RESUMEN
PURPOSE: To evaluate the clinical and functional outcomes of a custom temporomandibular hemijoint fossa/eminence implant prosthesis. MATERIALS AND METHODS: This prospective cohort study enrolled patients with osteoarthritis of the temporomandibular joint. The primary study variables were pain experience, pain intensity, chewing ability, jaw opening, joint noise, and overall satisfaction of the surgical outcome at 3, 6, and 13 months after surgery. Pre- and postsurgical kinematic analyses measured maximum incisal opening, operated and unoperated condyle translations, and mandibular body axis rotation using mandibular kinematic data combined with patient-specific computed tomographic data. The primary analysis of interest concerned preoperative versus postoperative changes. RESULTS: The study sample was composed of 36 subjects (mean age, 46 years; 94% female; 40 joints). There were statistically significant improvements between pre- and postoperative measurements for each study variable. The kinematic data documented preservation or an increase of bilateral condylar motion, mandibular axis rotation, and mandibular incisor motion. CONCLUSIONS: Temporomandibular joint hemiarthroplasty with a custom metal fossa/eminence prosthesis provides satisfactory clinical and functional outcomes when used for advanced osteoarthritis in patients with focal joint pain secondary to computed tomographically documented joint pathology.
Asunto(s)
Prótesis Articulares , Rango del Movimiento Articular/fisiología , Articulación Temporomandibular/cirugía , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo/métodos , Estudios de Cohortes , Diseño Asistido por Computadora , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional/métodos , Masculino , Mandíbula/fisiopatología , Cóndilo Mandibular/fisiopatología , Masticación/fisiología , Persona de Mediana Edad , Osteoartritis/cirugía , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Diseño de Prótesis , Rotación , Sonido , Trastornos de la Articulación Temporomandibular/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
Adult patients who did not receive proper treatment for cleft palate are challenging for clinicians in terms of prosthetic rehabilitation. Moreover, during the late stages of adulthood when patients become edentulous, prosthetic reconstruction becomes even more challenging. This clinical report describes the prosthetic rehabilitation of 2 edentulous geriatric patients with unrepaired cleft palate by placement of dental implants after closure of the oronasal communications.
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Fisura del Paladar/cirugía , Implantes Dentales , Dentadura Completa , Prótesis de Recubrimiento , Arcada Edéntula/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the surgical outcomes and clinical experience of the treatment of degenerative osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement. MATERIALS AND METHODS: A retrospective chart review showed 99 patients (94 females and 5 males) who underwent treatment of degenerative joint disease with hemijoint replacement surgery, including data on 141 operated joints (57 unilateral, and 42 bilateral). A visual analog scale (VAS) patient-response questionnaire with directives was mailed to the 99 patients. The questionnaire investigated the patient's experience before and after the treatment procedure in 5 areas: 1) pain intensity, 2) pain experience, 3) chewing ability, 4) mouth opening, and 5) joint noise. In addition, patients were requested to score on a VAS of 1 to 10 their overall satisfaction with the treatment outcome. Treatment outcomes were also compared between patients who received an autogenous abdominal fat graft placement before wound closure, and those who did not receive this adjunctive treatment. RESULTS: Forty-two of 99 patients responded to the questionnaires, with an average follow-up time of 5.1 years. In these 42 patients, pain experience was reduced by 68.6% (4.5 +/- 1.3 [mean +/- SD], presurgery, vs 1.4 +/- 1.7, current, on a 6-point scale). In addition, pain intensity was reduced by 58.7% (7.5 +/- 2.2, presurgery, vs 3.1 +/- 3.0, current, on a 10-point scale). Thirty-three of 42 patients (78.6%) stated in the questionnaire that they were highly satisfied with the results of surgical treatment (average, 9.0 +/- 1.2 on a 0-to-10-point VAS scale). Fifty-one patients (71 joints) did not receive an adjunctive abdominal fat graft, whereas 48 patients (70 joints) received this adjunctive treatment. In the nonfat group, 17 (21.5%) joints required revision surgery, and in the fat group, 4 joints (6.5%) required revision surgery. CONCLUSIONS: Temporomandibular hemiarthroplasty with metal fossa-eminence prosthesis provides predictable and satisfactory results in patients operated upon for advanced osteoarthritis. The incidence of revision surgery was found to be reduced with the application of fat graft adjunctive treatment.
Asunto(s)
Artroplastia de Reemplazo/métodos , Prótesis Articulares , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Grasa Abdominal/trasplante , Adolescente , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Osteoartritis/complicaciones , Satisfacción del Paciente , Diseño de Prótesis , Rango del Movimiento Articular , Estudios Retrospectivos , Prevención Secundaria , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/etiología , Resultado del TratamientoRESUMEN
The purpose of the study was to test the precision and accuracy of a method used to track selected landmarks during motion of the temporomandibular joint (TMJ). A precision phantom device was constructed and relative motions between two rigid bodies on the phantom device were measured using optoelectronic (OE) and electromagnetic (EM) motion tracking devices. The motion recordings were also combined with a 3D CT image for each type of motion tracking system (EM+CT and OE+CT) to mimic methods used in previous studies. In the OE and EM data collections, specific landmarks on the rigid bodies were determined using digitization. In the EM+CT and OE+CT data sets, the landmark locations were obtained from the CT images. 3D linear distances and 3D curvilinear path distances were calculated for the points. The accuracy and precision for all 4 methods were evaluated (EM, OE, EM+CT and OE+CT). In addition, results were compared with and without the CT imaging (EM vs. EM+CT, OE vs. OE+CT). All systems overestimated the actual 3D curvilinear path lengths. All systems also underestimated the actual rotation values. The accuracy of all methods was within 0.5mm for 3D curvilinear path calculations, 0.05mm for 3D linear distance calculations and 0.2 degrees for rotation calculations. In addition, Bland-Altman plots for each configuration of the systems suggest that measurements obtained from either system are repeatable and comparable.
