The Experts below are selected from a list of 240 Experts worldwide ranked by ideXlab platform
D James - One of the best experts on this subject based on the ideXlab platform.
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Mandibular reconstruction in children with obstructive sleep apnea due to micrognathia.
Plastic and reconstructive surgery, 1997Co-Authors: D JamesAbstract:Obstructive sleep apnea in children with micrognathia may be severe enough to necessitate permanent airway maintenance. Affected children form a small, but important, group of patients because early reconstructive surgery to the mandible may permit decannulation. A policy of early and aggressive surgical management has been pursued for the past 15 years, and an audit of outcome was undertaken to confirm whether or not this policy has been justified. The records of 25 patients so treated between 1980 and 1994 were analyzed by an independent clinician. Decannulation was achieved in 20 of the children (80 percent). The conditions that were most amenable to successful treatment (100 percent) were hemifacial microsomia, Temporomandibular Ankylosis, and the Pierre Robin sequence. The outcome for children with Treacher Collins syndrome and Nager syndrome was less successful (75 and 60 percent, respectively). The worst outcome occurred in a mixed group of three children with other syndromes, two of whom failed decannulation. Surgery was most successful when carried out before the age of 2 years (87 percent) and after the age of 4 years (90 percent).
Divya Mehrotra - One of the best experts on this subject based on the ideXlab platform.
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hydroxyapatite collagen block with platelet rich plasma in Temporomandibular joint Ankylosis a pilot study in children and adolescents
British Journal of Oral & Maxillofacial Surgery, 2012Co-Authors: Divya Mehrotra, Sumit Kumar, Satish DhasmanaAbstract:Abstract The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with Temporomandibular Ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with Temporomandibular joint Ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of Ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months’ follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.
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Hydroxyapatite/collagen block with platelet rich plasma in Temporomandibular joint Ankylosis: a pilot study in children and adolescents
The British journal of oral & maxillofacial surgery, 2012Co-Authors: Divya Mehrotra, Sachil Kumar, Satish DhasmanaAbstract:The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with Temporomandibular Ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with Temporomandibular joint Ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of Ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months' follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.
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Management of Temporomandibular Ankylosis with temporal fascia inter-positional arthroplasty and distraction osteogenesis: report of 30 cases.
Journal of long-term effects of medical implants, 2009Co-Authors: Divya Mehrotra, Satish Dhasmanaa, Sumit KumarAbstract:UNLABELLED Interposition arthroplasty in cases of Temporomandibular Ankylosis provides satisfactory postoperative mouth opening but correction of the associated facial deformity demands proper attention. PURPOSE To evaluate the use of distraction osteogenesis for correction of facial deformity caused by Temporomandibular Ankylosis. MATERIAL This study was conducted in 30 children (age 6-22 , median 12 years), with mandibular deformity as a result of Temporomandibular Ankylosis. The mean duration of Ankylosis was 6.37(2.97) years, range 2-14 years. Extra oral or intraoral distractors were placed using pins or screws and distraction of mandibular body was achieved. Post operatively these patients were subjected to vigorous physiotherapy using wooden spatulas or jaw exerciser. RESULTS Pre-operative inter-incisal mouth opening ranged from 0-6 mm, mean 3.33(1.81) mm where as post-operative mean mouth opening was 39.40(2.36) mm, range 34-44 mm. All the patients showed improved facial profile and symmetry with maintained, satisfactory mouth opening on follow up which ranged from 2 to 5 years. These patients were later subjected to orthodontic treatment to achieve a good intercuspal relationship and a stable occlusion. CONCLUSION Distraction osteogenesis provides excellent cosmetic results in the patients of Temporomandibular Ankylosis and should be preferred as a method of correction for mandibular deformities.
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Random control trial of dermis-fat graft and interposition of temporalis fascia in the management of Temporomandibular Ankylosis in children
The British journal of oral & maxillofacial surgery, 2008Co-Authors: Divya Mehrotra, R. Pradhan, Shadab Mohammad, C. JaiswaraAbstract:Temporomandibular Ankylosis is a disabling condition that affects hygiene and cosmetic appearance. Several interpositional grafts such as meniscus, muscle, fascia, skin, cartilage, fat, dura, alloplastic materials and xenografts have been used to prevent recurrence of Ankylosis. We studied the advantages and disadvantages of dermis fat graft as an interposition material after arthroplasty and compared it with temporalis fascia interposition. Seventeen patients with Temporomandibular Ankylosis involving 20 joints were randomly divided into two groups; the first group had operations for interposition of dermis-fat graft that was taken from the groin. Patients in control group had operations to interpose temporalis fascia and muscle from the same surgical site. All were assessed by age, sex, etiology, clinical features and post surgical complications. The groups were matched in age and the male: female ratio was 0.89:1.The median duration of Ankylosis was 7.3 (range 2-11) years. Postoperative and follow up interincisal mouth opening was satisfactory with good healing of the dermis-fat graft donor site. We conclude that the use of dermis fat grafts has minimal donor site morbidity, and is a safe and effective interposition material to prevent the recurrence of Temporomandibular Ankylosis.
