Clinical and Therapeutic Aspects of Temporomandibular Ankylosis at the Conakry Teaching Hospital

Introduction: Temporomandibular joint ankylosis (TMJA) is a fusion of joint surfaces by fibrous or bone tissue and the resulting limitation of mouth opening. The objectives of this study were to determine the frequency of TMJA, describe the clinical aspects and assess management. Materials and Method: It was a retrospective study that was carried out in the Department of Odontostomatology and Maxillofacial Surgery of Donka National Hospital for a period of 5 years (January 2016 to December 2020). Included were all records of inpatients and managed cases of TMJA during the study period. Socio-demographic, clinical and therapeutic variables were analyzed. Results: During the study 13 TMJA cases were collected with the frequency of 0.47%. The age group 1 - 9 was the most affected (61.54%) with extremes of 4 and 28 years. Men were the most concerned (53.87%). Restriction of mouth opening was the main reason for consultation (69.23%). The etiologies of ankylosis were dominated by infection including cellulitis of dental origin (53.85%) followed by facial trauma (30.77%). Arthroplasty was the most commonly used technique (73%), two cases of recurrence were noted (15.38%). Conclusion: TMJA affects mainly children and the etiology is dominated by cellulite of dental origin hence the interest of sensitization of the population for early management of oral diseases.

Preliminary Outcome of Case Series of the Management of Unilateral and Bilateral Craniomandibular Ankylosis in Kenya <br/>—An Ongoing Prospective Study

Temporomandibularmandibular ankylosis also known as the craniomandibular joint (CMJ) ankylosis is a Greek terminology that means “stiff joint”. It is most commonly associated with trauma and to a lesser extent middle ear infections. The condition is debilitating with regard to nutrition, mantainance of oral hygiene, growth and the overall psychology state of the patient. In this paper we present preliminary results of an ongoing study to assess the clinical parameters, for example, maximum inter incisal opening (MIO) and chin deviation (CD) of patients with CMJ ankylosis receiving early surgical intervention.

Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

Objective. To study the effects of temporalis myofasdal flap (TMF) transferred to treat the long ankylosis of temporomandibular joint (TMJ). Methods : Seventeen cases with ankylosed condytes received arlhroplasty. The degrees of mouth opening pre- and post-operation were e-vahiated, and the spaces of joints in the X-ray films were also measured. The evaluation of the results of the surgical treatment was based on the TMJ functions. Results .Following up 0. 5-3. 0 years, in 12 of 17 cases the degree of mouth opening improved up to 27 mm. The doctors and the patients were both satisfied with the results. Conclusion:The use of TMF in artkroplasty of temporomandibular joint is a good approach in the treatment of TMJ.

Zygomatico-Coronoid Ankylosis: A Case Report

Extra-articular ankylosis resulting from bony union between the coronoid process and the zygoma is very rare. It may result from facial fractures caused by gunshots, treated or untreated facial fractures or may arise as an extension of intracapsular ankylosis. We report a case of ankylosis between the coronoid process and the zygomatic arch in a 33-year-old Black male. The bony ankylosis was the result of a 2 year old untreated zygomatic arch fracture. Ankylosis developed secondary to heterotopic bone formation following trauma. The patient was treated by intra-oral coronoidectomy, followed by physiotherapy for three months. He returned for review one year later with a mouth-opening of 40 mm and a stable occlusion.

USE OF A BLIND INTUBATION DEVICE FOR NASOTRA-CHEAL INTUBATION IN TEMPOROMANDIBULAR JOINT ANKYLOSIS

Objective To evaluate light-guided tracheal intubation using blind intubation device (BID) in adult patients with temporomandibular joint ankylosis. Methods Twenty adult patients, American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, with temporomandibular joint ankylosis were selected for awake blind nasal intubation. The patients were prepared with nasal decongestants and inhaled 100% oxygen for 3min, then fentanyl (2μg/kg) and midazolam (1-5 mg) were intravenously injected for sedation. Topical anaesthesia for the glottis was performed by using cricothyroid injection of local anaesthesia. A blind intubation device was used to help blind nasal intubation. Three attempts of blind nasal intubation were permitted, otherwise, fiberoptic bronchoscope (FOB) intubation was utilized considering the failure of blind intubation. During the procedure, heart rate, mean arterial pressure, and pulse oxygen saturation (SpO2) were measured. Results Nineteen patients successfully underwent blind nasal intubation by BID. The success ratio for first attempt was only 65.0%, while it reached 95.0% for three attempts. Light-guided catheter failed to be inserted for three attempts in only one patient. However, FOB was successfully used for the first attempt by the same anaesthetist. Conclusion Light-guided tracheal intubation by using blind intubation device is a safe and effective method for blind nasal intubation in the patients with temporomandibular joint ankylosis.

Rescuing“hopeless”avulsed teeth using autologous platelet-rich fibrin following delayed reimplantation:Two case reports

BACKGROUND Tooth avulsion is one of the most severe types of dental trauma.Most avulsed teeth undergo long-term ankylosis and replacement resorption after delayed reimplantation and exhibit a poor prognosis.The aim of this work was to improve the success rate of avulsed teeth after delayed reimplantation using autologous platelet-rich fibrin(PRF).CASE SUMMARY Case 1 was a 14-year-old boy who fell and knocked out his left upper central incisor 18 h prior to his arrival at the department.The diagnoses were avulsion of tooth 21,lateral luxation of tooth 11 and alveolar fracture of teeth 11 and 21.In case 2,a 17-year-old boy fell 2 h prior to his presentation to the hospital,and his left upper lateral incisor was completely knocked out of the alveolar socket.The diagnoses included avulsion of tooth 22,complicated crown fracture of tooth 11and complicated crown-root fracture of tooth 21.The avulsed teeth were reimplanted along with autologous PRF granules and splinted using a semiflexible titanium preshaped labial arch.The root canals of the avulsed teeth were filled with calcium hydroxide paste,and root canal filling was performed 4 wk after reimplantation.The reimplanted teeth showed no symptoms of inflammatory root resorption or ankylosis at the 3-,6-,and 12-mo follow-up examinations after reimplantation with autologous PRF.In addition to the avulsed teeth,the other injured teeth were treated using corresponding conventional treatment methods.CONCLUSION These cases provide examples of the successful use of PRF to reduce pathological root resorption of the avulsed teeth,and the application of PRF may provide new healing opportunities for traditionally“hopeless”avulsed teeth.

Congenital stapes suprastructure fixation presenting with fluctuating auditory symptoms:A case report

BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive conductive hearing loss that typically began in the early years of life.CASE SUMMARY Herein,we report a case of a 37-year-old female with an isolated stapedial suprastructure fixation.The patient presented with unusual fluctuating auditory symptoms of tinnitus,ear fullness and mixed hearing loss.Pre-operative temporal bone computed tomography findings and operative findings revealed an isolated stapedial suprastructure fixation with monopod stapes caused by elongated pyramidal eminence.The hearing threshold recovered completely,and fluctuating auditory symptoms disappeared after the surgery.CONCLUSION This is the first report of stapedial suprastructure fixation with fluctuating auditory symptoms.Successful results are expected with surgical treatment.

Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine: A Case Report

Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine. A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained.

甲氨喋呤与美洛昔康联合治疗强直性脊柱炎的临床观察

目的观察甲氨喋呤(MTX)与美洛昔康(MLX)联合治疗强直性脊柱炎(AS)的疗效和安全性,探索使用MTX的合理剂量。方法将32例AS患者分成A、B两组,A组14例,B组18例。A组给予MTX(12.3±3.6)mg,口服,次/周,B组给予MTX(21.3±3.2)mg,口服,次/周;两组患者均给予MLX7.5mg/d。共治疗3月。结果两组各项临床指标及实验室指标较治疗前均有改善,A组总有效率为78.6%,B组总有效率为88.9%;不良反应发生率A组50.0%,B组83.3%,总有效率和不良反应发生率均无显著性差异(P>0.05)。结论MTX与MLX联合应用治疗AS,疗效良好;其疗效与MTX剂量不存在相关性,但因不良反应发生率较高,MTX以小剂量为宜;在短时间(3月)内,MLX不增加MTX的毒性作用。

Counter-regulatory phosphatases TNAP and NPP1 temporally regulate tooth root cementogenesis

