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Osteotomy for ankylosis of left temporomandibular joint
Case Report OSTEOTOMY FOR ANKYLOSIS OF LEFT TEMPOROMANDIBULAR JOINT GEORGE
W. CHRISTIANSES,
A.B., D.D.S., MS., DETROIT,
MICH.
Case Report r
HE patient dates the onset of his illness to 1943 while on duty in bhe Army r at Fort Leavenworth, Kansas. He remembers wakening one morning with This condition did not disappear, his jaws sore from tenderness in the joints. and d.uring the next two years he was unable to open his jaws widely. In June, 1.945, an operation was performed on the right temporomandibular joint in order to increase his ability to open the mouth, but he states t,hat since the operation he has not been able to open the jaws as widely as before.
Examination The patient was a 42-year-old man. He was cooperative and oriented as to time, place, person, and circumstance, but memory was poor and he His pupils were irregular and fixed to was somewhat euphoric and childish. light. He could open his mouth only about one-half inch, and there was partial edentulism with numerous cavities in the remaining teeth. He suffered from advanced gingivitis. The knee jerks were hyperactive bilaterally; no abnormal reflexes were demonstrated. Kahn and Kline tests were both 2t, and Wassermann examination was negative. Examination of his spinal fluid showed a midzone gold curve, with a positive Wassermann.
Roentgenologic Report Skull and Mandible.-The bones of the skull are normal. in appearance. The head of the condyloid process on the left side is very large, projects considerably inward, and the head and the remainder of the ramus of the mandible on this side are consi,derably broader and denser than average. On the right side the head and the major portion of the neck have been removed, but the coronoid process, together with the remainder of the ramus, is, considerably denser and broader than average. The remainder of the mandible likewise appears to be slightly broader than average, but does not share in the increase in density to the same extent that the rami do. I believe t,he joint space of the left temporomandibular joint ‘is entirely obliterated, and that there is complete ankylosis of this joint. A common cause of hyperostosis, of course, is syphilis. -Received
for publication
April
Q, 1948. 811
Opinion : Nyperostosis of the mandibular condyle with ankylosis of the left side, and postoperative SW*gical removal of the head and neck on the right side (Figs. 1 and 2).
Rig.
2. -Anteropostet’iw
view
of left
mndyle.
Treatment Under sodium pentothal a,nd regional block anesthesia, dn incision was made upward from the external auditory meatus in the preauricular area to slightly above the zygomatic ridge and then anteriorly for a total length of about 9 cm. (Big. 3). The fascia and periosteum were eleva.ted from the bone and examination revealed a complete bony ankylosis of the right temporoman-
OSTEOTOMY
FOR
ASKYLOSIS
OF LICEY’ TEiUI’OROMAP\‘DIBULAR Fig.
JOIKT
813
3.
Fig. 4. Fig. J.-Inverted L-shaped incision in preauricular area. Fig. 4.-The mouth owns withcut difficulty to near normal
distance.
The capsular ligaments were completely ossified and no movedibular joint. ment of the jaw was possible. A bone drill was used to divide the ascending ramus a,bout 2 cm. below the zygoma. The bone was dense, Aintiike in hardFollowing ness, and nearIy 3 cm. in thickness at the point of separation. division of the ra,mus a mouth gag was inserted between the upper and lower jaws at the midline, and pressure was used to free the adhesion on the right side. The mandible now moved freely. Sulfanilamide powder was sprink1e.d freely in the wound ; one strip of rubber drain was placed between the bone ends deep in the cavitation ; the wound closed in layers and the skin with triple 0 silk. Course.-Recovery was rapid and no evidence of damage to branches of the facial nerve was noted. The patient was able to open the mouth normally without ieff ort (Fig. 4). 413
DAVID
WHITNEY
BUILDING.
W. CHRISTIANSES,
A.B., D.D.S., MS., DETROIT,
MICH.
Case Report r
HE patient dates the onset of his illness to 1943 while on duty in bhe Army r at Fort Leavenworth, Kansas. He remembers wakening one morning with This condition did not disappear, his jaws sore from tenderness in the joints. and d.uring the next two years he was unable to open his jaws widely. In June, 1.945, an operation was performed on the right temporomandibular joint in order to increase his ability to open the mouth, but he states t,hat since the operation he has not been able to open the jaws as widely as before.
Examination The patient was a 42-year-old man. He was cooperative and oriented as to time, place, person, and circumstance, but memory was poor and he His pupils were irregular and fixed to was somewhat euphoric and childish. light. He could open his mouth only about one-half inch, and there was partial edentulism with numerous cavities in the remaining teeth. He suffered from advanced gingivitis. The knee jerks were hyperactive bilaterally; no abnormal reflexes were demonstrated. Kahn and Kline tests were both 2t, and Wassermann examination was negative. Examination of his spinal fluid showed a midzone gold curve, with a positive Wassermann.
Roentgenologic Report Skull and Mandible.-The bones of the skull are normal. in appearance. The head of the condyloid process on the left side is very large, projects considerably inward, and the head and the remainder of the ramus of the mandible on this side are consi,derably broader and denser than average. On the right side the head and the major portion of the neck have been removed, but the coronoid process, together with the remainder of the ramus, is, considerably denser and broader than average. The remainder of the mandible likewise appears to be slightly broader than average, but does not share in the increase in density to the same extent that the rami do. I believe t,he joint space of the left temporomandibular joint ‘is entirely obliterated, and that there is complete ankylosis of this joint. A common cause of hyperostosis, of course, is syphilis. -Received
for publication
April
Q, 1948. 811
Opinion : Nyperostosis of the mandibular condyle with ankylosis of the left side, and postoperative SW*gical removal of the head and neck on the right side (Figs. 1 and 2).
Rig.
2. -Anteropostet’iw
view
of left
mndyle.
Treatment Under sodium pentothal a,nd regional block anesthesia, dn incision was made upward from the external auditory meatus in the preauricular area to slightly above the zygomatic ridge and then anteriorly for a total length of about 9 cm. (Big. 3). The fascia and periosteum were eleva.ted from the bone and examination revealed a complete bony ankylosis of the right temporoman-
OSTEOTOMY
FOR
ASKYLOSIS
OF LICEY’ TEiUI’OROMAP\‘DIBULAR Fig.
JOIKT
813
3.
Fig. 4. Fig. J.-Inverted L-shaped incision in preauricular area. Fig. 4.-The mouth owns withcut difficulty to near normal
distance.
The capsular ligaments were completely ossified and no movedibular joint. ment of the jaw was possible. A bone drill was used to divide the ascending ramus a,bout 2 cm. below the zygoma. The bone was dense, Aintiike in hardFollowing ness, and nearIy 3 cm. in thickness at the point of separation. division of the ra,mus a mouth gag was inserted between the upper and lower jaws at the midline, and pressure was used to free the adhesion on the right side. The mandible now moved freely. Sulfanilamide powder was sprink1e.d freely in the wound ; one strip of rubber drain was placed between the bone ends deep in the cavitation ; the wound closed in layers and the skin with triple 0 silk. Course.-Recovery was rapid and no evidence of damage to branches of the facial nerve was noted. The patient was able to open the mouth normally without ieff ort (Fig. 4). 413
DAVID
WHITNEY
BUILDING.