Sample records for ankylosis

  1. Bony ankylosis following thermal and electrical injury

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    Balen, P.F.; Helms, C.A. [Dept. of Radiology, Duke University Medical Center, Durham, NC (United States)


    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  2. Bony ankylosis of temporomandibular joint

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    Lee, Byeong Do; Yoon, Young Nam; Um, Ki Doo; Ra, Jong Ill; Lee, Wan [School of Dentistry, Wonkwang University, Iksan (Korea, Republic of)


    Ankylosis of joint is defined as limited movement due to infection, trauma, or surgical procedure. A 59-year-old female with a chief complaint of limited movements during mouth opening had a positive history of trauma to her right TMJ area about 5 years ago. From that time, progressive mouth opening limitation and intermittent pain have occurred. At the time of admission the patient showed mandibular deviation to the right side during mouth opening, with a maximum opening limited to 5 mm. On plain radiographs, right condylar enlargement and joint space reduction by newly formed bony tissues were observed. CT scans showed right condylar enlargement, cortical sclerosis, and thickening of the condyle, articular fossa and articular eminence.

  3. [Surgical treatment of temporomandibular joint ankylosis]. (United States)

    Worsaae, N; Hjørting-Hansen, E; Jensen, B; Seidler, B; Praetorius, F


    Surgical treatment of temporo-mandibular joint (TMJ) ankylosis may be a particularly difficult procedure due to unfavourable anatomic configurations and the proximity of vital structures. Postoperatively, it is followed by an often long and painful period of physiotherapy. The results of treatment of eight patients with TMJ ankylosis are reported. Different methods were used according to age of the patient and the extent of the ankylotic changes. The importance of early treatment is emphasized. This results in less extensive surgery and reduces secondary growth anomalies of the jaws.

  4. [Condylar fracture and temporomandibular joint ankylosis]. (United States)

    Zhang, Yi


    This article summarized the advances in treatment and research of temporomandibular joint surgery in the last 5 years which was presented in "The 2nd Condyle Fracture and Temporomandibular Joint Ankylosis Symposium". The content includes 5 parts: non-surgical treatment of children condyle fracture and long-term follow-up, the improvement of operative approach for condyle fracture and key techniques, the importance and the method for the simultanesous reduction of disc in condylar fracture treatment, the development of traumatic temporomandibular joint ankylosis similar to hypertrophic non-union and the improved safety and accuracy by applying digital surgery in joint surgery.


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    Full Text Available Ankylosis is a Greek terminology meaning "stiff joint." It can be defined as "inability to open mouth due to either a fibrous or bony union between the head of the condyle and glenoid fossa."1 Temporomandibular joint (TMJ ankylosis is a disorder that leads to a restriction of the mouth opening from partial reduction to complete immobility of the jaw. It is most commonly associated with trauma (13-100%, local or systemic infection (0-53%, or systemic disease, such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis.2, 3

  6. A Rare Case of Post Septic Temporomandibular Joint Ankylosis

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    Binayak Baruah


    Full Text Available Temporomandibular joint ankylosis involves fusion of the mandibular condyle to the base of the skull. It is a major clinical problem that affects many patients suffering from facial trauma, infection or systemic disease. The treatment of Temporomandibular joint ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. This report describe a rare case of a 16 year-man with complete inability to open his mouth, diagnosed with unilateral post septic left bony Temporomandibular joint ankylosis. The surgical approach consisted of gap arthroplasty followed by vigorous physiotherapy.

  7. Ankylosing Spondylitis Associated With Bilateral TMJ Ankylosis

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    Song, Ju Seop; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Iksan (Korea, Republic of)


    A 31-year-old male with severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no faical swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the both condylar heads. Labortory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the labortary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

  8. Temporomandibular joint ankylosis contributing to coronoid process hyperplasia. (United States)

    Wang, W H; Xu, B; Zhang, B J; Lou, H Q


    The purpose of this study was to investigate the association between coronoid process hyperplasia and temporomandibular joint (TMJ) ankylosis and to analyze the pathological mechanism and clinical significance of coronoid process hyperplasia. Forty-four patients treated for TMJ ankylosis between January 2007 and December 2014 were studied retrospectively; 176 patients with normal TMJs served as controls. The original DICOM data were used to reconstruct the jaw, and a three-dimensional cephalometric analysis (SimPlant Pro software version 11.04) was performed to assess the association between the severity of TMJ ankylosis and the height of the coronoid process. The height of the coronoid process was 20.41±5.00mm in the case group and 14.86±2.67mm in the control group; there was a significant difference between the two groups (Pprocess hyperplasia. Therefore, attention should be drawn to the coronoid process in patients with TMJ ankylosis. A coronoidectomy together with arthroplasty is recommended in patients with TMJ ankylosis.

  9. Temporomandibular joint ankylosis surgery in a child: case report. (United States)

    Lima, Paulo Valério Presser; Kramer, Paulo Floriani; Ioppi, Letícia; Hoffmann, Renata da Rocha


    Temporomandibular joint ankylosis is one of the most significant disorders of the stomatognathic system because it causes pain associated with severe functional limitations, such as difficulty in chewing and psychological and clinical problems due to poor oral hygiene. These disorders are quite significant in children, since the treatment is even more complex due to the fact that the condylar region is a site of active growth. The earlier the diagnosis is established, the better the treatment prognosis. Ankylosis can be treated by interposition arthroplasty of the temporalis muscle fascia in conjunction with ipsilateral coronoidectomy. The purpose of the present study was to report a clinical case of temporomandibular joint ankylosis in a pediatric patient treated by interposition arthroplasty of the temporalis muscle fascia associated with coronoidectomy.

  10. SAPHO syndrome with ankylosis of the temporomandibular joint. (United States)

    Müller-Richter, U D A; Roldán, J C; Mörtl, M; Behr, M; Reichert, T E; Driemel, O


    SAPHO syndrome is a rare combination of different symptoms with unknown aetiology. A complete ankylosis of the temporomandibular joint (TMJ) in a patient with SAPHO syndrome has not been described previously. The goal of this case report is to present the disease, give an overview about the frequency of mandibular involvement and describe different therapeutic strategies. The complication of an ankylosis of the TMJ is noted and the literature is reviewed. The authors report a 42-year-old patient with SAPHO syndrome and recurrent swelling of the right mandible and the soft tissue. The persisting involvement of the mandible resulted in a complete osseous ankylosis of the right TMJ and required resection with alloplastic replacement of the right condyle. SAPHO syndrome should be suspected in some cases of 'therapy resistant osteomyelitis' of the mandible. Smaller joints, such as the TMJ may also be affected. Treatment of SAPHO syndrome should include antibiotics and NSAIDs; corticosteroids may be helpful. Surgery is the ultimate treatment.

  11. [Surgical treatment results of 52 cases of temporomandibular ankylosis]. (United States)

    Kimura-Fujikami, Takao


    We courried out a retrospective study of 52 surgical cases of temporomandibular joint ankylosis, fibrous types I and II in 19 patients (36.4%) and osseous type III-IV in 33 patients (63.6%). Forty two children and teenagers at the Hospital de Pediatria (1983-1985/1989-1998) and Hospital General La Raza (1985-1989) were included also, 10 adults including those operated on at the Hospital de Especialidades, CMN Siglo XXI (IMSS) from 1998 to 2001 were included. We used Dunn modified method en 37 cases (67%) and 17 patients were with Risdon operated on technique (33%). Etiology of ankylosis were direct trauma to jaw, which affected temporomandibular joint mainly in children, while in adults causes were more varied and included as osteomyelitis, middle ear infection, sequels of hemifacial microsomy, and trauma results were considered as good upon obtaining mouth opening of 35 mm without neo-ankylosis during 1-year postoperative control.

