Treatment of temporomandibular joint ankylosis by gap arthroplasty.
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PURPOSE: The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating TMJ ankylosis. PATIENTS AND METHODS: Eight patients with TMJ ankylosis were treated by gap arthroplasty. The patients were evaluated by at least twenty-four months (minimum 24 and maximum 48 months). RESULTS: Of the eight patients (eleven joints), five (62.5%) had unilateral involvement and three patients (37.5%) had bilateral involvement. The mean age was 20 years -/+ 9 (range 3 to 30 years). The mean maximal incisal opening (MIO) in the preoperative period was 9.25 -/+ 6.41 mm and in the postoperative period it was 29.88 -/+ 4.16 mm. The complication of temporary facial nerve paresis was encountered in two patients (25%). No recurrence was observed in our series. CONCLUSIONS: Trauma was the major cause of tempomandibular joint ankylosis in our sample. Gap arthroplasty showed good results when treating TMJ ankylosis. (+info)
Genetic characterisation of spontaneous ankylosing arthropathy with unique inheritance from Fas-deficient strains of mice.
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BACKGROUND: The spontaneous onset of macroscopic arthropathy in the ankle of the particular F1 mice descended from two Fas-deficient strains of mice; a mutant substrain of MRL/Mp.Fas(lpr) (MRL/rpl) and C3H/He.Fas(lpr) (C3H/lpr) was recently observed. AIM: To histopathologically characterise and genetically interpret the unique inheritance mode of disease in this arthropathy model. METHODS: MRL/rpl, C3H/lpr, (MRL/rpl x C3H/lpr; MC) F1, (C3H/lpr x MRL/rpl; CM) F1 and MCF2 mice were bred under specific pathogen-free conditions. Histopathological grade of arthropathy was determined at 6 months by examination under a light microscope. To search for a linkage locus to the arthropathy, the whole genome of selected 48 male MCF2 mice with 71 polymorphic microsatellite markers was scanned, followed by quantitative trait locus analysis. RESULTS: The incidence of microscopically defined arthropathy in the male and female MCF1 groups was 100% and 19.4%, respectively. No incidence was observed in the parental strains, MRL/rpl and C3H/lpr, and in CMF1 mice. In the MCF1 mice, the arthropathy mainly affected the ankle joints and was histopathologically characterised by marked entheseal proliferation with chondrocytic differentiation and ossification in the ankle joints, the manifestations similar to ankylosing enthesitis reported previously. An MRL/rpl-derived autosomal dominant susceptibility locus was mapped in the distal of D7Mit68 (60 cM) to the ankylosis onset. CONCLUSION: The MCF1 mice stably develop spontaneous ankylosing disorders in the ankle, with a male predominance. The unique inheritance mode of ankylosis is possibly interpreted by the genetic interaction between the autosomal dominant locus and a Y-linked locus. (+info)
Computed tomography of the TMJ in diagnosis of ankylosis: two case reports.
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Ankylosis of the temporomandibular joint is characterized by restriction or limitation of mandibular movement. It presents as a classic symptom a limited range of motion on opening. Radiographically, ankylosis presents features that facilitate the diagnosis. However, its visualization is not clear in most of the cases involving conventional radiographic techniques. With the evolution of radiographic techniques, computed tomography (CT) became an important examination in the diagnosis of the ankylosis of temporomandibular joint. Due to the increasing use of the CT and its importance in the diagnosis of this disease, the aim of this paper is to present and describe tomographic images of ankylosis of this joint by presenting two clinical cases, using several slices as axial, coronal, and three-dimensional reformatted images. (+info)
Ankylosis of primary molar along with congenitally missing first permanent molar.
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Ankylosis of primary mandibular molars has been routinely found to be associated with various developmental disturbances in permanent dentition such as aplasia of the succedaneous tooth, ectopic eruption of the premolar, infraoclusion of the ankylosed tooth leading to tipping of the first permanent molar etc. This article describes a rare case where there was ankylosis of a mandibular second primary molar along with congenitally missing first permanent molar which resulted in the transposition of second premolar. Treatment options and prognosis of the case are discussed. (+info)
Evidence for uncoupling of inflammation and joint remodeling in a mouse model of spondylarthritis.
