Mean Maximal Mouth Opening Research Articles

Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study

BackgroundDetection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint. PurposeThe purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age. Study design, setting, sampleA single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome. Predictor/exposure/independent variableAge (in months) at the time of presentation, measured as a continuous variable. Main outcome variable(s)The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant’s mouth and apply slight pressure to encourage maximal mouth opening. In older infants with erupted central incisors, MMO was measured from the gingival margins. CovariatesThe covariates were sex, race, and gestational age. AnalysesFindings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age. ResultsThe sample was composed of 151 infants with a mean age of 5.2 months (95% CI 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, p<0.001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4-23.6), compared to a mean of 36.7 mm (95% CI 34.8-38.6) in infants 11 months of age. Conclusions and RelevanceThe results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Mouth opening in systemic sclerosis: Its course over time, determinants and impact on mouth handicap.

Decreased maximal mouth opening is a common and disabling manifestation in systemic sclerosis patients. We aimed to study the course of maximal mouth opening, determinants of smaller maximal mouth opening over time and the burden of smaller maximal mouth opening on mouth handicap. Consecutive systemic sclerosis patients participating in the prospective Leiden Combined Care in systemic sclerosis cohort were included. Annual clinical assessment included maximal mouth opening measurement and mouth handicap evaluation (Mouth Handicap in Systemic Sclerosis scale). Presence of microstomia (maximal mouth opening < 30 mm) was studied. Maximal mouth opening over time was assessed on group level and for all patients individually. Baseline characteristics were analysed for their association with smaller maximal mouth opening over time (linear mixed-effects models). Furthermore, cross-sectional association between maximal mouth opening with Mouth Handicap in Systemic Sclerosis scale was assessed (linear regression analysis). A total of 382 systemic sclerosis patients were studied with median follow-up time of 2.0 years (interquartile range = 0.0-3.0). At baseline, mean maximal mouth opening was 42.2 ± 8.0 mm and 7% suffered from microstomia. Annual decrease of > 5.0 mm in maximal mouth opening during follow-up occurred in 63 patients and was accompanied by increase in disease severity. Disease characteristics at baseline independently predictive for smaller maximal mouth opening over time were: more extended skin subtype; peripheral vasculopathy; pulmonary, renal and gastrointestinal involvement. Smaller maximal mouth opening was significantly associated with more reported mouth handicap. The course of maximal mouth opening is stable in a majority of systemic sclerosis patients. Still, maximal mouth opening over time was smaller in patients with more severe organ involvement. Although microstomia was infrequent, a smaller maximal mouth opening was significantly associated with more mouth handicap, indicating the importance to address maximal mouth opening in routine care of systemic sclerosis patients.

To Assess the Outcome of Temporo-Mandibular Joint Arthrocentesis in the Treatment of Internal De-Arrangement of Temporo-Mandibular Joint

Background: The two joints connecting the jawbone to the skull are called the temporomandibular joints. The TMJs are another name for these joints (TMJ). It's a connection between the mandible (at the bottom of the skull) and the temporal bone (at the top of the skull). Internal derangement of the temporomandibular joint (TMJ) is a condition in which the disc in the TMJ is displaced out of its normal functional relationship with the mandibular condyle and the articular region of the temporal bone. The problem is within the TMJ, where it can cause serious problems. Pain from an internal condition can be effectively treated with arthrocentesis, or AC (ID). Objectives: The purpose of this study is to evaluate the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement. Study Design: Descriptive case series. Setting: Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore. Duration of Study: Six months after approval of synopsis i.e. 22-12-2018 to 22-06-2019 Methodology: 60 Patients matched the inclusion criteria selected from OPD of department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. Informed consent was obtained. Demographic details also obtained. Patients were undergone surgery by senior consultant under LA. After surgery, patients were shifted in post-surgical wards and discharged from there after 48 hours. Patients were advised to present after 1 week of surgery in OPD. After 1 week, patients were evaluated for postoperative maximal mouth opening. Patients were also asked for presence of postoperative pain by using VAS and score was noted (as per operational definition) by researcher himself. All this information was recorded through proforma (attached). Results: Total of 60 patients, 46.7 % ( n=28) were male and 53.3 %( n=32) were female, Mean age of patients was 37.38±15.11. Sixty percent, or n=36, of the patients were found to be between the ages of 18 and 35, and forty percent, or n=24, were found to be between the ages of 36 and 60. Mean duration of TMJ Internal derangement was 49.86±19.12. Mean maximal mouth opening was 35.55±3.51mm. (p-value 0.001) and mean post-operative pain was 2.23± 1.06. (P-value 0.001). Practical Implication: This study will help to understand the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement Conclusion: Finally, we decided that arthrocentesis is a straightforward, minimally invasive treatment. Internally dislocated temporomandibular joints (TMJ) can be corrected with this method. For those who have closed-lock internal derangement, TMJ arthrocentesis appears to be a risk-free alternative with a reduced potential for consequences. Keywords: Temporomandibular Joint, Arthrocentesis, Post-operative Pain, Derangement, Arthrocentesis, Arthroscopy.

Trismus among Preclinical Students in a Medical College: A Descriptive Cross-sectional Study.

Trismus is a condition of reduced mouth opening due to tonic constrictions of the muscles of mastication. Trismus greatly affects health-related quality of life and thus daily life activities. The aim of this study was to find out the prevalence of trismus among preclinical students in a medical college at a tertiary care teaching hospital. A descriptive cross-sectional study was conducted in a medical college from 10th July 2021 to 10th December 2021 for a period of five months. Ethical clearance was obtained from the Institutional Research Committee (Reference number: 0311202004). A total of 315 preclinical students studying at a medical college were included in the current study. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Among 315 students, trismus was seen in 14 (4.44%) (1.45-7.43, 95% Confidence Interval) . The clicking sound on the right side of the temporomandibular joint was found to be in 6 (42.86%), on the left side was 5 (35.71%) and that of both sides of the temporomandibular joint was 1 (7.14%) among the 14 students with trismus. The mean maximal interincisal mouth opening was found to be 33.4±0.46 mm in students having trismus. The prevalence of trismus was found to be similar to the other studies performed in similar settings among preclinical students in a medical college. Awareness on mouth opening exercises and timely management can help reduce trismus. prevalence; temporomandibular joint; trismus.

Arthrocentesis- An minimally invasive method for TMJ disc disorder: An original research

TMJ dysfunction is a therapeutic challenge in the oral and maxillofacial clinic. Although TMJ pain and dysfunction can be caused by many different aetiologic factors, the role played by inflammation as an underlying mechanism of pain and dysfunction of the TMJ has played a major role. TMD patients having pain and tenderness for prolonged period of time will show signs of inflammation biochemically as well as radiographically. Therefore the aim of this study was to evaluate the efficacy of arthrocentesis in patients suffering from TMJ disc disorders. Materials and Methods A Total Of 60 Subjects Suffering From Tmj Disc Disorders Were Selected And Treated By Arthrocentesis. The Subjects Were Followed Up For A Period Of Two Year. Results The mean maximal mouth opening prior to arthro-centesis was 30.10 mm and after the procedure the mean maximal mouth opening was 45.3 mm. The mean right and left lateral movements before arthrocentesis were 6.15mm and 6.59mm respectively, and the mean right and left lateral movements of 9.09 and 9.21 respectively were present after the procedure. The mean degree of pain before arthrocentesis was 7.7, and after the procedure the mean degree of pain was 1.03 as per the visual analogue scale.

A systematic review of treatment and outcomes in patients with mandibular coronoid process hyperplasia.

Treatment of mandibular coronoid process hyperplasia (MCPH) has been described and explored in the literature. This systematic review aims to provide a comprehensive overview of the surgical and non-surgical treatment options for MCPH in pediatric and adult populations. Three databases were searched for treatment of MCPH patients (MEDLINE, Embase, and Web of Science). Two reviewers selected case reports and case series based on titles and abstracts. Finally, 55 studies reporting a total of 127 cases were included for qualitative synthesis and data extraction. The mean age at symptom onset was 15.6 years, while the mean age at diagnosis was 23.5 years. Of the included cases, 83.7% were male, and the condition was bilateral in more than 81% of the cases. Coronoidectomy was performed in 82.7% of the included cases, while coronoidotomy was performed in 3.9% of the cases. In 85.0% of the surgically treated cases, the approach was intraoral. The mean maximal intraoperative mouth opening was 38.1 mm compared with 16.5 mm at diagnosis. The mean maximal postoperative mouth opening was 35.3 mm, and the mean follow-up period was 16.3 months. Maximum mouth opening was achieved intraoperatively, and non-surgical treatment after surgery aims to reduce the risk of relapse. Additional research with a higher level of evidence is necessary to confirm these findings.

