1/267. 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. ( info) |
| We report on a family with conductive hearing loss due to congenital stapes ankylosis, and with hyperopia, broad thumbs, and broad first toes. Neither of the studied relatives had symphalangism, possibly distinguishing this syndrome as an entity separate from the facio-audio-symphalangism and proximal symphalangism syndromes. An alternative possibility is that this family falls within the spectrum of the facioaudio-symphalangism and proximal symphalangism syndromes. Visualization of the ossicular chain, and ophthalmologic and radiologic studies are important in the evaluation of families with congenital conductive hearing loss. A characteristic physiognomy in our patients is present; this autosomal dominant syndrome was first described by Teunissen and Cremers [1990: Laryngoscope 100:380-384]. ( info) |
3/267. Panclavicular ankylosis in pustulotic arthroosteitis. A case report. A 54-year-old man who had palmoplantar pustulosis showed bilateral, complete osseous fusion of the sternoclavicular and acromioclavicular joints. No significant abnormality was seen in the glenohumeral joint. The left clavicle had a nonunion develop, whereas the right did not. The elevation of the right shoulder was limited to 100 degrees in active and passive measurements. The total external rotation and internal rotation at the side was 135 degrees. This decreased to 90 degrees at 60 degrees elevation and to 10 degrees at maximum (100 degrees) elevation. Based on the kinematic data on normal shoulders, it was thought that the ankylosis of both ends of the clavicle held the scapula unrotated during the arm movement so that, at the arm to trunk angle of 100 degrees, the position of the humerus relative to the scapula was equivalent to that of a normal shoulder in complete elevation. The current case provided an extremely rare clinical setting where shoulder mobility depended only on glenohumeral motion as a result of the complete loss of scapulothoracic motion. ( info) |
4/267. Functional rehabilitation of ankylosed temporomandibular joints. Successful chrome-cobalt prostheses have been used to replace the condyle and glenoid fossa in six young macaca irus monkeys. In one group of two animals the left temporomandibular joint was replaced; in the second group the right joint and in the third group both temporomandibular joints were replaced. Neither masticatory function nor ability to open or close the mouth was affected, and all the animals remained in excellent health, living in the colony for 9 to 10 months. A similar surgical procedure was carried out for treatment of three human patients with ankylosed temporomandibular joints. ( info) |
5/267. Joint replacement for a spontaneously ankylosed hip in a haemophilic patient. A cemented Charnley total hip prosthesis was implanted in a 48-year-old man with mild haemophilia (factor viii 4 IU dL-1) in his right spontaneously ankylosed hip. At the time of surgery he was anti-HCV positive, anti-hiv negative, and no circulating inhibitors were encountered. The indication for surgery was long-lasting intractable low back and ipsilateral knee pain. At 4-month follow-up, relief of pain was achieved as well as correction of limb-length discrepancy, with a good result according to the Mayo Clinic hip score. Doses of 50 IU kg-1 body weight of recombinant factor viii (Recombinate; Baxter, Glendale, california, USA) was used during the 2 weeks of admittance to the hospital. The dosage was adjusted according to the recoveries of factor viii, with an overall factor consumption of 68 000 IU. As far as we know this is the first case reported in the literature of a person with haemophilia in whom a spontaneous hip ankylosis has been satisfactorily converted in a total hip arthroplasty with a short-term follow-up. However, a much longer follow-up is still needed to ascertain the efficacy of this surgical procedure in haemophilia. ( info) |
6/267. Proximal symphalangism and congenital conductive hearing loss: otologic aspects. OBJECTIVE: Results of stapedectomy are reported in a Belgian 26-year-old woman and two Dutch brothers having the proximal symphalangism syndrome (McKusick 18580). STUDY DESIGN: case reports are presented. A review of the results of ear surgery for congenital conductive hearing loss in this syndrome is given. SETTING: The Belgian patient was treated in a general hospital. The Dutch patients were treated in a university hospital, which was a tertiary referral center. patients: patients were referred to have an evaluation of their hearing impairment. INTERVENTION: Based on the syndromal diagnosis and based on routine audiometric tests, a congenital ossicular fixation was considered to be the cause of the hearing loss. By exploratory tympanotomies, this was confirmed. Reconstructive procedures including stapedotomy were performed. MAIN OUTCOME MEASURES/RESULTS: Long-term audiometric data are presented to evaluate the outcome of the surgical interventions. CONCLUSIONS: Congenital stapes ankylosis eventually combined with a congenital fixation of the short process of the incus in the fossa incudis, causing the congenital conductive hearing loss. Surgical intervention is very successful in most reported cases, but negative side effects are incidentally found as well. ( info) |
| Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (synovitis Acne Pustulosis hyperostosis osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvement similar to spondylarthropathies and skin manifestations including palmoplantar pustulosis and pustular psoriasis. We report the first case of SAPHO syndrome disclosed by SCI related to cervical spine ankylosis. ( info) |
8/267. Using three-dimensional-computerized tomography as a diagnostic tool for temporo-mandibular joint ankylosis: a case report. Roentgenographic examination has long been a useful diagnostic tool for temporo-mandibular joint (TMJ) disease. The methods include TMJ tomography, panoramic radiography and computerized tomography (CT) scan with or without injection of contrast media. Recently, three-dimensional CT (3D-CT), reconstructed from the two-dimensional image of a CT scan to simulate the soft tissue or bony structure of the real target, was proposed. In this report, a case of TMJ ankylosis due to traumatic injury is presented. 3D-CT was employed as one of the presurgical roentgenographic diagnostic tools. The conventional radiographic examination including panoramic radiography and tomography showed lesions in both sides of the mandible. CT scanning further suggested that the right-sided lesion was more severe than that on the left. With 3D-CT image reconstruction the size and extent of the lesions were clearly observable. The decision was made to proceed with an initial surgical approach on the right side. With condylectomy and condylar replacement using an autogenous costochondral graft on the right side, the range of mouth opening improved significantly. In this case report, 3D-CT demonstrates its advantages as a tool for the correct and precise diagnosis of TMJ ankylosis. ( info) |
| I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse. ( info) |
10/267. Coronal approach for the replacement of the condylar head in bilateral temporomandibular joint ankylosis: report of three cases. Limitation of mouth opening has long been the chief complaint for patients who suffer from temporomandibular joint (TMJ) ankylosis. For surgical treatment of this disease, several ways have been employed for access to the condylar fossa, including the preauricular, postauricular, perimeatal, endaural and Risdon approaches. In this article, we report three patients with bilateral TMJ ankylosis who underwent replacement of both condylar heads using the bicoronal approach. The advantages demonstrated with this surgical technique are ease of access to the condylar head, ideal surgical exposure field, utility of temporalis muscle and fascia and minimal risk of facial paralysis. ( info) |