This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
This document provides information about the editors and contributors of the book "Oral and Maxillofacial Surgery for the Clinician". It begins with an introduction by the editors explaining the motivation and scope of the book. It aims to be a comprehensive textbook on oral and maxillofacial surgery for clinicians and trainees. The book has contributions from AOMSI members in India as well as 41 international authors to represent global expertise. It contains 22 sections and 88 chapters covering all aspects of cranio-maxillofacial surgery, along with 68 video demonstrations. The editors thank the contributors and AOMSI for their support in producing this open access textbook.
Here are the key points about suction:
- The objective of suction is to maintain a clear airway by removing secretions like saliva, blood or vomit from the mouth or surgical site.
- It prevents aspiration which can lead to infections. Suction also helps surgeons see clearly during procedures.
- Safety considerations include using proper technique to avoid injury, knowing which patients are at risk of aspiration, monitoring for respiratory distress, and addressing other potential causes of distress beyond just secretions.
This document provides an introduction to mixed dentition space analysis. It discusses that during the mixed dentition period, there may be discrepancies between the space available in the dental arches and the size of the teeth. Accurate mixed dentition space analysis is important for orthodontic diagnosis and treatment planning. The document outlines that mixed dentition typically lasts from ages 6 to 12 years and is when maximum orthodontic problems can develop due to inadequate space for permanent teeth. It also categorizes different methods for mixed dentition space analysis, including those based on regression equations using measurements of erupted permanent teeth and those using radiographs.
This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
This document provides information about the editors and contributors of the book "Oral and Maxillofacial Surgery for the Clinician". It begins with an introduction by the editors explaining the motivation and scope of the book. It aims to be a comprehensive textbook on oral and maxillofacial surgery for clinicians and trainees. The book has contributions from AOMSI members in India as well as 41 international authors to represent global expertise. It contains 22 sections and 88 chapters covering all aspects of cranio-maxillofacial surgery, along with 68 video demonstrations. The editors thank the contributors and AOMSI for their support in producing this open access textbook.
Here are the key points about suction:
- The objective of suction is to maintain a clear airway by removing secretions like saliva, blood or vomit from the mouth or surgical site.
- It prevents aspiration which can lead to infections. Suction also helps surgeons see clearly during procedures.
- Safety considerations include using proper technique to avoid injury, knowing which patients are at risk of aspiration, monitoring for respiratory distress, and addressing other potential causes of distress beyond just secretions.
This document provides an introduction to mixed dentition space analysis. It discusses that during the mixed dentition period, there may be discrepancies between the space available in the dental arches and the size of the teeth. Accurate mixed dentition space analysis is important for orthodontic diagnosis and treatment planning. The document outlines that mixed dentition typically lasts from ages 6 to 12 years and is when maximum orthodontic problems can develop due to inadequate space for permanent teeth. It also categorizes different methods for mixed dentition space analysis, including those based on regression equations using measurements of erupted permanent teeth and those using radiographs.
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with sodium hypochlorite with clotrimaz
This document discusses the importance of adult immunization and provides guidelines for vaccination against various diseases. It begins by noting that while childhood immunization is well-known, adult immunization is less understood but still important. It then reviews literature on vaccination protocols for adults, including for travel, communicable diseases, hepatitis B, shingles, and more. The document focuses in depth on recommended vaccination for human papillomavirus (HPV), hepatitis, and human immunodeficiency virus (HIV). It provides vaccination schedules, target groups, and notes the need to increase awareness of adult immunization among healthcare professionals and the public.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
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- The review identified 20 relevant studies examining nonhuman primates, mice, hamsters, ferrets, cats and dogs. These animal models show some similar responses to SARS-CoV-2 infection as humans such as respiratory symptoms.
- However, the models do not fully mimic the severe complications seen in human COVID-19 patients such as acute respiratory distress syndrome and coagulopathy. While the models provide useful information, they have limitations in replicating the full disease severity in humans.
