Idiopathic Condylar Resorption: Analysis of Outcomes Following Total Joint Replacement

Oral Abstract Track 3 1.5 mm/day distraction rate at the center the mandible, the superior portion opened 1 mm/day while the inferior border opened at 2 mm/day. The 3 mm distraction rate opened the superior portion 2 mm/day and the inferior portion 4 mm/day. All mini-pigs survived the operation, distraction, and consolidation periods. Group 1 (n⫽5) averaged 1.4 mm/ day of distraction and 25 days of fixation. Mean scores for stability, clinical bone fill and radiographic densities were 2.4, 2.6 and 2.6, respectively. Group 2 (n⫽5) averaged 2.4 mm/day of distraction and 28 days of fixation. Mean scores for stability, clinical bone fill and radiographic densities were respectively 3, 2.6, and 2.6. The historical control groups using discontinuous distraction rates of 1, 2 and 4mm/day had mean stability scores of: 3, 1.5 and 1.5, respectively, clinical bone fill: 3, 2, and 2 and for radiographic bone fill 3, 2, and 1.5. Results of this study validate a novel automated device for DO and demonstrate that continuous distraction allows bone fill at faster rates than discontinuous DO. Continuous distraction rates up to 4 mm/day allowed for stability, clinical and radiographic bone fill. This device and technique has the potential to shorten treatment time in the management of craniofacial deformities. References: Glowacki J, Shusterman EM, Troulis M et al. Distraction osteogenesis of the porcine mandible: histomorphometric evaluation of bone. Plast Reconstr Surg:566-73, 2004. Troulis MJ, Glowacki J, Perrott DH et al. Effects of latency and rate on bone formation in a porcine mandibular distraction model. J Oral Maxillofac Surg58:507-13, 2000.

3D Evaluation and Analysis of the Growth Pattern of the Upper Airway Space in Normal Pediatric to Early Adult Patients J. A. Broujerdi: Private Practice, R. Jacobson, S. A. Schendel

transverse and AP dimensions at the PNS, hyoid, occlusal plane, retropalatal and retroglossal choke points measured. The vertical length of the UAS, soft palatal length and the distance from the hyoid to the mandibular plane measured. Results: The UAS volume at age 6-8 is 5.67cm3 and at age 21-25 is 14.23cm3, this is a 250% increase. The UAS height is 44 mm at age 6-8 and at age 21-25 is 59.77 mm, this is a 135% increase. The retropalatal volume, choke point surface area and length is larger than retroglossal but the retroglossal volume, choke point surface area and length increased more in percentage growth. The soft palate measured 29.23 mm at ages 6-8 and 37.50 mm at age 21-25, this is a 128% increase. The distance hyoid to the mandibular plane measured 8.34 mm at age 6-8 and 14.6 mm at age 21-25, this a 175% increase. There is a growth spur between the ages 9-17 in all 3 dimensions of the airway, this also affects the length and width of the soft palate and the descent of the hyoid. Conclusions: The UAS can be evaluated and quantified. There is growth in 3 planes, the growth spur accounts for vertical growth of the face. This data can be used as a norm and base line to evaluate, classify and treat pedatric to early adult group of patients with craniofacial anomalies (Pierre Roban Sequence) affecting the upper airway causing obstructive sleep apnea. Main Objectives of Presentation: Evaluate, quantify and analyze growth of the upper airway in normal heallthy pedatric patients. Refference: Schendel SA et al. Airway analysis: with bilateral distraction of infant mandible. J Craniofac Surg. 2009 Sep:20(5):1341-6. Schendel SA et al. Airway growth and development: A computerized 3-dimensional analysis. J Oral Maxillofac Surg. 2012 Feb 9.

Idiopathic Condylar Resorption: Analysis of Outcomes Following Total Joint Replacement P. Mehra, J. He, O. Norris: Boston University

Background & Purpose: To evaluate, quantify and analyze growth of the upper airway space of normal pediatric to early adult group of patients. Methods: 180 DICOM files from cone-beam CAT Scan study of individuals in orthodontic treatment were evaluated for the upper airway space (UAS) using 3dMDvaultus software (Atlanta, GA). Patients’ age ranged from 6 to 25 years and consisted of 90 male, 90 female patients. Patients were categorized into six age groups ranging from, 6-8, 9-11, 12-14, 15-17, 18-20 and 21-25. Patients were other wise healthy individuals and did not have symptoms or history of sleep apnea. The UAS was identified between the PNS to the hyoid. The UAS divided into retropalatal (PNS-soft palate) and retroglossal (soft palate-hyoid) space. The total volume of the UAS, retropalatal and retroglossal measured. The surface area, e-30

Statement of Problem: Idiopathic condylar resorption (ICR) continues to present a major diagnostic and therapeutic challenge to practitioners for many reasons including rarity of the condition, progressive nature of the deformity, and its simultaneous involvement of skeletal, occlusal and articular disorders. Recommended treatment alternatives range from no surgery, only orthognathic surgery (maxillary impaction and chin camouflage surgery), staged TMJ and orthognathic surgery, to concomitant TMJ and orthognathic surgery. Traditionally, costochondral grafts have been used for TMJ replacement in this sub-group of patients, but advances in technology and availability of modern, patient-fitted TMJ alloplastic replacement systems may offer many benefits over such autogenous replacement options. AAOMS • 2012

