Interpositional Material Research Articles

P-57311428-1202 - Long Term Clinical Outcome Of Temporomandibular Joint Ankylosis Treated With Buccal Fat Pad As Interpositional Material and quality of life after surgery

P-57311428-1202 - Long Term Clinical Outcome Of Temporomandibular Joint Ankylosis Treated With Buccal Fat Pad As Interpositional Material and quality of life after surgery

Posttraumatic proximal radioulnar synostosis: Current concepts on the clinical presentations, classifications, and open surgical approaches

In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6–12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.

To mesh or not mesh "apical prolapse," that is the question!

The management of pelvic organ prolapse (POP) involves both nonsurgical and surgical management. Views on best surgical approach for apical prolapse is an evolving field based on recent evidence and events related to transvaginal mesh. At the 97th Annual Meeting of the North Central Section of the American Urological Association (Scottsdale, AZ, USA), this topic was discussed and debated. The following article summarizes the concepts presented that day as well as the interactive debate with three perspectives on apical prolapse surgeries. The authors were asked to support their approach in various scenarios including: extremes of age, prior hysterectomy and intact uterus, desire to avoid mesh, sexual activity, and presence of comorbidities. Surgical approaches for POP have evolved and is a popular topic for debate, particularly when discussing apical prolapse. Transvaginal native tissue repairs remain the mainstay of POP surgeries; however, transabdominal approaches continue to evolve. Use of interposition material, such as synthetic polypropylene mesh, is the standard when performing an abdominal sacrocolpopexy, however, use of autologous fascia can be considered. Small series have demonstrated the safety and efficacy of autologous fascia-based repairs; however, larger studies with longer follow-up are needed. There are a variety of surgical strategies to repair POP. Ultimate decision making on specific surgeries should be determined by patient preference and goals after appropriate counseling on all options.

Comparison of different interposition techniques after surgical resection of tarsal coalitions in children: a systematic review.

In the surgical treatment of tarsal coalitions, it is unclear whether interposition material should be used to prevent recurrence. The aim of this review was to systematically examine the results of different interposition tissues after surgical resection of tarsal coalitions in children. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent investigators systematically searched electronic databases (PubMed, Embase, Cochrane) and included original articles reporting outcomes of tarsal coalition resection. The quality of included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Out of 294 articles, 21 studies examining 436 patients (581 feet), were included. The mean age was 12.2 years (range 7-18). There were 153 talocalcaneal, 425 calcaneonavicular, 2 naviculocuboidal, and 1 naviculocuneiform coalitions. The mean follow-up time was 58 months (range 12-276). In 96 feet, solely resection was performed. Resection and interposition were performed with muscle/tendon (n = 178), fat graft (n = 176), other material (n = 36), or a combination of interposition techniques (n = 95). Eighteen studies reported on recurrence, which was found in 45 of 485 feet (9%). The highest recurrence (17%) was described after muscle/tendon interposition for calcaneonavicular coalitions. However, a statistical comparison could not be performed. The included studies were diverse and the scientific quality was generally low (MINORS mean 7, range 3-20). Coalition resection with various interposition techniques results in low recurrence rates. It is unclear which interposition material shows the best results.

Interposition arthroplasty and bidirectional stabilization of the elbow: a novel surgical technique

Management of elbow arthritis in younger and higher demand patients is challenging. Interposition arthroplasty of the distal humerus is a well-described procedure whose results are highly dependent on elbow stability. We propose an interposition technique that employs an Achilles allograft as both an interposition material as well as a source of simultaneous bidirectional ligament reconstruction. By resurfacing one articulating surface and re-stabilizing the elbow, longevity may be improved. This technique may be indicated for treatment of post-traumatic or primary osteoarthritis of the elbow. The step-by-step instructions for surgical implantation of this interposition arthroplasty are described and illustrated.

