Ya-ting Qiu

Modified Preauricular Approach and Rigid Internal Fixation for Intracapsular Condyle Fracture of the Mandible

PURPOSE This article reports a modified preauricular approach for intracapsular condyle fracture (ICF) of the mandible and evaluates the stability of various internal fixation methods in the temporomandibular joint (TMJ) division of the Shanghai Ninth Peoples Hospital. MATERIALS AND METHODS One hundred fifty-one patients with 208 ICFs diagnosed by panoramic radiograph and computed tomographic (CT) scan received open treatment in the TMJ division from 1999 to 2008. Their charts were reviewed. Classification of the fracture was based on coronal CT scan. Forty-three patients also underwent magnetic resonance imaging before the operation to check displacement of the disc. A modified preauricular approach was used for all patients. Various internal fixation methods from wire, to screw, to plate were evaluated for stability. RESULTS There were 110 ICFs of type A fracture, 60 of type B fracture, 9 of type C fracture, 25 of type M fracture, and 4 fractures without displacement. A modified preauricular approach was used for open treatment, which can better expose and protect the TMJ and superficial temporal vessels. Wire and plate is the commonly used stable fixation method for type A, B, and M fractures, which accounted for 56.7% (101/178). Small fracture fragments were removed with disc repositioning for all type C fractures (n = 9) and some type B (n = 9) and M fractures (n = 5). Three type M fracture and 3 nondisplaced ICFs were treated closed. Eighty-nine patients with 115 ICFs had postoperative CT scan, which showed anatomic and nearly anatomic fracture reduction rates of 95.6%. Thirty-five patients with 44 ICFs had long-term follow-ups from 3 months to 5 years. Among them, 63.2% (n = 12/19) pediatric ICFs had continuous condyle growth after open reduction and rigid fixation; 92% adults had ICFs that healed well (n = 23/25). Postoperative complications were facial nerve injury (n = 3), TMJ clicking (n = 1), and condyle resorption that required plate removal (n = 4). CONCLUSION A modified preauricular approach provides better exposure and protection of the TMJ and superficial temporal vessels. Wire and plate provides stable fixation for type A and some type B and M fractures. Open reduction and rigid fixation produce good results for adult patients.

Synovial chondromatosis in the inferior compartment of the temporomandibular joint: different stages with different treatments.

PURPOSE To discuss a new classification and the treatment principles of synovial chondromatosis (SC) in the inferior compartment of the temporomandibular joint (TMJ). PATIENTS AND METHODS Five cases of SC in the inferior compartment were treated in an open manner between January 2008 and May 2011. Each case had different clinical and radiologic aspects and was treated with different surgical therapies. SC in the inferior compartment of the TMJ is classified into 3 stages. All patients were evaluated by computed tomography, magnetic resonance imaging, and clinical manifestations preoperatively and postoperatively. RESULTS There were 3 kinds of manifestation modes from radiologic findings. Case 1 was in stage 1, in which multiple loose bodies are noted without bony erosion. This patient was treated by removal of loose bodies and affected synovium. Case 2 was in stage 2, in which multiple calcified nodules were conglutinated to the condyle; the condyle was enlarged with pressure erosions. This patient was treated by condylectomy and reconstruction with costochondral graft. Case 3, case 4, and case 5 were all in stage 3, in which the condyle was destroyed as a result of pressure erosions or by direct bony invasion of the mass and the inferior surface of the disc was involved. These patients were treated by condylectomy together with discectomy, as well as reconstruction with costochondral graft and pedicled deep temporal fascial fat flap. No recurrence occurred. The height of the ramus and the occlusion were maintained in the same condition as preoperatively. CONCLUSIONS Our new classification of SC in the inferior compartment of the TMJ can better guide clinical treatment.

Metastatic spread to the mandibular condyle as initial clinical presentation: radiographic diagnosis and surgical experience.