  12. Temporomandibular joint ankylosis in child: A case report

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    Rahul J Hegde


    Full Text Available Background: Ankylosis of the temporomandibular joint (TMJ is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene. Case Report: This report describes a case of a 12-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty with interpositional temporalis muscle flap followed by vigorous physiotherapy. Conclusion: The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Its treatment includes the orthodontist, oral and maxillofacial surgeon, pediatric dentist, and psychologist and physical therapist as part of the healthcare team.

  13. Treatment of Post-Stroke Ankylosis by Warm-Needling

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    @@ Ankylosis is one of the post-stroke sequelae that hampers seriously the daily activities of the patients.Since 1996, the author has adopted warm needling for treatment of post-stroke ankylosis and obtained excellent therapeutic results. The statistical findings have shown that this therapeutic method can exert an important action in improving the joint spasm for patients with post-stroke sequelae. Especially, a better effect can be expected when it is used at the points of yin channels. A report follows.

  14. Congenital Temporomandibular Joint Ankylosis: Case Report and Literature Review

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    Ryan Chin Taw Cheong


    Full Text Available Congenital temporomandibular joint (TMJ ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma. The experience of managing one such case is reported in light of a review of the literature on this condition. Key management principles include adequate removal of the ankylotic mass, costochondral grafting, and post-op physiotherapy. Most patients reported in the literature with the condition experienced relapse. This echoes our own experience where there was recurrence of the ankylosis. However, after removal of the ankylotic mass, the patient maintains a satisfactory maximal incisal opening (MIO till the present day. The additional challenges faced in the congenital form in addition to the already complex management of acquired paediatric temporomandibular joint ankylosis are (1 much earlier insult to the TMJ, (2 reduced opportunity for neuromuscular development of the muscles of mastication, and (3 reduced compliance with postoperative physiotherapy programmes due to the younger age of these patients.

  15. The management of traumatic ankylosis during orthodontics: a case report.

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    McNamara, T G


    Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.


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    Amit Nandan


    Full Text Available We report a case of 10years old female child who presented with presenting complaints of progressive difficulty in jaw opening. The parents gave history of facial trauma suffered five years back. A radiograph obtained at that time was unremarkable. This time she was advised computed tomography (CT examination of temporo-mandibular joint (TMJ to evaluate the severity and extent of ankylosis. Examination was done on a 64 slice CT scanner (GE with isotropic images and additional volume rendered and multiplanar acquisitions. Findings were suggestive of bilateral mediolateral bifid mandibular condyles with fibrous, partial bony ankylosis. Both mandibular condylar head were enlarged with abnormal contour. Condyles were bifid separated by a distinct groove.

  17. Management of temporo-mandibular joint ankylosis in growing children

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    Shashikiran N


    Full Text Available Although temporo-mandibular joint (TMJ ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

  18. Interposition arthroplasty of temporomandibular joint ankylosis using temporalis muscle flap: our experience

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    Nilam U. Sathe


    Full Text Available Ankylosis is defined as loss of joint movement resulting from fusion of bones within the joint or calcification of the ligaments around it. Satisfactory surgical correction of temporomandibular joint (TMJ ankylosis is limited by a high recurrence rate. This study aims to show that interposition arthroplasty with temporalis muscle flap improves mouth opening in 6 patients with TMJ ankylosis. Six patients with TMJ ankylosis were treated by interposition arthroplasty. The patients were evaluated between ten and 18 months after surgery. Preand postoperative assessment included a thorough analysis of case history and a physical examination to determine the cause of ankylosis, the maximal incisal opening and type of the ankylosis, recurrence rate and presence of facial nerve paralysis. All 6 patients had unilateral involvement. The mean age was 12.5 years ±6.5 (range 6-19 years. The mouth incisal opening in the preoperative period ranged from 5 mm to 11 mm and in the postoperative period it ranged from 30 mm to 35 mm. No recurrence and no facial palsy were observed in our series. No recurrence was noted, and in all the cases there was type IV ankylosis. Trauma was the major cause of temporomandibular joint ankylosis in our sample. Interpositional arthroplasty is a highly effective and safe surgical management option for TMJ ankylosis with acceptable immediate and long-term outcome, particularly when temporalis fascia and muscle are used.

  19. Surgical management of temporomandibular joint ankylosis in ankylosing spondylitis. (United States)

    Felstead, Andrew M; Revington, Peter J


    Relatively few patients develop such severe degenerative temporomandibular joint (TMJ) disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis) or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic). Ankylosis of the temporomandibular joint (TMJ) secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

  20. Surgical Management of Temporomandibular Joint Ankylosis in Ankylosing Spondylitis

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    Andrew M. Felstead


    Full Text Available Relatively few patients develop such severe degenerative temporomandibular joint (TMJ disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic. Ankylosis of the temporomandibular joint (TMJ secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

  1. A protocol for management of temporomandibular joint ankylosis in children. (United States)

    Kaban, Leonard B; Bouchard, Carl; Troulis, Maria J


    Temporomandibular joint (TMJ) ankylosis in children is a challenging problem. Surgical correction is technically difficult and the incidence of recurrence after treatment is high. The purpose of the present report is to describe the protocol currently used at the Massachusetts General Hospital for the management of TMJ ankylosis in children. It has been our observation that the most common cause of treatment failure is inadequate resection of the ankylotic mass and failure to achieve adequate passive maximal opening in the operating room. The 7-step protocol consists of 1) aggressive excision of the fibrous and/or bony ankylotic mass, 2) coronoidectomy on the affected side, 3) coronoidectomy on the contralateral side, if steps 1 and 2 do not result in a maximal incisal opening greater than 35 mm or to the point of dislocation of the unaffected TMJ, 4) lining of the TMJ with a temporalis myofascial flap or the native disc, if it can be salvaged, 5) reconstruction of the ramus condyle unit with either distraction osteogenesis or costochondral graft and rigid fixation, and 6) early mobilization of the jaw. If distraction osteogenesis is used to reconstruct the ramus condyle unit, mobilization begins the day of the operation. In patients who undergo costochondral graft reconstruction, mobilization begins after 10 days of maxillomandibular fixation. Finally (step 7), all patients receive aggressive physiotherapy. A case series of children with ankylosis treated using this protocol is presented.

  2. Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria. (United States)

    Anyanechi, C E


    Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.

  3. Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria. (United States)

    Bello, Seidu Adebayo; Aluko Olokun, Bayo; Olaitan, Abayomi Ademola; Ajike, Sunday O


    Several studies have reviewed the management of ankylosis of the temporomandibular joint (TMJ), but only a few focused on the aetiology and clinical features. We retrospectively studied the aetiology and clinical features of patients with ankylosis of the TMJ who presented to the Maxillofacial Unit, National Hospital, Abuja, Nigeria, between 2004 and 2009. There were 13 male and 10 female patients, M:F ratio 1.3:1, age range 6-62, mean (SD) 20 (13) years. The aetiological factors were trauma (n=11) that comprised falls (n=6), untreated fractures of the zygomatic arch (n=4) and myositis ossificans (n=1); infection (n=9), that comprised cancrum oris (n=3) and ear infection (n=6); congenital or unknown (n=2), and coronoid hyperplasia (n=1). The maximum interincisal distance at presentation ranged from 0 to 25 mm (mean (SD) 6.7 (7.2) mm). Seventeen had facial deformities. The diagnoses recorded were as follows: left extracapsular ankylosis, (n=8); right intracapsular bony ankylosis, (n=6); left intracapsular bony ankylosis, (n=4); bilateral intracapsular bony ankylosis, (n=4), and bilateral intracapsular fibrous ankylosis (n=1). Extreme poverty was the main predisposing factor. There is a need for a concerted effort among healthcare providers, policy makers, and the world in general to eradicate poverty and improve healthcare to limit the incidence of ankylosis of the TMJ.

