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PubMed1998

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.

Adolescent↗
PubMed2003

Lateral pterygoid myotomy with reattachment to the condylar neck: an adjunct to restore function after total joint reconstruction.

OBJECTIVE: The purpose of this study was to investigate the results of performing a lateral pterygoid myotomy with reattachment to the condylar stump to restore more normal function after total joint reconstructive surgery. STUDY DESIGN: Twenty-four joints were reconstructed in 14 patients with stock Christensen chrome-cobalt prostheses. Patients were separated into 2 groups. Group I consisted of 4 joints without reattached lateral pterygoid muscle (-LPM), and group II consisted of 20 joints with reattachment of the lateral pterygoid muscle to the condylar stump (+LPM). Patients were evaluated at an average of 15 months postoperatively to assess mandibular movement. Group I was compared with group II, and statistical analysis was performed through the use of the Mann-Whitney test. Patient satisfaction was evaluated by using postoperative questionnaires. RESULTS: Group II had an average interincisal opening 7.3 mm greater than Group I (P <.001). Lateral movements averaged 3.86 mm in Group II versus 0.5 mm in Group I (P <.05). Protrusion was 2.83 mm greater in Group II than in Group I (P = 0.53). CONCLUSION: The reattachment of the lateral pterygoid muscle to the condylar stump during total joint reconstructive surgery may provide the patient with greater interincisal opening, lateral excursions, and protrusive movement. The preliminary data from these small, nonrandomized groups are promising for improved function following total joint reconstruction.

Arthroplasty, Replacement↗
PubMed2002

Disarticulation resections of the mandible: a prospective review of 16 cases.

PURPOSE: This article provides a review of the disarticulation resection of the mandible for various benign and malignant tumors and non-neoplastic processes. In so doing, the author proposes a classification to describe extension of pathology into the condylar region, thereby requiring its sacrifice. Recommendations are also proposed for preservation versus sacrifice of the meniscus when performing a disarticulation resection of the mandible. Finally, complications are evaluated in this type of mandibular resection. PATIENTS AND METHODS: This review is based on the author's accumulated clinical data obtained from performing disarticulation resections on 16 patients who presented with 10 different pathologic diagnoses. Disarticulation resections are performed for 3 different patterns of extension of pathologic processes into the condylar region, designated as type I, type II, and type III by the author. These designations reflect the radiographic involvement of the condyle or subcondylar region of the mandible by the pathologic entity. The designations of type II and type III extensions are diagnosis dependent, whereas type I extension is independent of diagnosis. RESULTS: Five patients in this series presented with type I condylar extension, 2 patients presented with type II condylar extension, and 9 patients presented with type III condylar extension. The meniscus required sacrifice in 3 of the 16 patients. Complications occurred in 3 of 16 patients and included 1 dislocation of the plate into the middle cranial fossa, 1 dislocation of the plate inferiorly and posteriorly to the mastoid process, and 1 cutaneous exposure of the plate. CONCLUSIONS: Disarticulation resections are rarely required variants of segmental resection of the mandible, and they are required by a variety of pathologic processes of the jaws and contiguous structures. The placement of a reconstruction bone plate with an affixed condylar prosthesis is well tolerated by patients and is associated with few complications. These reconstruction bone plates favorably support facial form, symmetry, and occlusion such that many patients delay their definitive bony reconstruction. Because these condyles are temporary prostheses, the surgeon should consider their removal with bony reconstruction of the disarticulation defect as soon as possible after the ablative surgery.

Bone Plates↗
PubMed1997

Prosthodontic treatment for patients with large mandibular defects; porous hydroxyapatite grafts.

It is difficult for both prosthodontists and their patients with large marginal defects to achieve a satisfactory prosthodontic result, because retention, support, and stability of the prosthesis are limited and recovery of esthetics is unsatisfactory owing to large mandibular defects. Alveolar ridge augmentation therapy is performed to compensate for such problems. We have experienced a good prognosis of prosthodontic treatment for over 10 years in two patients with large marginal defects of the partially edentulous mandible, who had undergone grafting of porous hydroxyapatite blocks to their bone defects. It has been reported that porous hydroxyapatite blocks are unsuitable for edentulous patients, because the mucosa covering the hydroxyapatite block is too thin and delicate to support dentures. We, therefore, designed the denture to prevent concentration of occlusal stress on the mucosa. In both of these two cases, we achieved recovery of occlusal function and esthetics by affixing denture to the large marginally resected defect augmented with a graft of porous hydroxyapatite block.

