1/8. 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.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. A 'made in one piece' skeleton in a 22-year-old man suffering from sickle cell anaemia.A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (99mTc-MDP (methyldiphosphonate) bone scan, Tc monoclonal antigranulocyte scan and 99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Characterization of a stapes ankylosis family with a NOG mutation.OBJECTIVE: To characterize the otologic phenotype in a family with autosomal dominant stapes ankylosis, hyperopia, and skeletal abnormalities caused by a mutation in the noggin gene (NOG). STUDY DESIGN: Case series. SETTING: Academic tertiary care center. patients: Eight affected and 3 unaffected family members. MAIN OUTCOME MEASURES: history, physical and radiologic examination, and surgical outcomes. RESULTS: Although affected members were initially presumed to have typical nonsyndromic otosclerosis, the clinical data were most consistent with an autosomal dominant congenital stapes ankylosis syndrome. Eight of eight affected family members had bilateral low-frequency conductive hearing loss. Six of eight underwent fenestration procedures and/or stapedectomies. All members with initial postoperative closure of the air-bone gap returned to their baseline conductive loss within 2 years. Two affected family members had documented maximal conductive hearing loss by age 4, and two members without previous otologic surgery have not experienced sensorineural hearing loss. High-resolution temporal bone computed tomography showed stapes ankylosis and indistinction of the incudomalleal junction bilaterally and bony regrowth over the stapedotomy for those with stapedectomies. Detailed physical and radiologic examination identified multiple other skeletal abnormalities. CONCLUSIONS: Although this phenotype may present as classic otosclerosis to the otolaryngologist, detailed investigation revealed a congenital stapes ankylosis syndrome. Because is essential in regulating normal bone development and maturation, mutations in this gene may be associated with excessive bony overgrowth and refixation of the stapes footplate after initial successful surgery. patients with hereditary conductive hearing loss should be assessed to rule out subtle features of a skeletal syndrome.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/8. ankylosis of the temporomandibular joint developing shortly after multiple facial fractures.A 41-year-old male patient was referred for treatment of extensive facial fractures and lateral condylar dislocations. The patient underwent open reduction and fixation under general anaesthesia. Intermaxillary fixation was released in 2 weeks and mouth opening was 21 mm. Despite postoperative physical exercises, the range of motion decreased to 10 mm at 5 weeks after the surgery. MR arthrography revealed a fibrous ankylosis in the bilateral TMJs. Coronal CT scans depicted a bony outgrowth of the left TMJ tuber. The patient underwent surgery for the ankylosis including discectomy and coronoidectomy, and removal of the bony outgrowth. An interincisal distance of 30 mm on maximal mouth opening has been maintained for 14 postoperative months. The importance of imaging assessment was emphasized for diagnosing the precise pathologic state of the ankylosis and selecting an appropriate surgical treatment of choice.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis.The classical treatment for temporomandibular joint (TMJ) ankylosis in children: 1) joint release; 2) arthroplasty; 3) reconstruction; and 4) postoperative physical therapy (PT), is often unsuccessful. Postoperative physical therapy is difficult in the young patient due to poor cooperation. Moreover, there is a subgroup of patients who have a refractory congenital proliferative bony process that is the cause of their disease. In these patients, a role for distraction osteogenesis (DO) has been defined. We present a series of young patients with congenital proliferative TMJ ankylosis. Some have failed classic treatment. In such cases, DO is used to expand the mandibular size and soft tissue matrix. This creates a static open bite, facilitates mid-facial growth, and avoids compromise of the airway, speech, nutrition, and oral hygiene. To maintain these objectives, mandibular DO may be repeated as the child matures. Once skeletal maturity is reached, DO is used to normalize occlusion and further expand the soft tissue envelope prior to definitive reconstruction and aggressive post-op PT. In seven patients, this protocol has been used. Five patients are currently in the active phase of growth and undergoing interim treatment with mandibular DO. Two patients have reached skeletal maturity and have completed the protocol of DO with definitive arthroplasty and reconstruction. DO is a valuable aid in the treatment of the problematic child with congenital proliferative TMJ ankylosis. Interim DO, prior to definitive arthroplasty and reconstruction, can provide a static open bite that prevents progressive deformity and its associated functional disturbances.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/8. Early surgical correction of unilateral TMJ ankylosis and improvement in mandibular symmetry with use of an orthodontic functional appliance--a case report.Early ankylosis of the temporomandibular joint (TMJ) can be a deterrent to normal mandibular growth. The frequency of occurrence is rare in the population of young patients who undergo orthodontic treatment. early diagnosis of TMJ ankylosis is important and early surgical intervention is now an accepted mode of treatment. ankylosis infers minimal, if any joint function. Caldwell argues that restoration of joint function at an early age is necessary to activate as much growth potential as possible. Laboratory and clinical studies have supported the theory that the mandibular condyle is adaptable under function and perhaps even the most deformed condylar head may exhibit growth when released and placed in function. The purpose of this article is to present a case report of surgical release of TMJ ankylosis followed by radiographic and clinical evidence of unilateral condylar growth. The surgical procedure involved maintenance of the condyle, the disk and majority of fibrocartilage covering the mandibular condyle. Aggressive postoperative physical therapy and the employment of a functional orthodontic appliance appeared to have assisted in a more symmetric growth pattern and maintenance of appropriate function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Sequelae of unrecognized, untreated mandibular condylar fractures in the pediatric patient.The mandibular condyle is a commonly involved site of maxillofacial trauma in children. However, this injury is often overlooked on initial physical examination in the emergency department. In cases involving blunt trauma to the chin it is important to suspect possible injury to the condyle of the mandible, as this type of facial injury can result in a spectrum of facial growth disturbances during the patient's later years. general practitioners and pediatric dentists are often the first clinicians to recognize the late complications of condylar trauma years after the injury. With a good clinical examination and past medical history, the diagnosis and etiology can be accurately determined. Once the diagnosis is made, the patient can be referred to a specialist involved in managing this type of problem. Three case reports of patients with facial deformity are presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Congenital temporomandibular joint ankylosis--a case report.A case of congenital temporomandibular joint (TMJ) ankylosis which caused facial disfigurement, significant reduction in mouth opening, difficulties in feeding and breathing, and general interference with physical and mental development is presented. The wide range of manifestations exceed the typical picture of TMJ ankylosis and resemble a syndrome rather than an isolated defect of the TMJ.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |