RESUMEN
El objetivo de este trabajo es presentar los riesgos anatómicos en el abordaje de la anquilosis de la articulación temporo mandibular (ATM) y el uso del sistema piezoeléctrico para realizar la resección de la misma. La paciente sexo femenino, 12 años, presento una anquilosis de la ATM derecha, previamente operada en base a reconstrucción con un injerto costocondral. Luego de 4 años de realizada la primera reconstrucción se presentó con una nueva anquilosis del área presentando una masa de tejido óseo de 31 mm en sentido latero-medial, que abarcaba hasta el foramen oval en la base de cráneo y de 28 mm en sentido anteroposterior. La lesión fue abordada con un acceso preauricular y posterior resección con sistema piezoeléctrico, utilizando una técnica de resección en bloque. Se presenta la técnica y se discute la potencialidad de realizar este procedimientos con los nuevos sistemas piezoeléctrico.
The aim of this report is to present the anatomical risk for to treat the temporo mandibular joint (TMJ) ankylosis and the use of the piezoelectric system for to make the bone resection. Female patient, 12 years old, presented a right TMJ ankylosis, that was previously operated with a costocondral graft reconstruction. After 4 year from these reconstructive surgery the patient was involved in a new TMJ anklylosis of the same side showing a bone mass with 31mm in an meddle-lateral direction, with compromise until to oval foramen in the skull base and 28mm in the anterior-posterior direction. The lesion was operated by a preauricular approach and then a bone resection with the piezoelectric system, using a block resection technique. In this report it´s present the technique and is discusses the potentiality of the new piezoelectric system for these procedures.
Asunto(s)
Humanos , Femenino , Niño , Articulación Temporomandibular/cirugía , Articulación Temporomandibular/patología , Piezocirugía/métodos , Anquilosis/cirugía , Anquilosis/patología , Osteotomía/métodos , Recurrencia , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Anquilosis/diagnóstico por imagenRESUMEN
Introdução: O desenvolvimento das técnicas de distracção do esqueleto craniofacial representou um grande avanço na prática da cirurgia craniofacial. A distracção é uma técnica menos invasiva, mais rápida e com uma morbidade aparentemente menor comparada com as técnicas tradicionais de reconstrução craniofacial. No ano de 2013, o serviço de Cirurgia Crânio Maxilo Facial do INTO realizou uma série de casos de distracção mandibular. Este trabalho objetiva apresentar nossa experiência. Métodos: De janeiro a março de 2013, sete pacientes realizaram cirurgia de distracção mandibular. Todos os pacientes operados apresentavam hipoplasia mandibular uni ou bilateral em decorrência de anquilose de ATM ou microssomia craniofacial. Em alguns pacientes com anquilose de ATM foi realizada também a ressecção do bloco anquilótico no mesmo tempo da distracção. Resultados: No pós-operatório houve melhora de todas as funções estomatognáticas, ganho de peso, decanulação da paciente traqueostomizada e melhora na qualidade do sono. Houve melhora nos perfis faciais, as laterognatias foram amenizadas e a abertura oral aumentou na maioria dos pacientes. A abertura oral aumentou de maneira mais significativa naqueles pacientes onde a cirurgia de anquilose foi realizada em conjunto com a distracção. A complicação mais comum foi dor à ativação, relato de cinco pacientes (71%).Conclusão: A distracção osteogênica da mandíbula é uma boa alternativa para o tratamento das hipoplasias mandibulares, muitas vezes sendo a primeira indicação em algumas situações clínicas. Aparentemente tem morbidade menor do que as reconstruções clássicas de mandíbula e possui o bônus de alongar também os tecidos moles.