English

BACKGROUND Mouth opening is an important clinical parameter in our daily clinical practice. Mouth opening and its adequacy is an important factor in the treatment and follow up of the common conditions involving head and neck. Normal mouth opening has been defined as the inter-incisal distance at the maximal mouth opening. The purpose of this study was to determine the normal range of maximal mouth opening in the young adult Kumaoni population between the age of 20-40 years. METHODS The study was undertaken in the institutional hospital, Almora. A total of randomly selected 200 subjects between the age group of 20-40 years representing a sample of dentate adults was included for the study. The sample was stratified into four groups according to age followed by gender stratification. The age groups were classified as 21-25 years (Group 1), 26-30 years (Group 2), 31-35 years (Group 3), and 36-40 years (Group 4). Each group comprised 50 patients (25 males and 25 females). All particulars of patients, relevant clinical history and examination findings were recorded in the clinical proforma after taking proper informed consent. The mouth opening was measured using a standardized protocol with a calibrated ruler, and the findings were recorded in millimetres. RESULTS The mean MMO for males was 51.85 mm [standard deviation (SD) ± 2.59]. The range was 48–56 mm. The mean MMO for females was 49.82 mm (SD ± 2.32). The range was 46–56 mm. In the age group of 21-25 years, the mean MMO was 50.14 (SD ± 2.53) mm. The mean value for males was 50.80 (SD ± 2.67) mm and for females was 49.48 (SD ± 2.25). In the age group of 26-30 years, the mean MMO was 50.20 (SD ± 2.54) mm. The mean for males was 51.16 (SD ± 2.52) mm and for females was 49.24 (SD ± 2.22). In the age group of 31-35 years, the mean MMO was 51.56 (SD ± 2.62) mm. The mean for males was 52.28 (SD ± 2.66) mm and for females was 50.60 (SD ± 2.44). In the age group of 36-40 years, the mean MMO was 50.83 (SD ± 2.66) mm. The mean for males was 53.56 (SD ± 2.62) mm and for females was 49.82 (SD ± 2.32). CONCLUSIONS The mean maximum mouth opening for male participants was 51.85 mm (SD 2.59) (Range: 48-56 mm). The mean maximal mouth opening for female participants was 49.82 mm (SD 2.32) (Range: 46–56 mm). The maximum mouth opening was observed to decrease with age. The mouth opening of females was also observed to be lesser than the males from the corresponding age groups. KEY WORDS Maximum Mouth Opening, MMO, Trismus, Oral Cavity, Jaw, TMJ, Kumaon

Maximum Mouth Opening among Libyan Population

Restricted mouth opening may be associated with musculoskeletal disorder or due to orofacial infections and trauma, as well as chronic condition such as disorders of the temporomandibular joint and tumors. Aim This study was aimed to measure the maximum mouth opening among the young healthy patients of Sirte city. Methods A total of 100 participates, 42 males and 58 females, in the age range of 12-20 years attending the orthodontic clinic in Sirte city were studied. The Participates were asked to open their mouth maximally until no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a digital calibrated. All data were analyzed using SPSS program and simple descriptive statistics of MMO with regard to gender and age were reported. Results The mean maximal mouth opening for males was 49.35(4.5) mm and mean maximal mouth opening for females was 47. 11(4.7) mm. Mouth opening differences among different gender was compared which showed male had wider mouth opening but the difference was not statistically significant. Statistically significant differences were found between age groups. Conclusions The results of this study indicated that the positive relationship between MMO and age and the base line data was achieved in our study which needs to be validated further by conducting study in larger population.

Do patient-reported outcome measures correlate with clinical follow-up after arthroscopic treatment of internal derangement of the temporomandibular joint?

