tmj reconstruction

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Under the Guidance o Dr. B.H Sripathi Rao (Prof HOD) Dr.Gunachandra Rai (Prof & Presented By: Dr.Niti Sarawgi

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Page 1: Tmj reconstruction

Under the Guidance of:Dr. B.H Sripathi Rao (Prof & HOD)Dr.Gunachandra Rai (Prof & Guide)

Presented By:Dr.Niti Sarawgi

Page 2: Tmj reconstruction

Temporo-mandibular Temporo-mandibular Joint Joint

Reconstruction-A Reconstruction-A ReviewReview

Page 3: Tmj reconstruction

IntroductionIntroduction

Some indications of TMJ reconstruction are :1)Developmental disorders2)Neoplasia of TMJ3)Arthritic diseases4)Trauma : Fracture5)Ankylosis

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Anatomy of TMJAnatomy of TMJ

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Autogenous GraftsAutogenous Grafts

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Sixth or seveth rib resected for the graft

Harvested costochondral graft

Graft placed in the TMJ

Costochondral graft

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Iliac Crest An iliac graft is a chondro-osseous graft, consists of a full-thickness

piece of the iliac crest, including the overlying cartilage layer as a cap.

Fibular The fibula is tubular in shape and is densely cortical. It can be easily

adapted to passively fit in the glenoid fossa, and its narrow shape allows an easy fit.

Sternoclavicular The Sternoclavicular joint (SCJ) and TMJ are similar anatomically and

physiologically. The head of the clavicle contains layers of cartilage that are similar to the mandibular condyle.

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Metatarsal The metatarsophalangeal (MTP) joint can provide a

good supply of articular cartilage combined with up to 7 cm of vascularized bone

Coronoid In 1989, Hong et al. reported the use of coronoid

process for condylar reconstruction.

Owing to its cotico-cancellous nature it is stiffer than CCG, so it can resist heavier forces, and facilitate the use of rigid internal fixation.

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Posterior border of ramus In 1986, Loftus et al. reconstructed the condyle by

superior repositioning of the pedicled stump of the proximal condylar segment into the condylar fossa as a local osseous pedicled graft.

It was based on the lateral pterygoid muscle in a case of osteochondroma

Now its use is limited to ankylosis cases.

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Autogenous Grafts Autogenous Grafts Advantages Limitations

Costochondral • Has a cartilage cap,mimicking both the bone

and cartilaginous components

• Has intrinsic growth potential

• Easy accessibility and adaptation,

• Gross anatomical similarity to the mandibular condyle

• Unpredictable growth.

• Poor bone quality• Possible separation

of cartilage from bone

• Possible donor-site complications like pleural tear, pneumothorax

Sternoclavicular • Similar anatomical and physiological characteristics

• Consists of a cartilaginous cap

• Has the potential for growth,

• Probability ofregeneration at donor site

• Unacceptable location of surgical scar

• Donorsite complications- Clavicle

fracture

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Autogenous GraftsAutogenous GraftsAdvantages limitations

Fibular • Tubular in shape and densely cortical

• Vascularized graft has better survival rate

• Lacks articular cartilage,• Donor-site complications

like ankle stiffness,instability and weakness; numbness of the

lateral side of the leg;Iliac Crest • Has a cartilage cap,

mimicking both the bone

and cartilaginous components

• Has potential for growth.

• Donor-site complications like altered gait, poor scar/bone contour, herniation of abdominal contents.

Metatarsophalangeal

• Combination of articular cartilage and bone

• Fitting anatomy because of small size

• Has potential for growth

• Donor-site complications like aesthetic loss of a toe MTP joint being a simple hinge joint does not follow the same movements as the TMJ.

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Autogenous GraftsAutogenous GraftsAdvantages Limitations

Coronoid • Avoidance of a secondary surgical site and associated donor complications,

• Longstanding cases usually have elongated and sturdy coronoid

• Ankylosed segment also involves the coronoid process, then not possible to use,

• Relatively pointed architecture

• No long-term studies

Posterior border of ramus

• Bone of a size and shape adequate for new Condyle with similar histological characteristics

• Damage to the contour of the mandibular angle

• Lack of growth, • Two extra-oral incisions• Lack of long-term studies

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Alloplastic Devices Alloplastic Devices for for

TMJ ReconstructionTMJ Reconstruction

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Alloplastic Graft Alloplastic Graft MaterialsMaterials

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Kent-Vitek Kent-Vitek ProsthesisProsthesis

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Kent-Vitek Prosthesis Kent-Vitek Prosthesis condcond..

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Christensen’s Christensen’s ProsthesisProsthesis

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Patient-Specific all metal TJR mounted on a model.

Surgical placement of a customised TMJ TJRFossa and ramal components screw fixated

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Lorenz ProsthesisLorenz Prosthesis

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Lorenz Prosthesis

Lorenz Prosthesis

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TMJ Concepts/ Techmedica TMJ Concepts/ Techmedica Custom Made Total Joint Custom Made Total Joint

ProsthesisProsthesis

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Model Surgery

TMJ concept Prosthesis

TMJ Concept Prosthesis

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Alloplastic Grafts condAlloplastic Grafts cond..

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Distraction Distraction Osteogenesis Osteogenesis

In 1997, Stucki-Mccormick was the first to apply transport distraction osteogenesis (DO) for TMJ reconstruction

The authors further observed, in the post-distraction MRI scans, an intervening fibrous tissue layer which apparently performed as a pseudo disc.

Gap arthroplasty and bidirectional transport distraction of the mandibular ramus is a good and effective therapeutic option in the treatment of ankylosis and especially unilateral TMJ ankylosis

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A reverse L corticotomy is made in the lateral cortex with the vertical aspect extending from the sigmoid notch to approximately 10 mmfrom the angle. The horizontal corticotomy extends to the posteriorborder of the mandible

Distractor

Distraction Osteogenesis

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Distraction Distraction Osteogenesis condOsteogenesis cond..

The forces produced by the distractor on the mandible are similar to physiological forces during mandibular development.

Distraction seems to have beneficial effects not only on the harmony of the craniofacial complex but also on temporo-mandibular articulation.

By reestablishing correct function of the soft and skeletal tissues, it is possible to regain the normal potential growth of the mandible .

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Distraction Distraction Osteogenesis condOsteogenesis cond

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Tissue EngineeringTissue Engineering The principal elements of tissue engineering are the creation of a scaffold

into which cells are seeded.

Then the applied biochemical or biomechanical stimulus to make the cells grow and secrete substances that eventually produce the desired tissue that can be used to replace diseased or missing tissue in humans.

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DiscussionDiscussion

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Discussion cond.Discussion cond.

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ConclusionConclusion

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