Temporomandibular Joint Ankylosis Patients Research Articles

Analysis of Maximum Bite Force, Chewing Efficiency and Electromyographic Study of Temporalis and Masseter Muscles in Postoperative Temporomandibular Joint Ankylosis Patients

This study aims to analyze maximum voluntary bite forces (MVBF), masticatory efficacy, and electromyographic (EMG) pattern for temporalis and masseter muscle during maximum voluntary clenching in treated cases of unilateral TMJ ankylosis patients and compare it with the normal subjects.

Quality of life after distraction osteogenesis in TMJ ankylosis patients

The aim of our study was to evaluate the success of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients with facial deformities at our maxillofacial unit; assess the psychosocial and well-being outcomes of distraction osteogenesis and its impact on oral health; and discriminate the differences in quality of life (QoL) with application of external or internal devices, unilateral or bilateral, linear or multivector, and maxillomandibular or mandibular distraction. QoL and the Oral Health Impact Profile (OHIP) were prospectively studied in 42 consecutive patients with facial deformities, planned for maxillofacial distraction osteogenesis, using 2 validated questionnaires, the Orthognathic Quality of Life Questionnaire and OHIP-14. Patients who had undergone any previous surgeries were excluded. Among these patients, 16 were female, 26 male; mean age was 14.98 ± 4.88 years, and all had prearthroplastic distraction. The shortening in the mandible was in the proportion 29:01:12 in the body, ramus, and ramus-body, respectively. Mean QoL scores before and after distraction were 68.52 ± 9.50 and 26.62 ± 3.51; and mean OHIP scores before and after distraction were 33.88 ± 6.26 and 15.36 ± 2.54, a highly significant difference (P < .001) suggesting improvement. Significant improvement was identified on all QoL and OHIP questions after distraction (P < .01). The postdistraction overall mean QoL score among patients with extraoral or intraoral distractor did not have a significant difference (P=.32), but facial appearance in the bilateral distraction group; jaw function and overall well-being in the multivector distraction group; and facial appearance, jaw function, and overall well-being in maxillomandibular distraction group had significant improvements (P < .05). Distraction osteogenesis considerably improves oral health and health-related QoL in patients with TMJ ankylosis with facial deformities. The use of an external or internal distractor did not make any difference in the QoL; however, bilateral distraction, multivector distraction, and maxillomandibular distraction resulted in better QoL outcomes.

Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis.

Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1cm of bony block and insertion of 2cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3-35years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity.

Outcome of Stock Total Joint Replacement With Fat Grafting in Adult Temporomandibular Joint Ankylosis Patients

Adult temporomandibular joint ankylosis (TMJA) lacks a uniform management protocol. The purpose of the study was to evaluate the outcome of stock total joint replacement (TJR) along with fat grafting around the joint in adult TMJA patients. Specific aim was to find out whether TJR can be a definitive management for adult TMJA. The investigators implemented a prospective study on adult TMJA patients treated with ostearthrectomy of ankylosis and stock temporomandibular joint (TMJ) TJR with fat grafting. Concomitant orthognathic correction of facial asymmetry was performed in some unilateral cases. Follow-up was carried out at regular intervals for assessing primary outcome variable of maximal incisal opening (MIO) and reankylosis. Secondary outcome variable included demographic data, etiology, duration of ankylosis (DOA), correlation between DOA and preoperative and postoperative MIO, occlusion and complications of hemorrhage, facial nerve paresis, periprosthetic joint infection, dislocation, and implant failure. The study sample was composed of 41 patients (54 joints) (bilateral, n=13; unilateral, n=28 [right side, n=12; left side, n=16]). The number of recurrent cases was 15. Trauma as etiology of ankylosis was seen in n=30 (73.2%), infection in n=7 (17.1%), unknown in n=3 (7.3%), and ankylosing spondylitis in n=1 (2.4%) cases. Mean DOA was 11.95years. Paired t test revealed a statistically significant difference between preoperative and follow-up MIO (P < .001). None of the cases showed reankylosis in the follow-up period. Pearson correlation revealed statistically negative correlation between DOA and postoperative MIO. The result of this study suggests that stock TMJ TJR along with fat grafting around the joints provides adequate mouth opening without any sign and symptoms of reankylosis. Stock TMJ TJR with fat grafting can be considered as a definitive treatment modality in adult TMJA with minimum comorbidity.