IntroductionArthroscopic treatment of the temporomandibular joint (TMJ) has traditionally been evaluated with clinical measurements. Additional recordings of patient reported outcome measures (PROM) is expected to make the evaluation more complete. The aim of the study was to evaluate if PROM correlates with clinical follow-up measures after arthroscopic treatment of internal derangement of the TMJ. Material and methodsPatients with temporomandibular dysfunction (TMD), treated with arthroscopic lysis and lavage of the TMJ, were followed with a PROM questionnaire; Jaw Functional Limitation Scale 20 (JFLS-20) and a review of patient medical records. Out of 239 patients treated, 134 were eligible for inclusion to the study. Results91 subjects, 21 males and 70 females, with mean age 42.6 years completed the follow-up. The JFLS-20 mean score was 25.43 (range: 0–148). A correlation was found between JFLS and mouth opening. The JFLS-20 score was decreased by 1.48 (p = 0.0001) for ever millimeter larger mouth opening and with 1.16 (p = 0.001) for every gained millimeter of mouth opening after arthroscopic treatment of the TMJ. The mean maximal mouth opening was 38.43 mm preoperatively (15 to 75 mm) compared to 42.19 mm postoperatively (range: 21–75 mm). A total of 80 subjects with TMD associated pain preoperatively was reduced to 25 postoperatively (p = 0.0001). DiscussionAdvantageous treatment effect with arthroscopic lysis and lavage was presented. The outcome of the JFLS-20 questionnaire indicates a correlation with the clinical findings. Future studies will focus on larger cohorts and using PROM with a case-control setting.

Evaluation of normal range of maximum mouth opening for Pune Maharashtra adult population

Background and Aim: Maximal mouth opening (MMO) is used as a marker of masticatory pathology. MMO varies with age, height, gender, and race. The current study is an attempt to calculate the normal range of maximum mouth opening in an adult Pune Maharashtra population. Materials and Methods: A total of 800 individuals, 400 males and 400 females, in the age group of 18–60 years attending outpatient department in Bharati Dental College and Hospital, Pune were randomly selected and divided into four groups according to their age ranges. In addition to the basic demographic data, MMO was measured in these individuals. The subjects were asked to open their mouth maximally until no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a calibrated fiber ruler. Statistical analysis was performed. Results: The mean MMO for males was 50.58 (standard deviation [SD] ± 2.16) mm (Range 37–56 mm) and for females was 48.29 (SD ± 3.12) mm (Range 36–53 mm). There was a statistically significant difference between the mouth opening of male and female in all the age groups with P < 0.05 A linear relationship was observed between the mouth opening and age in both males and females and the mouth opening decreased as the age increased. In the age group of 18–29 years, the mean MMO was 54.34 (SD ± 1.84) mm. The range was 39–56 mm for males and 51.63 (SD ± 2.33) mm. with range 38–53 mm for females. In the age group of 30–39 years, the mean MMO was 52.09 (SD ± 1.72) (range 38–53 mm) and 50.07 (SD ± 2.09) (range 38–51 mm) for males and females, respectively. For the age group 40–49 years, the mean MMO was 48.94 (SD ± 1.66) mm (range 39–54 mm) for males and 46.73 (SD ± 2.84) mm (range 38–50 mm) for females. In the age group of 50–60 years, the corresponding values for males and females were 46.98 (SD ± 2.04) (range 36–50 mm) and 44.76 (SD ± 2.59) mm (range 36–49 mm). Conclusion: The MMO range for different age groups is established for normal adult Pune Maharashtra population.

Temporomandibular Joint Dysfunction and Impaired Stomatognathic Alignment: A Problem Beyond Swallowing in Patients With Stroke.

The aim of this study is to evaluate the efficacy of supervised structured exercise programme in post stroke patients with temporomandibular joint dysfunction (TMJD). 30 post stroke patients diagnosed as TMJD according to "diagnostic criteria for temporomandibular disorders" (DC/TMD) were included for the study. A structured exercise programme including active and active-assisted range of motion (ROM) exercises for neck and temporomandibular joint (TMJ), chins tuck exercises, breathing and relaxing exercises and posture exercises were performed. Cervical ROMs including flexion, extansion, lateral flexion and rotation, Mann assessment of swallowing ability (MASA) and mini mental state exam (MMSE) scores, maximal mouth opening (MMO) and craniomandibular index (CMI) of the patients compared at baseline, 1st and 6th month after supervised rehabilitation procedure. All parameters were significantly improved both in 1st and 6th month evaluation. At 6th month evaluation, the cervical ROMs of the patients improved from severe to mild restriction (p = 0.001), the mean MASA score of the patients improved from moderate to mild swallowing disorder (p = 0.001), mean MMSE score of 30 patients was accepted as normal (p = 0.001), mean MMO of the patients was 56.00 ± 4.84mm and mean CMI was 0.16 ± 0.05 indicating that the patients had a "mild" limitation in mouth opening and "mild" dysfunction in TMJ (p = 0.001 respectively). Our structured supervised exercise programme improves swallowing quality by establishing proper stomatognathic alignment and TMJ function.

