TMJ ankylosis can cause issues with mastication, digestion, speech, aesthetics, and oral hygiene. It is important to surgically treat TMJ ankylosis to improve function and prevent complications. The goals of treatment are to create a gap in the joint to allow mobilization, improve nutrition and oral hygiene, perform necessary dental work, reconstruct the joint, and prevent recurrence. Surgical techniques include aggressive resection of the ankylotic mass, coronoidectomies, lining the joint with temporalis fascia or other grafts, and reconstructing the ramus with distraction osteogenesis or costochondral grafts. Early mobilization after surgery and aggressive physiotherapy are important.
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
fracture is the breakdown in the continutity of the bone alignment this has many types as the fracure this topic include its definition , etiology, pathophysiology, clinical menisfestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from fracture and for learning for their examination and knowledge purpose
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. INTRODUCTION
The TMJ is one of the most complex joints in the body being
responsible for the various movements of the jaws, any pain or
restriction of function can cause immense distress to the patient
7. CLASSIFICATIONS
Topazian classification (1966)
Type I : Fibrous adhesion in / around front restricted condyle
Type II : Bony bridge between condyle & glenoid fossa
Type III : Condylar neck is ankylosed to fossa completely
8. Rowe’s (according to the tissue involved )
Fibroosseous ankylosis
Osseous ankylosis
Cartilagenous ankylosis
Osteo cartilagenous ankylosis
9. Sawhneys classification (1986)
Type I : presence of fibro-adhesions at the condyle
Type II : bone fusion with condyle remodelling and an intact
medial pole
Type III : ankylotic mass, mandibular ramus union with the
zygomatic arch and medial pole intact
Type IV : complete ankylotic mass, total union of the
mandibular ramus with the zygomatic arch
10. TYPE OF ANKYLOSIS
TRUE
FIBROUS Fibrous callus replacing normal joint
• Osseous/ fibrocartilagenous mass
replacing joint
• Disc often replaced by bone/fibrous
tissue
• Immobile joint
11. ETIOLOGY
Trauma
At birth (with forceps)
Blow to the chin (causing haemarthrosis )
Condylar fracture
Infections and Inflammatory
Rheumatoid Arthritis
Septic arthritis
Otitis media
Mastoditis
Parotitis
Osteomyelitis
Osteoarthritis
Tonsillitis
Systemic disease
Small pox
Ankylosing spondylitis
Syphilis
Typhoid fever
Scarlet fever
Others
Malignancies
Post radiology
Post surgery
Prolonged trismus
12. PATHOPHYSIOLOGY
TRAUMA
Extravasation of blood into the joint space
Haemarthrosis
Calcification and obliteration of the joint space
Intra-capsular ankylosis Extra-capsular ankylosis
13. Intra-capsular ankylosis
destruction of the meniscus
flattening of the temporal fossa
thickening and flattening of the condylar head
narrowing of the joint space
Opposing surfaces then develop fibrous
adhesions that inhibit normal movements and
finally, may become ossified.
Extra-capsular ankylosis
There’s an external fibrous
encapsulation with minimal destruction
of the joint itself.
14. PATHOPHYSIOLOGY
In ADULT (Less common)
Thin neck common site of fracture.
Dense condylar head with thick cortex.
Sub articular plexus absent.
PATHOPHYSIOLOGY
Blow to chin
sub condylar fracture
extracapsular haematoma
telescoping of the fracture
distal mandibular fragment goes up & may contact zygomatic arch or base of skull
if displace medially—> post trauma exercise delayed —>organization of extracapsular—
>haematoma —>reunion of distal mandibular stump with bony structure above
ANKYLOSIS.