Development and validation of temporomandibular joint ankylosis quality of life questionnaire

The patient-reported outcome measures are endorsed for better evaluation of disease impact and treatment outcomes. Temporomandibular joint (TMJ) ankylosis has been observed to adversely impact the quality of life (QoL) of the patients, affecting both the physical and psychosocial aspects of their lives. The study was conducted to develop and validate a TMJ ankylosis specific QoL questionnaire (TMJAQoL). It had two phases. Phase 1 was associated with the development of the questionnaire while phase 2 examined its psychometric properties and validated the instrument. In phase 1, a 65 item pool was generated and was eventually reduced to a 37 item pool after sequential evaluation by two expert groups. The 37 item draft was subjected to item reduction by the impact method, resulting in a 12 item draft divided into 4 domains, which formed the TMJAQoL questionnaire. In phase 2, the TMJAQoL was completed by 51 TMJ ankylosis patients and was found to have optimum validity, reliability and internal consistency. 44 of these patients completed the TMJAQoL again after the surgery. A significant change in mean cumulative TMJAQoL scores (pre-op = 14.10, post op = 4.05, p = .001) was found after the surgery. This change was significantly correlated to the improvement in the maximal incisal opening and the right and left lateral movements (r > .30). Amongst the TMJAQoL domains, significant improvement was seen in functional limitation (p = .026), psychological well being (p = .017) and social wellbeing domains (p = .038). Overall, improved QoL was observed after the TMJ surgery. The TMJAQoL demonstrated optimum psychometric properties and promises to be an effective QoL instrument for the TMJ ankylosis patients.

COMBINED TEMPOROPARIETAL FASCIA AND THIN SILICON SHEET AS INTERPOSTIONAL ARTHROPLASTY FOR THE MANAGEMENT OF TMJ ANKYLOSIS- AN EXPERIENCE BASED ON SINGLE INSTITUTIONAL STUDY

Introduction: Temporomandibular joint ankylosis is a debilitating condition leading to problems in mastication, speech, digestion, oral hygiene and even facial appearance. The basic techniques for surgical correction of ankylosis include the gap arthroplasty, joint reconstruction or interpositional arthroplasty. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence.&#x0D; Material and Methods: 21 patients of temporomandibular joint ankylosis admitted from 2015 to 2018 in the Department of Plastic Surgery, SMS Hospital, Jaipur. . Diagnosis was based on history and clinical assessment supplemented with orthopantomogram (OPG) and computer tomographic scans. Mouth opening is measured as interincisoral distance using a scale. Intraoperatively, silicon sheet is sutured with the distal part of flap using non absorbable suture in half overlapped fashion with an overlapped portion across the joint space. Preoperative photograph is taken in all patients and serial post operative photograph were taken during their regular follow up&#x0D; Results: 21 patients were part of the study (14 males and 7 females). 16 of our patients were post traumatic. Their age ranged from 7 to 55 years. The disease was unilateral in 19 cases and bilateral in 2 cases. The pre-op interincisal mouth opening ranged from 0 to 9 mm. The intra-operative interincisal mouth opening ranged from 28 to 46 mm. There was no immediate complication and no incidence of facial nerve injury. One patient with bilateral congenital TMJ ankylosis had recurrence. Five patients were lost after the initial 1-year follow-up. &#x0D; Conclusion: Use of combined temporoparietal fascia with thin silicon sheet as interpositional arthroplasty provides extra protection in cases of TMJ ankylosis and thereby decreasing the incidence of its recurrence &#x0D; Keyword: Ankylosis, TMJ, Interpositional arthroplasty

A new clinical classification and treatment strategies for temporomandibular joint ankylosis