  4. Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet

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    G S Kalra


    Full Text Available Background: Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome. Materials and Methods: The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients. Results: A total of 80 patients were in this study (59 males and 21 females. The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients′ age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral

  5. Modified Technique of Retrograde Intubation in TMJ Ankylosis

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    Shaila Kamat


    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  6. Early treatment of unilateral temporomandibular joint ankylosis: a multidisciplinary approach. (United States)

    Ataç, Mustafa Sancar; Çakir, Merve; Yücel, Ergun; Gazioğlu, Çagri; Akkaya, Sevil


    Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

  7. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. (United States)

    Xiang, Guo-lin; Long, Xing; Deng, Mo-hong; Han, Qian-chao; Meng, Qing-gong; Li, Bo


    We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months-10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.

  8. Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases


    Al-Saadi, Noor J.; Bakathir, Abdulaziz A; Al-Hashmi, Ahmed K.; Al-Ismaili, Mohammad I.


    Temporomandibular joint (TMJ) ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with thi...


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    Objective To evaluate light-guided tracheal intubation using blind intubation device (BID) in adult patients with temporomandibular joint ankylosis. Methods Twenty adult patients, American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, with temporomandibular joint ankylosis were selected for awake blind nasal intubation. The patients were prepared with nasal decongestants and inhaled 100% oxygen for 3min, then fentanyl (2μg/kg) and midazolam (1-5 mg) were intravenously injected for sedation. Top...

  10. Atlantoaxial Ankylosis Detected on Neck CT Scans in a Patient with Ankylosing Spondylitis: A Case Report

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    Lee, Jeong Ah; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of); Ryu, Jeong Ah [Dept. of Radiology, Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of); Kim, Tae Hwan [Dept. of Rheynmatology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)


    Ankylosing spondylitis is a chronic inflammatory disorder of unknown cause that principally affects the axial skeleton. The cervical spine is also vulnerable to this disease process and the characteristic feature of cervical involvement is atlantoaxial subluxation. However, only a few cases of atlantoaxial ankylosis have been reported to date. We report a case of atlantoaxial ankylosis in a patient with ankylosing spondylitis with radiologic findings incidentally detected on neck CT scans.

  11. The development of traumatic temporomandibular joint bony ankylosis: a course similar to the hypertrophic nonunion? (United States)

    Yan, Ying-Bin; Duan, Deng-Hui; Zhang, Yi; Gan, Ye-Hua


    The traumatic temporomandibular joint (TMJ) bony ankylosis has generated great interest in the cranio-maxillofacial surgeons yet remains an enigma, due to its unknown pathogenesis. Organization and ossification of hematoma is the classical hypothesis concerning the underlying pathophysiology, but it could not explain all the unique characters of TMJ bony ankylosis. The previous imaging descriptions about bony ankylosis tend to over-emphasize the obliteration of joint space and the overgrowth of new bone around the joint. Our recent study has found that the radiolucent zone in the bony fusion area indicating impaired bone healing is one of the most important imaging features of bony ankylosis, and this imaging feature is similar to that of hypertrophic nonunion of long bone. We also observe that there is close relationship between the mouth opening and the degree of calcification of radiolucent zone. Therefore, we hypothesize that the development of traumatic TMJ bony ankylosis may be the course of bone healing of two injured articular surfaces under the interference of opening movement, which is similar to the hypertrophic nonunion. Our hypothesis could help to explain some unintelligible characters of bony ankylosis, and deserves further studies.

  12. CT imaging in the surgical treatment of one-sided extraarticular temporomandibular joint ankylosis; Uso da tomografia computadorizada no planejamento cirurgico da anquilose temporomandibular extra-articular unilateral

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    Villamizar, Lenin A.; Ghirelli, Carolina de Oliveira; Baroni, Carina Outi; Ferro, Daniel; Pinto, Ana Carolina Brandao de Campos Fonseca, E-mail: [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Dept. de Cirurgia


    Temporomandibular joint (TMJ) ankylosis is characterized by difficulty to open the mouth. The ankylosis may be articular when TJM is involved and extra-articular when other factors lead to a restriction of chewing movements without TJM involvement. Case report of one patient with unilateral ankylosis and his surgical planning through the tomography imaging. CT imaging helps preoperative planning because it can locate the exact point of injury and can make the difference between the true and false ankylosis of the TJM. (author)

  13. Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis. (United States)

    Campbell, Karen M; Casas, Michael J; Kenny, David J; Chau, Tom


    The objectives of this investigation were to: (i) assess the reliability of expert raters to detect ankylosis from recordings of percussion sounds, (ii) measure differences in Periotest values (PTV) between ankylosed and non-ankylosed incisors and (iii) identify characteristic differences in recorded percussion sounds from ankylosed and non-ankylosed incisors using digital sound wave analysis. A convenience sample of healthy children (age range 7-18 years) was invited to participate. Ankylosis group children had one or more documented ankylosed maxillary incisors. Control group children had intact, non-ankylosed incisors. Digital recordings of percussion sounds and PTV were acquired for each incisor of interest. Four experienced pediatric dentists rated the randomized percussion sound pairs for the presence of ankylosis. Percussion sounds were also subjected to digital sound wave analysis. Overall agreement for the expert raters was substantial (kappa = 0.7). Intra-rater agreement was substantial to almost perfect (kappa = 0.6-0.9). Diagnosis of ankylosis demonstrated sensitivity of 76-92% and specificity of 74-100%. PTV from ankylosed incisors were statistically lower than PTV from non-ankylosed incisors. Ankylosed incisor digital sound wave signals exhibited significantly more energy in high-frequency bands than non-ankylosed incisors. This investigation demonstrated that: (i) experienced pediatric dentists reliably detected ankylosis by percussion sound alone; (ii) PTV for ankylosed incisors were statistically lower than PTV from non-ankylosed incisors; and (iii) ankylosed incisors exhibited a higher proportion of their signal energy in high-frequency bands.

  14. Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap. (United States)

    Su-Gwan, K


    This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. This retrospective study of seven cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed, (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF), and (6) early mobilization and aggressive physiotherapy. The results of this protocol were encouraging, while the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were satisfactory. The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions.

  15. Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

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    Song, Ji Young [Dept. of Oral and Maxillofacial Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Seong Gon; Choi, Hang Moon [School of Dentistry, Gangneung-Wonju National University, Gangneung (Korea, Republic of); Kim, Hyun Jung [Dept. of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)


    Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

  16. TMJ ankylosis after neonatal septic arthritis: literature review and two case reports. (United States)

    Chaves Netto, Henrique Duque; Nascimento, Frederico Felipe Antonio de Oliveira; Chaves, Maria das Graças Afonso Miranda; Chaves, Leonardo M; Negreiros Lyrio, Mariana Camilo; Mazzonetto, Renato


    Ankylosis of the temporomandibular joint (TMJ) can be a result of several causes such as trauma, degenerative changes, infection, and space-occupying lesion. When occurring during early childhood, it can result in severe functional disability and facial deformity. Septic arthritis is an uncommon disease associated with systemic and local factors being most commonly caused by Staphylococcus aureus, Neisseria gonorrhoeae, and Haemophilus influenzae. This paper presents two unusual cases of TMJ ankylosis following neonatal infections treated surgically and does a literature review about the topic.