Adult↗
PubMed1975

Proplast in dental facial reconstruction.

Successful clinical applications since early 1970 have occurred with the use of temporomandibular condylar prosthesis and endosseous blade-vent implants coated with porous proplast. Proplast as a bulk material has also been used to augment atropic mandibular alveolar ridges and deficient facial contours in the mental, mandibular border, and zygomatic areas.

Alveolectomy↗
PubMedDate not supplied

Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants.

This study examined whether it is possible to restore an edentulous mandible with a complete-arch fixed prosthesis retained by only 4 implants without decreasing the survival rate. One hundred nineteen patients received complete-arch mandibular prostheses retained by 4 implants. Most patients were followed for 3 years or more. All patients followed a routine protocol, including annual check-ups and regular radiographic examinations. Twenty-one patients dropped out. Radiographic measurements used the threads of the implants as a basis for comparison. No indication was found that the number of supporting implants could have influenced the observed frequency of technical and surgical complications. Three implants were lost, 2 after 1 year and 1 after 5 years. A statistically significant difference in bone loss between the mesial and distal implants was found. The number of fractured resin teeth in mandibular prostheses was higher when patients had an implant-supported prosthesis in the maxilla. The present study revealed an implant survival rate of 98.6% after 5 years. Therefore, it was concluded that there may not be a need for more than 4 implants to support a fixed mandibular prosthesis, when implants at least 10 mm long can be used.

Acrylic Resins↗
PubMedDate not supplied

[Intraoral support prosthesis of the laryngohyoid complex and of the chin after complete removal of the mandible].

The various methods proposed to date for supporting the glossohyoid-laryngeal complex after removal of the mandibular arch have been examined. A new type of intra-oral maxillofacial prosthesis for supporting the soft lining tissues of the lower 3rd of the face is then described. This has made it possible to avoid final tracheostomy in spite of total mandible removal.

Adult↗
PubMedDate not supplied

Fibrosarcoma of the infratemporal fossa in an 8-year-old girl.

The consultants agree that an open biopsy is generally necessary to establish the histology of a pediatric head and neck neoplasm. Although a frozen section may be useful to ascertain whether tumor tissue has been sampled, definitive therapy should be based only on the histopathologic interpretation of the permanent specimen. The consultants also agree that certain studies should be obtained prior to a biopsy. Dr. Grundfast recommends a chest x-ray, liver function tests, complete blood count, and an magnetic resonance scan. Dr. Healy would obtain additional CT cuts and an MRI scan. Dr. Richardson prefers coronal cuts on the CT scan and an MRI. The skull base is regarded as the area that might pose the greatest difficulty in obtaining a surgical margin. In addition, Dr. Healy states that eustachian tube involvement would compromise the resection. Although all consultants agree that the facial nerve should be sacrificed, they disagree as to how to reconstruct this defect. Dr. Grundfast would restore the mandibular profile with a prosthesis and reconstruct the soft tissue defect with a myocutaneous flap. Dr. Healy would use an iliac bone graft for the skull base defect and would replace soft tissue with a rectus free flap or a myocutaneous flap. Dr. Richardson favors a latissimus dorsi free flap. Because the survival rates for poorly differentiated fibrosarcomas of the head and neck are so low, the experts recommend adjunctive chemotherapy. Drs. Grundfast and Richardson would also advise radiotherapy. Dr. Healy feels that the morbidity of radiotherapy is too high and would use it only in cases of positive margins, parameningeal involvement, or perineural invasion.

Biopsy↗
PubMed1992

Temporomandibular joint diskectomy. No positive effect of temporary silicone implant in a 5-year follow-up.