Introduction: The introduction of distraction of the craniofacial skeleton represented a great advancement in the practice of craniofacial surgery. Distraction is a less invasive technique that is faster and with an apparently lower morbidity than the traditional craniofacial reconstruction techniques. In 2013, the craniomaxillofacial surgery service of the Institute of Traumatology and Orthopaedics performed a series of mandibular distraction surgeries. In this article, we aim to present our experience. Methods: From January to March 2013, seven patients underwent mandibular distraction surgery. All patients exhibited unilateral or bilateral mandibular hypoplasia due to ankylosis of the temporomandibular joint (TMJ), or craniofacial microsomia. In some patients with ankylosis of the TMJ, resection of the anlylotic block was also performed concomitantly with the distraction. Results: Postoperative improvement was noted in all the stomatognathic functions: weight gain, decannulation of a tracheostomized patient, and improved quality of sleep. There was an improvement in facial profiles: the laterognathism was eased and the mouth opening increased in most patients. The mouth opening increased more significantly in patients in whom ankylosis surgery was done in conjunction with the distraction. The most common complication was pain upon distraction, reported by five patients (71%). Conclusion: Mandibular distraction osteogenesis is a good alternative for the treatment of mandibular hypoplasia, often being the first indication in some clinical situations. It apparently has a lower morbidity than the classic mandible reconstructions and has the added benefit of also lengthening the soft tissues.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Informes de Casos , Estudios Retrospectivos , Anomalías Craneofaciales , Osteogénesis por Distracción , Procedimientos de Cirugía Plástica , Cara , Huesos Faciales , Mandíbula , Anquilosis , Desarrollo Maxilofacial , Anomalías Craneofaciales/cirugía , Osteogénesis por Distracción/efectos adversos , Osteogénesis por Distracción/métodos , Procedimientos de Cirugía Plástica/métodos , Cara/cirugía , Huesos Faciales/cirugía , Mandíbula/cirugía , Mandíbula/patología , Anquilosis/cirugía , Anquilosis/patologíaRESUMEN
We present a description of osteological alterations observed in the tucuxi, Sotalia fluviatilis (Gervais, 1853) from a sample of 43 specimens. Fractures were the most frequent alterations in the sample (16%), occurring in various regions of the skeleton such as the ribs, hyoid apparatus, transverse and neural processes of vertebrae and scapula. We observed three individuals with ankylosis between the cervical vertebrae and two individuals with morphological changes (cranio-caudally elongated hemal arch and flattened cranial margin of the scapula). The only observed pathology was a case of osteomyelitis in the left dentary, which caused the loss of teeth, deformation of the associated alveoli and the formation of a medial fistula (lingual) for drainage of purulent material. This represents the first record of osteomyelitis in S. fluviatilis.
Apresenta-se a descrição das alterações ósseas observadas no tucuxi, Sotalia fluviatilis (Gervais, 1853) de uma amostra de 43 exemplares. As fraturas foram as alterações mais frequentes na amostra (16%), ocorrendo em diversas regiões do esqueleto como costelas, aparato hioide, processos transversos e neurais das vértebras e escápula. Foram observados três indivíduos com anquilose entre vértebras cervicais e dois com alterações morfológicas (arco hemal alongado no sentido crânio-caudal e escápula com borda cranial plana). A única patologia registrada foi um caso de osteomielite no dentário esquerdo, o que ocasionou a perda de dentes, a deformação dos alvéolos no local e a formação de uma fístula medial (lingual) para drenagem de material purulento. Este é o primeiro registro de osteomielite para a espécie.
Asunto(s)
Animales , Anquilosis/patología , Delfines/anomalías , Delfines/lesiones , Osteomielitis/patologíaRESUMEN
We present a description of osteological alterations observed in the tucuxi, Sotalia fluviatilis (Gervais, 1853) from a sample of 43 specimens. Fractures were the most frequent alterations in the sample (16%), occurring in various regions of the skeleton such as the ribs, hyoid apparatus, transverse and neural processes of vertebrae and scapula. We observed three individuals with ankylosis between the cervical vertebrae and two individuals with morphological changes (cranio-caudally elongated hemal arch and flattened cranial margin of the scapula). The only observed pathology was a case of osteomyelitis in the left dentary, which caused the loss of teeth, deformation of the associated alveoli and the formation of a medial fistula (lingual) for drainage of purulent material. This represents the first record of osteomyelitis in S. fluviatilis.(AU)
Apresenta-se a descrição das alterações ósseas observadas no tucuxi, Sotalia fluviatilis (Gervais, 1853) de uma amostra de 43 exemplares. As fraturas foram as alterações mais frequentes na amostra (16%), ocorrendo em diversas regiões do esqueleto como costelas, aparato hioide, processos transversos e neurais das vértebras e escápula. Foram observados três indivíduos com anquilose entre vértebras cervicais e dois com alterações morfológicas (arco hemal alongado no sentido crânio-caudal e escápula com borda cranial plana). A única patologia registrada foi um caso de osteomielite no dentário esquerdo, o que ocasionou a perda de dentes, a deformação dos alvéolos no local e a formação de uma fístula medial (lingual) para drenagem de material purulento. Este é o primeiro registro de osteomielite para a espécie.(AU)
Asunto(s)
Animales , Delfines/anomalías , Delfines/lesiones , Anquilosis/patología , Osteomielitis/patologíaRESUMEN
A anquilose da Articulação Têmporo-Mandibular (ATM) é a fusão entre o côndilo mandibular e a cavidade glenóide, restringindo os movimentos articulares, limitando a mastigação e induzindo a problemas estéticos, nutricionais, psicológicos, sociais, e alterações funcionais que influenciam no crescimento facial, quando acomete pacientes infantis.Objetivo: apresentar um caso clínico de anquilose da ATM em uma criança com hipótese diagnóstica de anquilose fibrosa, intra-articular, unilateral, completa, verdadeira, tipo I de Sawhney, da articulação temporomandibular direita, com retro-láterognatia, com etiologia provavelmente congênita ou idiopática, com limitação da abertura bucal e dificuldade à mastigação, sendo indicada a cirurgia e posteriores tratamentos ortopédico funcional dos maxilares, fisioterapêutico e fonoaudiológico.Conclusão: a anquilose da ATM em crianças de baixa idade pode levar a distúrbios no crescimento. Uma descrição detalhada dos achados clínicos, funcionais e radiográficos é necessária para estabelecer o correto diagnóstico...
