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Temporomandibular joint ankylosis: a reverse surgical protocol
520 Free Papers—Oral Presentations noted in all patients during the follow up period. Conclusion: This study concluded that both techniques provided satisfactory results. However, chemical application of chemotherapeutic agent was found to be superior in some aspects; no mandibular shifting during the movement, elimination of grafting problems and saving surgical time.
surface created on the condylar head allows in a long-term follow-up adhesion of the disc to the condyle. Conclusion: The absorbable anchor in our opinion is the best choice as it ensures the maintenance of fixing the disk into position and long-term leaves no relics on X-rays that can prevent a follow-up with magnetic resonance imaging. doi:10.1016/j.ijom.2009.03.440
doi:10.1016/j.ijom.2009.03.439
O12.13 Disc repositioning surgery of the temporomandibular joint using bioabsorbable anchor F. Spallaccia 1 , A. Rivaroli 2 , P. Arangio 3,∗ , S. Marino 1 , G. Giuliani 2 , D. Scopelliti 1 1 Department of Maxillo-Facial Surgery, Ospedale “Santo Spirito” ASL RM-E Roma, Italy 2 Department of Maxillo-Facial Surgery, Azienda Ospedaliera “S. Maria”, Terni, Italy 3 Università “Sapiensa” di Roma, Department of Maxillo-Facial Surgery, Ospedale “Santo Spirito” ASL RM-E Roma, Italy
Background and Objectives: The most common temporomandibular joint (TMJ) pathology is anterior and/or medial displacement of the articular disc, which can initiate a cascade of events leading to arthritis and other TMJ-related symptoms like local pain, functional impairment, headache and cervical pain. Methods: Indications to this kind of surgery are: irreversible temporomandibular joint (TMJ) damage associated with temporomandibular pain. In this presentation surgical technique is described using a preauricular approach; high condylectomy is performed to reshape the superior surface of the condylar head. Fixation of the disc is performed using an absorbable micro anchor (MITEKÒ Microfix QuickAnchor Plus1.3) to the lateral aspect of the condylar head. The anchor is linked with a 3.0 Ethibond absorbable suture that is used to fix the posterolateral side of the disc above the condyle. Results: The aim of each surgery is to alleviate the patient from temporomandibular pain symptoms, headaches and cervical pain and to restore good jaw motility. We achieved these objectives in the long-term result because the condylar shaving allows us to gain space in the lower articular compartment. This space is used to easily accommodate the disc without excessive overloading or tension. Moreover, the new
O12.14 Temporomandibular joint ankylosis: a reverse surgical protocol V. Mishra Division of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospitals, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
Temporomandibular joint (TMJ) ankylosis is a challenging surgical procedure even in this modern era. There are various protocols aiming at the maximum success of the surgical outcome. The timing of the primary and secondary surgery, the type of surgical technique and quantity, quality of the interposition substance used playing a maximum role in achieving maximum mouth opening. At present there is no ideal interpositional material because none of the material produces equal success in all cases. Free dermis fat graft is one of the interposition material with very minimal reaction in recipient site and of easy harvested. Distraction osteogenesis in TMJ is usually performed to correct secondary deformity after ankylotic release. Performing this procedure after ankylosis release can lead to various disturbances at the surgical site. Hence, the reverse protocol of performing the distraction first and followed by a adequate gap arthroplasty and interpositioned with free dermis fat graft was studied at the Rajah Muthiah Dental College and Hospitals. The results of this study and the surgical outcome will be discussed in detail in this presentation.
Background and Objectives: An animal model of a condylar head fracture similar to a type B intracapsular condylar fractures in humans were created in the same period treated with open rigid internal fixation (ORIF). To evaluated this model on mandibular function and morphological changes of temporomandibular joint (TMJ) structure. Methods: Twelve 6-month-old sheep were divided into experimental (8 sheep) and control groups (4 sheep), and randomised number 1 to 12, sacrificed at 3 months (6 sheep) and 6 months (6 sheep) after surgery. One side of the TMJ of 8 sheep was considered the surgical group and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. The others of 4 sheep were control group without operation. Preoperative and postoperative body weight, maximum mouth opening, were recorded. The spiral computed tomography (CT) was undertaken immediately after operation and 3 and 6 months postoperatively in the surgical groups and the control group. The SAS software program was used for all statistical analyses. Results: There were no significant differences in maximum mouth opening between the preoperative and postoperative 3 and 6months in surgical group or control group as well as between experimental group and control group (P > 0.05). But weight increased significantly between the preoperative and postoperative 3 and 6 months in surgical group or control group (P 0.05). Three months and six months postoperative coronal CT and three-dimensional reconstruction of CT mages demonstrated intracapsular fractures of the mandibular condyle has healed completely, suture and nonunion of bone can not been seen, the development of condyle was normal, the vertical condyle raised gradually in surgical group. Conclusions: The appropriate rigid internal fixation was taken after intracapsular condylar fractures, which can promote the healing of fracture and prevent serious complications.