  17. Ankylosis of the temporomandibular joint. Follow-up of thirteen patients. (United States)

    Schobel, G; Millesi, W; Watzke, I M; Hollmann, K


    We undertook a postoperative clinical study of 13 patients with ankylosis of the temporomandibular joints. The study consisted of an evaluation of the surgical concepts of resection and subsequent surgical reconstruction by osteotomy in previous height of the joint space and lining of the glenoid fossa with lyophilized dura. Early mobilization and aggressive physiotherapy are mandatory postoperative measures. According to the theory of mandibular growth as a result of functional matrix, early surgical intervention to correct ankylosis should be performed, regardless of the age of the patient, to prevent recurrence and later asymmetry or distoclusion.

  18. Ankylosis of primary molar along with congenitally missing first permanent molar

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    Suprabha B


    Full Text Available Ankylosis of primary mandibular molars has been routinely found to be associated with various developmental disturbances in permanent dentition such as aplasia of the succedaneous tooth, ectopic eruption of the premolar, infraoclusion of the ankylosed tooth leading to tipping of the first permanent molar etc. This article describes a rare case where there was ankylosis of a mandibular second primary molar along with congenitally missing first permanent molar which resulted in the transposition of second premolar. Treatment options and prognosis of the case are discussed.

  19. Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

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    Yuli Nugraeni


    Full Text Available Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA; the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

  20. Temporomandibular joint ankylosis: Case-series of two different surgical procedures

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    Gholamreza Shirani


    Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.

  1. 创伤性颞下颌关节强直%Traumatic ankylosis of the temporomandibular joint

    Institute of Scientific and Technical Information of China (English)

    刘昌奎(综述); 胡敏; 胡开进(审校)


    Ankylosis of the temporomandibular joint(TMJ) severely limits movements of the mandible. Although it is well known that trauma is the most common cause of TMJ ankylosis, the mechanisms by which the traumatic TMJ ankylosis develops are still unclear. In this article, we reviewed the risk factors and proposed some hypotheses to explain pathogenesis of TMJ ankylosis.%颞下颌关节(TMJ)强直是一种严重影响下颌运动的疾病,创伤是其常见的病因,但创伤如何引起TMJ强直的发生,目前尚未完全阐明,本文就创伤性颞下颌关节强直危险因素、发病机制假说进行综述。

  2. Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases

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    Noor J. Al-Saadi


    Full Text Available Temporomandibular joint (TMJ ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries.

  3. Arthroplasties of hips and knees ankylosis in an adolescent with acute lymphoblastic leukaemia.

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    Dipo Samuel OLABUMUYI


    Full Text Available Acute lymphoblastic leukaemia (ALL is the most common malignancy in children, representing one third of all paediatric malignancies. Patients are often at high risk for complications due aggressive chemotherapy regimes required for treatment. Musculoskeletal complications include septic arthritis, osteonecrosis, osteoporosis, avascular necrosis and bony ankylosis. We report the case of a 16-year-old boy with ALL who developed osteonecrosis of multiple bones on a background of septicaemia, resulting in bony ankylosis of both hips and knees. He was treated with bilateral conversion of ankylosed hips (one hip to total hip replacement, the second hip to Girdlestone arthroplasty and bilateral ankylosed knees to total knee replacements. He remained well in remission five years after the last surgery. Our case highlights he possible musculoskeletal complications of ALL. 

  4. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

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    Naranje Sameer


    Full Text Available 【Abstract】 Myositis ossificans is defined as forma-tion of bone at the site of injured muscle. It is one of the rare complications of supracondylar fracture of humerus in children. Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion, but complete ankylosis is rare. To the best of our knowledge, this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica. In this case, a six-year-old child presented to the casualty department with pain in the right elbow after a fall on out-stretched hand during play. After surgical excision through the anterior approach, the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last follow-up of one year after surgery. Key words: Humerus; Fractures, Bone; Myositis; Ankylosis

  5. Preservation of condyle and disc in the surgical treatment of type III temporomandibular joint ankylosis: a long-term follow-up clinical study of 111 joints. (United States)

    Jakhar, S K; Agarwal, M; Gupta, D K; Tiwari, A D


    The purpose of this study was to establish the role of retaining the condyle and disc in the treatment of type III ankylosis, by clinical and computed tomography (CT) evaluation. A total of 90 patients with type III ankylosis met the inclusion criteria; 42 patients had left temporomandibular joint (TMJ) ankylosis, 27 patients had right TMJ ankylosis, and 21 had bilateral TMJ ankylosis, thus a total 111 joints were treated. Considerable improvements in mandibular movement and maximum mouth opening were noted in all patients. At the end of a minimum follow-up of 2 years, the mean inter-incisal mouth opening was 30.7 mm. Postoperative occlusion was normal in all patients, and open bite did not occur in any case because the ramus height was maintained through preservation of the pseudo-joint. Only three patients had recurrence of ankylosis, which was due to a lack of postoperative physiotherapy. The advantages of condyle and disc preservation in type III ankylosis are: (1) surgery is relatively safe; (2) the disc helps to prevent recurrence of ankylosis; (3) the existing ramus height is maintained; (4) the growth site is preserved; and (5) there is no need to reconstruct the joint with autogenous or alloplastic material. It is recommended that the disc and condyle are preserved in type III TMJ ankylosis.

  6. Airway Management in a Mental Retardation Patient with Temporo-mandibular Joint Ankylosis

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    Rauf GÜL


    Full Text Available Temporo-mandibular joint (TMJ ankylosis makes it impossible orotracheal intubation for general anesthesia because of limited mouth opening. We applied a nasotracheal intubation via fiberoptic bronchoscopy (FOB guidance on a 36 years old mental retarded (MR patient with bilateral TMJ, having extremely limited mouth opening. As a result, nasotracheal intubation via FOB is reliable technique on even mental retarded patients with extremely limited opening.

  7. [A particular temporomandibular disorder: the temporomandibular joint ankylosis. Basic and clinical concepts]. (United States)

    Bocquet, Emmanuelle; Mercier, Marie; Moreau, Alexis; Ferri, Joël; Danguy, Michel


    Ankylosis of the temporomandibular joint mostly affects children and young adults. Although it is rare, it is an extremely debilitating disease whose effects on growth, morphological development and personal development are significant. To manage this disorder, it is essential to be informed about the causes, about the anatomical shapes it presents and about its symptoms. This knowledge will also help us choose the most appropriate therapy, that may nevertheless result in failures and in relapses requiring prosthetic rehabilitation.

  8. The role of trauma on temporomandibular joint ankylosis and mandibular growth retardation: an experimental study. (United States)

    Oztan, Hasan Yucel; Ulusal, Betul Gozel; Aytemiz, Cemal


    The purpose of this pilot study was to analyze the role of different types of trauma in the formation of temporomandibular joint ankylosis. The specific aim was to explore the physical and histological effects of trauma on temporomandibular joint and mandibular growth. Fifty-five growing white male guinea pigs were used for the study. Initially, cadaveric studies were performed (n = 1) to assess the topographic anatomy of the temporomandibular joint region. Animals were then assigned to pilot (n = 4), experimental (n = 40), and control (n = 10) groups. The pilot group was used to assess the technical feasibility of creating various trauma types and endurance of the animals to the surgery. Four types of trauma were carried out in the experimental group: A) intra-articular hematoma (n = 10), B) mechanical damage to the articular surface (n = 10), C) fracture of the condyle neck (n = 10), and D) excision of the condyle head (n = 10). Each trauma group was further divided into two subgroups. Procedures were performed unilaterally or bilaterally in the subgroups. In the control group, no procedure was performed. Subjects were examined after a 2-month follow-up period. The development and anatomical structure of the mandible were evaluated, and histopathological assessment of the temporomandibular joint was carried out in each group. The results revealed that hyaline cartilage of the condylar head had an important role in the development of the mandible and traumas targeting this site may cause ankylosis, growth retardation, and resultant facial malformations. Hence, mechanical damage to the articular surface (B1, B2) and resection of the condylar head (D1, D2) almost always resulted in ankylosis. Intra-articular hematoma alone (A1, A2) was established not be a causative factor for ankylosis formation, however.

