Long-standing Temporomandibular Joint Research Articles

Long-standing temporomandibular joint dislocation treated by intraoral condylectomy: a case report and review of the literature

BackgroundNoninvasive management by closed reduction is a desirable treatment for temporomandibular joint dislocation. However, reduction of long-standing temporomandibular joint dislocation is often difficult. Various conservative treatments have been attempted, but these often render poor outcomes. This article reports the case of long-standing temporomandibular joint dislocation that was successfully closed using intraoral condylectomy.Case presentationA 69-year-old Japanese man who sustained an injury in a car collision was unable to close his mouth. Owing to the diagnosis of long-standing temporomandibular joint dislocation, intraoral condylectomy was performed. In the case of temporomandibular joint dislocation, it is convenient to reach the condyle from the oral cavity because sufficient opening is maintained. The condyle can be clearly visualized using an approach similar to sagittal split ramus osteotomy, and the operation using surgical instruments can be facilitated by resecting the coronoid process. By separating the surrounding soft tissue and pulling the cut condyle with sufficient visual field, the condyle can be resected while addressing the hemostasis. During the 12-month postoperative follow-up period, no temporomandibular joint dislocation recurred and the occlusion remained stable.ConclusionsThe limited intraoral incision of this surgical technique provides sufficient access for condylectomy. The results of this case report suggest that condylectomy by intraoral approach could become the treatment of choice for long-standing temporomandibular joint dislocation.

Management of unilateral temporomandibular joint ankylosis with facial asymmetry

Long-standing temporomandibular joint (TMJ) ankylosis may compromise facial form and function. Treatment planning needs to address both the ankylosis and the facial deformity. A 21-year-old male patient with unilateral TMJ ankylosis of the right side with gross facial asymmetry was planned for a two-stage surgical procedure. First-stage surgery was done to release fibrous ankylosis, create a new functional joint and achieve adequate mouth opening. A vertical ramus osteotomy with superior repositioning of the proximal ramal segment and interpositional temporalis myofascial flap was done to achieve a functional joint and correct the facial height discrepancy. As the mouth opening was <35 mm, ipsilateral coronoidectomy was done and the resected coronoid process was used a graft in the mandibular angle region. 35 mm of mouth opening was achieved intraoperatively.

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.

Efficacy and Versatility of Intraoral Monoplanar Distractors in the Correction of Extreme Mandibular Deformities and Severe Facial Asymmetries - A Retrospective Study.

Introduction:Distraction osteogenesis, has emerged as a revolutionary concept and an effective means to treat extensive craniomaxillofacial defects and malformations. In cases of mandibular distraction for patients with extreme acquired mandibular deformities, there is so far, no recorded literature on precise quantification and scientific estimation of the percentage of the efficacy of intraoral monoplanar distractors, for an objective evaluation of their effectiveness. The objective was to study the efficacy of intraoral mandibular monoplanar distractors in the correction of severe acquired mandibular deformities and gross facial asymmetries. To objectively evaluate their effectiveness by calculating the percentage of distraction achieved as against that aimed for, and to evaluate early and late complications encountered with their use.Materials and Methods:Five patients in the age group of 10–22 years, with extreme mandibular deformity and gross facial asymmetry secondary to longstanding temporomandibular joint (TMJ) ankylosis, were treated. Four patients had unilateral and one patient had bilateral TMJ ankylosis, with varying degrees of acquired mandibular hypoplasia, retrogenia, retrognathia, and asymmetry. They were managed by unilateral (3 patients) and bilateral (2 patients) mandibular distraction.Results:Maximum horizontal corpus and vertical Ramal distraction achieved was 19 mm and 17.6 mm, respectively. The percentage of the efficacy of the intraoral monoplanar distractors used in this study ranged from 65.38% to 109.09%. Severe mandibular deformities and facial asymmetries were successfully corrected in all five patients, with no major early or late complications encountered in any of them. Results achieved were stable with nil incidence of relapse.Discussion:Estimation of percentage of the efficacy of distraction achieved, helped in objectively evaluating the effectiveness of the intraoral mandibular distractors. A low complication rate and good esthetic and functional outcomes achieved in all the patients demonstrated the reliability of this treatment modality in the management of extreme mandibular deformities and severe facial asymmetries.

