Treatment of traumatic craniofacial deformation JVD 2008

Question 1

What clinical signs were noted initially noted in this case report?

Answer 1

Dog was small for age (6wks of age) and could only partially open the mouth

Question 2

Did this dogs condition resolve at any point between the first 2 months?

Answer 2

No, progressive, and worsening

Question 3

What was the range of motion measurement of the TMJ initally?

Answer 3

2-cm

Question 4

What other findings were noted at this time?

Answer 4

Dome shaped-skull and maxilla and mandible deviated to the right

Question 5

Describe the extraoral craniofacial abnormalities were described?

Answer 5

Right-sided deviation of the face and muzzle, ventral position of the left eye relative to the right, and domed skul

Question 6

At 4- months of age, what was thought to be the most likely diagnosis?

Answer 6

TMJ dysplasia

Question 7

Name 3 differential diagnoses for these craniofacial abnormalities?

Answer 7

Masticatory myositis
Convential anomaly
Growth deformity/disparity
Trauma

Question 8

When the masseter and temporal muscles are not used, how would you expect to see that on allow what

Answer 8

Bilateral atrophy; disuse of these muscles aid in opening the mouth

Question 9

When the masseter and temporal muscles are not used, how would you expect to that to present?

Answer 9

Bilateral atrophy; disuse of these muscles aid in opening the mouth

Question 10

What abnormalities were found on oral examination?

Answer 10

Class I malocclusion

Impingement of the 304 on the gingiva mesial to 204

Question 11

What advantage does 3D reconstruction provide that 2D cannot?

Answer 11

Differentiate bone and fibrous tissue
Emphasis of
abnormalities

Question 12

CT findings

Answer 12

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

Question 13

What was determined to be the most likely cause of these craniofacial abnormalities?

Answer 13

Trauma cause by fractures, secondary stunted growth of right sided facial structures

Question 14

What was the cause of the entrapment?

Answer 14

muscular pull on the mandibular ramus

Question 15

What treatment options were discussed included?

Answer 15

Removal of zygomatic arch with potential for also resection a portion of mandibular ramus

Question 16

Resection of the mandibular ramus was recommended under what condition would resection of the mandibular ramus be a viable option?

Answer 16

If TMJ ROM was not improved substantially

Question 17

What anatomical structures need to be considered prior to surgery due to the potential risks?

Answer 17

Facial nerve, artery and vein

Question 18

What prognosis was given for obtaining increased ROM?

Answer 18

Fair

Question 19

What prognosis was given for maintained ROM? and why?

Answer 19

Guarded long-term; progressive fibrous and/or TMJ arthritis could develop post-op

Question 20

Surgery took place within what timeframe?

Answer 20

30days

Question 21

How much of the mandibular ramus was removed before any significant increase in TMJ ROM was noted?

Answer 21

2-4cm

Question 22

What was the difference in ROM pre- and intra-op?

Answer 22

4cm

Question 23

How many layers were used to close the incion ?

Answer 23

4 layers

Question 24

Which layers were closed individually?

Answer 24

pterygoid muscle, masseter muscle, and subcutaneous tissues

Question 25

What was involved in the step following closure?

Answer 25

used depressors to open mouth further and streAch the fibrous tissues that had formed

Question 26

What was the determining factor for stopping the depressor therapy?

Answer 26

until a ROM of 6cm was obtained

Question 27

What is the purpose of initialing a physical therapy program in this case?

Answer 27

To rehabilitat the temporal and masseter musculature and maintain ROM by preventing additional scarring and fibrosis

Question 28

What was the recommend time for the physiotherapy routine?

Answer 28

3 times a day for 10-20 minutes