This study aimed to evaluate the knowledge and concerns of 124 dental health professionals in southern India regarding COVID-19. A survey was administered to assess understanding of COVID-19 transmission, oral manifestations, appropriate testing and emergency procedures. The results found good knowledge of COVID-19 and precautions, but some lack of awareness regarding appropriate testing and managing contaminated air. While most respondents understood transmission risks and emergency protocols, there was uncertainty around testing patients and using mouthwashes as prevention. This highlights gaps in knowledge that could be addressed with further education for dental professionals on COVID-19 clinical guidelines.
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A 34-year-old male presented with pain and pus discharge from a recently extracted tooth. Radiographs showed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma as it is uncommon to have multiple cyst types occurring bilaterally in the mandible without an associated syndrome. Careful radiographic and histological analysis was needed to arrive at the accurate diagnosis and appropriate treatment.
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36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
This study assessed oral microbiota in different trimesters of pregnancy. Samples were taken from 70 pregnant women divided into groups by trimester and 15 non-pregnant controls. The amount of colony forming units (CFU)/ml was highest in the first trimester, decreased in the second, and was higher again in the third trimester compared to non-pregnant women. Higher CFU/ml positively correlated with worse periodontal diagnoses. The study concluded that oral bacteria levels increase in the first and third trimesters of pregnancy, which can negatively impact oral and overall health of the mother and developing fetus.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and boost overall mental well-being.
70.Dayalan N, Kumari B, Khanna SS, Ansari FM, Grewal R, Kumar S, Tiwari RVC. Is Open Reduction and Internal Fixation Sacrosanct in the Management of Subcondylar Fractures: A Comparative Study. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S1633-S1636. doi: 10.4103/jpbs.jpbs_352_21. Epub 2021 Nov 10. PubMed PMID: 35018044; PubMed Central PMCID: PMC8686876.
This study aimed to design and validate a new risk scoring system to predict cardiovascular (CV) events in COVID-19 patients. The researchers conducted a retrospective study of 1000 COVID-19 patients divided into two groups. Ten independent risk factors for CV events were identified, including male gender, older age, chronic heart disease, low lymphocyte count, elevated blood urea nitrogen, and decreased kidney function. A risk scoring system was developed based on these factors and validated in the second patient group. CV events were found to be significantly associated with worse patient outcomes. The new risk score may help predict CV complications in COVID-19 infected individuals.
This document compares the surgical outcomes of removing impacted mandibular third molars using either a conventional rotary handpiece or a piezoelectric device. A study was conducted on 20 patients where one impacted tooth was removed using a rotary bur and the other using piezosurgery. The piezoelectric surgery took longer on average but resulted in less post-operative pain, trismus, and higher patient satisfaction compared to the rotary technique. The document concludes that piezoelectric surgery is a precise technique that causes minimal soft tissue damage and reduced postoperative complications for removing impacted third molars.
This document reviews the presence and role of trace elements in teeth. It discusses how calcium and phosphate form the inorganic portion of teeth, while trace elements are also present in small amounts. Trace elements in enamel include fluorine, strontium, potassium, aluminum, silicon, and others. Their levels differ between primary and permanent teeth. Trace elements in dentin also increase with age and accumulate in collagen fibers. Some elements like fluoride, molybdenum, and strontium may have anticariogenic effects, while others like selenium, copper, and cadmium may promote dental caries. The exact roles of trace elements on oral health require further exploration.
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2. CASE REPORT – OPEN ACCESS
R.K. P. et al. / International Journal of Surgery Case Reports 26 (2016) 34–37 35
Fig. 1. Pre operative Clinical view showing reduced mouth opening.
Fig. 2. Pre op OPT showing radio opaque projection in the sigmoid notch (Red arrow)
and TM Joint space (Yellow arrow).
auto rickshaw (a public transport vehicle commonly used in India).
At the time, he sustained lacerations to his forehead and chin. A lit-
tle later, the boy developed mild swelling in the right preauricular
region, which eventually resolved without any form of interven-
tion. No history of loss of consciousness or bleeding from the ear or
nose was reported. There were no other major injuries associated.
His medical history was unremarkable. Primary care constituted
wound debridement and closure of the forehead laceration at a
local primary health centre. As time went by, the boy’s father began
noticing a progressive reduction in his son’s ability to open his
mouth (Fig. 1).
