[논문]Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation

Braimah, Ramat; Taiwo, Abdurrazaq; Ibikunle, Adebayo; Oladejo, Taoreed; Adeyemi, Mike; Adejobi, Francis; Abubakar, Siddiq

doi:10.5125/jkaoms.2018.44.3.112

Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation 원문보기

Journal of the Korean Association of Oral and Maxillofacial Surgeons, v.44 no.3, 2018년, pp.112 - 119

Braimah, Ramat (Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital) , Taiwo, Abdurrazaq (Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital) , Ibikunle, Adebayo (Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital) , Oladejo, Taoreed (Department of Plastic and Oral & Maxillofacial Surgery, National Orthopaedic Hospital Dalla) , Adeyemi, Mike (Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos) , Adejobi, Francis (Department of Oral & Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University Teaching Hospitals Complex) , Abubakar, Siddiq (Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital)

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Objectives: Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. Materials and Methods: This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics. Results: Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with $mean{\pm}standard$ deviation ($13.8{\pm}6.6years$). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis. Conclusion: Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

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문제 정의

The main aim of this study, therefore, is to present an audit of TMJA management in a resource-scarce population.

제안 방법

This is a retrospective study conducted from 2012 to 2016 at two tertiary referral centers (Usmanu Danfodiyo University Teaching Hospital, Sokoto; Sokoto State and National Orthopaedic Hospital Dalla, Kano, Kano State) in the northwest region of Nigeria. The data collected includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Ethical approval was obtained from the ethics and research committee of Usmanu Danfodiyo University Teaching Hospital (UDUTH/HREC/2017/No.
The pressure pack was removed 5 days after the operation. The patient, who was suffering from facial nerve palsy, was prescribed and administered vitamin B complex followed by physical therapy of the facial muscles. The patient’s condision28 tion improved with time as injury to the facial nerve was neuropraxia³⁸.

대상 데이터

Thirty-six patients with TMJA were examined during the study period. There were 21 males (58.
8%) of reankylosis was observed in our series, and it occurred in the patient with fibrous ankylosis. This patient is a young boy in secondary school who is living in the school student house with no supervision on jaw physiotherapy, which may have led to re-ankylosis. The patient’s compliance to aggressive physiotherapy is essential to prevent re-ankylosis in the case of either bony or fibrous ankylosis.

성능/효과

(Fig. 1) Eighteen patients (50.0%) underwent tracheostomy, 17 patients (47.2%) had fiber optic intubation, and only one patient (2.8%) had blind nasal intubation. The Bramley-Al-Kayat incision (Fig.
There was no significant difference associated with age and gender.(Table 1) Thirty-five cases (97.2%) were classified as true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. In most cases, TMJA was secondary to a fall (16 cases, 44.
1%) of bilateral TMJA.(Table 2) All cases of ankylosis with maxillary extension were secondary to cancrum oris, with a statistically significant difference of P=0.001. Seventy-five percent of the patients had plain radiographs, while only 25% had undergone computed tomography (CT).

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Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation 원문보기

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Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation 원문보기

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