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Temporomandibular arthroplasty in the treatment of prognathism
798
ABSTRACTS
OF
CURRENT
LITERATURE
sence of the chin or half of the jawbone causes a curious and striking esthetic deficiency. The function of this arch is to establish security for the grinding surfaces during mastication and assist in the manipulation of food and saliva in the act of deglutition. The use of an inert substance as a reparative or reconstructive procedure should never take precedence over the use of an autogenous bone graft unless there are definite and serious contraindications for the use of that graft, Replacement of deficient structures is best accomplished by the utilization of tissues of a type similar to those lost, when this is warranted. This is not always possible and it is in these special instances that the use of inert compounds has its place in surgery. These appliances have also proved most useful in attaining internal fixation in bone grafting procedures. It is important that the contraindications to the use of vitallium implants be recognized so that unnecessary and futile attempts to utilize them will be kept at a minimum. It is a sound, natural and physiologic law to repair any deficiency with the same type of tissue normally intended to be there. Vitallium implants should never be substituted for bone grafting when the latter has a reasonable chance of success. Vitallium implants should not be used when it is impossible to cover them generously with skin and mucous membrane unless there is extensive loss of tissue resulting from an injury and it is anticipated to repair this deficiency with appropriate flaps. T. J. C.
Temporomandibular Plast.
Arthroplaaty
& Reconstruc.
in the Treatment
Surg. 8: 136, August,
of Prognathism.
Mario Gonzalez-Ulloa.
1951.
The advantages of this procedure according to the author are to reduce operative trauma, control mandibular retroposition, correct mandibular asymmetry and restore mandibular function immediately. The object of the operation is to shorten the two condyles: with this procedure the mandible shifts in an upward and backward direction in proportion with the resected fragment of the condyle. P1-oce&re.-The distance from the root of the helix to the middle part of the tragus is taken without lifting the end of the caliper from the helix root; a 2 cm. line is drawn toward the center of the face, beginning at the head of the condyle perceived by palpaAn incision is described which does not injure the superior branches of the facial tion. nerve and avoids the trunk and principal branches of the superior temporal artery. The The sectioncondyle is left uncovered after sectioning the capsule and articular ligaments. The fragment may be drawn with ing of the condylar fragment is done with chisels. forceps upon finishing the section. Packing is applied and the operation in the opposite side is performed. Once the sectioning of the condyle is made on both sides, the relation of both dental arches is checked. Further reduction can be made by resecting another fragment from either side until a good relation with the superior arch is obtained. Careful hemostasis is made and the soft tissues are sutured with plain catgut 2-O. The skin is sutured with atraumatic nylon 5-O. A compressive dressing is applied and a bandage is placed to keep the mandible in to wire the dental arches together. recess. It is not necessary Heat for several days following the operation is advisable. The masticatorg function is begun within twenty-four hours following the operation and may continue in progressive form. T. J. C.
ABSTRACTS
OF
CURRENT
LITERATURE
sence of the chin or half of the jawbone causes a curious and striking esthetic deficiency. The function of this arch is to establish security for the grinding surfaces during mastication and assist in the manipulation of food and saliva in the act of deglutition. The use of an inert substance as a reparative or reconstructive procedure should never take precedence over the use of an autogenous bone graft unless there are definite and serious contraindications for the use of that graft, Replacement of deficient structures is best accomplished by the utilization of tissues of a type similar to those lost, when this is warranted. This is not always possible and it is in these special instances that the use of inert compounds has its place in surgery. These appliances have also proved most useful in attaining internal fixation in bone grafting procedures. It is important that the contraindications to the use of vitallium implants be recognized so that unnecessary and futile attempts to utilize them will be kept at a minimum. It is a sound, natural and physiologic law to repair any deficiency with the same type of tissue normally intended to be there. Vitallium implants should never be substituted for bone grafting when the latter has a reasonable chance of success. Vitallium implants should not be used when it is impossible to cover them generously with skin and mucous membrane unless there is extensive loss of tissue resulting from an injury and it is anticipated to repair this deficiency with appropriate flaps. T. J. C.
Temporomandibular Plast.
Arthroplaaty
& Reconstruc.
in the Treatment
Surg. 8: 136, August,
of Prognathism.
Mario Gonzalez-Ulloa.
1951.
The advantages of this procedure according to the author are to reduce operative trauma, control mandibular retroposition, correct mandibular asymmetry and restore mandibular function immediately. The object of the operation is to shorten the two condyles: with this procedure the mandible shifts in an upward and backward direction in proportion with the resected fragment of the condyle. P1-oce&re.-The distance from the root of the helix to the middle part of the tragus is taken without lifting the end of the caliper from the helix root; a 2 cm. line is drawn toward the center of the face, beginning at the head of the condyle perceived by palpaAn incision is described which does not injure the superior branches of the facial tion. nerve and avoids the trunk and principal branches of the superior temporal artery. The The sectioncondyle is left uncovered after sectioning the capsule and articular ligaments. The fragment may be drawn with ing of the condylar fragment is done with chisels. forceps upon finishing the section. Packing is applied and the operation in the opposite side is performed. Once the sectioning of the condyle is made on both sides, the relation of both dental arches is checked. Further reduction can be made by resecting another fragment from either side until a good relation with the superior arch is obtained. Careful hemostasis is made and the soft tissues are sutured with plain catgut 2-O. The skin is sutured with atraumatic nylon 5-O. A compressive dressing is applied and a bandage is placed to keep the mandible in to wire the dental arches together. recess. It is not necessary Heat for several days following the operation is advisable. The masticatorg function is begun within twenty-four hours following the operation and may continue in progressive form. T. J. C.