Clinically, the patient appeared to have limited mouth-opening
− his maximal interincisal distance measured 15 mm, and the chin
was mildly retruded. There were extensive scars noted on the
forehead and chin. Conventional imaging included an orthopan-
tomogram (OPT) that revealed deformed condylar head on the
right side and shortened condyle on the left side which is outside
the glenoid fossa. A unique, radiopaque bone-like projection (Red
arrow) situated in the right sigmoid notch between the condyle and
coronoid process was also observed (Fig. 2).
For further elucidation, and owing to considerable distortion
in regional osseous anatomy, computed tomography (CT) with 3D
Fig. 3. Pre op 3D CT scan − Lateral/oblique view showing relationship of right
condyle and deformed condyle to TMJ and Zygomatic arch.
Fig. 4. Pre op 3D CT scan of mandible.
reconstruction was advised. The 156-slice scan revealed an osseous
mass fused to the sigmoid notch between the condyle and coro-
noid process on the right side. Bilaterally, the condyles appeared
to be deformed and shortened, reminiscent of an old fracture
(Figs. 3 and 4) Axial views survey revealed an osseous mass located
just medial to the zygomatic arch (Fig. 5). 3D reconstruction view
of the mandible (Fig. 4) shows a shortened, deformed and remod-
eled condyles on both the sides. There is also fractured anteriorly
dislocated condylar stump into the sigmoid notch on the right side.
There is also an evidence of an osseous mass on the left side sug-
gestive of a medially displaced fractured condyle. Taken together, a
final diagnosis of post-traumatic, pseudo-ankylosis of the TM joint
was made, for which surgery was planned.
3. CASE REPORT – OPEN ACCESS
36 R.K. P. et al. / International Journal of Surgery Case Reports 26 (2016) 34–37
Fig. 5. Pre op CT scan −Axial View showing a bony mass medial to zygomatic arch
(Black arrow).
Fig. 6. Post op OPT showing absence of radioopaque mass and coronoidectomy on
the right side.
2.1. Surgical procedure
Routine blood investigations revealed anemia Hb-(9.8gm%),
nevertheless, the patient was taken up for surgery. Under naso-
tracheal, hypotensive anesthesia, the right TM joint was exposed
via a preauricular incision − the joint had no structural abnormal-
ity, however, a bony projection (seen as ‘projection’ on the OPT &
CT Scan) from the sigmoid notch loosely ankylosed (Fibrous) just
medial to the ipsilateral zygomatic arch was seen. Release of this
ankylotic mass was done using a fissure bur, freeing it of all bony
and fibrous adhesions (Fig. 6). At first, a 32 mm mouth-opening
was successfully achieved using a Hister’s jaw stretcher. To further
optimize the intraoperative result, an ipsilateral coronoidectomy
was performed so as to facilitate adequate mouth-opening. Pri-
mary closure of the incision was done, and patient reversal and
recovery were uneventful. The fibrous ankylotic mass was sent for
histopathological analysis which revealed proliferating connective
tissue with fibroblast transition to osteoblasts and areas of cartilage,
osteoid and bone.
Active physiotherapy was instituted on the 2nd post-operative
day, and a maximum interincisal opening of 37 mm was achieved
and maintained using a Therabite appliance (Fig. 7). The patient also
Fig. 7. Post op Clinical View showing significant increased mouth opening.
demonstrated positive outcomes in psychological and nutritional
status.
3. Discussion
Many distinctive findings that have been noted in this particular
patient are worth discussing. Several case reports [4–6] cite falls as a
cause of condylar fractures in children below the age of 6 years, with
intracapsular or ‘burst’ fractures being more common than extra
capsular fractures [2]. However, in the current case, the patient
had sustained trauma at the age of 6 years, and both the patient’s
condyles had a ‘low’ (extracapsular) fracture. While a vast majority
of mandibular condylar fractures are displaced in an anteromedial
or anterolateral direction, very few cases report of a superolateral
dislocation/displacement [7], or traumatic impaction-dislocations
into middle cranial fossa with the condyle intact [8]. However, a
case of anterior dislocation and displacement of a fractured condyle
in a child below 6 years of age is rarely seen.