  9. Hypohidrotic ectodermal dysplasia with ankylosis of temporomandibular joint and cleft palate: A rare presentation

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    Manisha Goyal


    Full Text Available The ectodermal dysplasias are a heterogenous group of diseases, which have one or more anomalies of the hair, teeth, nails, and sweat glands. Hypohidrotic ectodermal dysplasia (HED is the most common type and is usually transmitted as an X-linked recessive trait. It is characterized by classical triad of hypotrichosis, anhidrosis/hypohidrosis, and hypodontia/anodontia. Here, we describe an Indian boy affected with HED and rare features including ankylosis of temporomandibular joint and cleft palate.

  10. Case report - Root resorption and ankylosis associated with guided tissue regeneration


    Cury, PR; Furuse, C; Martins, MT; Sallum, EA; de Araujo, NS


    Background. Root resorption and ankylosis have been reported rarely as sequelae to guided tissue regeneration (GTR). The authors describe a clinical case of root resorption following GTR that involved the use of a bioabsorbable membrane. Case Description. Two years after GTR was performed on a Class II furcation defect, the clinical examination revealed root resorption reaching the pulp chamber. The furcation defect was filled with epithelium and connective tissue, which contained inflammator...

  11. Temporomandibular joint ankylosis as part of the clinical spectrum of Carey-Fineman-Ziter syndrome? (United States)

    Pasetti, Martina; Mazzoleni, Fabio; Novelli, Giorgio; Iascone, Maria; Bozzetti, Alberto; Selicorni, Angelo


    The Carey-Finema-Ziter syndrome (CFZS, MIM 254940) is an apparently autosomal recessively inherited disorder consisting of the combination of non-progressive congenital myopathy with Moebius and Pierre Robin sequence, facial anomalies and growth delay. Mental development has been described as normal or delayed. Temporomandibular joint (TMJ) ankylosis is the immobility of the joint caused by ankylotic fusion of the mandible to the cranial base or zygoma. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and oral hygiene. Most often is a true ankylosis of the TMJ but other pathological mechanisms are described (i.e., the fusion of the coronoid process to temporal bone or with the zygoma, or a variety of soft tissues disorders like Fibrodysplasia Ossificans Progressiva). Here we report a 2-year-old girl fitting with a clinical diagnosis of CFZS associated with a limited mouth opening in which temporomandibular joint ankylosis was suspected. Because it has been postulated that many clinical features in CFZS may only be secondary effects of brainstem anomalies and muscle weakness during development, the limited opening of the mouth observed in our patient could represent a rare clinical feature of CFZS itself. © 2016 Wiley Periodicals, Inc.

  12. Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series. (United States)

    Rajan, R; Reddy, N V V; Potturi, A; Jhawar, D; Muralidhar, P V; Reddy, B


    This article describes a technique of gap arthroplasty in temporomandibular joint (TMJ) ankylosis performed by transoral access. The treatment of TMJ ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with TMJ ankylosis (eight TMJ) were treated by gap arthroplasty using an intraoral approach. The average mouth opening before surgery was 8.6mm and the average mouth opening achieved postsurgery was 37.9 mm. The average follow-up time was 13 months and none of the patients had any recurrence or significant complications during or after surgery. Our technique relies on the use of a stable landmark to trace the superior-most extent of the ankylotic mass thereby facilitating the removal of the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 min, it has many advantages over conventional extraoral approaches in terms of facial scars and facial nerve injury. The authors also emphasize the importance of good postoperative physiotherapy and presurgical patient counselling to prevent future recurrences.

  13. Temporomandibular joint ankylosis caused by chondroid hyperplasia from the callus of condylar neck fracture. (United States)

    Kim, Soung Min; Park, Jung Min; Kim, Ji Hyuck; Kwon, Kwang Jun; Park, Young Wook; Lee, Jong Ho; Lee, Sang Shin; Lee, Suk Keun


    A patient who complained of difficulty in opening his mouth after condylar neck fracture 1 year ago presented typical features of temporomandibular joint ankylosis in clinical and radiologic examinations. To demonstrate a possible pathogenesis of temporomandibular joint ankylosis after condylar neck fracture, the fractured condylar portion removed was examined by histologic and immunohistochemical stainings. Interpositional gap arthroplasty was performed by removing the inferomesially displaced fractured condyle, and reconstruction with subcutaneous dermis to the previous vertical height was performed immediately. The fractured condylar portion was almost intact with slight erosion of the condylar cartilage. In the hematoxylin and eosin and Masson trichrome stainings, an extensive chondroid hyperplasia with abundant hyaline cartilage was shown in the removed condylar portion. There were also hyperplastic features of the synovial membrane, which were abnormally distributed throughout the chondroid tissues. In the immunohistochemical stainings of proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein (BMP)-2 and BMP-4, the chondroid tissues were conspicuously hyperplastic and strongly positive for BMP-4 but sparse for BMP-2. From these results, we think that the hyperplastic chondroid tissue was derived from the callus of the primary fractured site of the condylar neck and propose that the chondroid tissue could proliferate continuously because of synovial tissue support from around the temporomandibular joint, resulting in temporomandibular joint ankylosis. This pathogenesis is quite different from those of other diaphyseal fracture of long bones.

  14. Ankylosis of the temporomandibular joint and mandibular growth disturbance caused by neglected condylar fracture in childhood

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    Endrajana Endrajana


    Full Text Available Background: Fractures of the mandibular condyle may lead to complications such as disturbance of occlusal function, internal derangement of the joint, ankylosis and mandibular growth disturbance. When treating young patients with the history of mandible trauma, ankylosis of the temporomandibular joint and mandibular growth disturbance are two most important complications of condyle fracture that should be considered. Purpose: This case report attempts to emphasize the long term complication of neglected condylar fracture in children i.e. ankylosis of the temporomandibular joint and subsequently lead to mandibular growth disturbance. Case: A case of right temporo-mandibular joint ankylosis and mandibular growth disturbance in a 28 years old male patient is presented. He had a history of trauma to the mandible after a traffic accident when he was 8 years old. Since then, he experienced difficulty in mouth opening which eventually developed into severe trismus. Case management: The case was treated surgically with gap and interpositional arthroplasty using Mersilen mesh™. Conclusion: Mandibular fractures involving temporomandibular joint in young children should be examined thoroughly and treated adequately in order to prevent ankylosis of the TMJ and the subsequent mandibular growth disturbance.Latar belakang: Fraktur pada kondilus mandibula dapat menyebabkan beberapa komplikasi berupa: gangguan oklusi, internal derangement sendi, ankilosis serta gangguan pertumbuhan mandibula. Pada perawatan penderita usia muda dengan riwayat trauma pada mandibula, perlu diwaspadai dua macam komplikasi akibat fraktur pada kondilus, yaitu ankilosis sendi temporo mandibula dan adanya gangguan pertumbuhan mandibula. Tujuan: Laporan kasus ini bertujuan untuk menekankan bahwa fraktur kondilus pada anak-anak yang tidak mendapatkan perawatan yang semestinya akan mengakibatkan komplikasi jangka panjang berupa ankilosis sendi temporomandibula yang diikuti dengan

  15. 中药熏洗治疗肘部骨折术后关节僵直%The Smoke-washing therapy with traditional Chinese medicine to postoperative ankylosis of fracture of elbow

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    李福春; 刘景娟; 张元智; 郭连奎


    @@ Background: Postoperative ankylosis of fracture of elbow, frequent in clinical, can seriously influence patient daily activities. The effect of Smoke-washing therapy using the traditional Chinese medicine to postoperative ankylosis of fracture of elbow is satisfied.