Asunto(s)
Movimiento (Física) , Articulación Temporomandibular/fisiología , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/métodos , Fenómenos BiomecánicosRESUMEN
PURPOSE: This study compared the functional kinematic outcome of the temporomandibular joint (TMJ) in patients with end-stage TMJ osteoarthritis before and after TMJ hemijoint replacement surgery. MATERIALS AND METHODS: Fourteen patients (15 joints), with a mean age of 46.1 years, undergoing metal fossa eminence hemijoint replacement surgery, participated in this study. Each patient's jaw motion was recorded using an electromagnetic tracking device and patient-specific computed tomography images. A visual analog scale patient response questionnaire was used before and after the operation to assess the subjective outcome of the surgery. RESULTS: The mean linear distance (LD) traveled by the incisors increased significantly due to the surgical intervention, from 30.4 +/- 6.9 mm preoperatively to 35.5 +/- 5.3 mm postoperatively (P = .02). The LD of the operated condyle decreased from 14.1 +/- 5.7 mm to 11.4 +/- 6.2 mm, but this was not significant. The mean LD for the unoperated condyle remained similar (preoperative, 13.2 +/- 5.9 mm; postoperative, 13.3 +/- 6.5 mm). The total mandibular rotation increased significantly, from 19.3 +/- 4.9 degrees preoperatively to 24.8 +/- 3.9 postoperatively (P < .01). CONCLUSIONS: Kinematic data support the functional efficiency of hemijoint replacement surgery, with benefits of increased maximal mouth opening, preservation of operated and unoperated condyle translation motion, and increased mandibular rotation.
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Artroplastia de Reemplazo/métodos , Prótesis Articulares , Osteoartritis/cirugía , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/fisiología , Adulto , Anciano , Aleaciones de Cromo , Humanos , Registro de la Relación Maxilomandibular , Cóndilo Mandibular/fisiología , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Movimiento , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Encuestas y Cuestionarios , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to develop a method to accurately study the kinematic changes of the temporomandibular joint (TMJ) in patients treated with hemijoint implant reconstruction for dysfunction of advanced degenerative osteoarthritis. MATERIALS AND METHODS: Mandibular kinematic motion data and patient-specific computed tomography (CT) data were acquired. Patients were fitted with custom dental stents that were embedded with metal markers to link the mandibular kinematics data with the 3-dimensional TMJ CT images. An electromagnetic tracking device was used to collect kinematic motion data during maximal mouth opening and closing. The coordinate systems of the kinematic data and CT data were registered to calculate the motion of the mandibular condyle. RESULTS: This technique was successfully used to study patients with motion aberration of the TMJ due to osteoarthritis. A typical case is illustrated in which the motion of both mandibular condyles was simulated preoperatively and postoperatively. CONCLUSIONS: The results of this study suggest that it is possible to use the proposed methodology to accurately quantify the motion of the mandibular condyle in 3 dimensions. The developed technique is user-friendly and noninvasive to the patient. The proposed methodology is a potential clinical tool that may be used in the management of patients with TMJ dysfunction.
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Fenómenos Electromagnéticos/instrumentación , Cóndilo Mandibular/fisiopatología , Osteoartritis/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Articulación Temporomandibular/fisiopatología , Femenino , Humanos , Imagenología Tridimensional , Cóndilo Mandibular/diagnóstico por imagen , Movimiento , Osteoartritis/diagnóstico por imagen , Proyectos Piloto , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Stents , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The primary purpose of this study is to quantify the kinematics of the temporomandibular joint (TMJ) in patients following unilateral TMJ arthrotomy with metal fossa-eminence partial joint replacement and compare them with TMJ kinematics of healthy individuals. MATERIALS AND METHODS: Fourteen healthy volunteers and 13 female surgical patients (minimum 4 years postoperative) participated in this study. An electromagnetic tracking device was used to record the kinematics of the mandible relative to temporal bone during opening-closing, protrusive, and lateral movements. The mean linear distance (LD) traveled by condyles was compared between operated and normal subjects. RESULTS: Patients responded with statistically significant improvement in pain and jaw function questions. Mean satisfaction with the surgical result was 25.7 on a scale of 1 to 30. The LD measured for condyles during all 4 movements showed similar measurements. However, operated and unoperated condyles showed statistically significant motion values during opening and protrusive motion from each other and from normal subjects. In addition, contralateral condyles during lateral motion showed statistically significant values in operated, unoperated, and normal condyles. CONCLUSION: The results of this study suggest that the surgical reconstruction of the TMJ with partial joint replacement provided highly significant clinical improvement. Moreover, condyle and incisor kinematics were preserved to a significant amount as compared with the normal group. The difference in kinematic measurements between the operated and unoperated condyle was significant and secondary to previous joint disease and previous surgical intervention. These results should be evaluated by prospective studies in pre- and postsurgical patients.
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Artroplastia de Reemplazo , Rango del Movimiento Articular/fisiología , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/fisiología , Adulto , Fenómenos Biomecánicos , Fuerza de la Mordida , Estudios de Casos y Controles , Femenino , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Valores de Referencia , Estadísticas no Paramétricas , Articulación Temporomandibular/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification. PATIENTS AND METHODS: Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death. RESULTS: Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality. CONCLUSION: Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.