The purpose of this study was to evaluate the long-term clinical and radiologic effects of a temporary silicone implant after diskectomy of the temporomandibular joint. Forty-three temporomandibular joints in 43 patients with painful disk displacement underwent a diskectomy. A sheet of medical-grade silicone was temporarily placed in 22 patients; 21 patients did not receive an implant. The patients were clinically and radiologically examined 5 years after surgery. On the basis of symptoms and jaw function, they were classified as having good (30 patients), acceptable (8 patients), and bad (5 patients) results. All the patients with bad results and five of the eight patients with acceptable results had received implants. Erosive changes of the condyle or fossa were seen radiographically at follow-up in eight patients, each of whom had received an implant. No positive clinical or radiologic effects of the implants could be identified. The use of a temporary silicone implant after diskectomy of the temporomandibular joint in patients with internal derangement should be seriously questioned.

Adult↗
PubMed1996

Prosthetic rehabilitation in patients with temporomandibular disorders.

Decision-making in prosthetic dentistry and in the management of patients suffering from temporomandibular disorders is strongly influenced by the clinical and educational background of the dentist. The prosthetic rehabilitation of patients affected by one of the various subsets of temporomandibular disorders is a particularly challenging task, and the literature about this topic is limited. This article reviews the current situation and gives suggestions on how the dentist should proceed in the prosthetic treatment of these patients.

Decision Making↗
PubMed1989

A technique for the treatment of mandibular body fractures in young children.

Mandibular body fractures in young children are uncommon, yet their treatment and management often present several difficulties. The presence of developing dental follicles may lead to irregular fracture lines and precludes the use of intraosseus wiring. In addition, treatment of fractures in children of this age requires a technique that limits the number of separate procedures that they are subjected to. The technique outlined below for the treatment of mandibular body fractures in young children, uses a plastic impression tray as a splint and provides a simple means for their reduction and fixation.

Child↗
PubMed2003

Comparison of 2 temporomandibular joint total joint prosthesis systems.

PURPOSE: The study goal was to evaluate the comparative outcomes of patients treated with temporomandibular joint (TMJ) total joint prostheses, using either the Christensen prosthesis (TMJ Inc, Golden, CO) (CP) or the TMJ Concepts prosthesis (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) (TP). PATIENTS AND METHODS: Forty-five consecutive patients treated with either CP or TP total joint prostheses were evaluated. The CP group consisted of 23 patients (40 prostheses; average patient age, 38.8 years). The TP group consisted of 22 patients (38 prostheses; average patient age, 38.5 years). The average number of previous operations for the CP group was 3.9, whereas it was 2.6 for the TP group. The CP and TP groups had an average follow-up of 20.8 and 33.0 months, respectively. Patients were evaluated for incisal opening and occlusal and skeletal stability. A visual analog scale was used for subjective assessment of TMJ pain (0 = no pain, 10 = worst pain), jaw function (0 = normal function, 10 = no function), and diet (0 = no limitations, 10 = liquids only). Statistical analysis was performed using an independent t test, and a value of P <.05 was considered significant. RESULTS: The average postsurgical incisal opening for the CP group was 30.1 mm (increase of 6.7 mm), and that for the TP group was 37.3 mm (increase of 9.9 mm), indicating significant increase of the TP group (P =.008). The average postsurgical pain level for the CP group was 6.0, a decrease of 1.8, and that for the TP group was 4.1, a decrease of 3.1, indicating significant improvement for the TP group (P =.042). Postsurgical average jaw function for CP was 5.5, an improvement of 1.2. The postsurgical TP average was 3.9, an improvement of 3.0, showing significant improvement for the TP group (P =.008). Average postsurgical diet rating for the CP group was 5.4, an improvement of 1.8. The TP group average was 3.9, an improvement of 2.0, indicating significant improved eating ability for the TP group (P =.021). Skeletal and occlusal stability were good in both groups. CONCLUSION: The TP group had statistically significant improved outcomes compared with the CP group relative to postsurgical incisal opening, pain, jaw function, and diet. Both groups showed good skeletal and occlusal stability.

Adolescent↗