Cementum is critical for anchoring the insertion of periodontal ligament fibers to the tooth root. Several aspects of cementogenesis remain unclear, including differences between acellular cementum and cellular cementum, and between cementum and bone. Biomineralization is regulated by the ratio of inorganic phosphate （Pi） to mineral inhibitor pyrophosphate （PPi）, where local Pi and PPi concentrations are controlled by phosphatases including tissue-nonspecific alkaline phosphatase （TNAP） and ectonucleotide pyrophosphatase/phosphodiesterase 1 （NPP1）. The focus of this study was to define the roles of these phosphatases in cementogenesis. TNAP was associated with earliest cementoblasts near forming acellular and cellular cementum. With loss of TNAP in the Alpl null mouse, acellular cementum was inhibited, while cellular cementum production increased, albeit as hypomineralized cementoid. In contrast, NPP1 was detected in cementoblasts after acellular cementum formation, and at low levels around cellular cementum. Loss of NPP1 in the Enppl null mouse increased acellular cementum, with little effect on cellular cementum. Developmental patterns were recapitulated in a mouse model for acellular cementum regeneration, with early TNAP expression and later NPP1 expression. In vitro, cementoblasts expressed Alpl gene/protein early, whereas Enppl gene/protein expression was significantly induced only under mineralization conditions. These patterns were confirmed in human teeth, including widespread TNAP, and NPP1 restricted to cementoblasts lining acellular cementum. These studies suggest that early TNAP expression creates a low PPi environment promoting acellular cementum initiation, while later NPP1 expression increases PPi, restricting acellular cementum apposition. Alterations in PPi have little effect on cellular cementum formation, though matrix mineralization is affected.

Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset- juvenile idiopathic arthritis:A case report

We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month.On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier.

What qualifies as rheumatoid arthritis?

Expansion of diagnostic criteria for rheumatoid arthritis and deletion of exceptions increases sensitivity, but at the expense of specificity.Two decades later, modification of criteria included the caveat: "absence of an alternative diagnosis that better explains the synovitis."That puts great faith in the diagnostic skills of the evaluating individual and their perspectives of disease.The major confounding factor appears to be spondyloarthropathy, which shares some characteristics with rheumatoid arthritis.Recognition of the latter on the basis of marginally distributed and symmetrical polyarticular erosions, in absence of axial(odontoid disease excepted) involvement requires modification to avoid failure to recognize a different disease, spondyloarthropathy.Skeletal distribution, pure expression of disease in natural animal models and biomechanical studies clearly rule out peripheral joint fusion(at least in the absence of corticosteroid therapy) as a manifestation of rheumatoid arthritis.Further, such studies identity predominant wrist and ankle involvement as characteristic of a different disease, spondyloarthropathy.It is important to separate the two diagnostic groups for epidemiologic study and for clinical diagnosis.They certainly differ in their pathophysiology.

JNK phosphorylation promotes degeneration of cervical endplate chondrocytes through down-regulation of the expression of ANK in humans

Background C-Jun N-terminal kinase （JNK） signaling pathway and ankylosis gene （ANK） play a critical role in endplate chondrocytes degeneration. The purpose of this study was to investigate whether the expression levels of ANK was associated with the activation of JNK. Methods Cartilage endplates of 49 patients were divided into the control group （n=19） and the experimental group （n=30）. The patients in the control group were graded 0 and those in the experimental group were graded I-III according to Miller＇s classification. Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro. The inverted phase contrast microscope, teluidine blue staining, HE staining, real time RT-PCR, and MTT were used to observe morphological appearances, biological characteristics, and growth curve of endplate chondrocytes from the cartilage endplate of the two groups. Real time RT-PCR and Western blotting were used to analyze the mRNA and protein expression levels of associated factors in the degeneration process in the cultured endplate chondrocytes with or without subjected SP600125. Results The expression levels of type II collagen, aggrecan, and ANK in endplate chondrocytes of experimental group were lower than that of control group and phosphorylation level of JNK in the experimental group which was higher than that in the control group. Application of JNK phosphorylation inhibitor to degeneration chondrocytes resulted in a marked decrease in the phosphorylation level of JNK and a significant increase in the expression levels of type II collagen, aggrecan, and ANK.Conclusion The degeneration of the human cervical endplate chondrocytes might be promoted by JNK phosphorylation by down-regulating the expression of ANK