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Temporomandibular joint lower compartment surgery
I. Rosenberg
ANZAOMS, Australia
The temporomandibular joint is divided into upper and lower joint
compartments by the intraarticular cartilage. Significant pathology
occurs in the lower joint compartment and therefore the arthro-
scopic procedure is incomplete without the ability to operate in
both upper and lower joint compartments. Pathology found in the
lower joint compartment is as follows: synovitis, effusion, adhe-
sions, osteoarthritic bone changes, stuck disc Essential to this
technique is that the joint be suitably distracted. Steinman pins and
special distractor is used for this purpose. Three portal surgery is
necessary: An anterior portal, a posterior portal and an interme-
diate portal to enable manipulation of the disc with a fine probe.
The procedures that can be carried out in the lower joint com-
partment are as follows: Investigation of lower joint compartment
pathology lysis and lavage in the lower joint compartment high
condylar shave. An anterior release incision made in combination
with the lateral disc access incision enables the disc to be reduced
and stabilised with the Prolene endaural plication suture and cau-
terisation. Injection of Marcaine and steroid can be done into the
lower joint compartment and posterior attachment by direct vision.
In severely arthritic joints where a thorough lysis and lavage of
adhesions in the lower joint compartment is carried out, with post-
operative physiotherapy and occlusal splint management the joints
can be rendered functional and comfortable for the patient without
undergoing major arthroplasty procedures.
http://dx.doi.org/10.1016/j.ijom.2017.02.796
Is total joint replacement along with fat grafts a new protocol
for adult temporomandibular joint ankylosis treatment?
A. Roychoudhury ∗ , R. Yadav, O. Bhutia, B. Aggrawal, B. Soni,
D. Gowswami, D. Baidya
All India Institute of Medical Sciences, New Delhi, India
Objective: To record the outcomes of stock total joint replace-
ment (TJR) along with fat grafts in adult temporomandibular joint
(TMJ) ankylosis treatment and develop a protocol.
Methods: A prospective study to evaluate the outcome of stock
total TMJ replacement along with fat graft (buccal pad fat) in
adult TMJ ankylosis patients. Aetiology, duration of ankylosis,
maximal incisal opening (MIO), pre- and postoperative occlusion,
mandibular movements, quality of life and recurrence was evalu-
ated. Three-dimensional plastic models were fabricated for proper
planning and measurements. Ankylosis was released and stock
total joints were fixed through preauricular extended temporal
incision in the same sitting. Concomitant orthognathic correction
of facial asymmetry was carried out in two patients.
Results: 11 patients (six females, five males) with 17 ankylosed
joints (five unilateral, six bilateral) and mean age of 18.82 + 2.7
years were operated and followed up for 12–30 months. Sawhney’s
type III (n = 8) and type IV (n = 7) were predominant ankylosis
types. The MIO ranged from 0 to 4 mm preoperatively. The mouth
opening improved to 38 mm ± 6 mm. No change in occlusion,
no incidence of open bite encountered in any case. The dietary
scores and quality of life improvement was marked (P < 0.01) No
recurrence was noted.
Conclusions: Smooth mouth opening and ability to keep the
occlusion unchanged together with no recurrence and ability to
address the functional and aesthetic requirements by concomi-
tant orthognathic surgery in adult TMJ ankylosis patients leads
to a conclusion that TJR is probably the new protocol for the
management of adult TMJ ankylosis.
http://dx.doi.org/10.1016/j.ijom.2017.02.797
Oral mucosa rete ridge elongation is dependent, but not
impact on integrin signalling
G. Sa ∗ , S. He, Y. Zhao
Wuhan University, Wuhan, China
Background: Epithelial rete ridges contribute to the adhesion of
epithelium by enlarging the contact areas between epithelium and
lamina propria. Integrin family promotes the epithelial adhesion
via tying epithelial cells to the basement membrane.
Objectives: This study aims to explore whether elongation of rete
ridge links with the integrin expression and signalling pathway.
Methods: 40 Sprague Dawley were averagely divided into 5
groups, control, phosphate-buffered saline (PBS), keratinocyte
growth factors (KGF), HYD-1 (a competitive antagonists of inte-
grin), and KGF+HYD-1 group, respectively. The length of rete
ridges, the expression intensity of integrin subunit alpha 6 (␣6),
beta 4 (␤4), ␣3, and ␤1, as well as the strength of epithelial
adhesion were measured after rat was topically injected with cor-
responding reagent in the venture of rat tongue.
Findings: Oral mucosa rete ridges of rats of KGF group were
longer that those of the control, PBS, HYD-1, and KGF+HYD-
1 group. However, the expression of integrin ␣6, ␤4, ␣6 and ␤1
of KGF group was not upregulated compared to the other groups.
In vitro studies demonstrated that stimulating the HaCat cells with
KGF did not impact the expression of integrin subunit ␣6, ␤4, ␣6,
and ␤1. Oral epithelium of KGF group exhibited stronger, whereas
those of HYD-1 and KGF+HYD-1 groups showed weaker adhe-
sion strength compared with those of control and PBS groups.
Conclusions: Rete ridge elongation does not impact the expres-
sion of integrin, but depends on the integrin function and
strengthen the epithelial adhesion.
http://dx.doi.org/10.1016/j.ijom.2017.02.798
Condylectomy and gap arthroplasty using fascia of temporal
for treatment unilateral bone ankylosis of
temporomandibular joint — a case report
S.A. Sadputranto ∗ , A.T. Yuza
Department of Oral and Maxillofacial Surgery, Hasan Sadikin
General Hospital; and Faculty of Dentistry, Padjadjaran
University, Indonesia
Ankylosis is a condition of temporomandibular joint which clin-
ically shows limitation or total restricted of mouth opening.
Ankylosis is classified by severity (total or partial ankyloses), loca-
tion (capsular and intracapsular) and the type of tissue involvement
(fibrous, osseous and fibre osseous). Complication of ankylosis
can be vary as the limitation of mouth opening may cause distur-
bance on speech, chewing and oral hygiene.