Ajoy Roychoudhury

Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: A report of 50 cases

OBJECTIVE The purpose of this study was to determine the cause of temporomandibular ankylosis and the long-term results of gap arthroplasty with coronoidectomy followed by immediate postoperative jaw exercises as a treatment of the condition. STUDY DESIGN This retrospective study evaluated the cause of temporomandibular joint ankylosis and the 36-month postoperative results of gap arthroplasty in 50 patients (62 joints). The patients were divided into 2 groups; group I (aged 0-12 years) consisted of 29 cases (24 unilateral and 5 bilateral; 34 joints); group II (aged 13-30 years) consisted of 21 cases (14 unilateral and 7 bilateral; 28 joints). A postoperative jaw opening exercise regimen was followed. Descriptive statistics, the Wilcoxon signed rank test, and rank sum 2-sample (Mann-Whitney) tests were applied. RESULT Trauma to the temporomandibular joint was documented as a major etiologic factor in 86% of cases. The 36-month postoperative mean maximal incisal opening was 30.62 mm (+/- 6.25 mm) for group I and 30.14 mm (+/- 3.9 mm) for group II. The P value in each group was highly significant for the Wilcoxon signed rank test; the Mann-Whitney test showed no difference between the groups, indicating that both groups had done well. The recurrence rate was 2%. CONCLUSION Trauma is the major cause of temporomandibular joint ankylosis in India. The long-term functional results of gap arthroplasty are satisfactory and comparable to those obtained through use of other treatments. Postoperative exercises play a crucial role in lasting success.

Review of osteochondroma of mandibular condyle and report of a case series.

PURPOSE To present a retrospective analysis of 10 cases of osteochondroma of the mandibular condyle (operated between 1993 and 2009) with respect to age, gender, site of the pathology, treatment modality and recurrence, with review of literature. MATERIALS AND METHODS Medical records with x-rays, computed tomography scans, and bone scans of all histologically proven osteochondroma of mandibular condyle cases operated between 1993 and 2009 were retrieved and examined. The data were tabulated and analyzed. RESULTS There were 8 males and 2 females, with a right:left ratio of 2.3:1. Age range was 18 to 45 years with a mean of 29.4 years. Seven of 10 were superomedial in location. Six patients were treated by conservative condylectomy, whereas 4 required total condylectomy. In all cases, a preauricular with extended temporal approach was used. In the follow-up period ranging from 1 year to 13 years, there was no recurrence. CONCLUSION Mandibular condylar osteochondroma is thought to be a relatively rare lesion with only 90 cases documented in the English language literature to date. Gradual facial asymmetry over the years is the most striking feature. Two types are identified: those causing growth potential in mandible causing bowing of ipsilateral body and requiring gnathic correction after excision of tumor, and others growing as tumors superior or superomedial to condyle without causing much growth in the mandible, requiring only excision and automatic swing back to correct asymmetry. Both the procedures---conservative condylectomy and the total condylectomy---are curative. The decision, however, depends on how much swing of mandible is required postsurgery for correction of asymmetry and occlusion.

Equivalence Randomized Controlled Trial of Bioresorbable Versus Titanium Miniplates in Treatment of Mandibular Fracture: A Pilot Study

