TMJ Ankylosis Flashcards
TMJ Ankylosis… C/F of UNILATERAL Features??
- Deviation of Mandible to the AFFECTED side..
- FULLNESS on the AFFECTED side…
** Pn – BOTH seen on the AFFECTED side…!
TMJ Ankylosis… C/F of B/L ??
- Bird face
- Vogel yeisht
- Andy gump!
EARLY movement after Surgery for TMJ Ankylosis is Harmful or Desirable??
Ans – Absolutely DESIRABLE!!
EARLY movement with aggressive Physiotherapy do at least 6 months Post - Op….
Rx of TMJ Ankylosis?? (3 broad techniques?)
Condylectomy - for Fibrous Ankylosis
Gap Arthroplasty - in Bony Ankylosis…. Here, 1 to 1.5 cm of bone removed n the lower stump of bone is RESHAPED like a CONDYLE…!!!!!
INTERPOSITIONAL GAP ARTHROPLASTY — Some material is interpositioned between the 2 bony fragments… To? To PREVENT REUNION…
Ankylosis Rx detailed…
- First thing is AGGRESSIVE RESECTION ( of at least 1 to 1.5 cm ) of the ankylosed bone… Special attention to The MEDIAL aspect as it is often neglected… Or left undone…
- IPSILATERAL CORONOIDECTOMY –
## See... In most cases, there is ELONGATED CORONOID process... (Why? So simple!! Because... We have removed a chunk of the ANKYLOSED CONDYLAR part making this one shorter compared to CORONOID...! Or say, now CORONOID looks longer (ELONGATED) compared to the Resected Condyle...) Therefore now we have to remove the CORONOID process as well... (CORONOIDECTOMY)...
Now, If the MOUTH OPENING is more than 35 mm after CORONOID removal, ONLY ********* IPSILATERAL CORONOIDECTOMY ********* done along with the attached TEMPORALIS Myotomy...!
But if the mouth opening is less than 35 mm... Go for BILATERAL ( or ONLY Contralateral....???????? Check!!) CORONOIDECTOMY with BILATERAL TEMPORALIS Myotomy...!
Now TMJ RECONSTRUCTION —-
- Reconstruction of Ramus - Condyle Unit —
Either with GRAFT + Growth CTR ( Bone + Cartilage ) or With GRAFT n without Growth CTR…
Grafts —
- Costochondral Graft
- Sternoclavicular Graft
- Metatarsal Head
Now, Reconstruction of ** Glenoid fossa ** ( which now acts as DISC ) —
Done with,
- DERMIS — Disadv - Cyst formation potential…
- TEMPORALIS myofacial flap — Best n Most commonly used!!
- Auricular cartilage — Disadv - hypomotility of joint n fibrous adhesions… N Can also lead to arthritic changes…
Now after all this, EARLY Mobilization of joint n AGGRESSIVE PHYSIOTHERAPY for at least 6 months…
Cosmetic surgery to be performed when Growth of the MANDIBLE is finished…
Clinical Q - (P 5/52)
In a pt with RHEUMATOUD ARTHRITIS n TMJ Ankylosis…progressively exhibiting reduced mouth opening n ANT OPEN BITE… Rx?
—- Titanium n Plastic graft for TMJ Reconstruction…
There r options such as…
A. Costochondral graft
B. Neocondyle formation (Study this..!!)
Here costochondral graft can’t be used… Because a pt with RHEUMATOID ARTHRITIS has cells called OSTEOPHYTES which r bone eaters… So basically an AUTOGENOUS Graft can’t be used… Bone eaters ———+ will eat away the graft… ——-+ RECURRENCE of Ankylosis…!
For a Child ( 8 yrs old )… Rx of TMJ Ankylosis?
Gap Arthroplasty with COSTOCHONDRAL Graft…
Here, it’s child… N the COSTOCHONDRAL Graft acts as a GROWTH Centre for the developing TMJ!! Hence used…
Clinical Q (P 5/49) In PEDEATRIC PT...planned for Costochondral graft for TMJ ankylo... Best intubation?
Awake FIBEROPTIC Intubation…
Not done treatment of Ankylosis?
High condylar shave…
Done r - Repositioning of temporal fascia
- Ipsilateral n contralateral coronoidectomy…
Not a theory of Ankylosis?
Are - ## fracture segment moves backwards n fuses with zygomatic arch
Calcification around the joint
Condylar burst theory…
Not - Synovial fluid leaks n attracts Calcium ions…
During Gap Arthroplasty Trigeminal nerve stimulation leads to?
Tachycardia…
## The Trigeminocardiac relfex is the sudden onset of DYSRHYTHMIA n HYPOTENSION during manipulation of ANY branches of TRIGEMINAL NERVE... It's reported to occur during Craniofacial surgeries, tumor resection in the cerebellopontine angle, balloon compression rhizolysis of TG Neuralgia...
Rx - Atropine…
In arthroscopy for TMJ Adhesion lysis… Laser used?
Ho - Yag
TMJ Joint cavity can be examined in much detail without much surgical exposure by?
ARTHROSCOPY…
Hydrocortisone is injected into a PAINFUL ARTHRITIC Joint to?
Reduce the inflammatory process…
The INITIAL clicking of TMJ while opening is due to?
RETRUDED Condyle in respect to DISC…
Explanation not understood at all… Can study.. ( P - 5/43 )
