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Condylectomy and gap arthroplasty using fascia of temporal for treatment unilateral bone ankylosis of temporomandibular joint — a case report
236 Temporomandibular joint lower compartment surgery I. Rosenberg ANZAOMS, Australia The temporomandibular joint is divided into upper and lower joint compartments by the intraarticular cartilage. Significant pathology occurs in the lower joint compartment and therefore the arthroscopic procedure is incomplete without the ability to operate in both upper and lower joint compartments. Pathology found in the lower joint compartment is as follows: synovitis, effusion, adhesions, osteoarthritic bone changes, stuck disc Essential to this technique is that the joint be suitably distracted. Steinman pins and special distractor is used for this purpose. Three portal surgery is necessary: An anterior portal, a posterior portal and an intermediate portal to enable manipulation of the disc with a fine probe. The procedures that can be carried out in the lower joint compartment are as follows: Investigation of lower joint compartment pathology lysis and lavage in the lower joint compartment high condylar shave. An anterior release incision made in combination with the lateral disc access incision enables the disc to be reduced and stabilised with the Prolene endaural plication suture and cauterisation. Injection of Marcaine and steroid can be done into the lower joint compartment and posterior attachment by direct vision. In severely arthritic joints where a thorough lysis and lavage of adhesions in the lower joint compartment is carried out, with postoperative physiotherapy and occlusal splint management the joints can be rendered functional and comfortable for the patient without undergoing major arthroplasty procedures. http://dx.doi.org/10.1016/j.ijom.2017.02.796 Is total joint replacement along with fat grafts a new protocol for adult temporomandibular joint ankylosis treatment? A. Roychoudhury ∗ , R. Yadav, O. Bhutia, B. Aggrawal, B. Soni, D. Gowswami, D. Baidya All India Institute of Medical Sciences, New Delhi, India Objective: To record the outcomes of stock total joint replacement (TJR) along with fat grafts in adult temporomandibular joint (TMJ) ankylosis treatment and develop a protocol. Methods: A prospective study to evaluate the outcome of stock total TMJ replacement along with fat graft (buccal pad fat) in adult TMJ ankylosis patients. Aetiology, duration of ankylosis, maximal incisal opening (MIO), pre- and postoperative occlusion, mandibular movements, quality of life and recurrence was evaluated. Three-dimensional plastic models were fabricated for proper planning and measurements. Ankylosis was released and stock total joints were fixed through preauricular extended temporal incision in the same sitting. Concomitant orthognathic correction of facial asymmetry was carried out in two patients. Results: 11 patients (six females, five males) with 17 ankylosed joints (five unilateral, six bilateral) and mean age of 18.82 + 2.7 years were operated and followed up for 12–30 months. Sawhney’s type III (n = 8) and type IV (n = 7) were predominant ankylosis types. The MIO ranged from 0 to 4 mm preoperatively. The mouth opening improved to 38 mm ± 6 mm. No change in occlusion, no incidence of open bite encountered in any case. The dietary scores and quality of life improvement was marked (P < 0.01) No recurrence was noted.
Conclusions: Smooth mouth opening and ability to keep the occlusion unchanged together with no recurrence and ability to address the functional and aesthetic requirements by concomitant orthognathic surgery in adult TMJ ankylosis patients leads to a conclusion that TJR is probably the new protocol for the management of adult TMJ ankylosis. http://dx.doi.org/10.1016/j.ijom.2017.02.797 Oral mucosa rete ridge elongation is dependent, but not impact on integrin signalling G. Sa ∗ , S. He, Y. Zhao Wuhan University, Wuhan, China Background: Epithelial rete ridges contribute to the adhesion of epithelium by enlarging the contact areas between epithelium and lamina propria. Integrin family promotes the epithelial adhesion via tying epithelial cells to the basement membrane. Objectives: This study aims to explore whether elongation of rete ridge links with the integrin expression and signalling pathway. Methods: 40 Sprague Dawley were averagely divided into 5 groups, control, phosphate-buffered saline (PBS), keratinocyte growth factors (KGF), HYD-1 (a competitive antagonists of integrin), and KGF+HYD-1 group, respectively. The length of rete ridges, the expression intensity of integrin subunit alpha 6 (␣6), beta 4 (4), ␣3, and 1, as well as the strength of epithelial adhesion were measured after rat was topically injected with corresponding reagent in the venture of rat tongue. Findings: Oral mucosa rete ridges of rats of KGF group were longer that those of the control, PBS, HYD-1, and KGF+HYD1 group. However, the expression of integrin ␣6, 4, ␣6 and 1 of KGF group was not upregulated compared to the other groups. In vitro studies demonstrated that stimulating the HaCat cells with KGF did not impact the expression of integrin subunit ␣6, 4, ␣6, and 1. Oral epithelium of KGF group exhibited stronger, whereas those of HYD-1 and KGF+HYD-1 groups showed weaker adhesion strength compared with those of control and PBS groups. Conclusions: Rete ridge elongation does not impact the expression of integrin, but depends on the integrin function and strengthen the epithelial adhesion. http://dx.doi.org/10.1016/j.ijom.2017.02.798 Condylectomy and gap arthroplasty using fascia of temporal for treatment unilateral bone ankylosis of temporomandibular joint — a case report S.A. Sadputranto ∗ , A.T. Yuza Department of Oral and Maxillofacial Surgery, Hasan Sadikin General Hospital; and Faculty of Dentistry, Padjadjaran University, Indonesia Ankylosis is a condition of temporomandibular joint which clinically shows limitation or total restricted of mouth opening. Ankylosis is classified by severity (total or partial ankyloses), location (capsular and intracapsular) and the type of tissue involvement (fibrous, osseous and fibre osseous). Complication of ankylosis can be vary as the limitation of mouth opening may cause disturbance on speech, chewing and oral hygiene.