Temporomandibular joint ankylosis (TMJA) is a complicated condition that affects not only the condyle, but also the maxillofacial complex. Thus, it is often challenging to find a standardized treatment strategy for TMJA. This study was performed to analyse our experience with 95 TMJA patients over a 4-year period and develop a new classification system (‘CDA’). The CDA classification system divides TMJA patients into eight different groups according to the preservability of the condyle (C), severity of the dentofacial bone deformity (D), and skeletal age (A). The 95 patients (129 ankylosed joints) were treated using different strategies based on this CDA classification. Treatment options included preserving or reconstructing the condylar head, surgical correction of jaw deformities, and close follow-up of mandibular growth. After treatment, all 129 ankylosed joints were completely released and the average maximum inter-incisal opening (MIO) increased from 3.6 ± 3.2 mm to 32.8 ± 5.4 mm, with no recurrence of ankylosis found during follow-up. In conclusion, this new CDA classification can effectively guide treatment strategies for TMJA patients. Using particular strategies for patients based on specific CDA classifications could provide optimal management to the benefit of TMJA patients.

Is There a Difference in Volumetric Change and Effectiveness Comparing Pedicled Buccal Fat Pad and Abdominal Fat When Used as Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis?

There is limited evidence in the literature about fat grafting in the management of temporomandibular joint ankylosis (TMJA). The purpose was to investigate which interpositional fat grafting technique is superior in the operative management of TMJA. The specific aim was to compare the volumetric change and maximal mouth opening (MIO) when pedicled buccal fat or abdominal fat is interposed in patients being treated for TMJA. A randomized controlled trial was conducted on TMJA patients divided into 2 groups: Pedicled buccal fat pad was used for interposition in group A, whereas abdominal fat was used in group B. At the end of 1year, the volumetric change in fat was analyzed by comparing immediate postoperative and 1-year follow-up magnetic resonance imaging (MRI). MIO and re-ankylosis were recorded. Categorical variables were analyzed by the χ2 test or Fisher exact test. Continuous variables were compared using the t test and Wilcoxon signed rank test. Linear regression analysis was performed. A total of 36 patients (51 joints [15 bilateral and 21 unilateral]) were included, comprising 18 in group A and 18 in group B. The mean preoperative MIO measured 6.8mm in group A and 4.2mm in group B. The mean immediate postoperative MRI fat volume was 4.3cm3 in group A and 10.8cm3 in group B. One-year follow-up MRI showed a fat retention rate of 32.44% in group A and 58.17% in group B. The rate of volumetric shrinkage was 67.5% in group A and 41.9% in group B (P<.001). Analysis of variance showed a statistically significant difference between volumetric shrinkage and both treatment groups (P<.001). MIO improved to 30.6mm in the pedicled buccal fat pad group (group A) and 41.9mm in the abdominal fat group (group B) (P<.001). No re-ankylosis occurred in either group at 1-year follow-up. Our study results suggest that the percentage of retention of interposed abdominal fat at 1year is more than that of pedicled buccal fat pad. Volumetric shrinkage is greater with buccal fat pad, which is a paradox considering the pedicled blood supply. Abdominal fat is better than pedicled buccal fat pad when used for interposition in TMJA treatment.

Assessment of paediatric quality of life in temporomandibular joint ankylosis patients after interpositional arthroplasty: a pilot study

A comprehensive evaluation of treatment outcomes in paediatric temporomandibular joint (TMJ) ankylosis patients should include the assessment of quality of life (QoL) along with the traditional clinical indicators. This longitudinal retrospective descriptive study evaluated the impact on QoL of interpositional arthroplasty for the treatment of TMJ ankylosis in 18 patients between 8 and 10 years of age. The subjects completed the Child Perceptions Questionnaire (CPQ 8–10) while their parents/primary caregivers completed the Parental/Caregiver Perceptions Questionnaire (PCPQ), once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. Significant improvements were seen in the oral symptoms, functional limitation (P<0.02), and social wellbeing domains (P<0.05) of the CPQ, and in the oral symptoms and functional limitation (P<0.05) domains of the PCPQ. The improvements in the physical domains were considered important for treatment success by both groups. The psychosocial domains were observed to be largely unaffected by the condition. The level of agreement between the two groups was higher for physical domains as compared to psychosocial domains. This study indicates that QoL outcomes in paediatric TMJ ankylosis patients are largely influenced by the physical factors, while the psychosocial factors play a secondary role.