Temporomandibular joint ankylosis (TMJ) is the fusion of the mandibular condyle and the glenoid cavity, restricting joint movement, limiting chewing and inducing aesthetic, nutritional, psychological and social problems, and functional changes that influence facial growth, when it affects children.Aim: this paper aims to present a clinical case of TMJ ankylosis in a child with a possible diagnostic of fibrous ankylosis, intra-articular, unilateral, complete, true, type I Sawhney, of the right temporomandibular joint, with retro-laterognatia, probably with congenital or idiopathic etiology, with limitation of mouth opening and chewing difficulties, with indication of surgery and subsequent functional orthopedic treatment of the jaws, physical therapy and speech therapy.Conclusion: an ankylosis of the temporomandibular joint (TMJ) in early childhood may lead to growth disturbances. Detailed descriptions of clinical, functional and radiographic findings are necessary in order to establish a correct diagnosis...
Asunto(s)
Humanos , Femenino , Niño , Anquilosis/patología , Cóndilo Mandibular/patología , Trastornos de la Articulación Temporomandibular/patología , Anquilosis , Anquilosis/terapia , Articulación Temporomandibular , Cóndilo Mandibular , Tomografía Computarizada por Rayos X , Trastornos de la Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular/terapiaRESUMEN
64 male Wistar rats were used: 24 for the removal of stem cells, 4 as a control group, and 36 for the experiment, in which either stem cells or bone graft was used. The rats were divided into groups according to the type of procedure and time span (15, 30 or 60 days). The joints were submitted to histological study in order to score the ankylosis. The mean differences between initial and final maximal mouth opening (MMO) were gradually increased from 15 to 60 days, for all times of evaluation for both groups, being statistically significant at 15 days (p=0.045) in the bone-graft group. When both groups were compared, the mean differences between initial and final MMO were statistically significant at 15 days (p=0.018) and 30 days (p=0.029). In relation to the histological scores, in the bone-graft group almost all animals had intra-articular fibrosis at all times of evaluation (n=17). In the stem-cell group, there was new bone at 15 days (n=4), 30 days (n=3) and 60 days (n=4). The study model permitted the development of fibrous ankylosis in the majority of animals for both groups and no bony bridge was observed.
