Results: Based on the history, clinical examination and radiographic findings, osteochondroma of the skull base was diagnosed, with a concurrent lesion of the condylar process. Treatment methods for this patient included excision of the skull base tumour and condylectomy with immediate temporomandibular joint reconstruction using appropriately sized stock total temporomandibular joint prosthesis. At the 24 month follow-up, patient was free of pain and her maximal incisal opening was maintained, with no radiographic evidence of tumour recurrence or failure of the device.
I, Dr. PUNEET KUMAR GUPTA , do hereby declare that the dissertation titled “RECONSTRUCTION OF THE TEMPOROMANDIBULAR JOINT USING DISTRACTION OSTEOGENESIS ” was done in the Department of Oral and Maxillo Facial Surgery, Tamil Nadu Government Dental College & Hospital, Chennai 600 003. I have utilized the facilities provided in the Government dental college for the study in partial fulfillment of the requirements for the degree of Master of Dental Surgery in the speciality of Oral and Maxillo Facial Surgery (Branch III) during the course period 2007-2010 under the conceptualization and guidance of my dissertation guide, Prof. Dr. G.UMA MAHESWARI, MDS.
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most of the joint reconstructions. In 2009, Qiu et al reported 122 patients treated with CCG using the endoscope for TMJ reconstruction. 5 patients of them had an injury of the inferior alveolar nerve, and some of the ribs were trimmed and contoured . In current study, all the grafted ribs were not trimmed or con- toured intraoperatively. No patient had com- plaints of malocclusion or numbness. The TMJ pain and mouth opening improved significantly in a short term follow up. The postoperative position of the bone grafts was similar with the presurgically designed position and the titani- um plate and screws were implanted accurate- ly. In other words, the use of CASS for TMJ reconstruction with CCG might decrease the postoperative complications, enhance the strength of the rib grafted, and increase the accuracy of the operation. However, our study just analyzed a small sample (only 7 patients) with a short-term follow up (6 months after sur- gery). Afterward, we hope to report the results of the long-term follow up with a big sample for this technique in the next study.
Controversies exist regarding the timing of surgery for TMJ ankylosis. Proponents of functional matrix theory by Melvin Moss advocated to relieve ankylosis as early as possible since an early mobilization stimulates bone growth. According to functional matrix theory the condyle is not a primary growth center but just an adaptive center whereby the secondary cartilage reacts to translational movement of the mandible by growing to keep contact with glenoid fossa 75 . Hence in ankylosis, absence of translational movements leads to failure of condylar and ramal growth and therefore early release of ankylosis and reconstruction with an autogenous graft to permit an adaptive growth is necessary.
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opened. After 8 months of first operation, reconstruc- tion of right TMJ was planned to maintain stable oc- clusion without intermaxillary fixation screws. During the operation for TMJ reconstruction, there was no abnormal finding around the previous operation site. After TMJ reconstruction, intermaxillary fixation screws were removed and stable occlusion was confirmed (Fig. 2b). Three months later, however, sharp pain and mild swelling developed in the right TMJ area. The symp- tom persisted in spite of using antibiotics and NSAIDs. Computed tomography (CT) was taken but no abnormal- ity could be found because of metal artifacts from the prosthesis. After four more months, magnetic resonance imaging (MRI) revealed re-growing tumor along the temporalis muscle. Additional surgeries were performed to remove tumor and prosthesis, but he is still suffering from uncontrolled primary tumor in the right TMJ and temporal area.
26. Brown, B. N.; Chung, W. L.; Almarza, A. J.; Pavlick, M. D.; Reppas, S. N.; Ochs, M. W.; Russell, A. J.; Badylak, S. F., Inductive, scaffold-based, regenerative medicine approach to reconstruction of the temporomandibular joint disk. J Oral Maxillofac Surg 2012, 70, (11), 2656-68.