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient’s quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P < 0.01), recreation and mood (P < 0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.

Posterior airway change after mandibular distraction osteogenesis in temporomandibular joint ankylosis patients: a retrospective study

Background: Mandibular distraction osteogenesis (DO) has been shown to lead to considerable improvement in the obstructive posterior airway space (PAS) in temporomandibular joint (TMJ) ankylosis patients, while the pattern of PAS changes after DO hasn’t been fully understood.

Gap arthroplasty with active mouth opening exercises using an interocclusal splint in temporomandibular joint ankylosis patients

BackgroundTemporomandibular joint (TMJ) ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating as well as in breathing during sleep. The purpose of this study is to describe the effectiveness of an interocclusal splint (IOS) for active mouth opening exercises in the treatment of TMJ ankylosis.MethodsA total of nine patients with 13 instances of TMJ ankylosis from 2008 to 2010 were included in this study, of which five patients were male and four patients were female. Five patients demonstrated unilateral ankylosis, while five patients showed bilateral symptoms. Ankylosed mass resection with coronoidectomy, fibrotic scar release, and resection of stylohyoid ligament calcification was performed with gap arthroplasty without an interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 6.6-year follow-up period.ResultsAll patients were subjected to postoperative mouth opening exercises from the day of the operation with the help of an IOS, which was based on an impression taken during surgery. All patients were sufficiently comfortable moving their mandible according to the IOS’s guiding plane and impingement, and satisfactory results were achieved, in which MMO was improved by 35 mm more than 6 years after surgery.ConclusionsComplete and adequate resection of the ankylosed mass and postoperative active mouth opening exercises are essential in the treatment of TMJ ankylosis. Moreover, a more comfortable mouth opening guide and interdigitation can be achieved using an IOS, and newly organized fibrosis in the gap space between the newly made resected condylar head and temporal fossa can be suggested.

Examination of OPG, RANK, RANKL and HIF1A polymorphisms in temporomandibular joint ankylosis patients

PurposeTo evaluate the association between polymorphisms in genes that regulate bone metabolism, such as OPG, RANK, RANKL, and HIF1A, in patients with temporomandibular joint (TMJ) ankylosis. MethodsThe sample consisted of 181 individuals, the study included 17 individuals with TMJ ankylosis and 164 controls. DNA was extracted from buccal epithelial cells. The genotyping of genetic polymorphisms in OPG (rs2073618), RANK (rs3826620), RANKL (rs9594738), and HIF1A (rs2301113 and rs2057482) was performed by real-time PCR using TaqMan™ technology (Applied Biosystems). The data were subjected to statistical analysis with a level of significance of 0.05. ResultsThe OPG (rs2073618) polymorphism was associated with TMJ ankylosis, both in the additive model and in the dominant model (p < 0.05). In the additive model, when the individuals carried the CC genotype, they presented as 10.80 times more likely to develop the condition (p = 0.03). In the dominant model, individuals that carried at least one C allele were 5.76 times more likely to have TMJ ankylosis, than those with the G allele (p = 0.01). ConclusionThe polymorphism rs2073618 of OPG is a possible marker that is associated with the risk of manifestation of TMJ ankylosis.

Correction of hypoplastic mandible in non-syndromic temporomandibular joint ankylosis patients with distraction osteogenesis in Mayo Hospital Lahore: A descriptive study.

