Lateral pterygoid myotomy with reattachment to the condylar neck: An adjunct to restore function after total joint reconstruction

Evaluation of Temporomandibular Joint Total Replacement with Alloplastic Prosthesis: Observational Study of 27 Patients

“…Regarding functions, one of the relevant disadvantages presented by TMJ replacement with alloplastic prostheses is the decrease or loss of contralateral lateral movement in patients with unilateral replacements, or loss of mandibular lateral movement in patients with bilateral replacements, due to the disinsertion of the external pterygoid muscle and the impossibility of reinserting it back inside the prosthetic component, thus enabling condylar rotation and limiting its translation. 10,[15][16][17][18] This is demonstrated with the results obtained, which indicate limited contralateral condylar excursion with respect to the prosthesis, and ipsilateral excursion is kept in those cases with total unilateral TMJ replacement, but in the case of bilateral replacements, lateral bilateral excursion is observed limited. Another disadvantage is the cost of the prosthesis, but if cost-benefit is considered (and compared with other surgical alternatives), then it is worth using, due to its design, mainly because the anatomical structures to be replaced are morphologically recreated, which enables a greater adaptability and eliminates the need for a another surgical team to handle autografts, eliminates morbidity at the donors site, and reduces the time of hospitalization and patient disability.…”

“…After conducting an analysis about the results and despite having a high degree of success as evidenced by the literature, [2][3][4][5][8][9][10][11][12][13][14][15][16][17][18][19][20][21] we cannot set aside the small percentage of patients who expressed dissatisfaction with the treatment. We also have to consider that these results in the study might be attributed to advanced stages of uncontrolled severe inflammatory disease (polyarthritis), failed previous multiple surgeries where there is a decrease in the prognosis for pain amelioration, a high degree of stress on the part of the patient, lack of compliance by the patient with the therapies or postoperative controls or due to a lack of postoperative follow-up, and reinforcement on the part of the therapist in self-care techniques for this type of pathologies.…”

Reconstrucción de la articulación temporomandibular (ATM): prótesis aloplástica

“…Si se sitúa la cabeza de la reconstrucción en el centro de la fosa anatómica, esta rotará en el movimiento de apertura aunque intentemos fijar los músculos pterigoideos a la cabeza de la reconstrucción (dos milímetros de traslación lateral en manos de Wolford, 19 tres mm y medio en la serie de Collins). 20 Si el injerto funciona bien es de esperar obtener un rango de apertura satisfactorio, aunque una reciente serie con injerto costocondral de 76 articulaciones en 57 pacientes, 4 refiere la media de aumento de apertura interincisal de 21 a 24 mm, y un movimiento de traslación nulo. El descenso del eje de rotación en los nuevos diseños de sistemas artificiales, 15 está consiguiendo un efecto de pseudotraslación que mejora en 8 ó 10 mms la apertura interincisal.…”

“…With both options we will find that translatory movements are restricted. If the reconstruction head is situated in the anatomical center of the fossa, it will rotate during the aperture movement, even if we try to attach the pterygoid muscles to the reconstruction head (two millimeters of lateral movement in Wolford's hands, 19 3.5 mms in Collins' series) 20 . If the graft works well, a satisfactory aperture range is to be expected, although a recent series with costochondral grafts of 76 joints in 57 patients 4 reported an average increase in the interincisal opening of 21 to 24 mms, and no translatory movement.…”

Reconstrucción de la articulación temporomandibular: injertos autólogos

“…18 With regard to the surgical manipulation of mastication muscles, some authors suggest lateral pterygoid myotomy and its reattachment to the condylar neck, below the level of the condylectomy, in order to achieve a greater restoration of joint function. 19…”