  16. Anquilose da articulação têmporo-mandibular Temporo mandibular joint ankylosis

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    Belmiro Cavalcanti do Egito Vasconcelos


    Full Text Available A anquilose pode ser definida como sendo a fusão das superfícies articulares e seu tratamento é um verdadeiro desafio devido à alta taxa de recorrência. OBJETIVO: Descrever seis casos clínicos tratados pela técnica da reconstrução articular, avaliar os resultados dessas cirurgias e fazer uma revisão da literatura. METODOLOGIA: A população estudada neste estudo retrospectivo foi obtida dos prontuários do hospital universitário e tinha que ter sido submetida a cirurgia para tratamento de anquilose por reconstrução aloplástica ou autógena entre os períodos de março de 2001 e outubro de 2005. Dados como a máxima abertura de boca (MAB, etiologia, tipo de anquilose e tratamento, e ocorrência de recidiva e lesão do nervo facial foram coletados no pré-operatório, através dos prontuários, e no pós-operatório, através de entrevista. RESULTADOS: A média da MAB no pré-operatório foi de 9,6mm (0 a 17mm e no pós-operatório foi de 31,33mm (14mm a 41mm, não houve lesão do nervo facial e apenas em um caso houve recidiva da anquilose. CONCLUSÃO: A reconstrução da articulação com material autógeno ou alógeno, para o tratamento da anquilose da ATM se mostrou eficaz em relação à MAB pós-operatória, recidiva e função da articulação.Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate. AIM: The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature. METHODS: The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth

  17. Influence of intentional ankylosis of deciduous canines to reinforce the anchorage for maxillary protraction

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    Luís Fernando Castaldi Tocci


    Full Text Available INTRODUCTION: This retrospective cephalometric study analyzed the influence of intentional ankylosis of deciduous canines in patients with Class III malocclusion and anterior crossbite, in the deciduous and early mixed dentition stages, treated by orthopedic maxillary expansion followed by maxillary protraction. METHODS: Lateral cephalograms of 40 patients were used, divided in 2 groups paired for age and gender. The Ankylosis Group was composed of 20 patients (10 boys and 10 girls treated with induced ankylosis and presenting initial and final mean ages of 7 years 4 months and 8 years 3 months, respectively, with a mean period of maxillary protraction of 11 months. The Control Group comprised 20 patients (10 boys and 10 girls treated without induced ankylosis, with initial and final mean ages of 7 years 8 months and 8 years 7 months, respectively, with a mean period of maxillary protraction of 11 months. Two-way analysis of variance and covariance analysis were applied to compare the initial and final cephalometric variables and the treatment changes between groups. RESULTS: According to the results, the variables evidencing the significant treatment changes between groups confirmed that the intentional ankylosis enhanced the sagittal response of the apical bases (Pg-NPerp and increased the facial convexity angles (NAP and ANB. CONCLUSIONS: The protocol involving intentional ankylosis of deciduous canines enhanced the sagittal response of the apical bases.INTRODUÇÃO: nesse estudo cefalométrico retrospectivo, analisou-se a influência da anquilose intencional de caninos decíduos em pacientes com má oclusão de Classe III e mordida cruzada anterior, nos estágios de dentição decídua e mista precoce, tratados com expansão ortopédica da maxila, seguida de tração reversa. MÉTODOS: foram utilizadas telerradiografias em norma lateral de 40 pacientes, divididos em 2 grupos pareados por idade e sexo. O Grupo Anquilose foi constituído de 20

  18. Full-thickness skin graft interposition after temporomandibular joint ankylosis surgery. A study of 31 cases. (United States)

    Chossegros, C; Guyot, L; Cheynet, F; Blanc, J L; Cannoni, P


    Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by Popescu & Vasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year.

  19. Retrograde Intubation in Temporomandibular Joint Ankylosis-A Double Guide Wire Technique

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    Vitha K Dhulkhed


    Full Text Available Intubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngo-scope is not available. In a 20-year-old male patient we successfully carried out endotracheal intubation with 7 mm portex cuffed PVC tube with the help of two flexible J tipped guide wires. One guide wire was passed into the airway from cricothyroid puncture site and another from subcricoid site. Both were brought out through the nose. The first guide wire was used for retracting the epiglottis and the second as a guide for passing the endotracheal tube.

  20. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis

    DEFF Research Database (Denmark)

    Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena


    bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary...... step in this pathway. METHODS: We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate...

  1. Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis. (United States)

    Honnas, C M; Schumacher, J; Kuesis, B S


    A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.

  2. Pseudoarthrosis and ankylosis of the vertebral spine without sacroiliitis associated with Takayasu's arteritis: review of the association

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    Schuetz, C.T.; Anderson, S.E. [Department of Diagnostic Radiology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland); Aeberli, D.; Oertle, S. [Department of Rheumatology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland)


    Pseudoarthrosis and ankylosis of the vertebral spine associated with Takayasu's arteritis is extremely rare. We present a patient with the entity who was HLA-B27 negative and had normal sacroiliac joints. The association between Takayasu's arteritis and ankylosing spondylitis appears real but seemingly rare. (orig.)

  3. Orthodontic-surgical management of a case of severe mandibular deficiency due to condylar ankylosis

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    Sridevi Padmanabhan


    Full Text Available Dentofacial deformities involve deviations from the normal facial proportions and dental relationships and can range from mild to being severe enough to be severely handicapping.The term handicapping malocclusions though not a term commonly used, involves a fortunately small section (2-4% of patients who can suffer from esthetic,psychological and functional problems. Craniofacial Orthodontics is the area of orthodontics that treats patients with congenital and acquired deformities of the integument and it′s underlying musculoskeletal system within the craniofacial area and associated structures.This case report of a young woman with severe mandibular deficiency and facial asymmetry due to condylar ankylosis highlights the importance of team work in rehabilitation of such severe craniofacial deformities.

  4. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

    Institute of Scientific and Technical Information of China (English)

    Sameer Naranje; Ramprasad Kancherla; Arun Kannan; Rajesh Malhotra; Lalit Sharma; Sukesh Rao Sankineani


    Myositis ossificans is defined as formation of bone at the site of injured muscle.It is one of the rare complications of supracondylar fracture of humerus in children.Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion,but complete ankylosis is rare.To the best of our knowledge,this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica.In this case,a six-year-old child presented to the casualty department with pain in the right elbow after a fall on outstretched hand during play,After surgical excision through the anterior approach,the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last followup of one year after surgery.

  5. Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis. (United States)

    Lee, Seung-Hun; Song, Eun-Kyoo; Seon, Jong-Keun; Woo, Seong-Hwan


    Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.