Asunto(s)
Anquilosis/etiología , Trasplante Óseo/métodos , Modelos Animales de Enfermedad , Células Madre/fisiología , Trastornos de la Articulación Temporomandibular/etiología , Animales , Anquilosis/patología , Células de la Médula Ósea/citología , Calcinosis/etiología , Calcinosis/patología , Técnicas de Cultivo de Célula , Diferenciación Celular/fisiología , Separación Celular , Condrogénesis/fisiología , Fibrosis , Masculino , Cóndilo Mandibular/patología , Osteogénesis/fisiología , Rango del Movimiento Articular/fisiología , Ratas , Ratas Wistar , Hueso Temporal/patología , Disco de la Articulación Temporomandibular/lesiones , Trastornos de la Articulación Temporomandibular/patología , Factores de Tiempo , Trasplante AutólogoRESUMEN
The causes of temporomandibular joint (TMJ) ankylosis, or hypomobility, are many, and it is important to understand the underlying etiology before treatment. Classically, TMJ ankylosis has been diagnosed by clinical evaluation and static imaging techniques such as plain radiographs, computed tomography, and magnetic resonance imaging. Static imaging demonstrates the size and location of the bones and soft tissues of the TMJ at a given moment; however, it fails to show the dynamic relationship of structures as the condylar head goes through its range of motion. The purpose of this study is to evaluate the use of videofluoroscopy as a dynamic means of assessing TMJ ankylosis. To do so, videofluoroscopy must be able to distinguish between bony fusion, fibrosis of the surrounding soft tissues, degeneration of the joint space, and mechanical causes of joint limitation. Six patients--2 healthy controls and 4 patients with known TMJ ankylosis--were submitted to standardized videofluoroscopic evaluation and thorough physical examination that included measurement of mandibular excursion. Videofluoroscopic data were compared with physical data. Condylar displacement was recorded in all patients, and values ranged from 0% to 100%. Videofluoroscopy allowed for the measurement of the TMJ joint space and for a detailed observation of bony and soft tissue components as they ranged in motion. In all cases, the exact cause limiting mandibular excursion was noted. Videofluoroscopy has become our preferred method of imaging the TMJ because it provides a detailed and dynamic evaluation at a reasonable cost.
Asunto(s)
Anquilosis/patología , Fluoroscopía/métodos , Trastornos de la Articulación Temporomandibular/patología , Adolescente , Adulto , Anquilosis/cirugía , Estudios de Casos y Controles , Niño , Preescolar , Humanos , Procedimientos Quirúrgicos Orales/métodos , Osteogénesis por Distracción , Rango del Movimiento Articular , Recurrencia , Trastornos de la Articulación Temporomandibular/cirugía , Grabación en VideoRESUMEN
La anquilosis de la A.T.M. es una patología clasificada conforme el local donde ocurre, el tipo de tejido envuelto y su extensión. El tratamiento debe ser quirúrgico, con remoción del cóndilo e interposición de algún tipo de material autógeno o alo plástico en el espacio formado
The anquilose of TMJ it is a pathology classified the place where happens accordingly, type of involved fabric and her extension. The treatment should be surgical, with removal of the condyle and interference of some type of autogenous material or aloplastic in the formed space
Asunto(s)
Femenino , Anquilosis/patología , Articulación Temporomandibular , Anomalías MaxilofacialesRESUMEN
A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.
Asunto(s)
Humanos , Masculino , Lactante , Anquilosis/diagnóstico , Articulación Temporomandibular/patología , Anquilosis/patología , Músculo Temporal/patologíaRESUMEN
A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.
Asunto(s)
Anquilosis/diagnóstico , Articulación Temporomandibular/patología , Anquilosis/patología , Humanos , Lactante , Masculino , Músculo Temporal/patologíaRESUMEN
The use of enamel matrix protein in the treatment of periodontal defects has shown a favorable action on the proliferation of periodontal ligament cells, as well as on collagen formation and mineralization. The goal was to evaluate, histologically and histometrically, periodontal tissue regeneration after dental reimplantation using enamel matrix protein derivative (Emdogain, Biora AB, Malmö, Sweden). Male rats (Albinus, Wistar), weighing between 180 and 200 g, were divided in 3 groups. Animals in group I (control) had the upper right incisors extracted, the root canal was sealed with calcium hydroxide, and teeth were reimplanted in their alveoli. Group II underwent the same procedure, but the remaining periodontal ligament was removed from the root surfaces by root planing before reimplantation. In group III,following removal of the periodontal ligament, Emdogain was applied to the root surfaces. Animals were sacrificed 7, 20, and 60 days after reimplantation, and the alveoli were fixed, processed, and stained with hematoxylin and eosin. Formation of periodontal ligament, resorption areas, and ankylosis were analyzed. The results showed that group I (control) was better than groups II and III, with statistically significant differences on days 7 and 20 after reimplantation for formation of periodontal ligament. It may be concluded that with the methodology used, Emdogain was unable to stimulate tissue repair in reimplanted teeth.