Reliability of a novel method for measuring maximal voluntary mouth opening in patients with oral carcinoma

Background/Aims Mouth opening is a routine and vital activity of daily life that facilitates ingestion and speech. It is often found to be limited in patients with oral carcinoma. Measuring mouth opening is essential to detect the therapeutic effect of an intervention aiming to improve it. During measurement, the procedure needs to be reliable, simple, inexpensive and safe. This study aimed to determine the intrarater and interrater reliability of a novel method of measuring maximal voluntary mouth opening in patients with oral carcinoma. Methods Patients aged between 40 and 60 years of either gender with a diagnosis of oral carcinoma and presenting with difficulty in mouth opening were recruited. The distance between incisors was marked on standard sized paper slips as the participants performed maximal voluntary mouth opening. Distance between the markings was measured with a ruler in millimeters. The measurement procedures were carried out by two independent investigators. Results A total of 15 patients (12 male and 3 female) with a mean age of 52.53 ± 8.28 years participated in the study. Mean maximal voluntary mouth opening measure was &lt;35 mm, indicating restricted mouth opening in these patients. Intrarater reliability of 0.95 (0.87–0.98) and interrater reliability of 0.96 (0.89–0.98) were found for the measurements. Conclusions The reliability of maximal voluntary mouth opening measurement using this novel technique was found to be excellent. This technique can be used in the routine clinical evaluation of patients with oral carcinoma.

Transoral vertical ramus osteotomy fixed with Kirschner pins

Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa. This is followed by a brief period of maxillomandibular fixation. We have reviewed the records of 95 patients who had unilateral or bilateral vertical ramus osteotomy fixed with K pins, after which the mean (SD) period of fixation was 19 (11) days. Fixation failed in two patients because excursion of the jaw was either too heavy or too early. The fixations were redone. All other fixations remained stable, including the 20 dual-jaw procedures in which VRO preceded maxillary osteotomy. The mean (SD) maximal mouth opening at final follow-up was 44 (7) mm, and in only one patient was it less than 30mm. Numbness of the lip or chin developed in seven patients, five of whom had other anterior mandibular procedures. Four patients had discomfort on palpation of the site of the pins, and one required removal. The new method was effective, and resulted in few complications within its limitations.

Evaluation of Total Alloplastic Temporomandibular Joint Replacement in TMJ Ankylosis.

Total joint reconstruction using autologous or alloplastic materials is one of the treatment options for the reconstruction of the affected joint in TMJ ankylosis. The clinical results of alloplastic TM joint replacement (Biomet Microfixation system) that was carried out for the treatment and reconstruction of TMJ ankylosis have been summarised. A retrospective analysis of eight cases clinically and radiographically diagnosed as TMJ ankylosis with minimal facial asymmetry presenting beyond the growth period and willing for at least 12months of follow-up who have been taken up for gap arthroplasty and reconstruction using Biomet Microfixation TMJ replacement system was carried out. Follow-up of these patients was carried out at regular intervals and assessed on the following criteria: maximal interincisal mouth opening, TM joint pain on the affected side (on VAS), lateral mandibular excursions to the unaffected side deviation on mouth opening, occlusal discrepancy and neuromotor deficit of peripheral branches of facial nerve. The mean maximal interincisal mouth opening pre-surgery and 1year post-surgery was 2 and 31.8mm, respectively. The mean lateral excursive movement to the unaffected side was found to be 5.5mm with mean deviation on mouth opening to be 4.6mm. No pain, occlusal discrepancy or neurological deficit existed at the end of 1year. Biomet Microfixation system is a viable treatment option for reconstruction of TMJ in cases of ankylosis with no major complications.

