1366 21st ICOMS 2013 - Abstracts: Oral Papers

T35.OR040

TMJ pyseudoankylosis after neurosurgery procedure of intracranial AV malformation. Howwe solved it

J. Mareque-Bueno 1,∗ , P. Rodriguez 2, F. Hernandez-Alfaro 1, J. Vazquez 1, A. Valls-Ontanon 1, J.López-Vilagran 1

1 Centro Medico Teknon, Spain2 Hospital Virgen de la Macarena, Sevilla, Spain

Introduction: Trismus after neurosurgical procedures is an unusual complication.Case report: In the postoperative recovery of temporal bone craniotomy for treatment of intracra-

nial AV malformation the patient developed a progressive trismus that limited the mouth opening to14 mm. With physiotherapy it arrived to 22 mm. MRI and CT showed a normal TMJ. Coronoidec-tomy and temporal muscle detachment was performed and an intraoperative opening of 34 mm wasachieved. After postoperative physiotherapy we reached 39 mm.

Conclusions: Mouth opening limitation may be due to extraarticular reasons such as fibrousscars of the temporal muscles. This cases may be solved with simple coronoidectomy.

http://dx.doi.org/10.1016/j.ijom.2013.07.697

T35.OR041

TMJ ankylosis in patient with Treacher-Collins syndrome and anomalous articulation betweenzygomatic arch and mandibular condyle: clinical case report

H. Marques 1,∗ , R. Nunes 2, T. Neto 3, M. Mesquita 2, J.P. Marcelino 2, A. Ferreira 2, D. Sanz 2,S. Bitoque 2, F. Pimentel 2, R. Saleiro 2

1 Centro Hospitalar Porto, Portugal2 Centro Hospitalar Universitário Coimbra, Portugal3 Centro Hospitalar S. João, Portugal

Treacher-Collins syndrome usually affects bilateral and symmetric structures that include theorbits, zygomatic complex, mandible, and ears. The purpose of this report is to describe a clinicalcase of the syndrome, focusing on the temporomandibular joint (TMJ). A 33 year-old male presentedto our department with severe mouth opening limitation, he had never been treated for his condition.Midfacial hypoplasia with a bilaterally symmetric convex facial profile, prominent nose, downwardslant of the eyelids, sparse lower eyelashes and small ears were present. Family history was con-sistent with autosomal dominant inheritance. He had hypoplasia of the maxilla and mandible withuncharacteristic posterior open bite and severe mouth opening limitation (<5 mm), CT scan revealedabnormal bilateral ankylosis between a hyperplasic zygomatic arch and the mandibular condyle. Weperformed surgical excision of the ankylosis (lateral aspect of the zygomatic and condyle) preservingthe medial portion of the condyle, coronoidectomy and on lay malar bone graft with the excisedbone. Mouth opening greatly improved with the procedure (20 mm). Most cases of TCS present withunderdeveloped zygomatic arch. We report a case of ankylosis between a hyperplasic zygomatic archand the condyle of the mandible, successfully treated with excision of the ankylosis.

http://dx.doi.org/10.1016/j.ijom.2013.07.698

T35.OR042

Pre arthroplastic distraction vs simultaneous distraction in TMJ ankylosis: an study

S. Mohammad

King George’s Medical University, India

TMJ ankylosis is very common affliction in this part of the world which leads to fixation of TMJleading to restricted or no mouth opening. It also causes gross facial deformity making the patientdebilitated. It also leads to various psychological problems in these patients. This study consists of 20patients having TMJ ankylosis who underwent pre arthroplastic vs simultaneous distraction followedfor long term to see the merit and limitations of these two treatment modalities.

http://dx.doi.org/10.1016/j.ijom.2013.07.699

T35.OR043

Costochondral grafts (CCGs) as growth sites: how useful are they?

S. Mohanty

Maulana Azad Institute of Dental Sciences, India

Objective: CCGs have long been used to reconstruct the RCU in children and young adultsfollowing resection of diseased bone (ankylosis, tumour) or in cases of condylar aplasia, due to theirenormous growth potential. The aim of our study is to determine the efficacy/accuracy of CCGs insuch reconstruction.

Materials and method: In the last 10 years, 65 patients between the ages of 7 and 16 yearshave been treated by RCU reconstruction with CCG at our centre. In all patients CCG with a 3–5 mmcartilaginous cap was used, either unilaterally (U/L) or bilaterally (B/L) as the case warranted. The graftwas fixed to the ramal stump with 2 screws. At follow up appointments, the following parametres werenoted: mouth opening, symmetry of face, re-ankylosis, hypertrophic scar and facial nerve weakness.Additionally, pain, regeneration of bone and damage to mammary gland were assessed clinically, withphotographs and radiographs.

Results: Out of the total 65 cases, 55 were treated with U/L reconstruction and 10 with B/Lreconstruction. The mean post-operative mouth opening in these patients was noted to be 32 mm. Outof the 55 U/L cases, 16 showed normal growth, whereas lateral over growth was seen in 3 patientsand 36 patients showed less/no growth compared to the normal growing side. In the 10 B/L cases,improvement in facial aesthetics was seen in 4 patients with no changes seen in 6 patients. Each ofthe U/L and B/L cases showed re-ankylosis.

Conclusion: The above findings suggested that even though CCG has tremendous growth poten-tial in growing children, its behaviour is non predictable irrespective of age, sex and thickness ofcartilage. So distraction has become a preferred option over grafting with any autogenous material,for growth and reconstruction of RCU, hence avoiding unpredictability and a second surgical site.

http://dx.doi.org/10.1016/j.ijom.2013.07.700