PURPOSE The present study was undertaken to test bioresorbable fixation versus titanium for equivalence in terms of clinical union and complications using the American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomized, controlled, equivalence trial. MATERIALS AND METHODS A total of 40 patients were enrolled and allocated to the titanium group and bioresorbable group using a computerized randomization table. All were plated using standard plating principles. In the bioresorbable group, 2 weeks of maxillomandibular fixation was also used. Evaluation of the study endpoint was done at 8 weeks postoperatively. For statistical analysis, the upper limit of the 95% confidence interval was calculated for failure to achieve the primary outcome variable and compared with the maximal clinically acceptable difference between the standard and test modalities in the failure to achieve clinical union (delta). Delta was predetermined as 2%. The other complications were tested for significance using Fishers exact test. RESULTS Of the 40 patients, 21 were in the titanium group and 19 were in the bioresorbable group, with 20 men and 1 woman in the titanium group and 18 men and 1 woman in the bioresorbable group. The mean age was 28.7 years in the titanium group and 26.6 years in the bioresorbable group. In the titanium group, the complications noted were nonunion in 0%, malocclusion in 7.7%, continued postoperative swelling in 0%, chronic pain in 2%, infection in 5.2%, an inability to chew hard food after 8 weeks in 7.7%, the need for alternative treatment in 0%, and the need for reoperation in 31%. In the bioresorbable group, the complications were nonunion in 4.17%, malocclusion in 11.1%, swelling in 8.3%, chronic pain in 37.5%, infection in 0%, an inability to chew hard food in 11.1%, the need for alternative treatment in 11.1%, and need for reoperation for plate removal in 0%. CONCLUSIONS The small sample size did not allow any meaningful conclusion to be drawn from the present study in terms of the primary question of achieving union. Both groups matched in outcomes when evaluated only on a clinical basis. The avoidance of repeat surgery for plate removal is a definite advantage of using resorbable plates. However, the results are inconclusive in favor of any particular plating system.

Primitive neuroectodermal tumor of maxilla in an adult

Primitive neuroectodermal tumor is primarily a central nervous system tumor. These tumors are generally manifest in infancy or early childhood. The following article reports a rare case of primitive neuroectodermal tumor in posterior maxilla in an adult. Treatment for primitive neuroectodermal tumor in extracranial sites in adults is not clearly defined in the literature. This case was treated by combined chemotherapy followed by radiotherapy, which failed to cause regression of the lesion.

Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach

The objective of this study was to evaluate any damage to the facial nerve after a retromandibular transparotid approach for open reduction and internal fixation (ORIF) of a subcondylar fracture. We studied 38 patients with 44 subcondylar fractures (3 bilateral and 38 unilateral) treated by ORIF through a retromandibular transparotid approach. All patients were followed up for 6 months. Postoperative function of the facial nerve was evaluated within 24h of operation, and at 1, 3, and 12 weeks, and 6 months. Variables including type of fracture, degree of mouth opening, postoperative occlusion, lateral excursion of the mandible, and aesthetic outcome were also monitored. Nine of the 44 fractures resulted in transient facial nerve palsy (20%). Branches of the facial nerve that were involved were the buccal (n=7), marginal mandibular (n=2), and zygomatic (n=1). In the group with lateral displacement, 2/15 showed signs of weakness, whereas when the fracture was medially displaced or dislocated 7/23 showed signs of weakness. Of the 9 sites affected, 7 had resolved within 3 months, and the remaining 2 resolved within 6 months. The mean (range) time to recovery of function was 12 weeks (3-6 months). There was no case of permanent nerve palsy. The retromandibular transparotid approach to ORIF does not permanently damage the branches of the facial nerve. Temporary palsy, though common, resolves in 3-6 months. Postoperative occlusion, mouth opening, and lateral excursion of the mandible were within the reference ranges. We had no infections, or fractured plates, or hypertrophic or keloid scars.

Melanotic Neuroectodermal Tumor of Infancy of the Maxilla: A Case Report With Review of Literature

