

Background: The temporomandibular joint (TMJ) ankylosis management incorporates various modalities. Total alloplastic temporomandibular joint replacement (TJR) has opened a new avenue in TMJ reconstruction. Costochondral grafts (CCGs) are the gold standard treatment option. Aim: This study was designed to compare the clinical outcome between total alloplastic TJR and CCG in TMJ ankylosis cases. Materials and Methods: The retrospective data of patients were collected between 2017 and 2020. A total of 12 TJR cases and 8 cases of CCG were included in the study. Maximum mouth opening was recorded in mm and pain score/diet score was recorded on a Visual Analog Score system where 0 was no pain/normal diet and 10 was worse pain/liquid diet. The data were statistically analyzed using the “two-sample t-test (Welch's t-test).” Results: The mean interincisal opening in the TJR group was 32.67 (±2.19) and in the CCG group was 33.71 (±4.77). The pain reduction score was better in the TJR group with 0.5 (±0.90) and the diet score was better in the CCG group with 0.714 (±0.95). Conclusion: The stock TJR devices have a predictable outcome with a good pain reduction score and an acceptable diet score; however, the autogenous CCG is still better in terms of maximum mouth opening. Although failed CCG cases can be taken up for further correction with the TJR.

A case of temporomandibular joint ankylosis due to SAPHO syndrome

A case of temporomandibular joint ankylosis due to SAPHO syndrome

Perioperative trigeminocardiac reflex in patients undergoing surgical treatment of temporomandibular joint ankylosis: A study.

Purpose:The behavior of trigeminocardiac reflex (TCR) is limited to few case reports only in maxillofacial surgery, especially for temporomandibular joint (TMJ) ankylosis cases. The present study aims to find out the incidence of bradycardia due to TCR during intraoperative forceful mouth opening in TMJ ankylosis patients.Materials and Methods:A prospective, unicentric observational study was conducted selecting those patients who were planned for osteoarthrectomy with interpositional gap arthroplasty under general anesthesia. Sixty cases of TMJ ankylosis were randomly selected from December 2018 to-03-2020. Predictor variables were patient age, gender, and type of ankylosis, and outcome variables were pulse rate, mean arterial blood pressure (MABP), and oxygen saturation level (SPO2). Data were recorded at baseline and during intraoperative mouth opening via heister jaw stretcher. A Chi-square test was used for testing the association between variables. P values were considered statistically significant at <0.05.Results:The sample size of 60 subjects has been divided into two age groups (10–19) years and (20–40) years. The mean standard deviation age of the patients was 18.32 ± 6.81 years. About 63.3% were male. Out of 60 cases, 14 patients developed bradycardia. The frequency of bradycardia was found 23.3%. According to logistic regression analysis, age and type of ankylosis were the significant predictors of bradycardia.Conclusion:We conclude that bradycardia due to TCR in TMJ ankylosis patients is not an uncommon entity. Incidences are more prevalent in the age group of 10–19 years and type IV bony ankylosis. Male had a high incidence of bradycardia though P value was nonsignificant.

A case of temporomandibular joint ankylosis caused by psoriatic arthritis

A case of temporomandibular joint ankylosis caused by psoriatic arthritis

Analysis of maximum bite force and chewing efficiency in unilateral temporomandibular joint ankylosis cases treated with buccal fat pad interpositional arthroplasty

There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function.

Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children

IntroductionThe treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. Materials and MethodsYoung patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. ResultsOne hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. ConclusionOur study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.

Temporomandibular Joint Ankylosis among Patients at Saint Paul’s Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study

Background Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study aimed to determine the pattern of TMJA at St. Paul's Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia. Methods A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program. Results A total of 130 patients' medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20–29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty. Conclusions TMJA was predominant among females than their male counterparts. Of note, 20–29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients' quality of life.

Temporomandibular joint ankylosis: A tertiary center-based epidemiological study.

Introduction:Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh.Materials and Methods:This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria.Results:After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10–15-year-old age group (mean age was 12.1 ± 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma.Conclusion:The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management.

Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study.

