Management of temporomandibular joint reankylosis in syndromic patients corrected with joint prostheses: surgical and rehabilitation protocols.
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ABSTRACT:
SUBMITTER: Clauser LC
PROVIDER: S-EPMC3931772 | biostudies-other | 2014 Mar
REPOSITORIES: biostudies-other
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Project description:The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure. When the first description on TMJ surgery by Orlow in 1913 was published it gave an account describing the basic retroauricular, preauricular, endoaural and submandibular approaches, on treatment of articular pathologies as used today. The proposed study of the 'Bat Wing' approach, first described in 1993 by Garcia y Sanchez J.M. as a surgical alternative, offers great advantages is that it avoids the section of the ear canal and provides a wide surgical field. The management of the proposed technique has wide application with multiple joints addressed, achieving major objectives such as avoiding facial nerve damage, as well as avoiding the section of the external auditory canal with an optimum visibility of the operative field.The Department of Maxillofacial Surgery National Medical Center XXI Century records over a period of approximately 18 months have completed twenty TMJ surgeries using the 'Bat Wing', approach.The bat wing approach is a surgical alternative that offers broad exposure of the surgical field in TMJ, it is effective and meets the goal of exposing the area to intervene safely, good visibility and access to the site to intervene. It perfectly fulfills the above described.
| S-EPMC4511896 | biostudies-other
Project description:Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically visible intervertebral ossification. Peripheral joint involvement occurs in 10 to 30% of patients and shows a predilection for the shoulders, knees, ankles, feet, and wrists. Temporomandibular joint (TMJ) involvement has been described, and its reported frequency varies from 11 to 35%. However, ankylosis is uncommon with a single documented case utilizing an alloplastic prosthesis for total joint replacement. A case report of bilateral ankylosis of the jaw treated with alloplastic prostheses for total TMJ replacement using a Brazilian system in a patient with AS is presented.
| S-EPMC4078120 | biostudies-other
Project description:Management of the temporomandibular joint in ablative head and neck surgery is controversial with no standardized approach. The aim of the study was to establish risk-based guidelines for the management of the temporomandibular joint after ablative surgery. Analysis of all patients' records receiving ablative surgery involving the temporomandibular joint in the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zürich, from 2001 to 2012, was performed, identifying 15 patients and 14 reconstructive procedures. A literature search was done identifying all relevant literature on current approaches. Applicable cohorts were constructed, and relevant risks were extrapolated. Evaluated studies are not uniform in their reporting with nonhomogeneous patient groups. A diverse approach is used in the management of these patients with complications such as infection, ankylosis, limited mouth opening, plate penetration in the skull base, and plate loosening. Risk factors for complications appear to be radiation, costochondral graft, disk loss, and plate use alone. Clinical data suggest use of a plate with metal condyle reconstructions and previous radiation therapy as potential risks factors. Employing literature evidence and cumulated clinical data, a risk-based flowchart was developed to assist surgical decision making. Risk factors such as radiation, disk preservation, and soft tissue conditions are important complication-associated factors when planning surgery. Free vascularized fibula grafts appear to have the least complications that must be weighed against donor site morbidity.
| S-EPMC4221268 | biostudies-other
Project description:AimTo compare whether aphakic contact lenses or secondary iris-claw intraocular lenses are superior in the refractive management post-pars plana vitreolensectomy in a pedigree with an FBN1 mutation causing non-syndromic ectopia lentis (NSEL) with retinal detachment (RD).MethodsEight affected individuals had pars plana vitreolensectomy for bilateral ectopia lentis (EL). Twelve eyes of 6 patients had secondary iris-claw intraocular lenses inserted and 4 eyes of 2 patients were managed with contact lenses. Rhegmatogenous retinal detachment (RRD) was treated when necessary. Pre- and post-operative assessment included visual acuity, endothelial cell count and dilated fundal examination.ResultsMacula-on RRD was present in all individuals >18y, 64% (7/11 eyes) presenting post-vitreolensectomy with 57% having bilateral non-synchronous RRD. Surgical aphakia was managed with iris-fixated intraocular lenses (IOL group, n=6), or contact lenses (CL group, n=2). Visual acuity ≥0.3 logMAR (driving standard) was achieved in 75% of IOL group eyes and 25% of the CL group eyes. Mean loss of corneal endothelial cell count in the IOL group was 4% at 2y post-operative.ConclusionIn this cohort, refractive management with iris-claw IOLs provided superior outcomes to contact lenses and the authors recommend this as the optimal refractive correction in EL patients.
| S-EPMC7321954 | biostudies-literature
Project description:PurposeThe purpose of this study was to assess the availability and variability of publicly accessible acromioclavicular (AC) joint reconstruction rehabilitation protocols.MethodsProtocols were identified by searching the websites of orthopedic surgery residency programs in the United States located from the Fellowship and Residency Electronic Interactive Database Access System. Private practice groups with publicly available protocols were also included.ResultsTwenty-one protocols were included for review. Four of 14 (29%) protocols suggested starting passive range of motion (ROM) at postoperative week 2. Six of 20 (30%) protocols recommended initiation of full ROM at 6 weeks. Active ROM beginning at 6 weeks was recommended by 6 of 20 (30%) protocols. Six of 16 (38%) protocols recommended initiating active assisted ROM at 6 weeks. Sling immobilization for 6 weeks was recommended by 8 of 18 (44%) protocols. Shoulder isometric exercise initiated at 4 weeks was recommended by 4 of 13 (31%) protocols. Seven of 21 (33%) protocols recommended initiating shoulder strengthening at 12 weeks postoperatively. Return to sport time was included in 17 (81%) protocols with a range of 12 to 48 weeks (mean, 22 weeks).ConclusionsThere was substantial variability in publicly accessible AC joint rehabilitation protocols, including a wide range in the recommendations for appropriate time to return to sport. Although strengthening exercises, active ROM, and active assisted ROM were recommended by most protocols, there were considerable differences in recommendations for when to initiate these rehabilitation components.Clinical relevanceRehabilitation is important for outcomes of AC joint reconstruction. This study shows the variability present in rehabilitation recommendations among online-accessible AC joint reconstruction rehabilitation protocols.
