Terms Of Mouth Opening Research Articles

CAD/CAM and conventional reconstruction of the mandibular condyle by fibula free flap: a clinical and radiological evaluation

The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre- and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.

P-36666236-311 - Abdominal dermal fat graft versus nasolabial flap in oral submucous fibrosis: A randomised clinical trial

<h3>Background</h3> The surgical management of oral submucous fibrosis (OSMF) includes intraoral release of fibrous bands and creating a raw area, usually covered by biological or non-biological materials. The abdominal dermal fat graft is easy to harvest, with sufficient bulk and is cosmetically better, while the nasolabial flap has good vascularity. This study compares the efficacy of abdominal dermal fat graft with nasolabial flap in OSMF. <h3>Method</h3> Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (Abdominal dermal fat graft) and Group B (Nasolabial flap). They were evaluated for graft uptake, mouth opening, time taken for mucosalization, pain and thickness of masseter muscle on ultrasonogram (USG) till 6 months. <h3>Findings</h3> At 6 months, the average mouth opening improved by 22.4mm (20- 24mm) and 36.2mm (32-37mm) in Group A and Group B respectively which was clinically and statistically significant. Graft uptake was 80% in group A and 100% in group B and time taken for mucosalization was 11 weeks for group A and 6 weeks for group B which was statistically significantly better (p<0.05) for group B. No statistical difference was noted in pre and post operative pain and thickness of masseter muscle in both groups. Intraoral hair growth, facial scar and accentuation of the nasolabial fold was seen in Group B. <h3>Conclusion</h3> Nasolabial flap holds better in terms of mouth opening, graft uptake and time taken for mucosalization as compared to abdominal dermal fat graft in the management of OSMF.

Assessment between Aloe Vera Gel and Intralesional Hydrocortisone in the Management of Stage II Oral Submucous Fibrosis

Objective: To assess the effect of aloe vera gel and intralesional hydrocortisone in the management of stage II oral submucous fibrosis patients in terms of mouth opening and burning sensation. Subject and Methods: A total of 38 patients were equally divided into two groups; i.e Group A was treated with herbal antioxidant aloe vera gel, while Group B was treated with traditional intralesional hydrocortisone. Patients of stage II OSMF were diagnosed clinically on the basis of presenting symptoms. Mouth opening and burning sensations were recorded at start of treatment and postoperatively for 3 months period. All findings were recorded on proforma. Results: In both groups males were in majority as compared to females. Total of 13 males and 6 females, 14 males and 5 females were reported in Group A and B respectively (P Value 0.5190. Mean age of patients in group A was 25.19 ± 6.33, while in group B it was 28.93 ± 5.82. Significant improvement in mouth opening and burning sensation was found equally in both groups. Conclusion: Aloe vera gel applied topically and intralesional hydrocortisone are equally effective in reducing the symptoms of stage II OSMF patients. Keywords: Oral Submucous Fibrosis, Aloe Vera, Intralesional Hydrocortisone, Mouth Opening, Burning Sensation

Effect of Muscle Relaxant on Pain Perception among Patients of Temporomandibular Disorder

Objective: The objective of the study was to explore the impact of muscle relaxants on pain relief among patients of temporomandibular disorders. Method: This research study was based on clinical trial conducted in Oral and Maxillofacial Surgery Department of Dental Hospital, University College of Dentistry, Lahore. Data was collected from 60 patients reported the department of oral and maxillofacial surgery with complaints of myofascial pain using nonprobability convenient sampling technique. SPSS version 25. Was used for data analysis. Age and duration of symptoms were reported in mean and standard deviation whereas to calculate the effectiveness of muscle relaxant, independent sample t test was used. Results: The results of independent sample t test revealed a significant difference between the pre-treatment values and post-treatment values in terms of pain (P=.001) and mouth opening (P=.034). Pre-treatment in terms of pain, mean score was 7.70+2.4 whereas post-treatment, mean score was 4.01±1.3. Pre-treatment, in terms of mouth opening, mean score was 37.70+3.90 whereas post-treatment, in terms of mouth opening, mean score was 41.67±3.06. Conclusion: Muscles relaxant (diazepam) is quite effective in relieving TMD pain and in enhancing mouth opening due to temporomandibular disorders among patients Keywords: Muscle relaxant, Pain perception, TMD, Diazepam

Functional Rehabilitation after Mandibular Fracture - A Systematic Review.

The objective of this study was to evaluate the efficiency of functional rehabilitation in terms of mouth opening, quality of life, healing process, occlusion and dysfunction, between different treatment methods, after condylar fractures, based on the current literature. Using the PRISMA guidelines in search of clinical trials published between 2011 and 2021, a literature analysis was performed. This search was conducted using the following Medical Subject Headings (MeSH) terms: rehabilitation OR mouth opening recovery OR function recovery AND mandibular fracture OR condylar fracture. The literature search resulted in a total of 110 study articles, of which seven publications were used in the present review, according to a selection based on the pre-established eligibility criteria. The review showed that open reduction resulted in a better three-dimensional recovery of mandibular movements and revealed greater results regarding the absence of the symptoms after applied treatment. However, studies assessing closed reduction, especially performed with intermaxillary fixation screws (IMFS), revealed excellent results in terms of quality of life, mouth opening and occlusal parameters. This systematic literature review showed that open reduction resulted in a better three-dimensional recovery of mandibular movements and showed greater results regarding the absence of symptoms. However, studies assessing CR, especially those performed with IMFS, revealed excellent results in terms of quality of life, mouth opening and occlusal parameters.