Piero Cascone - One of the best experts on this subject based on the ideXlab platform.
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Surgical treatment of Temporomandibular joint ankyloses: meniscus conservation and relocation.
The Journal of craniofacial surgery, 2013Co-Authors: Claudio Rinna, Gabriele Reale, Francesco Calvani, Piero CasconeAbstract:Ankylosis of the Temporomandibular joint is a serious complication, mainly after trauma and local or systemic infection. In rare cases, Ankylosis is associated with systemic disease such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis. According to the functional restriction and the provoked disturbances of facial growth in the youth, an early and effective therapy is desirable. There is a wide variety of surgical approaches to Temporomandibular joint Ankylosis, ranging from chondro-osseous grafts to prothesis. In the article the authors present the clinical case of a 60-year-old patient who, at the age of 6, accidentally fell from a height of about 2 m. In 60 years old, after removing the Temporomandibular Ankylosis with surgical technique, patient showed a marked improvement of mandibular kinetics.
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Mandibular distraction: evolution of treatment protocols in hemifacial microsomy.
The Journal of craniofacial surgery, 2005Co-Authors: Piero Cascone, Paolo Gennaro, Giorgio Spuntarelli, Giorgio IannettiAbstract:Osteodistraction is currently used in those disorders presenting with osseus tissue deficit, excellent results having been obtained in the craniofacial complex. The factors contributing to the success of this procedure are a thin layer of subcutaneous tissue, minimum movement of the cutis, good vascularization of the soft tissues, and the good healing that ensues. The good plastic effects on the soft tissues and the possibility of constantly modulating the strength and monitoring the results have led to distraction osteogenesis gaining increasing consensus in the treatment of congenital and acquired deformities and in some selected cases, for the treatment of osseous deficits caused by trauma, postsurgical outcomes, or even severe alveolar deficits. Furthermore, in the last few years, this surgical technique has been successfully used in the treatment of pediatric deformities such as hemifacial microsomia, some severe class II skeletal deformities, and some syndromic cases, such as the treatment of Temporomandibular Ankylosis outcomes. In our opinion, guidelines in the indications for distraction are mandatory to select the procedure best suited to the pathologic situation of each individual patient.
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Combined surgical therapy of Temporomandibular joint Ankylosis and secondary deformity using intraoral distraction.
The Journal of craniofacial surgery, 2002Co-Authors: Piero Cascone, Giorgio Spuntarelli, Alessandro Agrillo, Paolo Arangio, Giorgio IannettiAbstract:Temporomandibular joint (TMJ) Ankylosis is a pathological process caused by damage of the mandibular condyle. When this event takes place in subjects during the developmental age, it results in an alteration of the entire maxillofacial complex. Therefore, surgical methods able to remove the Temporomandibular Ankylosis also include necessary operations to correct the secondary maxillofacial deformity. The distraction osteogenesis has induced our center to modify the surgical protocol for the therapy of patients who have developed TMJ Ankylosis and secondary maxillomandibular deformity. We have treated four patients with monolateral Ankylosis of the TMJ and serious deformities of the maxillomandibular complex secondary to functional limitation. During the same operation, arthroplasty was performed with the removal of the ankylotic block and the interposition of a temporal muscle flap in the new articular space; an intraoral osteodistractor was also positioned to lengthen the mandible. All patients showed recovery of the eurhythmy of the face and good re-establishment of the symmetry. An average 12-month follow-up showed the average opening of the mouth to be at least 35 mm. The combination of TMJ arthroplasty and intraoral osteodistraction provides good functional and aesthetic results in patients affected by Ankylosis who have developed secondary maxillofacial deformities.
Preetha Balaji - One of the best experts on this subject based on the ideXlab platform.