237 The aetiology of the ankylose of temporomandibular joint can vary, but most due to the fracture on condylar head. Besides trauma or infection can also be the cause of the ankylose. The treatment of osseous ankylosis is surgery. The procedure of condylectomy and gap arthroplasty is a treatment choice. The case is of a 17-year-old girl who presented to our clinic with the main complaint of mouth opening restriction since two years. The procedure of condylectomy and gap arthroplasty was performed, followed by mouth opening training treatment. The result of normal mouth opening and normal mouth and jaw function was achieved. http://dx.doi.org/10.1016/j.ijom.2017.02.799 The effect of Herbst treatment on amount and direction changes of temporomandibular joint growth: a short-term investigation of cone-beam computed tomography M.K. Sah ∗ , K. Fei-wu, Z. Gang, W. You-chao Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Tongji University, Shanghai, China Objective: To evaluate the amount and direction of temporomandibular joint (TMJ) growth changes with a Class II malocclusion treated with the Herbst appliance via cone-beam computed tomography (CBCT). Methods: Twelve Class II malocclusions were treated with the Herbst appliance. CBCT images obtained one week before treatment (T1), three months during treatment (T2), six months during treatment (T3) and after treatment (T4) were analysed. Results: (1) Signs of ‘double contour’ were observed during T2 or T3 in all objects. Condylar remodelling was analysed: the maximum amount was 2.26 mm, the minimum was 0.80 mm and the mean was 1.77 mm. (2) During the treatment, the growth of condyle was active and the region of remodelling was located at the posterosuperior area of condyle. The condyle was stimulated to remodel toward posterosuperior. (3) The relationship between condyle and glenoid fossa did not change significantly before and after treatment. (4) The remodelling pattern of glenoid fossa was similar with condylar, but the amount of the remodelling of glenoid fossa was less than that of condylar. The anterior incline of postglenoid tubercle was stimulated to remodel toward anteroinferior. Conclusions: Herbst appliance can not only stimulate the posterosuperior border of condyle to remodel toward posterosuperior, but also have effect on glenoid fossa; it can stimulate the anterior incline of postglenoid tubercle to remodel toward anteroinferior; CBCT evaluates the effect of the Herbst appliance intuitively and accurately which has a significant value in the study related to TMJ remodelling. http://dx.doi.org/10.1016/j.ijom.2017.02.800
Comparison between buccal fat pad and temporomyofascial flap as an interpositional graft material after gap arthroplasty in temporomandibular joint ankylosis cases — a clinical study P. Sawadkar ∗ , Y. Kini, G. Venkateshwar, M. Padhye, M. Jain, N. Borkhade, S. Takalkar D. Y. Patil University, School of Dentistry, Navi Mumbai, India Background: Although the buccal fat pad (BFP) and temporomyofascial flap (TMFF) have been used as an interpositional graft materials in temporomandibular joint (TMJ) ankylosis, the longterm fate of both is not known. This study assesses the efficacy of both the interpositional grafts post gap arthroplasty in TMJ ankylosis. Objective: To procure an easy to harvest graft with longevity and low relapse rate in TMJ ankylosis patients. Objectives: (1) To compare the ease of harvesting graft during gap arthroplasty procedure and behaviour of the graft during intraoperative, postoperative and follow up period. (2) To compare complications if any; during and post-placement of the graft and also the efficacy to prevent reankylosis. Methods: 20 subjects with unilateral bony ankylosis of TMJ in the 10–20-years age group over a period of five years were included in the study. After routine preoperative evaluation, the surgical treatment included gap arthroplasty along with interposition of BFP and TMFF in 10 patients each, respectively. Other parameters evaluated were mouth opening, facial weakness, reankylosis and any other complications. Findings: Intraoperative surgical ease of handling and time taken was noted and postoperatively all the patients were analysed for functional