Treatment of Temporomandibular Joint Ankylosis by Posterior Border of Mandibular Ramus Osteotomy

Oliveira, Maiolino Thomaz Fonseca; Rocha, Flaviana Soares; Paiva, Luis Gustavo Jaime; Rodrigues, Átila Roberto; Silva, Marcelo Caetano Parreria da; Zanetta‐Barbosa, Darceny

doi:10.1097/scs.0000000000000451

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“…The advantages are that, firstly, in contrast to grafts (eg, costochondral and cranial bones), the use of the posterior mandible edge as a pedicled graft can be performed safely and easily, avoiding complications associated with the local donor. In addition, the posterior ramus border is attached to the medial pterygoid muscle, which can provide sufficient blood to prevent bone resorption/necrosis, resulting in less bone resorption, lower mandibular ramus height decrease, and mouth opening deviation and better clinical outcomes in the long term 9,10 …”

Section: Discussionmentioning

confidence: 99%

“…A variety of surgical flaps have been described for exposing TMJ through a preauricular approach with temporal extensions associated with the use of retromandibular approach, if necessary, to access the mandibular ramus. The most common surgical approach for the treatment of this condition is the preauricular and the modified preauricular 10 . Sufficient exposure requires a flap that can be extended to the size and extent of the ankylotic mass.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Dentofacial Deformity Associated with Temporomandibular Joint Ankylosis Through Vertical and Sagittal Osteotomies of the Mandibular Ramus

Filho

Gomes

Santos

et al. 2021

Journal of Craniofacial Surgery

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There should be no contrast enhancement. If the diffusion is essential to make the distinction between masses and other lesions for the differential diagnosis. Since the main feature imaging is requested, their signal is high in DWI and ADC images because of the increasing diffusion of molecules. PAC covers the internal carotid artery but it doesn't compress it. Most importantly, it is necessary to see typical suppression of CSF in FLAIR sequences. 6 These radiological features are present in our case.Arachnoid cyst is the main lesion in the differential diagnosis. However, some radiological features easily distinguish it from PAC. Massive erosion or indentation of a petrous apex is not expected. The other diseases in the differential diagnosis of the PAC include benign obstructive lesions of air cells (cholesterol granuloma and mucocele), congenital or acquired cholesteatoma, epidermoid cyst, and apical petrocyte. 4,7 Let's look at the radiological features that may be useful in the differential diagnosis: a signal intensity similar to that of CSF is observed in the case of effusion of petrous air cells, which is a favor in PAC. However, the nondeterioration of the air cells' trabecular structure and the absence of expansion are directing to other differential diagnoses. Cholesterol granuloma has a high signal in T1 WI unlike PAC. The signal of mucocele is similar to PAC in conventional MRI sequences, but signal differences are occurring in FLAIR sequences and DWI. Contrast enhancement is not usually seen in PAC. If contrast enhancement is present, only a very thin rim enhancement is observed. Indeed, there is no contrast enhancement in our case.According to the literature, PAC is accompanied by empty sella in 5% to 35% of the cases. The formation mechanism of the empty sella is similar to PAC's one. Increased intracranial pressure causes enlargement of sella turcica and indentation of the suprasellar cistern to this area. Due to the reasons explained above, since the mechanism is different in unilateral cases, empty sella is expected to occur only in patients with bilateral PAC. However, no study classifies empty sella according to unilateral and bilateral patients. In addition, there are reports about the relationship between PAC and Usher syndrome (a genetic syndrome associated with deafness/hearing loss and retinitis pigmentosa) in the literature. 8 In our patient, sella turcica was broad but there was no evidence of empty sella. Considering the benign clinic of our case, it was thought that the etiologic condition causing PAC probably could not create sufficient pressure for empty sella formation but widened the sella.In our case, a severe headache was the dominant symptom. 9 Usually, no treatment is required for asymptomatic cases. However, in symptomatic ones, there is a complicated treatment process including surgery. 10 CONCLUSIONS Petrous apex cephalocele is a rare type of cephalocele. Our case is one of the first 50 reported cases. Bilateral cases are rarer. They are a different entity from unilater...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%