Evaluation of using collagen membrane as interpositional material in closure of palatal fistula in cleft patients

Background Palatal fistula after palatal surgery in cleft patients is an annoying problem for both patients and maxillofacial surgeons. The occurrence of fistula is determined by the severity of the underlying defect, the repair technique utilized and the stress applied to the wound. Fistula recurrence rates range from 0% to 58%. Depending on the size, recurrence rate, and surgeon skill, various procedures for palatal fistula closure are documented, ranging from local mucoperiosteal flaps to free flaps. Colla-D is a pure collagen membrane developed to facilitate directed tissue regeneration and aid in the closure of palatal fistulas. Patients and methods A prospective randomized noncontrolled clinical research was conducted on 12 patients with palatal fistulas in the hard palate of cleft patients aged 6 to 20 years. Collagen membrane (Colla-D type BS) is utilized as an interposition material between the oral and nasal layers in cleft patients to aid in the closure of palatal fistulas. Results Collagen membrane was integrated with successful fistula closure in nine (75%) individuals, but palatal closure failure was detected early postoperatively in three (25%) patients. In seven patients, the oral mucosal layer dehisced, exposing the membrane, which was gradually covered by creeping oral mucosa in 4 of 7 patients over a period of 2 to 4 weeks postoperatively. All patients improved in nasalance and even failed cases improved slightly due to a decrease in fistula size, with a mean progress of 33.92% and a standard deviation of 7.28. Conclusions Colla-D collagen membrane is a safe and effective adjunct for the closure of palatal fistulas located in hard palate.

Resection of Bar in the Management of Calcaneonavicular Coalition: A Systematic Review.

The most commonly encountered type of tarsal coalition in symptomatic patients is the calcaneonavicular coalition. Non-surgical treatments are effective for most patients. However, if surgery is required, excision of the calcaneonavicular bar can be a successful option that preserves hindfoot mobility and function. We conducted a systematic review of calcaneonavicular bar excision in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. To conduct the review, we conducted a thorough search of several databases, including PubMed, Cochrane, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and bibliographies. We analyzed the chosen studies to collect information on patient demographics, clinical outcomes, surgical techniques, and potential complications. We identified 11 studies that included 274 patients for a total of 394 feet. The average age of patients in these studies was 12.5 years, ranging from 8.2 to 19.4 years. Follow-up periods varied from 2.3 to 23 years, with an average duration of 5.9 years. Excision of the calcaneonavicular bar was performed at 380 feet, while fusion was performed at 14 feet. In 50.5% of the feet, the extensor digitorum brevis was used as an interposition material. Successful outcomes after bar excision were observed in 82.9% of cases (304 feet) and were described as satisfactory, improved, good, or excellent outcomes. In one study, the American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 47.89 to 90.22 in 12 feet after bar excision. Recurrence was reported in 52 feet out of the 380 feet that underwent bar excision. Progression of arthritis in the ankle and subtalar joint was reported in 25 feet. Various complications were reported, including paraesthesia in the hindfoot (three feet), midfoot pain (three feet), hindfoot pain (two feet), mild wound infection (one foot), and swelling and stiffness (one foot). Surgical excision of the calcaneonavicular bar has shown successful outcomes in most patients, regardless of the use of interposition material. These outcomes are associated with minimal and acceptable complications. However, since the studies conducted in the literature were single-center retrospective and prospective trials, a multicenter prospective study with patient-centered, validated outcomes would provide a better opportunity to support the evidence in favor of surgical excision of the calcaneonavicular bar. Overall, the use of various interposition materials is associated with reduced chances of recurrence compared to cases where no interposition material was used.