PURPOSE Metastatic spread to the mandibular condyle is uncommon. The authors retrospectively evaluated a series of consecutive cases of condylar metastases presenting as the initial clinical event to increase awareness and provide a better understanding of this occurrence. PATIENTS AND METHODS This study consisted of 6 cases of metastatic tumor of the mandibular condyle presenting as the initial clinical event from July 2004 to May 2011. Primary sites included the bladder, prostate, lung, penis, colon, and breast. In 3 cases, positron emission tomographic/computed tomographic scans were performed to detect the primary lesions, which stayed occult at presentation. Surgical removal of the metastatic condylar lesions was performed in 3 patients, and palliative therapy was provided to all patients except a patient with a solitary metastasis. RESULTS Five patients developed disseminated systemic metastases and died within 12 months. Only the patient with a solitary metastasis stayed alive, without any sign or symptom of tumor recurrence or metastasis at the most recent follow-up visit. CONCLUSIONS For adult patients without a history of cancer, metastasis should be taken into consideration when the mandibular condyle is irregularly disrupted. Positron emission tomography/computed tomography is effective for detecting occult malignant lesions, whereas surgery might be indicated only for a solitary condylar metastasis.

Local resection of the mass to treat the osteochondroma of the mandibular condyle: Indications and different methods with 38‐case series

Local resection of the mass was reported to treat the condylar osteochodroma in some cases. The purpose of this study was to evaluate the feasibility and the indications of the local resection.

Role of retention of the condylar cartilage in open treatment of intracapsular condylar fractures in growing goats: three-dimensional computed tomographic analysis.

Our aim was to investigate the role of retention of the condylar cartilage in open reduction and internal fixation (ORIF) of intracapsular condylar fractures (ICFs) in growing goats by three-dimensional computed tomographic (CT) analysis. Twelve goats 6 months old were randomly divided into three groups. ICFs were created bilaterally in mandibular condyles and treated with ORIF. On the one side (n=4) the condylar cartilage was removed, and on the other side (n=4) it was retained. Condyles in the control group (n=4) were untouched. CT scans were taken immediately postoperatively, and 3 and 6 months later. The heights of the rami among the three groups were compared, There were significant reductions in the height of rami in the group from which the cartilage had been removed 3 and 6 months postoperatively compared with controls, but no significant differences between control group and the group in which it had been retained. We conclude that retaining condylar cartilage in the ORIF for ICF of growing goats has no harmful effect on condylar growth, but removal can limit growth.

Piezoelectric Versus Conventional Rotary Techniques for Impacted Third Molar Extraction: A Meta-analysis of Randomized Controlled Trials.

AbstractImpacted third molars are frequently encountered in clinical work. Surgical removal of impacted third molars is often required to prevent clinical symptoms. Traditional rotary cutting instruments are potentially injurious, and piezosurgery, as a new osteotomy technique, has been introduced in oral and maxillofacial surgery. No consistent conclusion has been reached regarding whether this new technique is associated with fewer or less severe postoperative sequelae after third molar extraction.The aim of this study was to compare piezosurgery with rotary osteotomy techniques, with regard to surgery time and the severity of postoperative sequelae, including pain, swelling, and trismus.We conducted a systematic literature search in the Cochrane Library, PubMed, Embase, and Google Scholar.The eligibility criteria of this study included the following: the patients were clearly diagnosed as having impacted mandibular third molars; the patients underwent piezosurgery osteotomy, and in the control group rotary osteotomy techniques, for removing impacted third molars; the outcomes of interest include surgery time, trismus, swelling or pain; the studies are randomized controlled trials.We used random-effects models to calculate the difference in the outcomes, and the corresponding 95% confidence interval. We calculated the weighted mean difference if the trials used the same measurement, and a standardized mean difference if otherwise.A total of seven studies met the eligibility criteria and were included in our analysis. Compared with rotary osteotomy, patients undergoing piezosurgery experienced longer surgery time (mean difference 4.13 minutes, 95% confidence interval 2.75–5.52, P < 0.0001). Patients receiving the piezoelectric technique had less swelling at postoperative days 1, 3, 5, and 7 (all Ps ⩽0.023). Additionally, there was a trend of less postoperative pain and trismus in the piezosurgery groups.The number of included randomized controlled trials and the sample size of each trial were relatively small, double blinding was not possible, and cost analysis was unavailable due to a lack of data.Our meta-analysis indicates that although patients undergoing piezosurgery experienced longer surgery time, they had less postoperative swelling, indicating that piezosurgery is a promising alternative technique for extraction of impacted third molars.