Temporomandibular joint (TMJ) ankylosis is an extremely disabling condition with almost complete inability to open the jaws causing difficulty in chewing, speech, poor oral hygiene and cosmetic disfigurement. Temporalis myofascial flap still remains the most common interpositional material used; however, patients usually complain of pain during movement, unesthetic bulging in the temporal region and trismus due to scar contracture. The main aim of the study was to evaluate the efficacy of abdominal dermis-fat graft and compare it with temporalis myofascial flap as to see which of the two grafts offers more advantages and provides better postoperative results following TMJ ankylosis surgery. A total of 30 diagnosed cases of TMJ ankylosis were randomly divided into two groups of 15 patients each. All the patients underwent TMJ ankylosis release under general anesthesia followed by abdominal dermis-fat interposition in Group A and temporalis muscle in Group B. The patients were assessed for pre-operative and postoperative mouth opening (immediate and 6month postoperative), pain during physiotherapy, donor and surgical site complications and recurrence of ankylosis. The mean maximum inter-incisal opening in dermis-fat group was significantly higher than temporalis group both at immediate and 6month postoperative periods (p = 0.041, 0.001). Physiotherapy was less painful in dermis-fat group than in temporalis group, and the differences in VAS scores among the 2 groups showed high statistical significance (p < 0.001). Hypertrophic scar developed at the donor site in 2 patients in dermis-fat group; however, it was located below the beltline and hardly noticeable. A total of 9 patients (4 in Group A and 5 in Group B) developed temporary facial nerve weakness, and no case of re-ankylosis was noted in either group. Dermis-fat graft in temporomandibular joint ankylosis showed better results than conventional temporalis myofascial flap in terms of postoperative mouth opening, physiotherapy and jaw function with esthetically acceptable results.

Can costochondral grafts fulfil ramus-condyle unit reconstruction goals in children with temporomandibular joint ankylosis?

The purpose of this study was to analyse whether costochondral grafts (CCG) fulfil temporomandibular joint (TMJ) reconstructive goals in children with TMJ ankylosis. A total of 23 patients (12 male, 11 female, aged 3–16 years) with unilateral or bilateral TMJ ankylosis operated on between January 2014 to April 2018 were included in the study. Maximal incisal opening (MIO), frequency of reankylosis, and growth of CCG, were evaluated at one month and six months for one year, and after that once yearly. Mouth opening changes with time were assessed by the Friedman test and growth was compared at follow up and analysed using the paired t test. Mean (range) follow up was 18 (12–48) months. Study results revealed follow up MIO at 12 months was highly significant (p=0.001). Out of 27 CCG studied, only one graft had undergone re-ankylosis. Based on the predetermined criteria using condylion to gnathion (Co–Gn) measurement in the posteroanterior cephalogram, CCG were categorised into optimum, sub-optimum, and overgrowth. However, long-standing TMJ ankylosis cases still displayed mandibular asymmetry at the end of the study, even with “optimal growth” radiographically. Overall comparison between the immediate postoperative and last follow up Co-Gn measurements in either unilateral or bilateral cases was not significant. CCG with functional matrix maintained the growth of the mandible and MIO in TMJ ankylosis. It can be concluded that CCG partially fulfils reconstructive goals; however, patients need to be followed up till the end of puberty for a substantive conclusion.

Effect of Preoperative Intramuscular Injection of Botulinum Toxin A on Pain and Mouth Opening After Surgical Intervention in Temporomandibular Joint Ankylosis Cases: A Controlled Clinical Trial

The aim of the present study was to determine the effect of intramuscular injection of botulinum toxin A (BTX-A) into the masticatory muscles on the physiotherapy pain and mouth opening outcomes after surgical intervention of temporomandibular joint (TMJ) ankylosis and to verify the effects using electromyographic studies. The study included 20 patients with TMJ ankylosis. The patients were further subdivided into control and interventional groups. The interventional group was given intramuscular injections of BTX-A in the masticator muscles before surgery. Only saline injections were given to the control group. All 20 patients were evaluated for pain and ease of active physiotherapy at the 1-week and 1-, 3-, and 6-month follow-up visits using a questionnaire. Intergroup comparisons were performed for both groups. Electromyographic (EMG) studies were also performed in the intervention group for each patient. EMG recordings were performed of the individual masticator muscle in each patient before injection and at 1 and 3months after injection. The intervention group showed better results with respect to pain during the mouth opening exercises and improvements in mouth opening. All the interventional group patients showed a transient decrease in the microvolt value on the EMG studies of their masticator muscles on injection of BTX-A. BTX-A injection can be a straightforward and useful adjunct to surgical treatment of TMJ ankylosis for the reduction of pain during postoperative physiotherapy.

Sternoclavicular Joint Transfer in the Management of Temporomandibular Joint Ankylosis- A case report

Temporomandibular joint ankylosis is a clinical condition resulting in loss of jaw function and retardation of growth. The main objectives of the treatment for Temporomandibular joint ankylosis are to increase mouth opening, restore joint function, initiation of mandibular growth, improve the patient’s facial esthetic profile and prevent reankylosis. To release of ankylotic mass and gap is filled up with interpositional material. We reported a case of temporomandibular joint ankylosis in a 15 years old girl, whose treatment was done in the Department of Oral and Maxillofacial Surgery,Bangabondhu Sheikh Mujib Medical University, with sternoclavicular joint transfer which is very rare in our country and this was nearly fulfill treatment objective.&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 90-94

Mandibular distraction osteogenesis in the treatment of pediatric temporomandibular joint ankylosis with micrognathia and obstructive sleep apnea syndrome: A case report with 4-year follow-up.