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Overgrowth of costochondral graft in Temporomandibular joint Ankylosis reconstruction: A retrospective study
Wolters Kluwer Medknow Publications, 2017Co-Authors: S M Balaji, Preetha BalajiAbstract:Background: Temporomandibular joint (TMJ) Ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ Ankylosis has a complicated chore, and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of reAnkylosis. Costochondral graft (CCG) is a common treatment modality for TMJ Ankylosis. One of disadvantages of CCG is unpredictability of growth pattern and risk of overgrowth. This report illustrates the fate of CCG used in the TMJ reconstruction and also the management of patients with CCG overgrowth. Materials and Methods: A retrospective evaluation of 14 patients presented with unilateral TMJ Ankylosis reconstructed using CCG treated in our hospital from 2000 to 2013 was done. Only patients with unilateral Ankylosis treated by CCG with at least 2-year follow-up and complete case records with clinical and radiographic details were included in the study. Patients with bilateral Ankylosis, reAnkylosis, missing details, and the patients with 2 years). Results: Totally 14 unilateral Temporomandibular Ankylosis cases were reconstructed using CCG from the period of 2000–2013. The mean age of the patients is 5.2 years with the standard deviation of 1.48 ranging from 3 to 9 years. Follow-up of the patients ranges from 2 to 6 years with mean follow-up of 3 years. Out of 14 patients, 2 patients had normal growth of CCG after the mean follow-up of 3 years, whereas 5 patients presented with moderate growth, 4 patients with CCG overgrowth, and 3 patients presented with no growth of CCG following surgery. Overgrown CCG was treated with condylar shaving, and orthodontic elastic was maintained to stabilize the occlusion. Moderately grown and nongrowing CCG was treated by internal distractor for the management of facial symmetry. Facial asymmetry and malocclusion were successfully corrected in all patients with altered growth pattern. Conclusion: The growth pattern of the CCG is extremely unpredictable, which can be in the form of no growth at all or excessive growth, and mandibular overgrowth on the grafted site can actually be more troublesome than the lack of growth. Care should also be taken to ensure proper postoperative functional therapy and to examine the role of cartilage thickness on future growth in young patients
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Overgrowth of costochondral graft in Temporomandibular joint Ankylosis reconstruction: A retrospective study
Indian journal of dental research : official publication of Indian Society for Dental Research, 2017Co-Authors: S M Balaji, Preetha BalajiAbstract:Temporomandibular joint (TMJ) Ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ Ankylosis has a complicated chore, and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of reAnkylosis. Costochondral graft (CCG) is a common treatment modality for TMJ Ankylosis. One of disadvantages of CCG is unpredictability of growth pattern and risk of overgrowth. This report illustrates the fate of CCG used in the TMJ reconstruction and also the management of patients with CCG overgrowth. A retrospective evaluation of 14 patients presented with unilateral TMJ Ankylosis reconstructed using CCG treated in our hospital from 2000 to 2013 was done. Only patients with unilateral Ankylosis treated by CCG with at least 2-year follow-up and complete case records with clinical and radiographic details were included in the study. Patients with bilateral Ankylosis, reAnkylosis, missing details, and the patients with <2-year follow-up were excluded from the study. The patients were selected based on the specified inclusion/exclusion criteria. All the patients were analyzed clinically and radiographically. Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long term (>2 years). Totally 14 unilateral Temporomandibular Ankylosis cases were reconstructed using CCG from the period of 2000-2013. The mean age of the patients is 5.2 years with the standard deviation of 1.48 ranging from 3 to 9 years. Follow-up of the patients ranges from 2 to 6 years with mean follow-up of 3 years. Out of 14 patients, 2 patients had normal growth of CCG after the mean follow-up of 3 years, whereas 5 patients presented with moderate growth, 4 patients with CCG overgrowth, and 3 patients presented with no growth of CCG following surgery. Overgrown CCG was treated with condylar shaving, and orthodontic elastic was maintained to stabilize the occlusion. Moderately grown and nongrowing CCG was treated by internal distractor for the management of facial symmetry. Facial asymmetry and malocclusion were successfully corrected in all patients with altered growth pattern. The growth pattern of the CCG is extremely unpredictable, which can be in the form of no growth at all or excessive growth, and mandibular overgrowth on the grafted site can actually be more troublesome than the lack of growth. Care should also be taken to ensure proper postoperative functional therapy and to examine the role of cartilage thickness on future growth in young patients.
Satish Dhasmana - One of the best experts on this subject based on the ideXlab platform.
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hydroxyapatite collagen block with platelet rich plasma in Temporomandibular joint Ankylosis a pilot study in children and adolescents
British Journal of Oral & Maxillofacial Surgery, 2012Co-Authors: Divya Mehrotra, Sumit Kumar, Satish DhasmanaAbstract:Abstract The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with Temporomandibular Ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with Temporomandibular joint Ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of Ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months’ follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.
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Hydroxyapatite/collagen block with platelet rich plasma in Temporomandibular joint Ankylosis: a pilot study in children and adolescents
The British journal of oral & maxillofacial surgery, 2012Co-Authors: Divya Mehrotra, Sachil Kumar, Satish DhasmanaAbstract:The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with Temporomandibular Ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with Temporomandibular joint Ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of Ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months' follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.