A systematic review on the outcome of distraction osteogenesis in TMJ ankylosis

IntroductionTMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa. Material and methodsThe research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects. Results1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed. ConclusionAlthough DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis.

Bilateral Biplanar Distraction Osteogenesis in Facial Deformity Secondary to Temporomandibular Ankylosis.

The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42years (mean 20.09) of bilateralTemporomandibular joint ankylosis. Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB). OSAHS was evaluated through Epworth sleepiness scale, Berlin's questionnaire, pharyngeal airway space, apnoeic hypoapnoeic index, oxygen desaturation index, average arterial oxygen saturation and minimal fall in O2 saturation. Patients were followed up for a period of 13-74months (mean 28.68). Statistically highly significant results were obtained in all parameters. Complications encountered were pin infection (13.63%), loosening of pins (4.5%), wound dehiscence (9.09%), tooth fracture (4.5%) and parotid fistula (9.09%). Intermediate segment necrosis and vector loss were not observed. This study is a large case series using two corticotomy cuts for external bilateral bidirectional distracters with concomitant neo callous moulding in patients both pre- and post-ankylosis release. It is extremely efficient in correcting mandibular corpal and ramal deficiency as well as improving OSAHS.

Gap Arthroplasty or Interpositional Arthroplasty for the Management of TMJ Ankylosis? A Prospective Randomized Comparative Multicenter Clinical Trial.

The main aim of this study is to compare the gap arthroplasty with interpositional gap arthroplasty for the management of TMJ ankylosis. A prospective randomized multicenter clinical trial had been performed, on 60 patients diagnosed with TMJ ankylosis from August 2005 to June 2015. Patients were equally divided into two groups: Group I patients were treated with gap arthroplasty, while patients in Group II were treated with interpositional arthroplasty. The mean age in Group I was 27.9years and in Group II was 25.6years. Trauma was the common etiological factor in both the groups. The mean postoperative mouth opening after 1month, 6months and 24months was found to better in Group II. Open bite after 24months was present in six patients in Group I and in one case in Group II. Permanent facial nerve palsy was present in one patient in both the groups. Frey's syndrome was present in one patient from Group I and none from Group II. Reoccurrence occurred in eight cases from Group I (26.6%) and none from Group II. This study concluded that interpositional arthroplasty is better than gap arthroplasty in terms of mouth opening and reankylosis.

Non-Vascularized Autogenous Bone Grafts for Reconstruction of Maxillofacial Osseous Defects.

To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. Case series. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015. Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening. A total of 30 patients ranging from 8 to 60 years (33.57 ±14.74 years) had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases (50%) were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases (36.7%) with rib; while in four cases (13.3%), costochondral graft was used for reconstruction. In 26 cases (86.7%), graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed. Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects.

Exercise intervention for the treatment of trismus in head and neck cancer – a prospective two-year follow-up study

Background This study aims to investigate the long-term effects of structured trismus intervention in patients with head and neck cancer (HNC) and trismus in terms of mouth opening, trismus-related symptoms and health-related quality of life (HRQL).Material and methods Fifty patients with HNC to receive radiotherapy ± chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engström device). Patients were assessed before and after trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & Neck Questionnaire (EORTC QLQ-H&N35)].Results The intervention group had a higher MIO at the two-year follow-up compared to the control group (40.5 mm and 34.3 mm, respectively), which was statistically significant. The intervention group also reported less jaw-related problems according to the GTQ and higher functioning as measured by EORTC QLQ-C30 and QLQ-H&N35 compared to the control group.Conclusion A positive persistent effect of exercise intervention for trismus in HNC patients was found with regard to MIO, trismus-related symptoms and HRQL. Exercise intervention is important in long-term treatment of radiation-induced trismus in HNC patients. The trismus-specific questionnaire, GTQ, is a valuable tool for observing and evaluating trismus over time.

Closed versus open treatment of mandibular condylar process fractures: A meta-analysis of retrospective and prospective studies.

The treatment of fractures of the mandibular process remains controversial, although there is a trend towards open reduction and internal fixation. This study compared open and closed treatments and assessed the results with a meta-analysis. A literature search of PubMed found eight studies that met the search criteria and were included in the meta-analysis. The studies increasingly suggest better results for open treatment, in terms of mouth opening, protrusion, laterotrusion, pain, and malocclusion. In the meta-analysis, the outcome was significantly better for laterotrusion and protrusion in patients treated by open reduction and internal fixation. Due to the different study protocols and lack of information on classification, follow-up time, and inclusion criteria, comparison of the studies remains difficult and further prospective, randomized studies should examine these issues.

Lycopene and intralesional betamethasone injections in the management of oral submucous fibrosis

Aims and Objectives: This study was conducted to determine the efficacy of lycopene in the management of oral submucous fibrosis (OSMF) and to compare its efficacy with intralesional betamethasone injections. Materials and Methods: Forty-four patients were divided randomly into two groups. Group I subjects were treated with 10,000 mcg of lycopene (Lyconex) daily, in two equally divided doses, for two months. Group II subjects were given intralesional injections of betamethasone. Both the groups were assessed in terms of mouth opening and burning sensation. Results: A significant improvement in mouth opening was seen in both the groups and the improvement was better in Group I. The mean improvement in mouth opening in Group I was 37.62% (12 mm) at the end of the study, which was statistically highly significant and weekly evaluation revealed that this high significance was from the third week onward, and Group II patients (only intralesional steroids) showed an average improvement of 13% (3.9 mm) at the final follow-up visit. Conclusion: Lycopene (Lyconex) is better than intralesional betamethasone injections in improving mouth opening and decreasing burning sensation.