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Controlled clinical trials and prospective and retrospective observational studies in humans, with more than 10 cases studied, comparing or containing results of surgical techniques for TMJ “temporomandibular joint prosthesis” and / or “tmj replacement” and / or “Alloplastic Prostheses (AP)” was used. Studies with a follow-up time of less than 2 years were excluded years, studies published outside the current decade, case reports, reports, animal studies and reviews. Clinical trials and prospective and retrospective observational studies that had pre- and postoperative information on mouth opening, pain, incidence of complications and recurrence were included.
Aim: This study aimed to evaluate temporomandibular joint reconstruction in Yemeni children with metatarsal bone graft after release of ankylosis. Methodology: Ten patients ≤12 years of age, comprising eight unilateral and two bilaterally TMJ ankylosis, were selected for this study. These patients underwent reconstruction with 10 non-vascularized metatarsal grafts. The reconstructed joints were then followed for an average of 1 year. Measures of opening, symmetry, and clinical symptoms relating to the reconstructed joints were assessed. Results: Mean pre-operative interincisal aperture was 8.2mm, and immediate post-operative aperture 23.4mm. At the end of the follow-up period, acceptable results were achieved in 8 out of 10 cases, with adequate mouth opening of 35.6mm in 8 out of 10 patients and overall interincisal aperture of 30.3mm. Re-ankylosis occurred in two bilaterally- treated patients at the end of follow-up. Subjectively, 80% of the patients rated their function as satisfactory and were able to occlude and masticate without any difficulty. Conclusion: Reconstruction of TMJ after release of ankylosis utilizing metatarsal bone graft shows a satisfactory interincisal aperture in 80% of patients.
Treatment of bone tumors in the mandible often involves extensive excava- tion of affected bone, followed by mandibular reconstruction. Prosthetic im- plants may be needed to restore jaw functionality. The challenges of making prosthetic bone implants include stress shielding and extending the mechani- cal life of the implant. We have developed a design algorithm to improve the efficiency of prosthesis design. A finite element model of the patient case is constructed from a computer tomography scan, and the computer implements topology optimization techniques to design the prosthesis with limited stress shielding affected by highly biomechanical compatibility. Topology optimiza- tion facilitates the design of low weight structures by automatically introduc- ing holes into the structure. This is governed by engineering predetermined constraints to meet certain job specifications. Such a design will be tested for fatigue life before it is ready to be manufactured and used. Topology optimi- zation can be performed as a design process to achieve a final design that takes stress shielding into consideration. The problem of stress shielding is solved by matching the stiffness of the orthopedic implant to the original bone that is being replaced. The material we used was titanium alloy (Ti-6Al-7Nb). Vo- lume fraction of the orthodox implant was used (0.2872 for the studied case) as volume constraints. Compliance of the bulk bone was set as a further con- straint to match the stiffness of the bone with the designed structure. Our re- sults show a good life expectancy for the designed parts, with 12% higher life expectancy for stress-based topology optimization than for compliance-based topology optimization.
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(TMJP) functions is to establish conditions for preventing any imbalance of the harmony and potential destruction of the TMJ and TMJP. TMJ is strained by pressure and traction, the contact surfaces of TMJ lead to separate in the case of traction and to press in the case of pressure action. Therefore, it is important to mathematically simulate and to analyze the different behavior of each joint during jaw movements, and above all, during nonsymmetrical movement after the surgery. Since the mathematical model allow us to evaluate the application of mechanical and biomechanical aspects of TMJ on prosthesis of TMJ (TMJP). The construction of TMJP and its application by surgical treatment must satisfy or be as much as possible close to human physiological biomechanical parameters, only then the TMJP for our patient will function for a long time without great difficulties. This is the aim of our study for the discussed patient with the large cyst of mandible ramus. Since the patients glenoid fossa was in a good condition, the reconstruction of the right TMJ was made by using the subtotal replacement only. Therefore, the object of our study was a patient after implantation of a subtotal TMJ replacement after resection of right mandible ramus due an extensive cyst. We focused on evaluation of the present and future function of her reconstructed TMJ joint. For this reason we first modeled the healthy 3D model of the mandible, the used data were the data set of axial CT. The results were published in , .
