Treatment Planing and Seminars (1)

8/13/2019 Treatment Planing and Seminars (1)

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Seyed Milad Nejat 200911570

MohdNoor Kebbewar 200910279


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What is your diagnosis?!

A 19 year old patient presented with inability

to open mouth with his teeth in contact witheach other . The problem was evident

around two years following a fall from height

at age of 6.


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Final dx is ankylosis

Differential diagnosis :

1. Tetanus (lock jaw)

2. Condylar fracture3. Tumors

4. Ankylosis


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INTRODUCTION

Temporomandibular joint,

Ankylosis (joint stiffness)

Ankylosis of the Temporomandibular joint Fibrous or bony ??


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PATHOPHYSIOLOGY

TRAUMA

Extravasation of blood into the joint space

haemarthrosis

Calcification and obliteration of the joint space

v Intra-capsular ankylosis Extra-capsular ankylosis


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Complicationsof TMJ ankylosis

Limited mouth opening with trismus Facial asymmetry : bird face

Micrognathia with receding mandible

Shorter length of mandibular rami

Occlusion defect

Dentition effect

Malnutrition

Poor oral hygiene Snoring and difficulty in sleeping on lying down

Impaired speech

Difficulty in breathing and swallowing


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MANAGEMENT

Non-surgical management

Surgical treatment


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NON SURGICAL TREATMENT

Physiotherapy

Maintain good oral hygiene

Psychotherapy

Nutritional diet plan

Dietary supplements


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GOALS OF SURGICAL TREATMENT

To create mobilityin the joint to a satisfactory limit.

To restore vertical height of the ramus.

To restore the mandible & TMJ to normal anatomic &

functional state.

To create a new joint space.

To allow the jaw to grow normally in child treated for

ankylosis.

To restore the facial esthetics.

To prevent recurrence of ankylosis.
http://gr.dentistbd.com/tooth-mobility-pedodontics-ppt.htmlhttp://gr.dentistbd.com/space-maintainers-ppt.htmlhttp://gr.dentistbd.com/space-maintainers-ppt.htmlhttp://gr.dentistbd.com/tooth-mobility-pedodontics-ppt.html


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SURGICAL MANAGMENET

Procedures

1. Condylectomy

2. Gap arthroplasty

3. Interpositional arthroplasty


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CONDYLECTOMY

This procedure is usually indicated when the joint space isobliterated with the deposition of fibrous bands; but, there

hasnt been much deformity of the condylar head. Usually

employed in cases of fibrous ankylosis.

Pre-auricular incision is made

Horizontal cut carried is out at the level of the condylar neck The head (condyle) should be separated from the superior

attachment carefully

The wound is then sutured in layers

The usual complication of this procedure is an ipsilateral

deviation to the affected side. And anterior open bite if theprocedure was bilaterally.


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COMPLICATIONS:

1.Loss of vertical height of ramus

2. in bilateral condylectomy it create an anterior

open bite.

3. In unilateral condylectomy there

is deviation of the jaw on opening.


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GAP ARTHROPLASTY

This procedure is employed in an extensive bony ankylosis.

The section here consists of two horizontal osteotomy cuts

And removal of bony wedges for creation of a gap between

the roof of the glenoid fossa and the ramus of the mandible.

This gap permits mobility

The minimum gap should be 1cm to avoid re-ankylosis


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INTERPOSITIONALARTHROPLASTY

This is actually an improvement/modification on gap

arthroplasty

Currently the surgical protocol of choice

Materials are used to interpose between the ramus of the

mandible and base of the skull to avoid re-ankylosis

The procedure involves the creation of gap, but in addition, a

barrier is inserted between the two surfaces to avoid

reoccurrence and to maintain the vertical height of the ramus


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Treatment Planing and Seminars (1)