RECURRENT TEMPOROMANDIBULAR JOINT ANKYLOSIS AMONG YEMENIS: A PROSPECTIVE STUDY

Background and aims: Recurrence of ankylosis is one of the most common complication following surgery especially during gap arthroplasty without interposition material. The main aim of these current study was to obtain a comparison between three different methods in prevent of recurrent temporomandibular joint ankylosis. Methods: A number of 15 patients with (2-22 years) age ranged between were obtained from those attending to Al-kawait Hospital, clinic of Oral and Maxillofacial Surgery Department, Sana’a University, Yemen. All patients in the present study that have ankylosis in the temporomandibular joint (TMJ) were included in period time from March 2017 to April 2020. the temporomandibular joint ankylosis Diagnosis was obtained through history of a chief complain, medical history, clinical and radiographic examinations. All patients were divided into three groups based on the type of treatment. Results: No any signs of surgical site infection in or around the incision. In group I: three cases of recurrence ankylosis were happened, while one case was dislodging of cartilage from harvested rib in group II. However, in group III, there were no complications observed after the end period of follow-up. Conclusion: The most effective procedure to prevent recurrence of temporomandibular joint ankylosis was the temporalis fascia as interpositional material, also produce a good esthetic and function results. Peer Review History: Received: 25 December 2022; Revised: 8 February; Accepted: 5 March 2023, Available online: 15 March 2023 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Similar Articles: HISTOLOGIC AND RADIOGRAPHIC STUDY OF PATHOLOGIC CHANGE IN COMPLETE IMPACTED THIRD MOLARS DENTAL FOLLICLES

Long term complications of costochondral graft reconstruction in temporomandibular joint ankylosis of the young- a systematic review

Costochondral graft has been a popular reconstruction choice in the past for temporomandibular joint ankylosis in young individuals. However, accounts of growth hampering complications have also been observed. Our systematic review aims to compile all existing evidence to determine the occurrence of these unfavourable clinical outcomes as well as factors affecting them to provide a better judgement on further use of these grafts. A systematic review was conducted following PRISMA guidelines where databases like PubMed, Web of science and Google Scholar were searched for the purpose of data extraction. Observational studies performed on patients younger than 18 years of age with a minimum follow-up of one year were selected. Incidence of long term complications like reankylosis, abnormal graft growth, facial asymmetry and others were considered as outcome variables. Eight articles with a total of 95 patients were selected where complications like reankylosis (6.32%), graft overgrowth (13.70%), insufficient graft growth (22.11%), no graft growth (3.20%) and facial asymmetry (20%) were reported. Other complications like mandibular deviation (3.20%), retrognathia (1.05%) and prognathic mandible (3.20%) were also observed. Our review concludes that the occurrence of these complications was noteworthy. Thus use of costochondral graft for reconstruction in temporomandibular ankylosis in young patients holds significant risk in development of growth abnormalities. However, modifications in surgical procedure such as use of appropriate graft cartilage thickness and the presence and type of interpositional material can favourably affect the frequency and type of growth abnormality.

Effectiveness of Dermis Fat Graft Versus Temporalis Myofascial Flap for Interposition in Temporomandibular Joint Ankylosis: A Systematic Review.

Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions. The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials. PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale. A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive. Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications. The online version contains supplementary material available at 10.1007/s12663-023-01869-9.

A 3D printed mimetic composite for the treatment of growth plate injuries in a rabbit model

Growth plate injuries affecting the pediatric population may cause unwanted bony repair tissue that leads to abnormal bone elongation. Clinical treatment involves bony bar resection and implantation of an interpositional material, but success is limited and the bony bar often reforms. No treatment attempts to regenerate the growth plate cartilage. Herein we develop a 3D printed growth plate mimetic composite as a potential regenerative medicine approach with the goal of preventing limb length discrepancies and inducing cartilage regeneration. A poly(ethylene glycol)-based resin was used with digital light processing to 3D print a mechanical support structure infilled with a soft cartilage-mimetic hydrogel containing chondrogenic cues. Our biomimetic composite has similar mechanical properties to native rabbit growth plate and induced chondrogenic differentiation of rabbit mesenchymal stromal cells in vitro. We evaluated its efficacy as a regenerative interpositional material applied after bony bar resection in a rabbit model of growth plate injury. Radiographic imaging was used to monitor limb length and tibial plateau angle, microcomputed tomography assessed bone morphology, and histology characterized the repair tissue that formed. Our 3D printed growth plate mimetic composite resulted in improved tibial lengthening compared to an untreated control, cartilage-mimetic hydrogel only condition, and a fat graft. However, in vivo the 3D printed growth plate mimetic composite did not show cartilage regeneration within the construct histologically. Nevertheless, this study demonstrates the feasibility of a 3D printed biomimetic composite to improve limb lengthening, a key functional outcome, supporting its further investigation as a treatment for growth plate injuries.