a t g b p u m Melanotic neuroectodermal tumor of infancy (MNTI) is an infrequent, melanin-containing neoplasm that primarily affects the maxilla during the first year of life. The rarity of this lesion and the controversies egarding its origin have led to use of a diverse nomenlature in the past. This includes terms such as congental melanocarcinoma, atypical ameloblastoma, retinal nlage tumor, and melanocytoma; however, neuroectoermal tumor of infancy continues to remain the most opular term used worldwide. Since the time it was first reported by Krompecher in 1918, around 360 cases have been described in he medical literature. Of these, we found 236 cases 65.5%) affecting the maxilla alone. Almost all the atients had presented in the first year of life, with nly a few exceptions that were diagnosed in adultood. The gender distribution has also been controversial, with some reporting a higher occurrence in male patients and others advocating no definite gender predilection. The lesions are usually benign, with only a few reports of malignancy being reported. However, factors such as rapid growth and local invasion justify resection with attainment of tumor-free margins in most cases. Recurrences can be expected primarily because of incomplete excision, tumor dissemination during surgery, or multicentric nature, and the occurrence for such ranges from 10% to 20%. We report a case of MNTI originating in the axilla of a 4-month-old male infant, which was man-

Immediate autotransplantation of third molars: an experience of 57 cases

OBJECTIVE We present our experience of success with immediate third molar transplants in young individuals while secondarily assessing factors predicting failure. STUDY DESIGN A total of 57 cases of third molar transplant with both open and closed apices were studied in individuals aged 15 to 25 years. Factors influencing prognosis were analyzed by univariate and multivariate analysis. RESULTS The replaced teeth included 17 maxillary molars (29.8%) and 40 mandibular molars (70.2%). After a follow-up of 19.9 ± 2.8 months, 49 cases (86%) were successful; 7 (12.3%) cases failed owing to root resorption, and 1 (1.7%) failed owing to infection. Pulp revascularization was seen in all successful cases with open apices. Proximal grinding of donor tooth was significantly associated with failure (odds ratio, 12.5; P = .025). CONCLUSIONS Autogenous third molar transplant is an excellent and viable treatment modality. By using proper case selection and minimizing damage to the donor tooth root, high success rates can be achieved.

Functional Outcomes of Gap and Interposition Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis

PURPOSE Recurrence is a major concern in management of temporomandibular joint ankylosis. In this study functional outcomes of gap arthroplasty (group I) and temporalis myofascial interposition arthroplasty (group II) are compared. MATERIALS AND METHODS Preoperative, intraoperative, and follow-up data were noted from our departmental database. Outcome variables were postoperative mouth opening, open bite, recurrence, and facial nerve dysfunction. The χ2 test, Fisher test, t test, 2-sample Wilcoxon rank sum test, and logistic regression analysis were used. RESULTS Group I comprised 207 patients, and group II comprised 55 patients. The mean age was 12.9 years (SD, 7.0 years). There were 220 nonrecurrent and 42 recurrent cases. The mean follow-up period was 3.78 years (SD, 3.0 years). In first time-operated cases, the recurrence rate was 14.7% in group I and 4.8% in group II. In recurrent cases, the recurrence rate was 34.5% and 30.8%, respectively. The differences were statistically insignificant. CONCLUSIONS In first-time operated temporomandibular joint ankylosis cases, both treatments are satisfactory in preventing recurrence, but the recurrence rate increases with previous recurrences.

Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint

AIM To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. METHODS Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. RESULTS Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. CONCLUSION Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea.

Evaluating success of autotransplantation of embedded/impacted third molars harvested using piezosurgery: a pilot study.

Abstract Objective. To evaluate the success of autogenous transplantation of embedded/impacted third molars harvested using piezosurgery. Materials and methods. This prospective pilot study enrolled 20 healthy patients with non-restorable first/second molars and a caries-free retrievable embedded/impacted third molar. Piezosurgery was used for removing inter-radicular bone at the recipient socket as well as for bone removal around the donor teeth. Results. After an average follow-up of 16.4 months (SD = 1.9), 18 cases were successful with formation of periodontal ligament around the teeth. One tooth was lost due to infection at 1 month. One patient was lost to follow-up. There was no root resorption or ankylosis in any of the cases. In six donor teeth with complete root formation, root canal treatment was carried out. All the remaining teeth responded positively with vitality testing. Conclusion. Piezosurgery is an effective device if embedded/impacted third molars are to be harvested for successful autogenous transplantation.