Document Detail


Is entire removal of a post-traumatic temporomandibular joint ankylotic site necessary for an optimal outcome?
MedLine Citation:
PMID:  23141984     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: Temporomandibular joint (TMJ) ankylosis that occurs after TMJ condylar fracture constitutes a treatment challenge. The purpose of the present study is shed light on an alternative treatment approach for certain such cases where the displaced condylar head or part of it can be detected in computed tomography. The leading principle of this protocol is accurate removal of the ankylotic mass only, leaving the condyle-disc apparatus un-touched.
PATIENTS AND METHODS: The study is based on such cases of post trauma ankylosis where the displace condyle was detected. Thirteen cases are reported (10 unilateral and 3 bilateral) age ranged from 8 to 51 years (mean 20). All patients were treated according to the presented protocol that emphasizes the significance of preserving the condyle-disc apparatus while accurately removing the ankylotic mass. To achieve the required precision, 3-dimensional computed tomography was used. An integral part of the treatment plan is intensive guided physiotherapy, which is intended to re-establish normal joint function, the original occlusion and facial symmetry (in growing individuals).
RESULTS: The patients were followed up for 6 to more than 60 months. After guided physiotherapy, all patients had significant postoperative improvement in maximal mouth opening from a mean of 18.4 mm (range 8 to 28) to a mean of 41.2 mm (range 35 to 50). All patients had returned to their original occlusion. In all the growing patients, a marked improvement in facial symmetry was observed.
CONCLUSIONS: In post trauma ankylosis the displaced head of the condyle and disc should be searched for using computed tomography. If detected we recommend its preservation while accurately remove only the ankylotic mass. Using this approach, in addition to achieving adequate mandibular motion, good occlusion, and normal facial growth, major surgery, with all its inconveniences and potential complications, is avoided.
Authors:
Dorrit W Nitzan; Jawad Abu Tair; Hadas Lehman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons     Volume:  70     ISSN:  1531-5053     ISO Abbreviation:  J. Oral Maxillofac. Surg.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8206428     Medline TA:  J Oral Maxillofac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e683-99     Citation Subset:  AIM; D; IM    
Copyright Information:
Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.
Affiliation:
Full Professor, Department of Oral and Maxillofacial Surgery, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel. Electronic address: dorrit.nitzan@mail.huji.ac.il.
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