Overall, the numbers of subjects enrolled in all the 13 studies were not adequate. Several studies held even fewer than 15 patients, making selection bias inevitable. The insufficiency in long-term outcomes is an obstacle to analyze the treatment effect on TMJ completely. As some studies emphasized that growth was limited, the adaptation of TMJ might temporarily correct skeletal de- formity. Whether it really assists in correcting the skel- etal disharmony remains unclear. Further long-term evidence is required for confirmation. Lacking the data of MRI, the included studies were deficient in the de- scription of soft tissues such as articular disc, articular ligament, and joint capsule [74 – 76]. Further studies on MRI are needed in the evaluation of TMJ.
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Arakeri et al.  considered that the traumatic TMJ ankylosis did not follow the characteristic events of frac- ture healing because it involved the fusion of 2 different bony surfaces. Indeed, in anatomy, hypertrophic non- union often involves in only one bone, whereas TMJ an- kylosis consists of 2 bones and even a disc. However, in biology, we believe that healing between different bony surfaces, such as vascularized bone graft or arthrodesis, is generally the same process as fracture healing. In fact, we have confirmed the similarity between bony ankylosis and fracture healing by histological analysis and molecu- lar examination in a sheep model [22,61,62]. From a broader point of view, arthrodesis, the artificial bony an- kylosis, is normal bone healing under the strict fixation of a joint; traumatic TMJ bony ankylosis is the course of hypertrophic non-union under the interference of opening movement; and TMJ fibrous ankylosis, which is postulated to be an independent pathological process different from bony ankylosis , can be regarded as atrophic non-union .
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It could be a significant variance on TMJ symptoms changes as a result of the various types of dento-facial deformities corrected, and most of the studies gener- ally showed a greater presence of TMJ disorders in class II patients or mandibular retrognathia . Westermark et al. found more TMJ symptoms in sam- ple of patients with retrognathism than with prognath- ism, and De Clercq et al. found that TMJ disorders were more prevalent in patient with class II deformi- ties, low angle and deep bite [19,22]. That is supposed to be caused by the high condylar compressive load- ings during function and different vector of compres- sive loading on class II and deep bite patients . But when we divide our patients into different dentofacial deformity subgroup there is no statistical difference in the prevalence of TMJ symptoms preoperativly in class II compared to class III patients. Furthermore, in the subgroup of patients with mandibular retrognathism and low or normal angle, the possibility is high, that TMJ symptoms will improve after surgery with a man- dibular advancement . However, our results found a similar improvement of TMJ pain, sounds, tenseness, joint locking, joint clicking, or limited mouth opening in the two subgroups of patients and no more onsets of TMJ symptoms in either of subgroup. Thus, we did not find any connection between TMD and the type of
The purpose of the study was designed to clarify the modern trends of physical therapy in treat- ment of temporomandibular joint dysfunctions in Parkinsonian patients, which in this respect in- cluded the degree of pain, the muscles power of both masseter and pterygoid, the range of TMJ motion, the angle of mouth opening and their effects on electromyography study in both sexes. Subjects: Thirty males and females were the same degree of disabilities according to modified Hoehn and Yahr scales (grade 3) of Parkinsonian patients, and their age ranged from 50 - 77 years old and their weight ranged from 60 - 88 kg. They were randomly divided into two equal groups (G1 and G2). G1 (control) consisted of 15 patients of both sexes and was treated by exercises therapy program and G2 (experimental) consisted of 15 Parkinsonian patients of both sexes and was treated by the same exercises therapy program and low level pulsed electromagnetic therapy. Vital signs such as blood pressure, body temperature, pulse rate and respiratory rate were meas- ured before and after the treatment sessions. Assessments: Visual analogue scale was used to measure degree of pain. Tensiometer was used to measure the muscle power of masseter and pterygoid, the digital goniometer was used to investigate the range of TMJ movement. Moreover, standard electromyography test (EMG) was used to measure the compound muscle action poten- tials. Statistically the results for all groups were analyzed by t-test to compare the differences be- tween the two groups. The statistical package of social sciences (SPSS, version 10) was used for data processing using the P-value 0.05 as a level of significance. Results showed that there were significant improvements in all variables in G2 only. However, there was a little improvement but not significant in both G1. Therefore, it could be concluded that the use of low level pulsed electro- magnetic therapy combined with exercises program was the good method to control pain of TMJ, in- crease of muscle power and the range of their movements together with determination of electro- myography. Our results opened a new link to manage the TMJ dysfunctions in Parkinsonian patients via the use of low level pulsed electromagnetic therapy combined with exercises program.