Management of multiple adjacent gingival recession defects using pouch & tunnel technique with different inter-positional materials– A report of two cases

Gingival recession is defined as the apical displacement of the marginal gingiva in relation to the cemento-enamel junction. It is a common clinical finding in individuals with good as well as those with a poor oral hygiene. It may affect a single tooth or multiple teeth simultaneously. Patients with multiple adjacent gingival recessions present as a major therapeutic challenge to the Periodontist, when it comes to balancing their esthetic and functional demands. Multiple adjacent gingival recession defects are associated with an extensive avascular surface. Furthermore, the clinician has to deal with the underlying anatomical factors such as thin gingival biotype, root prominence, root proximity and sub-optimal width of keratinized tissue. These factors make selection of surgical modality of treatment much more complex in contrast to the localized gingival recession defects. In the current report, we present two such cases of multiple adjacent gingival recession defects, managed by pouch and tunnel technique, using two different inter-positional materials namely the connective tissue graft and platelet rich fibrin.

Outcome of Temporalis Myofascial Flap as an Interpositional Material in Temporomandibular Joint Ankylosis

Temporomandibular joint ankylosis is a common problem in Bangladesh due to trauma and infection. Diverse interpositional materials have been proposed in this regard with especial advantages and limitation. Interpositional arthroplasty is the best solution. The aim of this review article is to provide a useful clinical update about interpositional arthroplasty in temporomandibular joint ankylosis, its advantages and limitations. For this purpose eighteen articles were selected through searching internet, reviewed and are summarized here. Dental surgeons need proper training for proper diagnosis and adequate treatment. Research in this field will be helpful for both patients and doctors. Temporomandibular joint ankylosis, treatment objectives of TMJ ankylosis and update of temporalis myofascial flap as an interpositional material are described here. J Enam Med Col 2020; 10(3): 186-189

8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions

BackgroundThe primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate. MethodsA search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed. Results43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%−83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%−73%), 80% (95% CI, 76%−84%) and 86% (95% CI, 71%−94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%−85%), with 100% (95% CI, 34%−100%), 80% (95% CI, 74%−85%) and 100% (95% CI, 65%−100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%−7%) for TCCs and 6% (95% CI, 4%−11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%−87%) and 79% (95% CI, 65%−88%), and for CNCs 81% (95% CI, 76%−86%) and 69% (95% CI, 44%−85%), respectively. ConclusionTreatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs. Level of evidenceLevel IV, Systematic Review.

Long Term Patient Reported Outcomes of Tarsal Coalition Resection in Pediatric Patients