To evaluate the efficacy of simultaneous gap arthroplasty and distraction osteogenesis in the treatment of non-syndromic temporomandibular joint ankylosis patients with hypoplastic mandible. The descriptive prospective study was conducted at the Department of Oral and Maxillofacial Surgery, King Edward Medical University / Mayo Hospital, Lahore, Pakistan, from January to December, 2016, and comprised patients having temporomandibular joint ankylosis with hypoplastic mandible. Interpositional gap arthoplasty, osteotomy and application of distractor were done in all the patients. Preoperative and post operative data was collected and analysed us in gSPSS12 . Of the 63 patients, 29(46%) were males with a mean age of 18.48±2.32 years and 34(54%) were females with a mean age of 16.41±3.21 years. Overall mean age was 17.37±3 years (range: 9- 24 years). Of the total, 20(32%) patients were given a single distractor on ramus per side, while 43(68%) were given double distractors (ramus + body) per side. Lengthening was achieved in all (100%) patients both in ramus and body. Only 1(1.6%) patient presented with a complication during the distraction period, and the case was successfully managed surgically. Distraction osteogenesis is a promising treatment option for the correction of mandibular deformities as a result of temporomandibular joint ankylosis.

Effects of video teaching combined with empowerment theory in open mouth functional training among traumatic temporomandibular joint ankylosis patients

Objective To explore the effects of video teaching combined with empowerment theory in functional training of open mouth among traumatic temporomandibular joint ankylosis patients. Methods From April 2015 to April 2017, we selected 60 traumatic temporomandibular joint ankylosis inpatients of Department of Stomatology in the First Affiliated Hospital of Zhengzhou University as subjects. All of the patients were divided into control group and observation group according to odd or even, 30 cases in each group. Patients of control group received the mode of video teaching. On this basis of control group, observation group combined with empowerment theory to provide functional training of open mouth for patients. We evaluated the positivity and pain with the Patient Activation Measure (PAM) and Numerical Rating Scales (NRS) and compared the limitation of open mouth as well as the maximum extent of open mouth before and after intervention among patients in two groups. Results Six months after intervention, the score of PAM of patients in observation group was higher than that in control group; the score of NRS was lower than that in control group; the differences were significant (P 0.05) . The maximum extent of the open mouth of patients in observation group was greater than that in control group with a significant difference (P<0.01) . Conclusions Video teaching combined with empowerment theory can improve positivity and maximum extent of the open mouth of traumatic temporomandibular joint ankylosis patients.It is an effective way to reduce patients'pain. Key words: Temporomandibular joint; Video teaching; Empowerment theory; Open mouth functional training

The coronoid process graft: A new revolution in management of temporomandibular joint ankylosis

Objectives: The aim of the present study is to compare the clinical outcomes of the widely used autogenous costochondral grafts with autogenous coronoid process grafts for condylar reconstruction in treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults.Patients and Methods: Nine patients of unilateral TMJ ankylosis in age group older than 18 years were selected from the outpatient clinic of the Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, they were 6 males and 3 females, the condyle was reconstructed after gap arthroplasty in 4 patients with costochondral grafts and with coronoid process graft in 5 patients. Clinical and radiographic examination was done postoperatively to compare between the 2 groups.Results: The clinical outcomes in both groups were satisfactory and comparable with no significant differences between the 2 groups in the measurements before and after the operation regarding mouth opening, lateral excursion and mandibular deviation. Complications related to the donor site were much higher in the costochondral group.Conclusion: Autogenous coronoid process is a promising alternative graft to the traditional costochondral graft for condylar reconstruction in adult patients with TMJ ankylosis.

Application of Bidirectional Distraction Osteogenesis for the Treatment of Mandibular Micriognathia Caused by Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis is a joint disorder that refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. When it happens on children, it is always accompanied by dentofacial deformities. The objective of this study was to describe the authors' experience of bidirectional distraction osteogenesis for the treatment of mandibular deformities caused by TMJ ankylosis. Sixteen patients with TMJ ankylosis and severe secondary mandibular deformities were treated with bidirectional distraction osteogenesis and release of joint from January 2013 to December 2015. Clinical outcomes were assessed based on the oral function, radiography, and medical photography. No reankylosis was found during the follow-up period. Sufficient volume and density new bone had been formed after the consolidation period. All patients have maintained stable improvement in oral function during the follow-up period. Most of the patients achieved satisfactory outcomes. Bidirectional transport distraction osteogenesis technique is a good and effective therapeutic option in treatment of bilateral or unilateral TMJ ankylosis patients associated with mandibular micrognathia.