  6. Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

    Institute of Scientific and Technical Information of China (English)

    朱志军; 邢树忠; 万林忠; 陶震江; 吴煜农


    Objective:To study the effects of temporalis myofascial flap(TMF)transferred to treat the long ankylosis of temporomandibular joint(TMJ).Methods:Seventeen cases with ankylosed condyles received arthroplasly.The degrees of mouth opeing pre-and post-operatium were evaluated,and the spaces of joints in the X-ray films were also measured.The evaluation of the results of the surrgical treatment was based on the TMJ functions.Results:Following up 0.5-3.0 years,in 12 of 17 cases the degree of mouth opening improved up to 27mm.The doctors and the patients were both satisfied with the results.Conclusion:The use of TMF in arthroplasty of temporomandibular joint is a good approach in the treatment of TMJ.

  7. One-stage operation for noma-induced bilateral ankylosis accompanied with mouth verrucous carcinoma - a case report and review of literature. (United States)

    Lu, Xu Guang; Cai, Zhi Gang; Zhang, Yi; Sun, Yong Gang


    A rare case of a male patient who suffered from noma with sequelae of ankylosis in bilateral temporomandibular joints for 52 years and a neoplasm in the right commissure of the lips for 1 year, was operated on to resolve the ankylosis, remove the neoplasm and reconstruct the soft tissue defect with a forearm flap through a one-stage operation. The neoplasm pathology was verrucous carcinoma.

  8. Surgical excision of heterotopic ossification of hip in a rare case of Moyamoya disease with extra articular ankylosis

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    Dhanasekararaja Palanisami


    Full Text Available We report a case of isolated ossification of iliopsoas with ankylosis of the left hip in a 27-year-old female. The patient was diagnosed to have Moyamoya disease, a rare chronic occlusive disorder of cerebrovascular circulation following an acute onset of hemiplegia. The patient presented 9 months later to us with ankylosis of left hip which was successfully treated by surgical excision of the heterotopic bone and there was no recurrence at the end of 5 years. A review of literature failed to reveal a similar case with isolated and complete ossification of iliopsoas muscle associated with Moyamoya disease which required surgical intervention. Surgical excision resulted in dramatic improvement in the quality of life. Surgical excision of neurogenic type of heterotopic ossification is a very successful procedure and timely intervention after maturity of mass is very important to prevent the onset of secondary complications and to avoid recurrence.

  9. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future. (United States)

    Khadka, A; Hu, J


    Temporomandibular joint (TMJ) ankylosis is characterized by difficulty or inability to open the mouth due to fusion of the temporal and the mandible, resulting in facial symmetry/deformity, malocclusion and dental problems. The only treatment option for TMJ ankylosis is surgical with or without condylar reconstruction. Various autogenous grafts are available for condylar reconstruction after freeing the ankylotic mass such as costochondral, sternoclavicular, fibular, coronoid, and metatarsophalangeal. Costochondral graft is preferred by surgeons, but distraction osteogenesis is slowly gaining popularity and may ultimately become the standard procedure, providing a cost-effective approach with low morbidity and excellent functional outcomes. Tissue engineering is another budding field which has shown promising results in animal studies but has not been applied to humans. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle.


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    Athaluri Vishnu


    Full Text Available BACKGROUND: Temporomandibular joint (TMJ ankylosis is associated with partial or complete restriction of mouth opening and poses a significant problem to the anesthesiologist making the airway management very challenging. Alternative methods of securing the airway should be kept ready because conventional laryngoscopy and intubation are impossible. Thoracic epidural anesthesia (TEA is one of the options to avoid general anesthesia in this case. We aimed to manage a case of bilateral modified radical mastectomy with TMJ ankylosis solely under thoracic epidural anesthesia. METHODOLOGY: Female patient of 32 years of age, with bilateral TMJ ankylosis with no mouth opening was posted for bilateral breast surgery. Thoracic epidural was instituted at T4-T5 interspace and 18G epidural catheters was secured. Alternative airway management strategies were included in our plan if thoracic epidural fails. OBSERVATION: Adequate preparation of the patient, counseling about anesthetic plan of management, placement of epidural catheter by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Regional anesthesia techniques are safer alternatives to provide intraoperative anesthesia with difficult airway for bilateral breast surgeries.

  11. Free flap transfer for closure and interposition-arthroplasty in noma defects of the lateral face associated with bony ankylosis. (United States)

    Giessler, Goetz A; Schmidt, Andreas B; Deubel, Ute; Cornelius, C-Peter


    Noma defects of the anterolateral face are often associated with fibrous or bony ankylosis fusing the mandibula to the skull base. According to the extent of the ankylosis, the temporomandibular joint mobility can be restricted or even completely frozen. In third world conditions the surgical approach to severe forms of bony ankylosis consists of a single linear opening osteotomy (trismus release) and the closure of the noma defect with locoregional flaps. Relapse of jaw immobility is common and may be caused by minor bone resection, the lack of adequate postoperative physiotherapy, or even the scarring of the defect coverage. In 4 years the authors have gained increasing experience with folded free flaps for simultaneous closure of outer and inner lining of large noma defects and the maintenance and training of re-established jaw function by the use of a dynamic external distractor fixed between the zygoma and the mandibular body. The authors report the bony reankylosis can be reduced by extended wedge osteotomies of the bony bridge and tip-like shaping of the ascending mandibular ramus. To preclude the reossification of the osteotomy site and fibrous scar formation, a dermofatty or muscular tail of the free flap is interposed into the bone gap. Two cases were treated according to this concept with a free parascapular and a latissimus dorsi flap in combination with simultaneous arthroplasty. During a 6-month follow-up period, no signs of a recurrent reduction of mandibular movement were noted in either case.

  12. Postinfectious ankylosis of the knee after bacterial arthritis following routine anterior cruciate ligament (ACL) reconstruction (United States)

    Mester, Bastian; Schoepp, Christian; Glombitza, Martin; Rixen, Dieter


    Aims and Objectives: Knee arthroscopy is a very common surgical procedure. It belongs to the most frequently performed procedures in orthopedics and traumatology and is considered to have a low complication rate. The risk of postoperative knee infection following ACL reconstrucion is estimated 1-2 %. Thereby the ACL reconstruction cannot always be preserved. Persistent defects after healing and postinfectios osteoarthritis are observed. We present the case of an adolescent patient suffering from postoperative knee infection following routine ACL reconstruction, who is developing - while infection is decreasing - a complete bony ankylosis of the knee, clinically meaning a severe constraint to joint function with complete stiffness of the knee. Materials and Methods: The 13-year-old male patient sustained a distorsion of the right knee during sports at school, after clinical examination magnetic resonance tomography showed a complete tear of the ACL. Single bundle ACL reconstruction was done using autologous hamstrings in Transfix technique. After 5 days at hospital the patient was discharged without any complications. Shortly afterwards the patient was admitted to hospital again presenting a postoperative knee infection. After primary operative revision the patient was shifted to our intensive care unit in a septic condition for stabilization. During 4 month of stay at our hospital multiple operative revisions were performed as arthrotomy, debridement, insertion of antibiotic carriers, complete removal of the autograft and total synovectomy. We found a severe bacterial infection (staphylococcus aureus) of the knee joint, classified Gaechter IV, histopathologically mostly avital cartilage tissue and chronic synovialitis. After decrease of the infection we could discharge the patient from hospital. Results: During the following 8 month under ongoing physiotherapy the patient was developing an increasing stiffness of the knee, finally fixed at 30 degrees of flexion and

  13. Anquilosis mandibular: una frecuente secuela por Noma Mandibular ankylosis: a Noma frequent sequel

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    R. Fernández García-Guilarte


