Treatment of traumatic craniofacial deformation JVD 2008 Flashcards
What clinical signs were noted initially noted in this case report?
Dog was small for age (6wks of age) and could only partially open the mouth
Did this dogs condition resolve at any point between the first 2 months?
No, progressive, and worsening
What was the range of motion measurement of the TMJ initally?
2-cm
What other findings were noted at this time?
Dome shaped-skull and maxilla and mandible deviated to the right
Describe the extraoral craniofacial abnormalities were described?
Right-sided deviation of the face and muzzle, ventral position of the left eye relative to the right, and domed skul
At 4- months of age, what was thought to be the most likely diagnosis?
TMJ dysplasia
Name 3 differential diagnoses for these craniofacial abnormalities?
Masticatory myositis
Convential anomaly
Growth deformity/disparity
Trauma
When the masseter and temporal muscles are not used, how would you expect to see that on allow what
Bilateral atrophy; disuse of these muscles aid in opening the mouth
When the masseter and temporal muscles are not used, how would you expect to that to present?
Bilateral atrophy; disuse of these muscles aid in opening the mouth
What abnormalities were found on oral examination?
Class I malocclusion
Impingement of the 304 on the gingiva mesial to 204
What advantage does 3D reconstruction provide that 2D cannot?
Differentiate bone and fibrous tissue
Emphasis of
abnormalities
CT findings
chronic, displaced, comminutedfractureoftheright mandibularramus,deformationof the right zygomatic arch, and a nonunion fracture at the right skull base (Fig. 1). Callous new bone was causing thickening and deformity of the medial side of the right mandible and ramus of the mandible. zygomatic arch entrapment of the right ramus of the mandible, callous adhesion of the ramus to the base of the skull, and TMJ deformity manifested as decreased joint space visibility
What was determined to be the most likely cause of these craniofacial abnormalities?
Trauma cause by fractures, secondary stunted growth of right sided facial structures
What was the cause of the entrapment?
muscular pull on the mandibular ramus
What treatment options were discussed included?
Removal of zygomatic arch with potential for also resection a portion of mandibular ramus
Resection of the mandibular ramus was recommended under what condition would resection of the mandibular ramus be a viable option?
If TMJ ROM was not improved substantially
What anatomical structures need to be considered prior to surgery due to the potential risks?
Facial nerve, artery and vein
What prognosis was given for obtaining increased ROM?
Fair
What prognosis was given for maintained ROM? and why?
Guarded long-term; progressive fibrous and/or TMJ arthritis could develop post-op
Surgery took place within what timeframe?
30days
How much of the mandibular ramus was removed before any significant increase in TMJ ROM was noted?
2-4cm
What was the difference in ROM pre- and intra-op?
4cm
How many layers were used to close the incion ?
4 layers
Which layers were closed individually?
pterygoid muscle, masseter muscle, and subcutaneous tissues
What was involved in the step following closure?
used depressors to open mouth further and streAch the fibrous tissues that had formed
What was the determining factor for stopping the depressor therapy?
until a ROM of 6cm was obtained
What is the purpose of initialing a physical therapy program in this case?
To rehabilitat the temporal and masseter musculature and maintain ROM by preventing additional scarring and fibrosis
What was the recommend time for the physiotherapy routine?
3 times a day for 10-20 minutes