Orthodontic Mini-implants for Treatment of Long-term Anterior Dislocation of Temporomandibular Joint:

Acute dislocation of the temporomandibular joint (TMJ) is a relatively common occurrence; chronic long-term dislocation is rare. Variance in the duration of dislocation and anatomical considerations make the treatment for long-standing dislocation complex and controversial. This case report describes a new method of conservative management of a long-standing TMJ dislocation using orthodontic mini-implants.

Nearthrosis in true long-standing temporomandibular joint dislocation; a report on pathogenesis and clinical features with review of literature

The behavior and function of the condyle are not the same in every type of temporomandibular joint (TMJ) dislocation. Acute displacement or dislocation of the condyle is not a rare incident, and the treatment modalities have been well known by physicians for a long time. Chronic dislocation of the condyle is considered a relatively common entity for which treatment may indispensably be surgical intervention. Type of dislocation, duration and the number of episodes are taken into account while constructing the treatment plan.Chronic dislocation that has been left untreated for a long time is a relatively less often encountered type exhibiting difficult clinical conditions for treatment. This type of dislocation is usually seen in elderly patients with poor general health conditions and can be classified as “long-standing dislocation.” In this clinical condition, after having some chronic dislocation episodes, the condyle leaves the original fossa, sits in the anterior part of the eminence permanently, creates a new fossa and never gets back to the original place again. Duration is the most important criterion in classifying long-standing dislocations and has a great effect on decisions regarding the type of management. The relevant literature includes few reports, most of which speculate upon “duration,” which varies on a large scale ranging from 5 weeks to 33 years. There has been neither an agreement on time span within which long-standing dislocation develops, nor a universally accepted definition for what “long-standing” is indeed meant to be. On the other hand, in some cases, the condition has been named “true long-standing dislocation” due to some permanent pathological changes that the TMJ undergoes, such as pseudoarticulation/nearthrosis/false joint/neo-joint.In this paper, management of true long-standing/permanent dislocation in two patients, whose conditions lasted more than 1 year and resulted in permanent changes in TMJ anatomy, is presented. Due to the poor general health condition of the two elderly patients, they were treated in the most conservative way possible. In one of the patients, eminectomy and head-gear application were used to attain gradual relocation of the condyles. Rehabilitation of masticatory function of the other patient was improved prosthetically.

Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature.

To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature. Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed. During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free. Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.

Long-standing temporomandibular joint dislocation: A rare experience

Long-standing temporomandibular joint (TMJ) dislocations persist for more than a month are most challenging to treat. The management of such condition varies widely, from closed reduction to complicated surgical procedures. The choice of an appropriate methodology is questionable. At present, there are no standard rules or conventions for the ideal strategy in different circumstances. This paper attempts to present the experience of managing two cases of long-standing TMJ dislocations.

A Novel Technique for Surgical Reduction of Long-standing Temporomandibular Joint Dislocation

A Novel Technique for Surgical Reduction of Long-standing Temporomandibular Joint Dislocation

口内法下顎頭切除術を適用した陳旧性両側顎関節脱臼の1例

Opportunities to treat elderly patients with temporomandibular joint (TMJ) dislocation complicated by systemic diseases or dementia have been increasing in recent years. Reduction is often particularly difficult in patients with long-standing TMJ dislocation caused by the soft tissue filling the mandibular fossa.

Temporomandibular joint ankylosis contributing to coronoid process hyperplasia

The purpose of this study was to investigate the association between coronoid process hyperplasia and temporomandibular joint (TMJ) ankylosis and to analyze the pathological mechanism and clinical significance of coronoid process hyperplasia. Forty-four patients treated for TMJ ankylosis between January 2007 and December 2014 were studied retrospectively; 176 patients with normal TMJs served as controls. The original DICOM data were used to reconstruct the jaw, and a three-dimensional cephalometric analysis (SimPlant Pro software version 11.04) was performed to assess the association between the severity of TMJ ankylosis and the height of the coronoid process. The height of the coronoid process was 20.41±5.00mm in the case group and 14.86±2.67mm in the control group; there was a significant difference between the two groups (P<0.001). Long-standing TMJ ankylosis contributes to coronoid process hyperplasia. Therefore, attention should be drawn to the coronoid process in patients with TMJ ankylosis. A coronoidectomy together with arthroplasty is recommended in patients with TMJ ankylosis.

Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis

MRI manifestation of temporomandibular joint arthritis is frequently reported in children with juvenile idiopathic arthritis. However, little attention has been paid to temporomandibular joint disk abnormalities. To assess combinations of MRI findings in the symptomatic temporomandibular joint in children with juvenile idiopathic arthritis with focus on disk abnormalities. This was a retrospective study of 46 patients with juvenile idiopathic arthritis, mean age 12 years (range: 5-17 years). Mean disease duration was 70 months (standard deviation: 61 months). MR images of 92 temporomandibular joints were scored for thickness of abnormally enhancing synovium (synovitis), joint effusion, bone marrow oedema, abnormal bone shape, bone erosion and disk abnormalities. The 92 temporomandibular joints were categorized as A: No synovitis and normal bone shape (30/92; 33%), B: Synovitis and normal bone shape (14/92: 15%), C: Synovitis and abnormal bone shape (38/92; 41%) and D: No synovitis but abnormal bone shape (10/92; 11%). Thirty-six of the 46 patients (78%) had synovitis and 33/46 (72%) had abnormal bone shape, most frequently in combination (30/46; 65%). Disk abnormalities (flat disk, fragmented disk, adherent disk and displaced disk) were found in 29/46 patients (63%). Disk abnormalities were found in all categories of juvenile idiopathic arthritis involved temporomandibular joints (B: 8/14 [57%]; C: 25/38 [66%] and D: 7/10 [70%]). Disk displacement was found in half of the joints (7/14) in category B. Synovitis was most pronounced in this category. Disk abnormalities were frequent. Disk displacement also occurred in joints with early temporomandibular joint arthritis, i.e., with normal bone shape. Other disk abnormalities were found in joints with bone abnormalities. Attention should be paid to disk abnormalities both in early and long-standing temporomandibular joint arthritis in children with juvenile idiopathic arthritis.

Midline Mandibulotomy for Reduction of Long-Standing Temporomandibular Joint Dislocation

Long-standing temporomandibular joint (TMJ) dislocation is an uncommon condition, and due to its rarity, no definitive guidelines have been developed for its management. Various reduction techniques ranging from indirect traction techniques to direct exposure of the TMJ have been used. Indirect traction techniques for reduction may fail in long-standing dislocation. Management of two cases of long-standing TMJ dislocation with midline mandibulotomy is discussed in which other indirect reduction techniques had failed. Midline osteotomy of the mandible can be used for reduction in difficult TMJ dislocations. An algorithm for the management of long-standing TMJ dislocation is proposed and related literature is reviewed.

The Difficult Diagnosis of Temporomandibular Joint Arthritis

Arthritis of the temporomandibular joint (TMJ) is a long-recognized feature of juvenile idiopathic arthritis (JIA). The consequences of longstanding TMJ inflammation — severe micrognathia and retrognathism — were mentioned in the original description of Sir Frederic Still1. Growth problems are common in JIA, but the extent of growth failure seen in the mandible of children with TMJ arthritis by far exceeds arthritis-related growth complications of other locations. They are caused by unique properties of the mandible: in contrast to what one would assume, the mandible does not grow at the chin. The teeth-bearing body of the mandible undergoes only minimal growth during childhood, while the majority of new bone formation takes place on the mandibular ramus and condyle2. In fact, the majority of mandibular growth originates from chondrocytes immediately adjacent to the TMJ joint space. Because of this close proximity, the inflammatory cytokines in the synovial fluid may have a direct effect on condylar growth very early on in the event of arthritis3. Further, the total growth of the mandible during childhood is considerable, and thus also the potential effect size of disturbed growth of this bone. Another unique factor of TMJ arthritis in JIA is the absence of clinical signs and symptoms in most patients. In the study of Twilt, et al 4, only 12% of patients had TMJ pain; Billiau, et al found 22% with muscle or joint tenderness5, and Argyropoulou, et al found 5%−8% with pain or chewing discomfort6. Also, clinical examination is not able to reveal early signs of active TMJ arthritis, even when performed by skilled examiners; whether they are pediatric rheumatologists or orthodontists, they will reliably find only the signs of … Address correspondence to Dr. Saurenmann; E-mail: traudel.saurenmann{at}kispi.uzh.ch