Superior half of the sternoclavicular joint pedicled with the sternocleidomastoid muscle for reconstruction of the temporomandibular joint: a preliminary study with a simplified technique and expanded indications

The sternoclavicular joint (SCJ) has similar anatomical and physical characteristics to the temporomandibular joint (TMJ). The purpose of this article is to introduce a modified technique for the pedicled SCJ and the expanded indications for its use. During the period June 2011 to June 2014, six TMJs were reconstructed using the superior half of the SCJ pedicled with the sternocleidomastoid muscle. The inclusion criteria were (1) poor vascularization jeopardizing a non-vascularized TMJ replacement, and/or (2) a large defect of both bone and soft tissue. The average follow-up period was 14.8 months (range 7-39 months). Fracture of the clavicle occurred in one patient (16.7%). No recurrence, graft resorption, or secondary deformity was found. Reconstruction of the TMJ using the superior half of the SCJ pedicled with the clavicle head of the sternocleidomastoid muscle and sternocleidomastoid branch of the superior thyroid artery benefited patients who had a poor blood supply and a medullary condition or who had a defect in both the condyle and surrounding soft tissue.

Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience

OBJECTIVE To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. MATERIAL AND METHODS A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. RESULTS The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. CONCLUSIONS The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars.

Osteochondroma of the mandibular condyle: a classification system based on computed tomographic appearances.

Objective The objectives of this study were to introduce the classification of osteochondroma of the mandibular condyle based on computed tomographic images and to present our treatment experiences. Materials and Methods From January 2002 and December 2012, a total of 61 patients with condylar osteochondroma were treated in our division. Both clinical and radiologic aspects were reviewed. The average follow-up period was 24.3 months with a range of 6 to 120 months. Results Two types of condylar osteochondroma were presented: type 1 (protruding expansion) in 50 patients (82.0%) and type 2 (globular expansion) in 11 patients (18.0%). Type 1 condylar osteochondroma presented 5 forms: anterior/anteromedial (58%), posterior/posteromedial (6%), medial (16%), lateral (6%), and gigantic (14%). Local resection was performed on patients with type 1 condylar osteochondroma. Subtotal condylectomy/total condylectomy using costochondral graft reconstruction with/without orthognathic surgeries was performed on patients with type 2 condylar osteochondroma. During the follow-up period, tumor reformation, condyle absorption, and new deformity were not detected. The patients almost reattained facial symmetry. Conclusions Preoperative classification based on computed tomographic images will help surgeons to choose the suitable surgical procedure to treat the condylar osteochondroma.

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension.

AbstractPigmented villonodular synovitis is an uncommon benign tumor-like proliferative lesion with an undetermined origin. Involvement of the temporomandibular joint is uncommon. Although pigmented villonodular synovitis is a benign lesion, it can grow with an aggressive pattern, and it extends extra-articularly in most of the reported cases, about one-third of them exhibiting intracranial involvement. The authors reported an additional case of a 47-year-old woman with intracranial extension, who had a history of joint pain and trismus. The preoperative diagnosis was made with arthroscopy. The lesion was completely excised via preauricular approach and condylotomy. The bone defect was covered by the pedicled temporalis myofascial fat flap. The patient has been symptom-free for 40 months postoperatively.