The probable mechanism explained in the literature for the dis-
placement of the fractured condylar segment has been attributed to
the action of unopposed pull of lateral pterygoid muscle on the frac-
tured condylar segment leading to anteromedial displacement [9].
In the present case scenario the probable explanation that could be
given for unusual anterior displacement and dislocation of the frac-
tured condylar segment against the usual action of lateral pterygoid
is as follows:
1 Stripping of lateral pterygoid due to the impact of the injury,
failing the action of lateral pterygoid on the fractured condyle.
2 Open mouth position during the impact causing the fracture of
the condyle in a position anterior to the eminence with resul-
tant premature displacement of the residual major component
of the mandible into the glenoid fossa preventing any further
movement of the already anteriorly displaced fractured condylar
segment towards either lateral or medial or superior directions.
The patient revealed that treatment had been delayed owing
to poor socioeconomic status, and late reporting/referral to doc-
tors, undesirably translating into a prolonged period of restricted
mouth opening due to pain following trauma, eventually leading to
4. CASE REPORT – OPEN ACCESS
R.K. P. et al. / International Journal of Surgery Case Reports 26 (2016) 34–37 37
Psuedo-ankylosis. Miyamoto stated that restricted jaw movement
is not the determinant factor, but rather the promoting agent for
ankylosis [10]. Malnourishment could be another factor influencing
such an outcome, as recent evidence indicates that, in malnutrition,
impaired callus formation as well as fibrous ankylosis in the TM
joint result on healing of a displaced condylar process [11].
Complete remodeling of the Temporomandibular joint bilater-
ally, was evident on the CT scan, the findings of which are consistent
with those of Lindalh, who reports that 20 of 27 study patients,
in the age group of 3–11 years, had complete return to normal
skeletal relationship,a finding that was not observed in other age
groups [12]. In our case, conventional radiographs revealed altered
regional (osseous) anatomy, further supplemented by a 3D CT scan
to locate the condylar fragment,displaced and/or dislocated into
the sigmoid notch, and study its relationship to the zygomatic arch,
as the latter modality greatly increases diagnostic accuracy in TMJ
ankylosis imaging [2].
Cases of condylar fractures are common in both developed
and developing countries, but cases of post-traumatic TM joint
ankylosis are few in developed countries compared to develop-
ing countries for various reasons as stated by Dongmei He et al.
& Gururaj Arakeri et al. [13,14].
4. Conclusion
TM joint ankylosis may be very recent or old but of vital
importance to any kind is an accurate diagnosis for successful man-
agement outcomes. It is equally important to recapitulate the types
and patterns of disruption in TM joint function when setting out to
‘open’ these cases as most cases usually get away without ‘open’
treatment, not to mention the considerable physical and psycho-
logical insult otherwise associated with TM joint ankylosis and its
management. Institution of aggressive physical therapy as early as
possible is as important as the surgical intervention itself, if not
more. Complications, though rare, are potentially fatal.
To conclude, we herein report a unique case of anterior disloca-
tion of fractured mandibular condyle leading to pseudo-ankylosis
in a 8 yr Old Child. In this case report we have highlighted the
hypothesis of mechanism of pseudo-ankylosis. This case report also
suggests that unusual dislocations of mandibular condyle do occur
in children, which require careful planning and treatment.
Conflict of interest
All authors have no conflict of interests.
Funding
All authors have no funding of research.
Ethical approval
Ethical approval not required.
Consent
Written informed consent was obtained from the patient for
publication of this case report and accompanying images. A copy
of the written consent is available for review by the Editor-in-Chief
of this journal on request.
Author contribution
Dr Ranjit kumar P: Treated the patient , writing the paper and
submission, Dr Naveen G: Obtaining patient records ,Followed up
the patient, Dr Raja Satish: Assisting in treating the patient, Writing
the paper, Dr Srinivas Chakravarthy P: Treated the patient, Review
the article, Dr L Krishna Prasad: Assisted in reivising the article.
Guarantor
Dr Ranjit Kumar Peravali.
Acknowledgement
We would like to acknowledge the contributions of Dr Phani
kumar, Dr Rajay Kamath and Dr Rahul Tiwary in the preparation of
this manuscript.
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