Surgical management of chronic temporomandibular joint dislocations.

Temporomandibular joint dislocation is described as the movement of mandibular condyle out of the fossa beyond its anatomical and functional boundaries causing pain and discomfort. It is often managed by conservative methods, but in long-standing, chronic conditions, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. This retrospective analysis involving a single center and a surgeon with 19 patients and 23 joint surgeries performed over a 10-year period. Patients who fulfilled inclusion and exclusion criteria and had earlier undergone surgical correction with hook-shaped miniplates and miniscrews fixed with or without bone grafts formed the study group. In all, 12 were female (mean age, 41.9 ± 12.07 years) and the rest 9 were male (mean age, 39.8 ± 13.6 years), ranging from 32 years to 58 years. All patients had the dislocation for an average period of 19.26 ± 12.6 months before the surgery. The mean maximal mouth opening (without pain) preoperatively was 17.78 ± 2.13 mm (12-25 mm) while postoperatively it was 32.28 ± 3.17 mm (27-37 mm). There were no immediate or late surgical complications in the follow-up period that ranged from 8 to 37 months. When proper case selection is employed and properly done, using hook-shaped miniplates with or without bone graft is more cost-effective, giving excellent short- and long-term effects. The results in this Indian population are very similar to that reported from other parts of the world.

Grafts of autogenous coronoid process to reconstruct the mandibular condyle in children with unilateral ankylosis of the temporomandibular joint: long-term effects on mandibular growth

Injury to the mandibular condyle in children usually leads to malocclusion and disharmony of facial growth. Our aim was to study the facial growth after reconstruction of the mandibular condyle using autogenous coronoid process grafts in children with unilateral ankylosis of the temporomandibular joint (TMJ). We followed up 10 growing patients with unilateral bony ankylosis of the TMJ who had been admitted to the West China Hospital of Stomatology, Sichuan University (Chengdu, China) between 1 January 2008 and 31 December 2012. There were three boys and seven girls, age range 5–12 years at the time of operation. In each case, patients were treated by gap arthroplasty, reconstruction of the condyle with an ipsilateral coronoid process, and interposition of the pedicled temporalis fascial flap during one operation. The mean (range) postoperative follow up was 4.73 (3–6) years. Postoperative panoramic radiographs were taken, and the growth of the mandibular height and length on the affected side was measured and compared with the healthy side. All patients had an uneventful, normal recovery. The mean (range) maximal mouth opening at the end of follow up was 35.6 (32–41) mm. Both the height of the ramus and the length of the mandible continued to grow after successful treatment of the ankylosis (using autogenous coronoid process grafts for reconstruction of the condyle) but the deficit in growth was not completely made up. The final height of the ramus on the affected side (at the end of follow up) had increased by 25% (p=0.012) and the final length of the mandible on the affected side by 26% (p=0.010) compared with immediately after operation. For comparison of the rate of growth, the increased height of the ramus of the affected side was 47% lower (p=0.003), while the increased length of the mandible on the affected side was 27% shorter (p=0.008) compared with the healthy side. The mandible on the affected side continued to grow after successful treatment of the ankylosis, but the growth deficit was not made up completely. The rate of growth of the affected mandible seemed to be less than on the undisturbed side even after treatment of the ankylosis.

EFFICIENCY OF TEMPOROMANDIBULAR JOINT ARTHROCENTESIS WITH OZONATED WATER IN MANAGEMENT OF ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION: A RANDOMIZED CLINICAL TRIAL

