Post-traumatic bifid condyle associated with temporomandibular joint ankylosis: report of a case and review of the literature

Bifid condyle is a rare condition. Most initially reported cases were found in studies conducted on skeletal specimens. While increasing numbers are being reported on living persons, most of them are asymptomatic and have been found on routine dental radiographic examination for other dental complaints. Most of the cases of bifid condyle reported so far have occurred unilaterally and predominantly on the left side. Bifid condyle associated with temporomandibular joint ankylosis is very rare with only 2 cases reported in the English-language literature as far as we know. An additional case of bifid condyle associated with temporomandibular joint ankylosis, involving the right side of mandible, is presented as well as a review of the literature on bifid condyles including those associated with temporomandibular joint ankylosis.     

人工关节头应用于颞下颌关节骨性强直治疗的临床探讨

目的：回顾性研究分析人工关节头在颞下颌关节骨性强直治疗中进行关节重建的方法和临床治疗效果。方法：对2007年8月～2012年3月间收治的6例（10侧）颞下颌关节骨性强直患者进行人工关节头关节重建。对治疗方法和效果进行综合分析。结果：6例均采用人工关节头置换恢复颞下颌关节,术后患者张口度恢复理想。结论：人工关节头置换用于治疗颞下颌关节骨性强直具有可行性,并能达到良好的治疗效果。     

颞下颌关节疾病的外科手术治疗

目的 :颞下颌关节疾病的治疗包括保守治疗和外科手术治疗 ,本研究目的是探讨颞下颌关节疾病外科手术治疗的适应证以及手术方法。方法 :对 1988年至 2 0 0 0年共收治的 76 5例颞下颌关节疾病患者进行回顾性研究。其中颞下颌关节紊乱病患者共 4 18例 ,颞下颌关节外伤 15 9例 ,颞下颌关节强直 131例 ,髁状突肥大 38例 ,颞下颌关节肿瘤 18例 ,颞下颌关节感染 1例 ,其中 6 37例进行了外科手术治疗。结果 :颞下颌关节紊乱病患中 2 18例行颞下颌关节内窥镜术 ,2 1例行颞下颌关节盘复位术 ,91例行颞下颌关节盘修补术 ,11例行陈旧性关节脱位开放复位术 ;131例行颞下颌关节成形术 ;10 9例行髁状突骨折开放复位术 ;38例行髁状突截骨术和正颌手术 ;18例行颞下颌关节肿瘤切除术。结论 :颞下颌关节紊乱病、损伤、关节强直、肿瘤、畸形以及其他关节疾病的手术适应证范围在不断地扩大 ,颞下颌关节外科的手术方法也在不断地改良。颞下颌关节外科手术治疗正向着微创和恢复关节功能的方向发展     

Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review

Many factors have been implicated in the development of bony ankylosis following trauma to the temporomandibular joint (TMJ) or ankylosis that recurs after surgical treatment for the condition. Although many reports have been published, to our knowledge very little has been written about the pathogenesis of the process and there are few scientific studies. Over the last 70 years various treatments have been described. Different methods have been used with perceived favourable outcomes although recurrence remains a problem in many cases, and ankylosis presents a major therapeutic challenge. We present a critical review of published papers and discuss the various hypotheses regarding the pathogenesis of the condition.     

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目的观察采用下颌升支垂直截骨上推术治疗真性颞颌关节强直的疗效。方法对2004年12月至2008年5月山西医科大学第一临床医院口腔颌面外科收治的19例真性颞颌关节强直患者采用下颌升支垂直截骨上推术治疗,并按期随诊,监测指标,观察其疗效。结果所有患者张口度均接近或达到正常,无关节疼痛及弹响症状,随访期内无一例复发。结论根据国内外文献及术后观察,下颌升支垂直截骨上推术是治疗真性颞颌关节强直的一种可选择的、有效的方法。     

Surgical treatment of TMJ ankylosis: our experience (60 cases)

Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint as sequela to trauma, infection, autoimmune disease, or failed surgery.Various procedures have been reported for treatment of temporomandibular joint (TMJ) ankylosis; this article aims to describe the diagnostic protocol and the surgical procedures adopted at the department of Maxillo-Facial Surgery of Rome University "La Sapienza".Between 1980 and 2000, 123 patients affected by TMJ ankylosis came under our observation; 60 of them (25 females and 35 males of 30 years average age) underwent surgery; bilateral TMJ ankylosis was observed in 21 cases, right-sided in 20 cases, left-sided in 19 cases. In 12 cases coronoid processes were involved. Etiopathogenesis was traumatic in 48 cases, septic in 5 cases, auto-immune (RA and seronegative spondyloarthropathies) in 5 cases; after block removing, arthroplasty was performed with pedunculated flap of temporal muscle (10 cases), Silastic material (11 cases), or lyophilized dura mater (2 cases). Simple condylar shaving was used in the remaining 36 cases.All patients under treatment showed a distinctive improvement both in articular functionality and symptoms; secondary surgery was necessary in seven cases due to the onset of articular complications from previous surgery. Silastic removal was necessary in five cases due to its inducement of foreign body granuloma. Follow-up was performed at 12, 24, and 48 months and 5 years postoperatively.In our opinion the gold standard surgery of TMJ ankylosis today is represented by shaving of articular surfaces and subsequent arthroplasty with or without temporal muscle myofascial flap interposition, whereas the use of Silastic as alloplastic material could be associated to an increased persistence of the local symptoms and a higher risk of foreign body granuloma and it may favor ankylosis relapse and hinder rehabilitation.     