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Temporomandibular disorders (TMD) are among the most common causes of orofacial pain of non- dental origin and are characterized by pain in the temporomandibular joint and/or masticatory muscles, conditions that could be aggravated by chewing and other mandibular activities, such as excessive mandibular opening due to wide yawning, laughing and/or biting on large objects [1,2]. Signs and symptoms of TMD occur frequently in the general population and its treatment involves a multidisciplinary team including several health professionals other than dentists .
Temporomandibular joint (TMJ) dislocation is defined as excessive forward movement of the mandibular condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. A 54 years old man attended our Emergency Department (ED) with complaints of slurred speech and inability to close his mouth after upper gastroendoscopic procedures. Lateral craniography was obtained and illustrated bilateral anterior dislocation of the patient's mandibular condyles. To confirm the diagnosis urgent radiographic imaging is required without delay as the risk of complications occurring increases as time elapses.
The condyle and mandibular segments were re approximated and reduced anatomically After proper reduction was achieved, Fixation was done with 4 hole mini plate. The mouth opening was checked and the occlusion was stabilised temporarily with IMF. The joint capsule was re- approximated and sutured with 2-0 vicryl
Dislocation of the temporomandibular joint is the dis- lodgement of the head of the condyle from its normal position in the glenoid fossa located in the squamo-tem- poral portion of the cranial base. It can be partial (sub- luxation) or complete (luxation), bilateral or unilateral, acute, chronic protracted or chronic recurrent [7-29]. Also, it can be anterior-medial, superior, medial, lateral or posterior dislocation and the cause is either sponta- neous or induced by trauma, [30-80] forceful mouth opening from endotracheal intubation with laryngeal mask or tracheal tube, ENT/Dental procedures, endo- scopy, excessive mouth opening from yawning, laughing, vomiting and also during seizures [81-84,94,96-111]. Altered structural components include a lax capsule, weak ligaments, small/short and atrophic condyle, atrophic articular eminence, elongated articular emi- nence, hypoplastic zygomatic arch and small, poorly grooved glenoid fossa. Predisposing factors include epi- lepsy, severe vomiting, Ehlers-Danlos syndrome and Marfan’s syndrome and dystonic movements from the effect of major tranquilizers/neuroleptics used for neuro-psychiatric diseases [5,28,46,51,68,116].
Tumoral calcinosis is an uncommon disease characterized by periarticular soft tissue hyper- plasia and calcification. Large joints such as the hip, shoulder, and elbow most frequently are involved. This entity most commonly presents in the first 2 decades of life. A familial predis- position has been reported. The cause, how- ever, remains unknown. We present an unusual case of tumoral calcinosis that involves the temporomandibular joint in a woman experi- encing intermittent temporomandibular joint pain.
Dentofacial Deformity (DFD) is derived from many fac- tors including genetic predisposition, environmental ex- posure, childhood facial trauma or infection, cyst or tumor, parafunctional habit causing developmental mal- occlusion, unilateral condylar hyperplasia, mandibular hypoplasia, prior surgical procedures, or temporoman- dibular joint disorder(TMD) . Patients with dentofa- cial deformity (DFD) require an orthognathic surgery (OGS) for an improved facial profile and a correction of skeletal malocclusion and asymmetry. The motivating factors for patients undergoing OGS are to improve mastication, speech, and swallowing functions as well as facial esthetic and psychosocial factors . The man- dibular condyle is one of the anatomic structures that consist of TMJ, and the position of condyles in relation to temporal bone can be altered via various movement during OGS. Thus, OGS can affect both functional and
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