morbidity, relapse rate over a follow up period of two to five years. Conclusion: Every interpositional graft materials have their pros and cons. Priority should be given to that graft which is simpler, less technique sensitive, less invasive, involves less risk of complications and reach their goals within the shortest time frame. http://dx.doi.org/10.1016/j.ijom.2017.02.801 High accurate positioning after implantation of the patient specific Groningen temporomandibular joint prosthesis: a cadaver studies for assessment of accuracy F.K.L. Spijkervet ∗ , B. Merema, J. Kraeima Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Background: For patients with severe temporomandibular joint (TMJ) dysfunction surgical treatment with a total joint prosthesis could be indicated. The Groningen-TMJ prosthesis was developed as a stock prosthesis and applied successfully in multiple cases.1 This prosthesis included an original design with a mathematically determined lower pivot point, accounting for both rotational and translational movement of the joint. Objectives: Customisation of medical implants, based on threedimensional planning, leads to improved positioning accuracy and predictability of outcome. This study aims to develop a validated custom TMJ prosthesis, including fully guided surgical implantation, based on the Groningen principles.
Conclusions: Smooth mouth opening and ability to keep the occlusion unchanged together with no recurrence and ability to address the functional and aesthetic requirements by concomitant orthognathic surgery in adult TMJ ankylosis patients leads to a conclusion that TJR is probably the new protocol for the management of adult TMJ ankylosis. http://dx.doi.org/10.1016/j.ijom.2017.02.797 Oral mucosa rete ridge elongation is dependent, but not impact on integrin signalling G. Sa ∗ , S. He, Y. Zhao Wuhan University, Wuhan, China Background: Epithelial rete ridges contribute to the adhesion of epithelium by enlarging the contact areas between epithelium and lamina propria. Integrin family promotes the epithelial adhesion via tying epithelial cells to the basement membrane. Objectives: This study aims to explore whether elongation of rete ridge links with the integrin expression and signalling pathway. Methods: 40 Sprague Dawley were averagely divided into 5 groups, control, phosphate-buffered saline (PBS), keratinocyte growth factors (KGF), HYD-1 (a competitive antagonists of integrin), and KGF+HYD-1 group, respectively. The length of rete ridges, the expression intensity of integrin subunit alpha 6 (␣6), beta 4 (4), ␣3, and 1, as well as the strength of epithelial adhesion were measured after rat was topically injected with corresponding reagent in the venture of rat tongue. Findings: Oral mucosa rete ridges of rats of KGF group were longer that those of the control, PBS, HYD-1, and KGF+HYD1 group. However, the expression of integrin ␣6, 4, ␣6 and 1 of KGF group was not upregulated compared to the other groups. In vitro studies demonstrated that stimulating the HaCat cells with KGF did not impact the expression of integrin subunit ␣6, 4, ␣6, and 1. Oral epithelium of KGF group exhibited stronger, whereas those of HYD-1 and KGF+HYD-1 groups showed weaker adhesion strength compared with those of control and PBS groups. Conclusions: Rete ridge elongation does not impact the expression of integrin, but depends on the integrin function and strengthen the epithelial adhesion. http://dx.doi.org/10.1016/j.ijom.2017.02.798 Condylectomy and gap arthroplasty using fascia of temporal for treatment unilateral bone ankylosis of temporomandibular joint — a case report S.A. Sadputranto ∗ , A.T. Yuza Department of Oral and Maxillofacial Surgery, Hasan Sadikin General Hospital; and Faculty of Dentistry, Padjadjaran University, Indonesia Ankylosis is a condition of temporomandibular joint which clinically shows limitation or total restricted of mouth opening. Ankylosis is classified by severity (total or partial ankyloses), location (capsular and intracapsular) and the type of tissue involvement (fibrous, osseous and fibre osseous). Complication of ankylosis can be vary as the limitation of mouth opening may cause disturbance on speech, chewing and oral hygiene.