Category:Hindfoot; Midfoot/ForefootIntroduction/Purpose:Tarsal Coalition has been known to be associated with pes planovalgus, unrelenting pain, recurrent sprains, and arthrosis due to an abnormal connection between two or more bones of the feet following failure of segmentation during development. Three entities of coalition exist fibrous, cartilaginous and osseous. Most commonly patients present with pain during activity. On exam range of motion is usually limited and there may be valgus or varus malalignment of the hindfoot. Patients are often offered surgical resection following failure of conservative management. Few large cohort studies exist analyzing complications and patient reported outcomes of pediatric patients undergoing operative treatment.Methods:After IRB approval, patients under the age of 18 undergoing excision of tarsal coalition at a single academic center from 2010-2019 were identified. Medical records were reviewed for variables such as demographics, surgical technique, coalition characteristics, postoperative complications, and coalition recurrence. Patients were contacted via telephone to complete a PROMIS Physical Function and Pain Interference in addition to the Foot Function Index. Contact was attempted at least 3 times before a patient was considered non-respondent. A total of 44 patients and 54 feet were included in the analysis with 17 patients (22 feet) completing patients reported outcomes.Results:The median age at the time of surgery was 12 (IQR 3). Thirty-five feet (64.8%) were from male patients, while 19 feet (35.2%) were from female patients. Pain was the presenting symptom in 49 (90.7%) of feet. Pes planovalgus was present in 25 feet (46.3%). Forty feet (74.1%) had calcaneonavicular coalition compared to 12 feet (22.2%) with talocalcaneal coalition and 2 feet (3.7%) with both. Fibrous coalition was found in 19 feet (35.2%) and the most common. Interposition material was used in 49/54 (90.7%) feet. Wound complications or temporary neuropraxias were seen in 7/54 feet (13.0%), and coalition recurrence occurred in 3/54 feet (5.6%). At a median of 6 years (6.0 IQR) postoperatively, the median postoperative outcomes scores were as follows: PROMIS Physical Function 54.7 (17.9 (IQR)), PROMIS Pain Interference 38.7 (10.0), FFI Pain 14.0 (30.0), FFI Disability 1.0 (9.0), FFI Activity Limitation 3.0 (8.0), and FFI Total 6.0 (12.0).Conclusion:Our study investigated complications and long-term patient outcomes following coalition resection. At follow-up, pediatric patients who underwent excision of tarsal coalition had higher physical function and less pain than the average U.S. population (PROMIS population mean is score of 50). Our recurrence rate of 5.6% is lower than reported in literature. Infection rate was similar to reports in literature at 3.1%. Overall, Coalition resection in pediatrics is a well-tolerated procedure that improves both physical and emotional health.

Use of the Temporalis Myofascial Flap in Internal Derangement of the Temporomandibular Joint - An Evaluative Study.

Internal derangement is an abnormal relationship between the articular disc and the mandibular condyle. The most common cause is trauma. Various classifications have been given for internal derangement. Initial management is done conservatively and if the disease is progressed, surgery is the option. Various surgical methods and interpositional materials following discectomy have been given in the literature. Over the past 15 years, we selected a group of 30 patients, Wilkes Class IV and V where conservative therapy had failed and were candidates for surgery. The patients had their disc repositioned, the damaged part of the disc was excised and disc was reinforced using the temporalis myofascial flap (TMF). In cases where the disc was non-salvageable, discectomy was done and TMF was placed between condyle and glenoid fossa, sutured with Prolene. The follow-up period was 3 years. Of the 30 patients, there were 9 male and 21 female. Range of mouth opening was 3.3-3.8 cm with improvements in 1 year. The jaw relations gradually improved and were restored after 3 weeks. Patients were totally pain free in 6 months. For the cases where surgery is the line of treatment, we strongly suggest disc repositioning and reinforcement with TMF as the flap is bulky, locally available and easy to harvest and causes no deformity at the donor site.

