Comparison of interpositional arthroplasty using dermis fat graft with gap arthoplasty (GA) in the management of temporomandibular joint ankylosis

Comparison of interpositional arthroplasty using dermis fat graft with gap arthoplasty (GA) in the management of temporomandibular joint ankylosis

223 Methods: A retrospective study. During the past two years, a new physiotherapy program was implemented for patients undergoing arthroscopy at our ...

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223 Methods: A retrospective study. During the past two years, a new physiotherapy program was implemented for patients undergoing arthroscopy at our department, and 82 patients suffering from acute closed lock and undergoing arthroscopic lysis and lavage were rehabilitated according to this program. An equal number of consecutive patients treated before the initiation of the new program with similar diagnosis and arthroscopic intervention were included in the study as control group. Both physiotherapy programs consisted of self-exercises and guided manual therapy, however differed in the time of initiation of self-exercises (immediate versus after one week), duration of each exercise (one versus five min), and number of exercises per day. The primary outcome variables were mouth opening and pain. Findings: Patients treated by the new physiotherapy protocol exhibited a significantly more rapid rehabilitation and gaining of full range of motion compared to the patients treated by the old program. In addition, the overall success rate was higher in the new program group. Conclusion: To achieve best results in treating acute closed lock, post-arthroscopy physiotherapy should consist of immediate mobilisation with short-duration exercises performed many times a day. http://dx.doi.org/10.1016/j.ijom.2017.02.753 Is facial symmetry attainable after “high condylectomy only” in patients with unilateral active condylar hyperplasia? W. Abboud ∗ , M. Krichmar, R. Yahalom Sheba Medical Center, Tel-Hashomer, Israel Background: Condylar hyperplasia (CH) causes various degrees of facial asymmetry and occlusal changes. The treatment of inactive CH is orthognathic surgery, whereas active CH requires in addition, high condylectomy to stop the hyperplastic condylar growth. Some authors reported high condylectomy to be also effective in achieving facial symmetry with no need for additional orthognathic surgery. Objective: To determine the degree of correction of facial asymmetry in CH after high condylectomy only. Methods: Ten patients with unilateral active CH were treated by condylectomy (removal of superior 5–8 mm of condyle) that was not followed by orthognathic surgery. Preoperatively, patients were classified as mild, moderate, and severe facial asymmetry according to the triangular analysis of the PA cephalogram as described by Reyneke. PA cephalograms and en-face photographs taken approximately one year after surgery were compared to baseline records. Findings: Four patients with mild facial asymmetry achieved excellent symmetry after high condylectomy and did not require further orthognathics. The other six patients with either moderate or severe facial asymmetry improved to various degrees after condylectomy, however, did not attain a satisfactory symmetric result, and three of them requested a secondary orthognathic surgery. Conclusion: Active condylar hyperplasia with mild facial asymmetry could be treated sufficiently with high condylectomy only, whereas moderate and severe degrees of facial asymmetry will benefit from the addition of orthognathic surgery. Surgeons could predictably determine based on the PA cephalometric analysis

which patients will be sufficiently treated with high condylectomy only and which will require the addition of orthognathic surgery. http://dx.doi.org/10.1016/j.ijom.2017.02.754 Comparison of interpositional arthroplasty using dermis fat graft with gap arthoplasty (GA) in the management of temporomandibular joint ankylosis N. Aggarwal ∗ , N.N. Andrade, C.P. Mathai Nair Hospital Dental College, Mumbai, India Background: Over the past 150 years, much has been said and done as far as temporomandibular joint (TMJ) pathologies are concerned, of particular importance is TMJ ankylosis. It is an age old affliction that causes problems in mastication, digestion, speech, function, cosmesis, and maintenance of oral hygiene. Today, both gap arthoplasty (GA) and interpositional arthroplasty (IA) have become the acceptable standards for the primary surgical management of TMJ ankylosis. Objectives: We compared GA with IA using dermis fat with our primary outcome as maximal mouth opening, and secondary outcomes as pain during mouth opening, fate of the dermis fat graft and patient satisfaction. Methods: Twenty patients with clinical and radiological diagnosis of TMJ ankylosis were randomly divided into two groups. One group underwent GA while the other group received dermis fat as an interpositional material. Both groups were followed up to two years and maximum mouth opening was recorded. Additionally, magnetic resonance imaging was done for dermis fat group to calculate the volume of the graft. Findings: The mean mouth opening after one year of follow-up was 37.4 and 38.9 mm in IA and GA group respectively. No significant difference was found between the two groups (P < 0.05). Conclusion: Both the modalities are successful in surgical management of TMJ ankylosis. However, clinically, compliance of the dermis fat group in jaw exercises was found to be better than the gap arthroplasty group as suggested by lower pain scores in this group. http://dx.doi.org/10.1016/j.ijom.2017.02.755 The outcome of trigger point therapy using bupivicaine injection as a primary treatment for myogenic temporomandibular disorders Y. Al Riyami ∗ , A. Al Hashmi Oman Medical Specialty Board, Muscat, Oman Objective: Assess effectiveness of trigger point therapy with bupivacaine local anaesthetic injected into painful muscles of mastication as a primary treatment for patients with myogenic temporomandibular disorders (TMD). Methods: Patients with myogenic subdivision according to the Research Diagnostic Criteria for TMD, severe pain according to the pain-visual analogue scale (VAS) and sever jaw dysfunction according to the Helkimo index were selected to receive the injections as primary treatment. None of the patients received conservative treatment. Intraoral local anaesthetic (bupivacaine) administered into painful muscles of mastication. Masseter, temporalis and