Asunto(s)
Sustitutos de Huesos/uso terapéutico , Proteínas del Esmalte Dental/uso terapéutico , Reimplante Dental , Proceso Alveolar/efectos de los fármacos , Proceso Alveolar/fisiopatología , Animales , Anquilosis/patología , Anquilosis/fisiopatología , Tejido Conectivo/efectos de los fármacos , Tejido Conectivo/patología , Incisivo , Masculino , Ligamento Periodontal/efectos de los fármacos , Ligamento Periodontal/patología , Ligamento Periodontal/fisiopatología , Ratas , Ratas Wistar , Regeneración/efectos de los fármacos , Tratamiento del Conducto Radicular , Aplanamiento de la Raíz , Factores de Tiempo , Resorción Dentaria/patología , Resorción Dentaria/fisiopatologíaRESUMEN
We examined unexfoliated primary molar teeth by scanning electron microscopy to study the resorbing internal enamel surfaces. They were fixed in a cacodylate buffered glutaraldehyde-formaldehyde mixture, treated with 2 percent sodium hypochlorite, washed, dehydrated with ethanol and air-dried, before sputter-coating with a 40 nm layer of gold. The examination with a Jeol 6100 scanning electron microscope revealed large areas of enamel resorption, characterized by closely adjoining honeycomb-like lacunae (concavities). In higher magnification, lacunae show enamel with various patterns of resorption: whereas in some regions, only the central portions of prisms are removed; in others, the prism sheath regions are seen below the other enamel structures. Also, regions showing a random pattern of resorption are observed. In addition, lacunae showing resorbing enamel prisms in longitudinal and other orientations are also observed. The results of the present study reveal, therefore, that in unexfoliated primary teeth, the odontoclasts first remove the coronal dentin and then reach and resorb large areas of enamel. Furthermore, the various patterns of resorption support the idea that removal of enamel by odontoclasts depends upon the orientation of enamel structures, rather than of the different degrees of mineralization suggesting that enamel structures do not possess different inorganic/organic composition.
Asunto(s)
Esmalte Dental/ultraestructura , Diente Molar/ultraestructura , Resorción Dentaria/patología , Diente Primario/ultraestructura , Anquilosis/patología , Esmalte Dental/química , Dentina/ultraestructura , Humanos , Microscopía Electrónica de Rastreo , Osteoclastos/ultraestructura , Fijación del Tejido , Calcificación de Dientes , Enfermedades Dentales/patologíaAsunto(s)
Niño , Adulto , Anquilosis/diagnóstico , Anquilosis/etiología , Anquilosis/cirugía , Anquilosis , Anquilosis/historia , Anquilosis/patología , Anquilosis/terapia , Articulación Temporomandibular/patología , Especialidad de Fisioterapia , Especialidad de Fisioterapia/estadística & datos numéricos , RecurrenciaRESUMEN
Anquilose dentária, também, comumente denominada de infra-oclusão ou dente submerso, significa a existência de um ou mais dentes num plano inferior de oclusão, em relação aos dentes adjacentes. A presença de anquilose geralmente está associada a algum tipo de má-oclusão e como não é uma condição estética, há uma tendência de progredir e influir em outros dentes do arco dentário. Devido a isso é de grande importância o correto diagnóstico, assim como o tipo de tratamento mais indicado para cada caso
Asunto(s)
Humanos , Masculino , Femenino , Niño , Anquilosis/clasificación , Anquilosis/diagnóstico , Anquilosis/etiología , Anquilosis/patología , Anquilosis/terapia , Diente Molar , Diente PrimarioRESUMEN
Fueron revisados 12 casos con artroplastia de codo, durante los años 1977 y 1989 ambos inclusive, en el Hospital San Juan de Dios, Caracas. Después de una descripción anatómica de la articulación del codo y de la etiología, estudiamos los diferentes métodos empleados para la artroplastia. Presentamos 7 pacientes con fracturas de codo (58%), 4 con A.R.J. (38%), y 1 caso con Osteomielitis (8%). Se obtuvieron excelentes resultados en dos casos y buenos resultados en tres y regulares en cuatro. En los nueve se utilizó Fascia Lata
Asunto(s)
Adolescente , Adulto , Humanos , Masculino , Femenino , Anquilosis/patología , Anquilosis/cirugía , Artroplastia/cirugía , Articulación del Codo/patologíaRESUMEN
Since the recognition of the Beckwith-Wiedemann syndrome was first noted in 1963, the number of associated anomalies has vastly increased. The rate of appearance of this abnormality is 1 in 13,5000 births. This article presents a case that includes macroglossia and ankyloglossia along with a bifid uvula and a submucous cleft of the palate. A discussion of treatment follows.