doi:10.1016/j.ijom.2009.03.441 doi:10.1016/j.ijom.2009.03.442
O12.15 A sheep model of rigid internal fixation of intracapsular condylar fractures Z.Q. Feng ∗ , C. Yang Department of Oral and Maxillofacial Surgery, Chinese Society of Oral and Maxillofacial Surgery, Shanghai, China
O12.16 Contrast study between temporomandibular joint ankylosis in animal model of Han sheep and clinical patients in computed tomography images and general sample
surface created on the condylar head allows in a long-term follow-up adhesion of the disc to the condyle. Conclusion: The absorbable anchor in our opinion is the best choice as it ensures the maintenance of fixing the disk into position and long-term leaves no relics on X-rays that can prevent a follow-up with magnetic resonance imaging. doi:10.1016/j.ijom.2009.03.440
doi:10.1016/j.ijom.2009.03.439
O12.13 Disc repositioning surgery of the temporomandibular joint using bioabsorbable anchor F. Spallaccia 1 , A. Rivaroli 2 , P. Arangio 3,∗ , S. Marino 1 , G. Giuliani 2 , D. Scopelliti 1 1 Department of Maxillo-Facial Surgery, Ospedale “Santo Spirito” ASL RM-E Roma, Italy 2 Department of Maxillo-Facial Surgery, Azienda Ospedaliera “S. Maria”, Terni, Italy 3 Università “Sapiensa” di Roma, Department of Maxillo-Facial Surgery, Ospedale “Santo Spirito” ASL RM-E Roma, Italy
Background and Objectives: The most common temporomandibular joint (TMJ) pathology is anterior and/or medial displacement of the articular disc, which can initiate a cascade of events leading to arthritis and other TMJ-related symptoms like local pain, functional impairment, headache and cervical pain. Methods: Indications to this kind of surgery are: irreversible temporomandibular joint (TMJ) damage associated with temporomandibular pain. In this presentation surgical technique is described using a preauricular approach; high condylectomy is performed to reshape the superior surface of the condylar head. Fixation of the disc is performed using an absorbable micro anchor (MITEKÒ Microfix QuickAnchor Plus1.3) to the lateral aspect of the condylar head. The anchor is linked with a 3.0 Ethibond absorbable suture that is used to fix the posterolateral side of the disc above the condyle. Results: The aim of each surgery is to alleviate the patient from temporomandibular pain symptoms, headaches and cervical pain and to restore good jaw motility. We achieved these objectives in the long-term result because the condylar shaving allows us to gain space in the lower articular compartment. This space is used to easily accommodate the disc without excessive overloading or tension. Moreover, the new
O12.14 Temporomandibular joint ankylosis: a reverse surgical protocol V. Mishra Division of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospitals, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
Temporomandibular joint (TMJ) ankylosis is a challenging surgical procedure even in this modern era. There are various protocols aiming at the maximum success of the surgical outcome. The timing of the primary and secondary surgery, the type of surgical technique and quantity, quality of the interposition substance used playing a maximum role in achieving maximum mouth opening. At present there is no ideal interpositional material because none of the material produces equal success in all cases. Free dermis fat graft is one of the interposition material with very minimal reaction in recipient site and of easy harvested. Distraction osteogenesis in TMJ is usually performed to correct secondary deformity after ankylotic release. Performing this procedure after ankylosis release can lead to various disturbances at the surgical site. Hence, the reverse protocol of performing the distraction first and followed by a adequate gap arthroplasty and interpositioned with free dermis fat graft was studied at the Rajah Muthiah Dental College and Hospitals. The results of this study and the surgical outcome will be discussed in detail in this presentation.
Background and Objectives: An animal model of a condylar head fracture similar to a type B intracapsular condylar fractures in humans were created in the same period treated with open rigid internal fixation (ORIF). To evaluated this model on mandibular function and morphological changes of temporomandibular joint (TMJ) structure. Methods: Twelve 6-month-old sheep were divided into experimental (8 sheep) and control groups (4 sheep), and randomised number 1 to 12, sacrificed at 3 months (6 sheep) and 6 months (6 sheep) after surgery. One side of the TMJ of 8 sheep was considered the surgical group and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. The others of 4 sheep were control group without operation. Preoperative and postoperative body weight, maximum mouth opening, were recorded. The spiral computed tomography (CT) was undertaken immediately after operation and 3 and 6 months postoperatively in the surgical groups and the control group. The SAS software program was used for all statistical analyses. Results: There were no significant differences in maximum mouth opening between the preoperative and postoperative 3 and 6months in surgical group or control group as well as between experimental group and control group (P > 0.05). But weight increased significantly between the preoperative and postoperative 3 and 6 months in surgical group or control group (P 0.05). Three months and six months postoperative coronal CT and three-dimensional reconstruction of CT mages demonstrated intracapsular fractures of the mandibular condyle has healed completely, suture and nonunion of bone can not been seen, the development of condyle was normal, the vertical condyle raised gradually in surgical group. Conclusions: The appropriate rigid internal fixation was taken after intracapsular condylar fractures, which can promote the healing of fracture and prevent serious complications.
doi:10.1016/j.ijom.2009.03.441 doi:10.1016/j.ijom.2009.03.442
O12.15 A sheep model of rigid internal fixation of intracapsular condylar fractures Z.Q. Feng ∗ , C. Yang Department of Oral and Maxillofacial Surgery, Chinese Society of Oral and Maxillofacial Surgery, Shanghai, China
O12.16 Contrast study between temporomandibular joint ankylosis in animal model of Han sheep and clinical patients in computed tomography images and general sample