| S-EPMC8129471 | biostudies-literature
Project description:BACKGROUND: Temporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60-70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews. METHODS: A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (+/- meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. RESULTS: The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 +/- 6.0% and the second met 77.5 +/- 12.8% of the methodological quality criteria (mean +/- sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. CONCLUSION: The results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.
| S-EPMC2576167 | biostudies-literature
Project description:Background:Temporomandibular joint (TMJ) arthritis is a degenerative pathology that may cause pain and dysfunction. Nonsurgical therapy is the traditional treatment of TMJ diseases but if ineffective, TMJ surgery can be performed and may include arthroplasty with interposition of autograft. The encouraging results reported with the use of human amniotic membrane (HAM) in different surgical fields have highlighted its potential, but approaches providing the positioning of HAM within the intra-articular space of arthritic TMJs have never been investigated. Case Presentation:A 48-year-old woman was presented with limited mouth opening and pain with palpation at the left joint. A severe TMJ degeneration was diagnosed, and a surgical treatment was necessary. In the present case report, the authors describe the application of a cryopreserved HAM patch within the joint space as a disc-replacing film during major surgeries for discectomy and arthroplasty. Three months after the intervention, the patient reported an overall improvement in chewing efficiency as well as the absence of pain. Conclusions:According to the regenerative effects of HAM, the design of trials on the topic should be encouraged for its possible inclusion within the field of TMJ disease practice.
| S-EPMC6421772 | biostudies-literature
Project description:We conducted a genetic analysis of the developing temporo-mandibular joint (TMJ), a highly specialized synovial joint that permits movement and function of the mammalian jaw. First, we used laser capture microdissection to perform a genome-wide expression analysis of each of its developing components. The expression patterns of genes identified in this screen were examined in the TMJ and compared to other synovial joints including the shoulder joint and the hip joint. Striking differences were noted, indicating that the TMJ forms via a distinct molecular program. Several components of the Hedgehog (Hh) signaling pathway are among the genes identified in the screen, including Gli2, which is expressed specifically in the condyle and in the disk of the developing TMJ. We found that mice deficient in Gli2 display aberrant TMJ development such that the condyle loses its growth plate-like cellular organization and no disk is formed. In addition, we utilized a conditional strategy to remove activity of the Hh co-receptor encoded by Smo from chondrocyte progenitors. This cell autonomous loss of Hh signaling allows for disk formation, but the resulting structure fails to separate from the condyle. Thus, these experiments establish that Hh signaling acts at two distinct steps in disk morphogenesis, condyle initiation and disk-condyle separation, and provide a molecular framework for future studies of the TMJ. Experiment Overall Design: Mouse embryos fresh frozen and TMJ tissue captured by LCM. 3 samples in biological triplicate.
2009-10-23 | E-GEOD-17473 | biostudies-arrayexpress
Project description:This study has characterized a rat model with temporomandibular osteoarthritis (TMJ-OA) following a surgical anterior displacement of their articular disc (ADD). The well-established model of OA, induced by an intra-articular injection of complete Freund's adjuvant (CFA) into the TMJ, was used for comparison purposes. Male Wistar rats were assigned into two surgical groups, namely, ADD (anterior disc displacement) and sham-operated (surgical access, without ADD). Additional groups received an intra-articular infiltration of CFA (50 ?l/site; 1:1 oil/saline emulsion), or the vehicle (0.9% NaCl). The separate experimental subgroups were euthanized at 15, 30 or 60 days and their left TMJs were collected for histological, immunohistochemistry and micro-CT analyses. The serum levels of IL-1?, IL-6 and TNF were analyzed. The fibrocartilage thicknesses were increased in the ADD groups at all of the analyzed time-points. In the CFA group, fibrocartilage thickenings were seen only in the posterior thirds at 15 days. The ADD group displayed an increase of the proteoglycan contents and ADAMTS5 immunopositivity in the fibrocartilage at 30 and 60 days, without any variations of the collagen contents or the osteoclast activation. Upon the micro-CT evaluation, the ADD group presented increments of their trabecular separations and bone surfaces, with reduced trabecular thicknesses and bone volumes, plus osteophyte formations and condyle flattenings, from 30 to 60 days. The IL-1?, TNF or IL-6 serum levels were undetectable. The surgical ADD in the rats led to long-term OA-like alterations, with typical structural and morphological derangements of the TMJ, representing a reliable experimental model to investigate the TMJ-OA-related mechanisms.
| S-EPMC6291709 | biostudies-literature
Project description:The temporomandibular joint (TMJ) has many essential functions. None of its components are exempt from injury. Facial asymmetry, malocclusion, disturbances in growth, osteoarthritis, and ankylosis can manifest as complications from trauma to the TMJ. The goals of initial treatment include achievement of pretraumatic function, restoration of facial symmetry, and resolution of pain. These same objectives hold true for late repairs and reconstruction of the TMJ apparatus. Treatment is demanding, and with opposing approaches. The following article explores various treatment options for problems presenting as a result of a history of trauma to the TMJ.
| S-EPMC3052671 | biostudies-other