Temporomandibular joint (TMJ) ankylosis in pediatric patients is rare and may cause severe micrognathia and obstructive sleep apnea syndrome. The present study reports on the treatment and 4-year follow-up of a pediatric patient with early-onset bilateral TMJ ankylosis and severe secondary micrognathia, as well as obstructive sleep apnea syndrome. A typical ‘bird face’ appearance was noted with severe mandible retrognathism and a significant convex facial profile. The treatment of this patient involved TMJ ankylosis release with condylectomy and simultaneous bilateral mandibular distraction osteogenesis, which enabled the surgeons to simultaneously reconstruct the neocondyle and correct facial malformations. Following treatment, the micrognathia was corrected and the oropharyngeal airway was significantly expanded. However, the maximal incisal opening was limited. During the 4-year follow-up, no signs of mandible retraction were noted and mouth opening increased to 17 mm (passive) compared with the inability to open that was noted immediately following surgery. A certain degree of MIO shrinkage was identified in the patient. In such cases of TMJ ankylosis, early post-operative exercise, active post-operative physiotherapy and stringent follow-up are essential to prevent post-operative shrinkage and adhesions.

TMJ Ankylosis Management: Our Experience.

Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Temporomandibular joint ankylosis is very common among young children. The aim of treatment is not only to treat the movement of the joint but also to prevent relapse. In this series, 18 cases of temporomandibular joint ankylosis were treated at our institute from January 2012 to January 2017 with osteoarthrectomy and interpositional arthroplasty. Patients were in the age range of 5-57years, with 11 males and 7 females and including 8 unilateral and 10 bilateral cases. Duration of ankylosis ranged from less than 2years to more than 6years. Seven of the patients were secondarily taken up for correction of their deformities with either orthognathic surgery or distraction osteogenesis. Good mouth opening was achieved in all the patients with a mean follow-up period of 12months. The early post-operative mouth opening ranged from 24 to 37mm. The late post-operative mouth opening ranged from 20 to 33mm. There was a stress on aggressive physiotherapy for a minimum of 6months in all our patients. Interpositional arthroplasty using vascularized temporalis fascia flap is a very reliable method to prevent recurrence of ankylosis, and it also avoids the disadvantages of alloplastic materials as well as nonvascularized autogenous tissues.

Temporomandibular Joint Ankylosis: An Epidemiological Study in Marrakesh

Temporomandibular joint (TMJ) ankylosis is a disabling disease where the main clinical feature is limited mouth opening. Aim: Our study’s aim is to draw epidemiological, clinical and imaging aspects of this disease in Marrakesh. Patients and methods: retrospective study gathering all TMJ ankylosis cases operated between 2008 and 2016 at maxillo-facial surgery department in University Hospital Mohamed VI of Marrakech. Results: a total of 27 cases were included, the mean age was 22,9 years (3-55 years). The sexe-ratio was 0,5. Unilateral cases (81,5%) were more common than bilateral. The most frequent aetiology was trauma (85,2%) followed by infection (7,4%) and one case of ankylosing spondylitis (3,7%). Mouth opening less than 10mm was observed in 67%. According to Topazian Classification, Stage I was predominant (59%). Conclusion: TMJ ankylosis is frequent in our context, especially due to neglected condylar trauma so the best treatment remains the prevention based on early diagnosis and proper management of TMJ trauma.

Facial nerve injury in temporomandibular joint approaches

Facial paralysis can be a devastating consequence resulting from blunt and penetrating trauma to the head and neck, as well as surgical injury, either accidental or due to involvement by tumor. In addition, the etiology can be attributed to a variety of other causes, ranging from infectious to metabolic, and is frequently idiopathic in nature. The incidence of facial nerve injury during temporomandibular joint (TMJ) surgeries varies among surgeons. There are many factors that could contribute to the injury of the temporal and zygomatic branches of the facial nerve. These nerves lie in a confluence of superficial fascia, temporalis fascia, and periosteum and may be injured by any dissection technique that attempts to violate the integrity of these regions. Excessive or heavy-handed retraction causes compression and/or stretching of nerve fibers resulting in neuropraxia. The facial nerve then enters the parotid gland, where the main trunk branches into the upper and lower divisions at the pes anserinus. The nerve further divides into five main branches: the temporal, zygomatic, buccal, marginal mandibular, and cervical. The temporal branch lies within the superficial muscular aponeurotic system at the level of the zygomatic arch. In this paper, we evaluate the facial nerve function based on the House–Brackmann grading index after the preauricular approach for the treatment of condylar fractures, pathologies, and TMJ ankylosis cases. The nerve functional regeneration postfacial nerve injury has been evaluated and reported in this retrospective study.

Comparison between buccal fat pad and temporomyofascial flap as an interpositional graft material after gap arthroplasty in temporomandibular joint ankylosis cases — a clinical study

Comparison between buccal fat pad and temporomyofascial flap as an interpositional graft material after gap arthroplasty in temporomandibular joint ankylosis cases — a clinical study