Joint Ankylosis In Children Research Articles

Morphometric assessment of mandibles with complications resulting from temporomandibular joint ankylosis in children from 4 months to 3 years of age.

Purpose: The main aim of this paper was to perform the morphological assessment of children's mandibles of different etiology of dys-functions within the temporomandibular joint, from isolated idiopathic ankylosis to craniofacial malformations co-existing with genetic disorders. Methods: The investigations encompassed seven patients at the age of 0-3. Measurements were conducted on the basis of data obtained from computed tomography. In the patients' 3D models 12 characteristic anthropometric points were marked, on the basis of which the researchers calculated 9 linear dimensions, 3 angles and, further on, 5 indices defining the proportions of the mandible. Results: The comparisons of the measurements showed that the mandibles with malformations were smaller than obtained for healthy children. The values of the mandible angles (alpha) revealed high changeability among the examined children. It was also revealed the significant asymmetry between the right and left side. Conclusions: This work shows an innovative approach to the evaluation of anatomical malformations, whereas the developed indices enable an objective quantitative assessment of geometry, which can be applied to the analysis of the degree of the deformation severity. An in-depth analysis of the image diagnostics should be a standard procedure in the pre-operative planning of surgical treatment and the preparation of multi-specialist logopaedic, functional and orthodontic rehabilitation.

Management of temporomandibular joint ankylosis in children with their surgical risk and benefits

Aim: To Overview and analyse the various treatment options and risk & benefits used for management of ankylosis in growing children. Summary: A Number of technique have been used for the treatment of temporomandibular Ankylosis. Since it is a known challenging problem in paediatric patients. Main aim of our treatment is excision of ankylotic mass followed by recontouring of the joint.

Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents.

Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.

Conservative gap arthroplasty without interpositioning material for management of temporomandibular joint ankylosis in children: Clinical and Radiographic Outcomes in Upper Egypt

Ankylosis is one of the challenging disorders of the TMJ especially in children. Trauma, infection, and systemic diseases are the most common causes, factors common to occur in children in Upper Egypt. Unfortunately, TMJ ankylosis responds only to surgical intervention. The aim of this study was to evaluate a conservative surgical approach. Materials and Methods: In this study inclusion criteria were set and 11 children suffering from ankylosis enrolled for the most conservative gap arthroplasty without interpositioning material and with postoperative physiotherapy protocol. The patients were evaluated clinically and radiographically for 24 months postoperatively regarding mouth opening and recurrence. Results: trauma was the main etiologic factor and bony ankylosis accounted for 81%, the mean gain in mouth opening was 29mm with no reported recurrence. Conclusion: using conservative gap arthroplasty in children is a success option within the justified inclusion criteria.

Comparison between gap arthroplasty and interpositional arthroplasty of temporomandibular joint ankylosis in children: a meta-analysis

Comparison between gap arthroplasty and interpositional arthroplasty of temporomandibular joint ankylosis in children: a meta-analysis

Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques.

We have described a new technique of using ultra-thin silicon sheet (0.2mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2cm. The mouth opening was about more than 2.7cm in all our cases at 2years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.

Management of temporomandibular joint ankylosis in children with arthroplasty and distraction osteogenesis in the same surgical time

Temporomandibular joint (TMJ) ankylosis in children is a challenging problem for the maxillofacial surgeon since the surgical technique is difficult and the recurrence rate is high. It is characterized by a hipomobility, breathing, eating problems,and facial asymmetry. There is a vertical and sagittal mandibular deficiency. Numerous treatment approaches have been proposed in the literature. The surgical excision of the ankylotic mass is mandatory; gap arthroplasty and interpositional flaps have been discussed.

Ultra thin silicone sheet arthroplasty in the management of recurrent TM joint ankylosis in children

TMJ ankylosis is a serious and disabling condition especially in children that may cause problems in mastication, digestion, speech, appearance, mandibular growth and oral hygiene. Post operative physiotherapy has been difficult to achieve in children.We are describing a new technique of using ultrathin silicon sheet for management of recurrent TMJ ankylosis in children followed by intensive physiotherapy using custom made dynamic jaw exerciser. 10 children aged 6–15 years with unilateral post traumatic or congenital ankylosis were followed up for minimum of one year after surgery.

Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study

Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study

A Protocol for Management of Temporomandibular Joint Ankylosis in Children

Temporomandibular joint (TMJ) ankylosis in children is a challenging problem. Surgical correction is technically difficult and the incidence of recurrence after treatment is high. The purpose of the present report is to describe the protocol currently used at the Massachusetts General Hospital for the management of TMJ ankylosis in children. It has been our observation that the most common cause of treatment failure is inadequate resection of the ankylotic mass and failure to achieve adequate passive maximal opening in the operating room. The 7-step protocol consists of 1) aggressive excision of the fibrous and/or bony ankylotic mass, 2) coronoidectomy on the affected side, 3) coronoidectomy on the contralateral side, if steps 1 and 2 do not result in a maximal incisal opening greater than 35 mm or to the point of dislocation of the unaffected TMJ, 4) lining of the TMJ with a temporalis myofascial flap or the native disc, if it can be salvaged, 5) reconstruction of the ramus condyle unit with either distraction osteogenesis or costochondral graft and rigid fixation, and 6) early mobilization of the jaw. If distraction osteogenesis is used to reconstruct the ramus condyle unit, mobilization begins the day of the operation. In patients who undergo costochondral graft reconstruction, mobilization begins after 10 days of maxillomandibular fixation. Finally (step 7), all patients receive aggressive physiotherapy. A case series of children with ankylosis treated using this protocol is presented.

A Clinical Study on Temporomandibular Joint Ankylosis in Children

Temporomandibular joint (TMJ) ankylosis is a disabling condition of the masticatory system and is most commonly due to trauma, infections, and some systemic diseases. Hypomobility affects the surrounding structures as well as the joint itself. Ankylosis arising in early childhood usually leads to facial asymmetry. Ankylosis in children usually occurs from an intracapsular compression fracture or rarely from a suppurative arthritis of middle ear infection.Treatment of the ankylosis is probably one of the greatest challenges in TMJ surgery, and the treatment of TMJ ankylosis in children is much more challenging than in adults because of high recurrence and the probable change in the unpredictable growth of the mandible. In treatment of TMJ ankylosis in children, to maintain a normal growth and the development of the face is as important as to provide a satisfactory mouth opening with free movement of the mandible.A variety of techniques and various success rates in the treatment of TMJ ankylosis both in adults and in children have been reported. However, no single method has produced uniformly successful results. In this study, gap arthroplasty was applied in 6 patients, and 2 different types of fossa implants were used as interpositional material in the other 8 patients, and the results of the treatments have been evaluated retrospectively.

Surgical Management of Posttraumatic Temporomandibular Joint Ankylosis by Functional Restoration with Disk Repositioning in Children

Management of temporomandibular joint ankylosis poses a challenge because of technical difficulties and recurrence. The problem is more troublesome in children because of the involvement of postoperative development of the mandible. During the process of management of temporomandibular joint ankylosis, in many cases, the authors observed that the disk may exist outside of the bone mass in posttraumatic ankylosis. On the basis of this fact, the authors' working hypothesis was that if the disk could be retained and repositioned, with limited resection of the residual stump of the ramus to maintain its height, the structure and function of temporomandibular joint could be restored to a maximum degree to provide normal function and growth in children. Ten children with temporomandibular joint ankylosis underwent this approach, in which the disk was retained and repositioned and the residual stump of the ascending ramus was preserved and reshaped to maintain its height. All patients were reviewed regularly and evaluated retrospectively. The follow-up period ranged from 17 to 52 months (average, 32.9 months). All patients had significant improvement in mouth opening and showed a distinctive improvement both in articular functionality and in symptoms. No relapse occurred and no secondary deformity in the mandible resulted. The approach described not only helps to prevent relapse of temporomandibular joint ankylosis but also takes postoperative mandible development into consideration. The authors deem that it is a good choice for surgical management of posttraumatic temporomandibular joint ankylosis in children.

Re: Treatment of Temporomandibular Joint Ankylosis in Children: Is it Necessary to Perform Mandibular Distraction Simultaneously?

Re: Treatment of Temporomandibular Joint Ankylosis in Children: Is it Necessary to Perform Mandibular Distraction Simultaneously?

Rehabilitating children with temporomandibular joint ankylosis

Although the probability of ankylosis following injury of the temporomandibular joint is small, patients, especially children with temporomandibular joint ankylosis, are greatly handicapped. Of the 42 cases of ankylosis seen in our clinic, six occurred in the adult, and 36 in children under 14 years of age. Treatment in all cases was surgical, and the results were beneficial, although the greatest difficulty in the treatment had been the early recurrence of ankylosis. Based on our experience, osteoarthrotomy for temporomandibular joint ankylosis in children has been advocated.

Surgical management of temporomandibular joint ankylosis in children

Surgical management of temporomandibular joint ankylosis in children