Objective: The aim of the study was to evaluate the efficiency of temporomandibular joint arthrocentesis with ozonated water versus ringer lactate in treatment of anterior disc displacement without reduction (closed lock) and to evaluate the effect of both procedures on the level of interleukin-6 (IL-6) in the joint space.Patients and methods: Forty patients with bilateral anterior disc displacement without reduction were included in the study. Patients were randomly allocated into 2 groups. Group I performed arthrocentesis using ozonated water while group II underwent the same procedure using sodium ringer lactate. Clinical evaluation of the patients was done preoperative, immediately ostoperative, at 1 week and 1, 3 and 6 months postoperatively. The pain was assessed using visual analog scales. Maximal mouth opening (MMO) was recorded at each follow-up visit. Synovial fluid sample was collected to detect the level of IL-6, preoperative, immediately postoperative and at six months postoperativeResults: Both groups showed improvement in clinical parameters. Concerning maximal mouth opening, there was no statistically significant difference between the two groups pre-operatively, after 1 week as well as after 1 month. After 3 months and 6 months, Group I showed statistically significant higher mean MMO than Group II. the pain score assessment showed no statistical significant difference between the two groups pre-operatively. Through all other periods, Group I showed statistically significantly lower mean VAS scores than Group II. The interleukin-6 levels showed no statistically significant difference between the two groups pre-operatively. Immediately post-operative as well as after 6 months, Group I showed statistically significantly lower mean IL-6 level than Group II.Conclusion: Arthrocentesis using ozonated water proved to have superior results in treatment of TMJ anterior disc displacement without reduction. Interleukin-6 level in the TMJ synovial fluid has direct correlation with the dysfunction symptoms.

Oral complications at 6months after radiation therapy for head and neck cancer.

To examine oral complications 6months after modern radiation therapy (RT) for head and neck cancer (HNC). Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6months from the start of RT. Mean stimulated whole salivary flow declined from 1.09 to 0.47ml/min at 6months (p<.0001). Mean maximal mouth opening reduced from 45.58 to 42.53mm at 6months (p<.0001). 8.1% of subjects had some oral mucositis at 6months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p≤.0001). At 6months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p<.0001). Despite advances in RT techniques, patients with HNC experience oral complications 6months after RT, with resulting negative impacts on oral function and quality of life.

Surgical intervention for oromandibular dystonia-related limited mouth opening: Long-term follow-up.

Oromandibular dystonia is a movement disorder that is characterized by involuntary masticatory and/or lingual muscle contracture. Jaw closing dystonia, the most common subtype of this condition, can cause trismus and is frequently misdiagnosed as temporomandibular joint disorder or masticatory muscle tendon-aponeurosis hyperplasia. This report describes the long-term results of 18 patients with limited mouth opening (mean maximal mouth opening: 12.2mm) due to jaw closing dystonia who underwent surgery. Fifteen patients were treated by injecting botulinum toxin (Botox) into their masseter and temporal muscles. The patients' involuntary muscle contractions improved, but the effects were only mild and transitory. Therefore, bilateral coronoidotomy and masseter muscle stripping were performed. The mean maximal jaw opening significantly increased to 28.3mm under general anesthesia combined with muscle relaxation, and was 47.1mm after surgery. An analysis based on an objective scoring system detected a mean overall improvement in the patients' symptoms of 80.2%. The mean duration of the follow-up period was 79.4 months. Six patients required additional Botox injections into the masseter and/or medial pterygoid muscles. It was suggested that coronoidotomy is useful for patients with jaw closing dystonia accompanied by trismus in whom other therapies are ineffective.

Normative values for mandibular mobility in Scandinavian individuals 4-17 years of age.

Assessment of mandibular mobility is an important part of the clinical oro-facial examination of paediatric and adolescent patients. The aims of the present cross-sectional study were to establish age-related normative values for mandibular mobility in a Scandinavian paediatric and adolescent cohort and to assess the validity of universal cut-off values for lower 'normal' mandibular ranges of motion. A total of 1114 Danish individuals between 4-17 years of age were included. Maximal mouth opening capacity and laterotrusion capacity were assessed, in each individual, according to a standardised measurement protocol. The mean maximal mouth opening capacity gradually increased from 38 mm (SD 6·1 mm) at age 4 to 54·5 mm (SD 6·8 mm) at age 17. No inter-gender difference in maximal mouth opening capacity was observed (P > 0·15). The mean maximal laterotrusion capacity gradually increased from 7·4 mm (SD. 1·1 mm) at age four to 10·1 mm (SD 1·9 mm) at age 17. A statistical significant inter-gender difference of 0·8 mm (SD 0·4 mm) was observed in relation to the total laterotrusion capacity; however, the clinical relevance of this significant difference is questionable. Normative values of mandibular function was established in individuals 4-17 years of age. Our findings oppose the use of a single universal cut-off value for 'normal' range of motion in paediatric and adolescent patients. Instead, we recommend to use the age-related normative values of mandibular range of motion as basis for the assessment of the development of oro-facial function.