If condyle displace laterally,
external fibrous encapsulation with minimal destruction of the joint itself
—>Extra-capsular ankylosis
15. Extra articular ankylosis :
Jacob’s disease – osteochondroma of the coronoid process causing
symptomatic enlargement with subsequent fusion to the base of the zygoma
SHABTAE & SCHWATRZ – also reported fusion of ramus and zygoma by
mandibular osteotomy
KARRAS – reported ostechondroma of the mandibular condyle and ispilateral
cranial base
17. CHILD (ROWE’S THEORY )
Thin Cortical Bone
Subarticular Interconnection Plexus Of Blood Vessels
With Flow Of Blood Vessels Extending Towards The
Articulating Surface After Penetration Of Bone
Neck Is Thick
18. TRAUMA TO CHIN
INTRACAPSULAR FRACTURE
HAEMARTHROSIS + HIGHLY OSTEOGENIC
POTENTIAL FRAGMENTS OF CORTICAL
LAYER OF CONDYLE.
NO AGGRESSIVE PHYSIOTHERAPY AFTER
TRAUMA
ORGANIZATION OF HAEMATOMA
FORMATION OF BONE ANKYLOSIS
19. Infection & inflammation
Infection – inflammation – leukocytic activity increases -
lysozymal enzymes released – tissue distraction , damage to
synovial membrane – necrosed tissue replacement – granulation
tissue filled the joint space - fibrosis occurs with time –
ossification or calcification of the fibrotic mass
20. TYPES OF ANKYLOSIS
TRUE ANKYLOSIS
U/L
Secondary to trauma
Intra- articular
Usually fibrous but may ossify
FALSE ANKYLOSIS
Affecting muscles,
VII N,
coronoid process
Extra- articular
26. OBJECTIVES OF THE TREATMENT
✦ Creat a gap to mobilize the joint
✦ To improve patient’s nutrition
✦ To improve patient’s oral hygiene
✦ To carry out necessary dental treatment
✦ To reconstruct the joint and restore the vertical height of the ramus
✦ To prevent recurrence
✦ To improve esthetics and rehablitate the patient
27. KABAN’S PROTOCOL ( 1990 )
• Early surgical intervention.
• Aggressive resection of the ankylotic segment .
• Ipsilateral coronoidectomy .
• Contralateral coronoidectomy & temporalis myotomy necessary if max.incisal opening < 35mm .
• Lining the joint with temporalis fascia and cartilage.
• Recontruction of the ramus with costochondral graft.
• Rigid fixation of the graft.
• Early mobilization and aggressive physiotherapy.
28. KABAN’S PROTOCOL (2009)
• Early surgical intervention.
• Aggressive resection of the ankylotic segment.
• Ipsilateral coronoidectomy .
• Contralateral coronoidectomy & temporalis myotomy necessary if max.incisal opening
< 35mm .
• Lining the joint with temporalis fascia and or the native disc if it can salvaged
• Reconstruction of ramus condyle unit either by distraction osteogenis or a costocondral
graft and rigid fixation
• Early mobilization of the jaw if DO after 1 st post operative day if CCG after 10 days of
MMF postoperatively
29. By Sahwney acc. to the type of ankylosis;
Type I & II – a discrete section of condyle is excised with a reciprocating saw a gap of 3 – 5 mm is made, fibrous
adhesion is removed if meniscus is intact no interpositional material is required if meniscus is damaged / absent
interpositional material is inserted
Type III -- extra-articular bony bridge extending from zygomatic arch to the ramus is removed
Type IV – new joint is fashioned to restore function in children(12-13) IMF for 10 – 14 days followed by early
mobilization and physiotherapy
Acc. To Ware & Munroe et al. costochondral graft should be used
30. Anaesthetic challenges
For child
Difficult intubation
Nutrionally challenged—so trachea smaller than others
Post extubation —desaturation obstructive sleep apnea
For adults
Associated ankylosis spondylitis
Nasotracheal intubation
Awake tracheostomy
Blind nasal intubation
Retrograde intubation
Fiberoptic nasotracheal intubation
Ventilatory bronchoscope
31.