Management of Long-standing Anteromedial Temporomandibular Joint Dislocation

Temporomandibular joint dislocations that persist for more than a month are labelled as long-standing or chronic temporomandibular joint dislocations, and are the most challenging and difficult to treat. No definite guidelines have been laid down for the management of such dislocations in the literature. This paper reports 5 such cases and recommends an algorithm for the management of long-standing temporomandibular joint dislocations.

Simultaneous genial distraction and interposition arthroplasty for management of sleep apnoea associated with temporomandibular joint ankylosis

Temporomandibular joint (TMJ) ankylosis affects the growth of the mandible and results in gross facial deformities. A critical clinical feature of long-standing TMJ ankylosis is retrogenia, which when combined with an inability to open the mouth leads to severe compromise of the airway. A case is presented of obstructive sleep apnoea syndrome secondary to TMJ ankylosis that was corrected by a new technique employing simultaneous genial distraction along with interposition arthroplasty.

Two-stage Treatment of TMJ Ankylosis by Early Surgical Approach and Distraction Osteogenesis

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of bone or fibrous adhesion of the anatomic joint components, which replaces the normal articulation and limitation of mouth opening. Early surgical intervention is considered as a treatment procedure to release the joint ankylosis and to maintain the function of the joint. Longstanding temporomandibular joint ankylosis which starts during the active growth period in early childhood resulting in facial asymmetry. Thus, the importance of the evaluation for the facial asymmetries and unfavorable remodeling of the mandible has to be considered during the initial treatment planning. Further operations, either osteotomies or distraction osteogenesis, are required for the treatment of maxillofacial deformities. The present study reports a case of unilateral TMJ ankylosis treated by interpositional arthroplasty prior to distraction osteogenesis for the treatment of mandibular secondary deformity. Various treatment procedures and timing protocols are reviewed and discussed.

Bradycardia following temporomandibular joint ankylosis release

Bradycardia following release of temporomandibular (TM) joint ankylosis is uncommon. We are reporting a case of longstanding TM joint ankylosis, which after release, resulted in significant bradycardia on jaw opening. The possible etiology of this bradycardia is discussed. There is hardly any literature available on this topic.

Modified coronoid process grafts combined with sagittal split osteotomy for treatment of bilateral temporomandibular joint ankylosis

Purpose: This article describes the use of autogenous coronoid process grafts for lengthening the ramus in patients with long-standing temporomandibular joint (TMJ) ankylosis and severe mandibular retrognathia. Patients and methods: A retrospective clinical study of 6 cases of bilateral TMJ ankylosis surgically treated during a 3-year period from June 1996 to March 1999 was performed. All patients were treated by condylectomy, mandibular sagittal split osteotomy, and immediate autogenous coroniod process grafts. Clinical examination, radiographs, and photographs were used postsurgically to evaluate the grafts, condylar function, and facial appearance. Results: Very satisfactory postsurgical results were obtained in terms of function of the TMJ, the airway, and aesthetics. Conclusion: In children suffering from TMJ ankylosis, the coronoid process can be used for mandibular lengthening. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:11-18, 2002

Bird face deformity secondary to bilateral temporomandibular joint ankylosis

This paper describes our experience in the treatment of 10 patients with bilateral longstanding temporomandibular joint ankylosis occurring during the active growth period and causing severe bird face deformity. The clinical manifestations were: (1) upper airway obstruction in the form of either severe night snoring or obstructive sleep apnoea; (2) inability to open the mouth and (3) severely convex facial profile. Surgery consists of simultaneous release of the ankylosed joints, advancement of the mandible and insertion of posterior mandibular costochondral graft struts. A Le Fort I osteotomy was performed concomitantly in marked deformities to help in the restoration of the posterior facial height. Dramatic improvement in the airway, facial profile and jaw function were obtained by this programme.