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OBJECTIVE: To study the relationship between inflammation and remodeling by inhibiting tumor necrosis factor alpha (TNFalpha) in male DBA/1 mice with spontaneous arthritis, a model of spondylarthritis (SpA). METHODS: TNFalpha was inhibited using etanercept, a soluble TNF receptor. The efficacy of the dose used (25 micro g/mouse) was confirmed in methylated bovine serum albumin (mBSA)-induced monarthritis, a model of inflammation-driven joint destruction. Male DBA/1 mice with spontaneous arthritis were caged together from the age of 10 weeks onward and were treated twice weekly with etanercept. The incidence and clinical severity of disease were recorded. Mice were killed at age 25 weeks, and histomorphologic analysis was performed. The presence of TNFalpha, NF-kappaB, and Smad signaling was studied using immunohistochemistry. Entheseal endochondral bone formation was modeled using micromass cultures of periosteal cells. RESULTS: Etanercept inhibited mouse TNFalpha in vitro and in vivo. Etanercept treatment of mBSA-induced arthritis had a significant effect on the severity of disease. Etanercept did not affect the incidence or severity of spontaneous arthritis. Pathologic analysis revealed no differences between etanercept-treated and phosphate buffered saline-treated mice. TNFalpha-positive cells were observed in the synovium, in vessel-associated cells, in fibrocartilage, and in new cartilage. Activation of Smad signaling was observed in earlier stages of disease than was active NF-kappaB signaling. TNFalpha inhibited chondrogenesis in the micromass model. CONCLUSION: Inhibition of TNF did not affect the severity and incidence of joint ankylosis in a mouse model of SpA. Therefore, the process of entheseal ankylosis may be independent of TNF. New tissue formation in SpA could be considered an additional and specific therapeutic target. (+info)
Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint.
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OBJECTIVE: The purpose of the present paper was to carry out a longitudinal study of a series of cases in which injury of the facial nerve was observed following surgery for the treatment of temporomandibular ankylosis. STUDY DESIGN: The sample was composed of 13 patients, both male and female, in whom 18 surgical approaches were made. A postoperative assessment of the motor function of the facial nerve was made in accordance with the House-Brackmann grading system. All the patients were photographed and assessed at the following postoperative times: 24 hours, one week, one month and three months. RESULTS: The results showed that injury of the facial nerve occurred in 31% of the cases. An increase in the frequency of nerve injury was observed in the cases in which the interpositional arthroplasty technique was employed, as well as the fact that 75% of the patients had undergone at least one surgical intervention prior to the study. After three months all the patients displayed normal function of the facial nerve. CONCLUSION: The frequency of facial nerve injury is related to the degree of difficulty involved in the surgery determined by the type of ankylosis. The nerve lesions were shown to be of a temporary nature. (+info)
Treatment of severe bilateral temporomandibular joint ankylosis in adults: our protocol.
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AIM: In order to evaluate the reliability of interpositional gap arthroplasty with temporalis myofascial flap the authors retrospectively analysed the data of 5 patients suffering from bilateral temporomandibular ankylosis operated on with this technique. METHODS: The preoperative assessment included evaluation of pain during function, interference with eating and the maximal interincisal distance. All patients received bony ankylosis removal, interposition of a finger-shaped temporalis myofascial flap in the articular gap and coverage with temporoparietal fascial flap as a new capsule. In the postoperative period an aggressive physiotherapy was carried on for at least 6 months. RESULTS: All cases experimented release of pain (evaluated by a Visual Analogue Scale method), a return to a normal diet and a stable improvement in mouth opening during the follow-up period. CONCLUSIONS: This technique should be considered a reliable method to avoid relapse of ankylosis and to stabilize postoperative results. (+info)
Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report.
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Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings. (+info)