32. Surgical anatomy
Outer aspect of zygomatic arch to MMA=31mm
MMA to glenoid fossa (AP distance)= 2.4mm
Zygomatic arch to carotid artery= 37.5mm
Zygomatic arch to IJV= 38.3mm
Zygomatic arch to mandibular N = 35mm
Gleniod fossa to mandibular N = 9.2mm
33. Areas of concern
Proximity of medial aspect to structures of infra temporal fossa
Excessive bleeding- Internal max. Artery
Presence of retrodiscal venous plexus
34. Surgery outline
Temporalis fascia flap Under GA, increase in gap arthroplasty of 1.5-2cm
Costochondral graft placed stabilized wit plate & screw
Ipsilateral / contralateral coronoidectomy
Genioplasty
42. Aggressive excision of fibrous/bony mass
Coronoidectomy on affected side
Coronoidectomy on opposite side if MIO>35mm or to point of dislocation of opposite side
Lining of the joint with temporalis fascia or the native disc if salvaged
Reconstruction of RCU with DO or CCG and rigid fixation
Early mobilisation - if DU used to reconstruct RCU, mobilise on day of surgery; if CCG used,
early mobilisation with minimal IMF ( not > 10 days)
Aggressive physiotherapy
43. Gap arthroplasty ABBE (1880)
- Gleno mandibular dysjunction
-1cm bone removal minimum
SALINS - Ankylosis subcondylar #
- Pseudoarthrosis with post op
physiotherapy
44. Interpositional arthroplasty
Extensive resection of callus
Presence of dead space
Hematoma formation
Differentiation of local pluripotent stem cells to fibroblasts and
osteoblasts
Decrease in vascularity and pO ₂ favouring the change of fibrous
tissue to bone
OBJECTIVE : create the functional pseudoarthrosis to prevent
recurrence and provide joint mobility
46. Variations of TMF-
Feinbery & Larsen – Full thickness TMF+periosteum
Pogrel & Kaban – Fascia alone & inferior rotated over arch
at joint space
Omura & Pujita – Flaps fold over fascia- both condyle &
fossa surface
47. Other flaps-
Dermal grafts Masseter muscle grafts Auricular cartilage Full thickness skin graft
Fascia lata
Alloplasts - Proplat / teflon implants
Polyethylene condyle caps
Christensen metallic fossa implants
Silatic sheets
Acrylic marbles
48. Int. J. Oral Maxillofac . Surg. 2011; 40: 50-56 A.Thangavelu et al
55. Ankylosis surgery in child
POSNICK & GOLDSTEIN – Trauma was most common cause
Use of miniplates & screw to secure costochondal graft & early mobility
PENSLER ET AL – Beneficial to leave posterior open bite post op
56. COMPLICATIONS
Perforation into middle fossa Secure bleeding from infra temporal fossa
Costochondral over growth – use of 0.5-2cm dimensional chance of all cartilage bone
Scar formation
Facial nerve damage
Frey’s syndrome
EAM perforation
57. Re- ankylosis – young pt osteogenesis is high
CADCAM replacements in 2 stage procedure
1 st stage – Gap arthroplasty
2nd stage – Insertion of implants 10Gy fractioned in 5 doses
58. CONCLUSION
TMJ ankylosis is a challenging problem
Surgical correction is technically difficult and the incidence of recurrence after
treatment is high
59. References:
Peter wardbooth
Okeson-tmj Is aggressive gap arthroplasty essential in the managementof temporomandibular joint
ankylosis ?—a prospectiveclinical study of 15 cases
Lokesh - Lokesh Babua,e , Manoj Kumar Jainb ,∗, C. Rameshc,f , N. Vinayakad,g British Journal of Oral
and Maxillofacial Surgery xxx (2013) xxx–xxx 4.
Use of Human Amniotic Membrane as a Interpositional Material in Treatment of Temporomandibular
Joint Ankylosis - Umut Tuncel , MD,* and G. Y. Ozgenel , MD† 5. Intraoral approach for arthroplasty for
correction of TMJ ankylosis - E. C. Ko , M. Y. Chen, M. Hsu, E. Huang, S. Lai: Intraoral approach for
arthroplasty for correction of TMJ ankylosis . Int. J. Oral Maxillofac . Surg . 2009; 38: 1256–1262