Congenital prearticular temporo-mandibular ankylosis in two siblings

A report of congenital ankylosis of the temporo-mandibular joint has only very rarely been published. The existence of this entity has been met with great scepticism and therefore believed to be due to perinatal trauma and subsequent development of the ankylosis. However, publications are now available of observations at birth after an uneventful pregnancy and spontaneous delivery. Our cases are the first publication of congenital TMJ ankylosis in two siblings, although there are hints in the histories in two other papers that a sibling may have suffered from the same condition. We discuss the hypothesis that the potential to ankylose in the temporomandibular area is a congenital disorder as in our cases, and that even later in life trauma or infection are only supervening initiating factors.     

三维手术模拟辅助自体喙突移植再造髁突关节成形术

目的研究计算机三维手术模拟系统在利用自体喙突移植再造双侧颞下颌关节强直患者髁突关节成形术中的应用及其临床效果。方法对2007~2009年我院收治的8位双侧颞下颌关节骨性强直患者,利用Surgicase CMF软件行术前设计和三维手术模拟并行相关测量。在相关数据的指导下行双侧强直块切除术、自体喙突游离移植再造髁突。术后行临床检查,放射检查等对骨瓣愈合情况和颞下颌关节功能进行评价。结果术后患者获得良好的开口度与咬合关系。曲面体层X线片示,所有患者的移植喙突位于关节窝内,愈合良好;喙突有一定吸收,但未引起咬合的明显改变。随访期间未有复发患者,无其它明显并发症。结论在自体喙突移植再造双侧颞下颌关节强直患者髁突成形术中应用计算机辅助三维手术模拟系统可以使得手术更加精确和方便,提高了患者的满意度。     

Temporomandibular joint ankylosis: an Indian experience.

Seventy-five condylectomy and coronoidectomy specimens of temporomandibular joint ankylosis in 61 patients were studied. Fourteen patients had bilateral ankylosis, six of whom had fibrous ankylosis on one side. There were two types of ankyloses: intra-articular and juxta-articular. Intra-articular ankylosis was seen only in reankylosis or in postinfective cases. Sixty-six cases were posttraumatic juxta-articular ankylosis. A rudimentary temporomandibular joint with an atrophic condylar articular surface was found in all juxta-articular ankyloses. The size of new bone in the specimens varied from 0.5 to 3 cm. Fusion of the extra-articular bone mass with tympanic plate was also observed. Contracture of temporalis muscle was noted in all the cases, which made excision of the coronoid processes mandatory in all the arthroplasties. Arthroplasty early in childhood did not hamper growth; instead, facial remodeling was enhanced.     

Lateral Thigh Fascia Lata as Interpositional Graft for Temporomandibular Joint Ankylosis

Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft is commonly used in neurosurgical practice and in other surgical specialities. We present a case of lateral thigh fascia lata used as interpositional graft for the treatment of a unilateral fibrous temporomandibular joint ankylosis.     

Temporomandibular joint ankylosis

The reconstruction of a permanent functional joint and the provision for correction of any associated deformity are the aims of treatment of temporomandibular joint ankylosis. Methods which merely free the ankylosis, in our opinion, compromise the likelihood of achieving these aims.     

Treatment of temporomandibular joint ankylosis by a modified fossa prosthesis.

BACKGROUND AND OBJECTIVE: Treatment of temporomandibular joint ankylosis is a challenge and suffers from a high incidence of recurrence. Although treatment of ankylosis has been tried as early as nearly 200 years ago, no single technique produced satisfactory results. An alternative technique and a modified spacer system are described in this paper. MATERIAL AND METHODS: Fifteen patients, nine of whom had unilateral and the remaining six had bilateral ankylosis were evaluated. Modified fossa implants were used in all cases. RESULTS: The highest incidence of ankylosis was observed in the 11-20 year age group (nine patients). Falls during childhood was the common aetiological factor. Eight patients had been previously operated upon. Postoperative interinsicial opening values were remarkably different from the preoperative ones and the long-term results were satisfactory. CONCLUSION: With continued research and development in the treatment of ankylosis, temporomandibular joint implants will become more predictable and reliable. This specially designed fossa implant seems to be promising in the treatment of TMJ ankylosis.     

Cephalometric studies of patients with ankylosis of the temporomandibular joint following surgical treatment.

Cephalometric studies of eighteen cases of ankylosis of the temporomandibular joint, treated surgically, were undertaken. Arthroplasty tended to correct the characteristic facial deviation of patients with ankylosis and approximate the facial features of these patients to those of a normal person. These changes were found to occur in a larger percentage of the patients and to a greater magnitude 6 months postoperatively than 1 week following surgery. These findings support the concept that the mandible grows in response to functional stimulation and emphasize the importance of early surgical treatment of ankylosis of the temporomandibular joint.     