Oral Abstract Track 3 Materials and Methods: A retrospective analysis of all patients who underwent surgical treatment of ICR by a single surgeon at Boston University Medical Center hospital between 2000 and 2008 was performed. Criteria for inclusion in the study included: 1) Progressive mandibular retrusion secondary to TMJ resorption, 2) Negative screening for known forms of systemic arthrides causing TMJ resorption, c) Absence of any history of trauma, 4) Presence of anterior open bite with Class II skeletal and dental malocclusion, and, 5) Surgical treatment involving bilateral TMJ total joint replacement and concomitant mandibular advancement with or without maxillary surgery. Clinical and radiographic examination was performed presurgically (T1), immediately postsurgery (T2), and at longest follow-up (T3). Visual analog scales were used for subjective examination of jaw function, dietary restrictions, functional disability, patient satisfaction, and pain at each of the above intervals. Objective examinations included: a) clinical evaluations of TMJ sounds, anterior open bite, occlusal relationship, mandibular range of motion (excursions, protrusion, and maximum opening), cranial nerve VII injury, and objectionable scarring, and, b) radiographic analysis by superimposition of cephalometric tracings for measurement of surgical change (T2-T1) and relapse (T3-T2). Results: A total of 21 patients were included in the study. The average patient age was 25.6 years (range 22 - 32) and average follow up was 3.4 years (R 2-8). All patients were females. 10/14 (70%) patients correlated the period of active orthodontic treatment to the initiation of resorption. All patients gave a history of clicking/ popping of their TMJ’s at some stage during their lifetime. Average surgical time was 8.5 hours (R 5.5-9) and the average duration of hospitalization was 2.6 postsurgical days (R 2-5). Average mandibular advancement at Point B was 18.9 mm (R 14-27) and average occlusal plane change was ⫺6.8 degrees (R 3-8). 16/21 (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. One patient had prolonged weakness of the frontal/temporal branch, which resolved completely in 7 months. Long-term follow-up revealed excellent stability of surgical movements with significant decrease in TMJ and myofascial pain, headaches, and dietary restrictions. Conclusions: ICR patients can be treated very effectively using patient-fitted TMJ total joint prostheses for correction of TMJ resorption and mandibular advancement in combination with maxillary orthognathic surgery, when indicated for correction of the associated dentofacial deformity. Use of these prostheses eliminates donor site morbidity and allows for extremely large mandibular advancements to be performed in a predictable manner with a drastic reduction in TMJ dysfunction AAOMS • 2012

symptoms and excellent stability of orthognathic movements.

Clinical Findings Associated With Temporomandibular Joint Involvement in Children With Juvenile Idiopathic Arthritis H. K. Susarla: Harvard School of Dental Medicine, S. Abramowicz, S. Kim, L. Kaban Statement of the Problem: The gold standard for diagnosis of temporomandibular joint (TMJ) synovitis in children with Juvenile Idiopathic Arthritis (JIA) is magnetic resonance imaging (MRI). MRIs can be costly, time consuming and may require general anesthesia. Therefore, it would be beneficial to recognize physical findings that consistently reflect the presence of TMJ synovitis. The purpose of this study was to identify clinical findings associated with synovitis in pediatric JIA patients. Methods of Data Analysis: The sample included children with JIA, according to International League of Associations for Rheumatology, who were evaluated by Oral and Maxillofacial Surgery (OMFS) at Children’s Hospital Boston and who had an MRI with contrast of TMJs. Data collected included: (1) Demographics (gender, age); (2) clinical examination (jaw pain, facial asymmetry, joint noises, maximal incisal opening (MIO), lateral excursions, deviation on mouth opening, maxillary occlusal cant); and (3) MRI findings (presence or absence of synovitis). Cases were defined as patients with JIA and TMJ synovitis on MRI; controls were patients with JIA without synovitis. Statistical analysis was used to identify associations between clinical findings and TMJ synovitis. P-value⬍0.05 was considered significant. Results: There were 43 subjects (33 females) with a mean age of 11.4 years (range 3-19 years) who met inclusion criteria. Of these, 27 cases (63%) had MRI findings consistent with TMJ synovitis. Sixteen patients (37%) did not have synovitis. Frequency of abnormal findings in patients with synovitis was: limited MIO (N⫽23, 85%), facial asymmetry (N⫽10, 37%), deviation on mouth opening, (N⫽9, 33%), jaw pain (N⫽8, 30%), joint noises (N⫽5, 18.5%), and maxillary cant (N⫽5, 18.5%). In patients without synovitis the frequencies were: limited MIO (N⫽6, 37.5%), facial asymmetry (N⫽5, 31%), pain (N⫽5, 31%), joint noises (N⫽4, 25%), maxillary cant (N⫽2, 12.5%), and deviation on mouth opening, (N⫽1, 6%). Of all predictor variables tested with univariate analysis, limited MIO and deviation on opening were significantly associated with synovitis on MRI (p⫽0.004 and p⫽0.007, respectively). Limited MIO had a sensitivity of 0.85, specificity of 0.86, and deviation on opening had a sensitivity of 0.10 and specificity of 0.94. In a multiple e-31