Temporomandibular joint ankylosis; aetiology, pattern and treatment

Introduction: Temporomandibular joint ankylosis is fusion of the head of mandibular condyle to the glenoid fossa of temporal bone at skull base. Untreated ankylosis causes distressing conditions such as speech impairment, difficulty in chewing, poor oral hygiene, malocclusion, facial disfigurement, and compromise of the airway. The two main causes are trauma and infection in or around the joint regions. Methodology: A retrospective cross sectional study was conducted in 25 patients (n=14 male and n=11 female) with mean age of 21.9(ranged 6-50) diagnosed with Temporomandibular joint ankylosis at Addis Ababa University, Oral and Maxillofacial Surgery affiliate Hospitals both Yekatit 12 Hospital medical college and St. Peter specialized Hospital. Data was collected from patients’ medical records registered in a period of 3 years from January 2017 to December 2019. Epidemiological information (EPI- INFO 7) computer software was used for data analysis. Result: The study results revealed trauma was the most common cause of TMJ ankylosis representing (80%) of all causes. Males were more affected (56%) than females. The highest incidence of ankylosis was between the age of 11 and 20 (40%). Unilateral ankylosis was reported in (60%) and (68%) was bony ankylosis based on tissue involved. A total of (40%) of the patients were treated by interposition gap arthroplasty by using temporal muscle and fascia as an interposition material. Conclusion: The findings of this study conclude trauma was the commonest cause of ankylosis. A proper screening of childhood injuries and early referral to maxillofacial centers recommended ensuring proper evaluation of specific post traumatic aetiologic factors and for early treatment to prevent ankylosis.

Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery.

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor.

Auricular Cartilage Interposition Arthroplasty in Recurrent Temporomandibular Joint Ankylosis in Pediatric Patients

Background: Temporomandibular joint (TMJ) ankylosis in early childhood can lead to disturbances in growth, facial asymmetry and difficulties in eating as well as in breathing. The objective of the study was to evaluate the effectiveness of auricular cartilage as an interpositional material after gap arthroplasty in pediatric patients with temporomandibular joint ankylosis in maintaining the achieved postoperative mouth opening.
 Material and Methods: This prospective study was conducted at the Oral and Maxillofacial Surgery Department of King Edward Medical University, Lahore, from 1st January 2019 to 30th November 2019. Thirty patients, aged 5 to 15 years with clinical and radiological diagnosis of TMJ ankylosis were included in the study. TMJ ankylotic mass was removed, the gap was created and interposition of auricular cartilage graft was done in these patients. Mouth opening was measured as a distance between the incisal edges of mandibular central incisors to maxillary central incisors using the scale. Preoperative and postoperative mouth opening was noted and compared using the paired t-test.
 Results: Among the thirty patients, 19 were male and 11 were female. The mean (±SD) age of patients was 9.23±3.23 years (age range 5 to 15 years). The mean preoperative mouth opening (T1) was 7.3±3.1 mm, while the mean postoperative mouth opening (T2) was 29.2±3.3 mm. The mean interincisal distance was 29.0 mm (range 21 mm to 35 mm). The mean difference in pre- and postoperative mouth opening (T2-T1) was 21.6 ± 5 mm.
 Conclusions: Autogenous auricular cartilage graft is an efficient and reliable interpositional material for achieving early postoperative mouth opening in TMJ ankylosis patients.

Analysis for different functional results of TMJ ankylosis management by comparing ramus-condyle unit reconstruction using vertical ramus osteotomy and interpositional gap arthroplasty

The objective of the present study was to analyze the functional results of temporomandibular joint (TMJ) range; that is, trismus index, lateral excursion, protrusion, retrusion, occlusion, masticatory efficiency), reestablishment of the anatomic relationship of the TMJ, aesthetics to improve quality of life, and complications in terms of ramus shortening on the affected side, deviation, facial asymmetry, neurologic deficits, and reankylosis. Sixteen patients with unilateral bony ankylosis were included and randomly divided into 2 groups with 8 patients in each group. Group I was treated with interpositional gap arthroplasty followed by reconstruction of the ramus-condyle unit using vertical ramus osteotomy. Group II was treated with interpositional gap arthroplasty. In both groups, a pedicled flap made up of fascia, temporalis muscle, and pericranium was used as an interpositional material. The functional range of the mandible was analyzed pre- and postoperatively. Group I improved significantly more than group II in terms of TMJ range; that is, trismus index, lateral excursion, protrusion, retrusion, reestablishment of the normal anatomic relationship of the TMJ, aesthetics, and masticatory efficiency. The reestablishment of anatomic relationship showed better result in mastication significantly. No reankylosis was reported in any of the groups. The functional results and aesthetics with TMJ reconstruction are significantly better.