Myositis ossificans of medial pterygoid muscle. A cause for temporomandibular joint ankylosis.

An unusual case of myositis ossificans of the medial pterygoid muscle has been discussed. It is important to know the exact cause of the temporomandibular joint ankylosis, for successful treatment. Computed tomographic scan and panoramic radiographs are essential diagnostic aids for evaluating conditions such as myositis ossificans. Myositis ossificans can be one of the causes of extra-articular temporomandibular joint ankylosis.     

牵引成骨术治疗儿童单侧颞下颌关节强直伴OSAHS 4例报道

目的:评价牵引成骨术治疗儿童单侧颞下颌关节强直伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果。方法:4例儿童单侧颞下颌关节强直伴发OSAHS患者,男女各2例,年龄5～13岁(中位年龄6.5岁)。均采用颞下颌关节成形术以恢复开口功能,下颌体牵引成骨术治疗OSAHS;其中3例行同期手术,1例行分期手术;单侧和双侧下颌体牵引各2例。固定期约3个月时行呼吸监护仪监测(PSG)复查和牵引器拆除术。结果:4例患儿OSAHS症状均消失,平均AHI由术前的42.7降到4.9,平均最低血氧饱和度由术前的74.3%上升到89.8%;平均开口度由6.5mm增加至25.5mm;面部畸形得到满意矫正。经过平均38.1个月(13～58个月)的随访,无1例复发。结论:下颌骨牵引成骨术联合颞下颌关节成形术能够有效地治疗儿童单侧颞下颌关节强直及其伴发的OSAHS、面部不对称畸形,并且可以同期手术。     

Inverted, T-shaped silicone implant for the treatment of temporomandibular joint ankylosis

Reconstruction of the ankylosed temporomandibular joint is a challenging task. Speech impairment, difficulties with mastication, poor oral hygiene, facial asymmetry, and mandibular micrognathia results in physical and psychologic disabilities. Various surgical techniques with varying success rates have been reported. Many autogenous and alloplastic materials have been proposed. The authors used an inverted, T-shaped silicone implant for the reconstruction of the temporomandibular joint after the release of the ankylosis in 10 patients without any complications in the postoperative period. The authors assert that the reconstruction of the ankylosed temporomandibular joint with an inverted, T-shaped silicone implant is a reliable and effective alternative. This technique can be used according to the special requirements of each patient and obviating the need for the fixation of the implant and is a safer and better way of using silicone for the treatment of temporomandibular joint ankylosis.     

口内下颌骨升支垂直截骨倒置治疗颞下颌关节强直

目的：应用口内下颌骨升支垂直截骨倒置及耳前切口去除骨球关节窝成形术治疗颞下颌关节真性强直,评价其重建颞下颌关节的效果。方法：对5例颞下颌关节骨性强直患者切除病变区骨质,形成关节窝,采用口内下领骨升支垂直截骨倒置升支后部构造新的”髁突”,重建颞下颌关节。手术后常规随访,评价其疗效。结果：全部病例术后随访3～24个月,开口度3．1～4．1cm,平均开口度3．6cm,效果满意。结论：应用口内下颌骨升支垂直截骨倒置及耳前切口去除骨球关节窝成形术治疗颞下颌关节真性强直具有多方面优势,减少了并发症的发生,是治疗颞下颌关节真性强直的有效手术治疗方法。     

创伤性颞下颌关节强直的病程特点与分类治疗

目的调查创伤性颞下颌关节强直（TMJA）的髁突骨折类型及病程特点；探讨各分类治疗方法及疗效。方法31例42侧创伤性TMJA，按Sawhney分类分成4型。Ⅰ型和Ⅱ型强直分别行关节松解和融合骨切除术＋关节盘复位术；Ⅲ型和Ⅳ型强直分别行全关节切除和全关节扩大切除术＋颞肌筋膜瓣衬垫术、选择性下颌支后缘垂直骨牵引及颏成形术。术后复查9～54个月（平均30个月），评价治疗效果。回顾调查引起强直的髁突骨折类型和强直发生的过程。手术与CT及MRI对照观察早期骨化部位、关节盘移位和关节残余运动方式。结果创伤性TMJA均继发于髁突矢状和粉碎性骨折，且关节盘发生移位者。I型（纤维性）强直通常出现在伤后4～5个月，平均张口度18．3mm。术中探及的关节盘全部发生移位，早期强直骨化发生在无关节盘区域。随诊期内，2例（6．45％）复发，其他患者张口度均稳定维持在30mm以上。结论髁突矢状和粉碎性骨折是最容易导致关节强直的骨折类型。关节盘移位是强直形成的重要因素。早期手术可以复位关节盘，避免后期强直时必须切除全关节。     

创伤性颞下颌关节外强直10例临床分析

总结分析10例创伤性颞下颌关节外强直患者的临床特点,如创伤及关节外强直类型、伴发颌面部骨折情况、病理、治疗方法及效果,为临床医师在诊断治疗上提供参考。     

Post-traumatic severe trismus caused by impairment of the masticatory muscle

Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.