237 The aetiology of the ankylose of temporomandibular joint can vary, but most due to the fracture on condylar head. Besides trauma or infection can also be the cause of the ankylose. The treatment of osseous ankylosis is surgery. The procedure of condylectomy and gap arthroplasty is a treatment choice. The case is of a 17-year-old girl who presented to our clinic with the main complaint of mouth opening restriction since two years. The procedure of condylectomy and gap arthroplasty was performed, followed by mouth opening training treatment. The result of normal mouth opening and normal mouth and jaw function was achieved. http://dx.doi.org/10.1016/j.ijom.2017.02.799 The effect of Herbst treatment on amount and direction changes of temporomandibular joint growth: a short-term investigation of cone-beam computed tomography M.K. Sah ∗ , K. Fei-wu, Z. Gang, W. You-chao Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Tongji University, Shanghai, China Objective: To evaluate the amount and direction of temporomandibular joint (TMJ) growth changes with a Class II malocclusion treated with the Herbst appliance via cone-beam computed tomography (CBCT). Methods: Twelve Class II malocclusions were treated with the Herbst appliance. CBCT images obtained one week before treatment (T1), three months during treatment (T2), six months during treatment (T3) and after treatment (T4) were analysed. Results: (1) Signs of ‘double contour’ were observed during T2 or T3 in all objects. Condylar remodelling was analysed: the maximum amount was 2.26 mm, the minimum was 0.80 mm and the mean was 1.77 mm. (2) During the treatment, the growth of condyle was active and the region of remodelling was located at the posterosuperior area of condyle. The condyle was stimulated to remodel toward posterosuperior. (3) The relationship between condyle and glenoid fossa did not change significantly before and after treatment. (4) The remodelling pattern of glenoid fossa was similar with condylar, but the amount of the remodelling of glenoid fossa was less than that of condylar. The anterior incline of postglenoid tubercle was stimulated to remodel toward anteroinferior. Conclusions: Herbst appliance can not only stimulate the posterosuperior border of condyle to remodel toward posterosuperior, but also have effect on glenoid fossa; it can stimulate the anterior incline of postglenoid tubercle to remodel toward anteroinferior; CBCT evaluates the effect of the Herbst appliance intuitively and accurately which has a significant value in the study related to TMJ remodelling. http://dx.doi.org/10.1016/j.ijom.2017.02.800
Comparison between buccal fat pad and temporomyofascial flap as an interpositional graft material after gap arthroplasty in temporomandibular joint ankylosis cases — a clinical study P. Sawadkar ∗ , Y. Kini, G. Venkateshwar, M. Padhye, M. Jain, N. Borkhade, S. Takalkar D. Y. Patil University, School of Dentistry, Navi Mumbai, India Background: Although the buccal fat pad (BFP) and temporomyofascial flap (TMFF) have been used as an interpositional graft materials in temporomandibular joint (TMJ) ankylosis, the longterm fate of both is not known. This study assesses the efficacy of both the interpositional grafts post gap arthroplasty in TMJ ankylosis. Objective: To procure an easy to harvest graft with longevity and low relapse rate in TMJ ankylosis patients. Objectives: (1) To compare the ease of harvesting graft during gap arthroplasty procedure and behaviour of the graft during intraoperative, postoperative and follow up period. (2) To compare complications if any; during and post-placement of the graft and also the efficacy to prevent reankylosis. Methods: 20 subjects with unilateral bony ankylosis of TMJ in the 10–20-years age group over a period of five years were included in the study. After routine preoperative evaluation, the surgical treatment included gap arthroplasty along with interposition of BFP and TMFF in 10 patients each, respectively. Other parameters evaluated were mouth opening, facial weakness, reankylosis and any other complications. Findings: Intraoperative surgical ease of handling and time taken was noted and postoperatively all the patients were analysed for functional morbidity, relapse rate over a follow up period of two to five years. Conclusion: Every interpositional graft materials have their pros and cons. Priority should be given to that graft which is simpler, less technique sensitive, less invasive, involves less risk of complications and reach their goals within the shortest time frame. http://dx.doi.org/10.1016/j.ijom.2017.02.801 High accurate positioning after implantation of the patient specific Groningen temporomandibular joint prosthesis: a cadaver studies for assessment of accuracy F.K.L. Spijkervet ∗ , B. Merema, J. Kraeima Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Background: For patients with severe temporomandibular joint (TMJ) dysfunction surgical treatment with a total joint prosthesis could be indicated. The Groningen-TMJ prosthesis was developed as a stock prosthesis and applied successfully in multiple cases.1 This prosthesis included an original design with a mathematically determined lower pivot point, accounting for both rotational and translational movement of the joint. Objectives: Customisation of medical implants, based on threedimensional planning, leads to improved positioning accuracy and predictability of outcome. This study aims to develop a validated custom TMJ prosthesis, including fully guided surgical implantation, based on the Groningen principles.