The autogenous graft versus transport distraction osteogenesis for reconstruction of the ramus–condyle unit: a prospective comparative study

This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores. The radiographic evaluation 6 months postoperatively (computed tomography) included subjective assessment of joint morphology and measurements of the mean condylar height, width achieved, and amount of condylar resorption. The χ2 test and Student t-test were used to compare qualitative and quantitative variables, respectively. Similar mean mouth opening (SCG=31.8mm, TDO=32.1mm at 6 months), excursive movements, and pain scores were observed in the two groups throughout follow-up. Mean condylar resorption was significantly greater in the TDO group (TDO=7.0mm, SCG=2.7mm; P=0.005). The duration of reconstruction surgery was greater in the SCG group (P=0.035). A greater incidence of complications was observed with TDO. In conclusion, based on the protocols used in this study, SCGs are superior to TDO in terms of condylar morphology, stability, and surgical safety.

Cone-beam computed tomography evaluation of the maxillofacial features of patients with unilateral temporomandibular joint ankylosis undergoing condylar reconstruction with an autogenous coronoid process graft.

ObjectiveTo evaluate the changes in the jaws and the upper airways of unilateral temporomandibular joint ankylosis patients who underwent condylar reconstruction via autogenous coronoid process grafts using cone-beam computed tomography (CBCT).Study designThe 27 included patients underwent CBCT examinations at three stages: T0 (within two weeks before surgery), T1 (two weeks after surgery), and T2 (an average of 13 months after surgery). Forty items related to the maxillofacial hard tissues and the upper airway collected at the three times and the coronoid process graft volumes after surgery were compared.ResultsSome integral items related to the mandibular hard tissues exhibited statistical difference shortly after surgery. Some integral items related to maxillofacial hard tissues changing obviously long period after surgery may result from graft remodeling. Asymmetry-related item regarding local neo-condyle and some airway items were significantly different between T0 and T1. Due to variations in graft remodeling, some related local asymmetry items and airway items differed significantly between T0 and T2.ConclusionsAnteriorly and inferiorly located neo-condyles and a trend toward the pronation of the mandible were observed and the narrowness of the upper airway was improved shortly after surgery. The grafts remodeled differently and some integral and asymmetry items related to neo-condyle changed. The improvements in the upper airway were slightly reduced.

Role of pro-inflammation factors in the pathogenesis of temporomandibular joint ankylosed bone mass formation

Background: Temporomandibular joint ankylosis (TMJA) is a severe TMJ disease which leads to progressive mouth-opening inability while the pathological mechanisms of TMJ ankylosed bone mass formation are not fully clear. Previous studies had shown that pro-inflammation factors-induced osteoclastogenesis played important roles during bone healing and the inhibition of osteoclastogenesis during fracture healing will lead to hypertrophy callus formation. Our previous results had suggested that osteoclasts deficiency might contribute to hypertrophy TMJA bone mass formation. However, the mechanisms of osteoclast decreased in TMJA bone mass, and how pro-inflammation factors involved was not clear. Objectives: To explore the role of pro-inflammation factors in the pathogenesis of TMJA bone mass formation. Methods: 14 TMJA patients were recruited in this study and classified into four groups according to the Sawhney classification. The healthy mandibles were considered as control group. The pro-inflammation factors expressions in vivo and in vitro and the effects of pro-inflammation factors deficiency on osteoclastogenesis were assessed. Results: The pro-inflammation factors, tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6 and IL-17 were dramatically decreased while anti-inflammation factors, IL-10 and transforming growth factor-beta 1, were increased in TMJA bone mass. The histological results showed that TNF-α and IL-17 were abundant in early-progressed TMJA bone mass and decreased with the TMJA severity accompanied with reduced osteoclastogenesis. The osteoclast differentiation ability was impaired in bone marrow monocytes derived from TMJA bone mass and TNF-α partially rescued the osteoclast differentiation inhibition of TMJA bone marrow monocytes. Conclusion: Decreased pro-inflammation factors might inhibit osteoclast-mediated bone resorption and progressively contribute to TMJ ankylosed bone formation.