1、1,Treatment of Ankylosis of Temporomandibular Joint,Definition: intra-articular and extra-articular processes may restrict jaw motion severely. Ankylosis of the TMJ is an intra-articular process characterized by fibrous, fibro-osseous, or osseous obliteration(消失) of the joint space. Extracapsular ca
2、uses of restricted jaw motion (pseudoankylosis) include but are not limited to coronoid-zygomatic fusion(融合), coronoid hypertropy, and muscular fibrosis.,2,Indications for therapy for ankylosis,(may include one or more of the following),Severely restricted jaw motion accompanied by one or more of th
3、e following: Inadequate masticatory function Abnormal speech Inability to undergo dental and /or medical care Compromised anesthetic management Inhibited facial growth Imaging evidence of osseous or soft tissue abnormality,3,Presence of a general therapeutic goal B. Release of ankylosis C. Access fo
4、r dental and/or medical care D. Improved speech E. Improved masticatory function F. Relief or reduction of pain,Specific Therapeutic Goals for Ankylosis (The goal of therapy is to restore form and/or function. However, risk factors and potential complications may preclude(妨碍) complete restoration of
5、 form and/or function),4,Specific Factor Affecting Risk for Ankylosis (Severity factors that increase risk and the potential for known complications),Presence of a general factor effecting risk Type of ankylosis (ie, fibrous or bony) C. Etiology of the ankylosis (eg, traumatic or inflammatory) D. Ex
6、tent and duration of ankylosis E. Degree of pre-existing muscular atrophy F. Ankylosis in a growing child,5,Indicated therapeutic standards for ankylosis,General history and physical examination Focused history and physical examination of the TMJ region to region to determine the presence of indicat
7、ions for care of ankylosis and to identify factors affecting risks An imaging examination, if indicated, based on the history and physical findings. The examination may include but is not limited to: panoramic radiograph, cephalometric radiograph, conventional tomogram, CT scan, and/or MRI,The pretr
8、eatment assessment includes:,6,Post-treatment management,Wound care Pain management Diet and oral hygiene(卫生) management Occlusal management Physical therapy Appropriate diagnostic records to determine progression of the disease Patient reassessment Instruction for post-treatment care and follow-up,
9、7,Arthroscopic surgery (early stage of fibrous ankylosis) Open surgery (most) Arthroplasty Condylectomy: partical or total and +/- replacement (eg, total joint prosthesis, costochondral graft) Gap arthroplasty +/- autogenous or alloplastic or allogeneic interposition (my favor: temporal fascia or au
10、ricular cartilage) Coronoidectomy or cononoidotomy (often) Orthognathic surgery for residual maxillofacial deformity pseudoankylosis Osteotomy of zygoma or zygomatic arch Myotomy Coronoidectomy or cononoidotomy Scar revision (eg, intraoral and /or extraoral) (adjacent tissue transfer),Management,fib
11、rous, fibro-osseous, or osseous ankylosis,8,Diagnoses,Arthroscopic surgery,9,Treatment,10,Adhesion between eminence & disc,CASE REPORT F 33,PREOPERATION,POSTOPERATION,11,CASE REPORT M 40,CHRONIC SEPTIC ARTHRITIS WITH INFECTION OF INFRATEMPORAL SPACE AFTER EXTRACTION OF TEETH,Duration 2m,Grans stain,
12、Bacteria culture,12,Open Surgery (focus on ankylosis),Removal of bony tissue on medial aspect of the TMJRelease of soft tissue in the peri-articular regions (etiology of ankylosis is inflammatory),Important procedures,13,Gap arthroplasty withauricular cartilage interposition,Case 1: Fibrous-osseous
13、ankylosis,14,Gap arthroplasty,auricular cartilage interposition,Fibrous-osseous ankylosis,15,Case 2: osseous ankylosis(recurrent case),Arthroplasty with temporal fascia graft interposition,16,Case 3: osseous ankylosis,costochondral graft replacement,17,Remove lateral osseous ankylosis with remaining
14、 medial condyle, disk, and fossa,Case 4,The condylar neck stump(残余部分) is ankylosed to the fossa while the medially displaced fracture condyle is ankylosed to the anteromedial aspect of condylar stump,18,Case 5: osseous ankylosis,Ankylosis Maxillofacial deformityOSAS,Orthognathic surgery for residual
15、 maxillofacial deformity,19,20,21,22,23,Case 6,24,4 mo,25,Case 7 release of ankylosisdouble jaws osteotomy,26,Distraction osteogenesis, DO,For prolonging mandible body,27,术前,术后,Case 8,28,定制式人工关节1,Customized TMJ Implant,29,30,pseudoankylosis,31,Osseous fusion between medial aspect with Pterygoid process of sphenoid bone,32,osteotomy,33,Masseter muscle fibrosis （scar） T m,Myotomy cononoidotomy,34,Co hypertrophy,Coronoidectomy,35,Zygomatic bone fracture,36,