    Full Text Available Conocemos poco sobre el Noma o Enfermedad Cancrum Oris. Esta entidad afecta a niños con malnutrición crónica, poca higiene oral, poco desarrollo sanitario y enfermedades concurrentes debilitantes. Existe un consenso general sobre que el Noma empieza como una gingivitis; en su fase aguda, puede haber respuesta al tratamiento antibiótico, no obstante, las secuelas tras su curación incluyen daños estéticos y funcionales variables, que pueden requerir cirugía reconstructiva. Presentamos 3 casos de anquilosis mandibular que en el examen preoperatorio presentaron dimorfismo mandibular, fusión de hueso maxilar y mandibular y anquilosis de la articulación témporomandibular. La ortopantografía y la Tomografía Axial Computerizada (TAC fueron muy útiles en la planificación de la cirugía. El tratamiento quirúrgico consistió en todos los casos en la resección del hueso anquilótico y la reconstrucción con injerto condrocostal en uno de los casos. En el postoperatorio se siguió fisioterapia intensiva. Clínicamente todos los pacientes mostraron una gran mejoría en la masticación, la alimentación y el habla, obviamente debido a una buena oclusión. El problema más común fue la baja colaboración en la rehabilitación mandibular por parte de los pacientes.Little is known about Noma or Cancrum Oris Disease. This entity affects to children with chronic malnutrition, poor oral hygiene, poor environmental sanitation and debilitating concurrent illness. There is general consensus that noma starts as gingivitis. The acute stage responds readily to antibiotic treatment. The sequelae after healing include variable functional and aesthetic impairments, which require reconstructive surgery. We report 3 cases of mandibular ankylosis. Preoperative examination revealed mandibular dismorphism, fusion of maxilla and mandible and ankylosis of the temporomandibular joint. Orthopantography and Computed Thomography scan (TCS were very useful in planning

  14. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

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    Kumkum Gupta


    Full Text Available Background : Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results : The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion : Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.

  15. TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement—A Case Report

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    Pavankumar Janardan Vibhute


    Full Text Available This report describes the multidisciplinary phasewise treatment of a 20-year-old female patient having unilateral right TMJ bony (true ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism; additionally, she was also suffering from speech problems, snoring, difficulty in breathing, and low level of self-esteem and self-confidence. Bilateral gap arthroplasty and temporalis myofascial graft interpositioning through preauricular approach were done in surgical phase followed by the aggressive jaw physiotherapy in postsurgical period. Oral prophylaxis and restorations were followed by the fixed orthodontic therapy to resolve bimaxillary protrusion. Advancement sliding genioplasty was performed to enhance the chin button. Speech therapy and psychological counseling were also performed from time to time to boost up the self-esteem and self-confidence. At the end of treatment, facial esthetics was improved considerably and patient got over the impact of disfigurement, impaired functions, and psychosocial stigma. Rationale to use the multidisciplinary team approach in treatment of such cases is discussed.

  16. Comparison of gap arthroplasty versus creating a pseudoarthrosis – modified technique for surgical management of temporomandibular joint ankylosis: a new approach

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    Irfan ul Hassan Haji


    Full Text Available Objectives: To compare the postoperative results like vertical ramus height, vertical facial height, anterior open bite, unilateral cross bite and reankylosis in patients with TMJ ankylosis after doing gap arthroplasty versus creating a pseudoarthrosis by this modified technique. Background: This surgical study done on 10 patients with TMJ ankylosis were 5 patients had unilateral ankylosis and 5 had bilateral ankylosis. Pseudoarthrosis was created by this modified technique in all 10 patients. Methods: In this technique, a pseudoarthrosis is created by two oblique osteotomies and resection of triangular shaped bony wedge between the articular cavity and subcondylar region involving ankylotic bony mass and sub-ankylotic normal bone and a surgical gap is created without interposing any material with gap of 1cm anteriorly and gap height decreasing posteriorly resulting in pseudoarthrosis at posterior border without any loss of vertical ramus height. Results and conclusion: The postoperative results show that this new approach of creating a pseudoarthrosis is effective and convenient method of treating TMJ ankylosis and has many advantages over conventional gap arthroplasty.

  17. Rehabilitation treatment of ankylosis after relaxing and plastic operation of adhesion of knee extension apparatus%伸膝装置粘连松解成形术后康复治疗膝关节僵直

    Institute of Scientific and Technical Information of China (English)

    史桂秋; 尹中华


    Background:Ankylosis is the result of adhesion of knee extension apparatus that is often the complications of trauma of femoral shaft and knee .Because ankylosis will impair the flexion of knee joint,postoperational exercise is the key to rebuild flexing function of knee joint.

  18. Congenital infiltrating lipomatosis of the face with exophytic temporomandibular joint ankylosis: a case report and review of the literature. (United States)

    Sahai, S; Rajan, S; Singh, N; Arora, H


    Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed.

  19. Congenital infiltrating lipomatosis of the face with exophytic temporomandibular joint ankylosis: a case report and review of the literature (United States)

    Sahai, S; Rajan, S; Singh, N; Arora, H


    Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed. PMID:22241871

  20. Management of obstructive sleep apnea syndrome secondary to temporomandibular joint ankylosis by mandibular elongation using distraction osteogenesis

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    Yadavalli Guruprasad


    Full Text Available Obstructive sleep apnea syndrome (OSAS is associated with repetitive nocturnal upper airway obstruction leading to daytime sleepiness, cardiovascular derangements, and can be a debilitating, even life-threatening condition. The most favorable treatment for patients with OSAS is multidisciplinary care by a team that represents various dental and medical disciplines. Prescribed therapies might include weight loss, behavior modification, oral appliances, soft tissue surgery, skeletal surgery, or some combination of approaches. Osteogenesis by mandibular distraction has proved effective in children in the treatment of obstructive apnea syndrome associated with congenital malformations. In the adult, the possibility of using distraction osteogenesis in the management of OSAS remains to be defined. We report a case of an adult patient treated for OSAS secondary to temporomandibular joint ankylosis by mandibular distraction followed by interpositional arthroplasty.

  1. [Interposition of a full-thickness skin graft in the surgery of temporomandibular joint ankylosis. A study of 31 cases of which 20 had long-term follow-up]. (United States)

    Guyot, L; Chossegros, C; Cheynet, F; Gola, R; Lachard, J; Blanc, J L


    Recurrence is the main problem in temporo-mandibular joint ankylosis treatment. Two therapy are used against this, physiotherapy and surgical joint interposition. Following ankylosis removal, many materials can be interposed but, for us, fullthickness skin graft using Popescu and Vasiliu technique seems to be the best and simplest one. This retrospective study of 31 cases, 20 with long-term follow-up, shows that good results are obtained using this skin graft, with 90% successful rate.

  2. Stability of interceptive/corrective orthodontic treatment for tooth ankylosis and Class II mandibular deficiency: A case report with 10 years follow-up

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    Carlos Henrique Guimarães


    Full Text Available The purpose of this article is to present the treatment of a 8-year-old boy with tooth ankylosis in teeth 85 and Class II division 1 malocclusion and to report a 10-year follow-up result. The patient was initially treated with a sagittal removable appliance, followed by an eruption guidance appliance and braces. The interceptive orthodontic treatment performed to recover the space lost by ankylosis of a deciduous tooth allowed a spontaneous eruption and prevented progression of the problem. The use of an eruption-guidance appliance corrected the dentoskeletal Class II, thus improving the patient's appearance. Besides the treatment producing a good occlusal relationship with the Class I molar, the correction of the overjet and overbite was stable over a ten-year period.

  3. A multidisciplinary approach to the management of temporomandibular joint ankylosis in a sickle-cell anemia patient in a resource-limited setting. (United States)

    Braimah, Ramat Oyebunmi; Oladejo, Taoreed; Olarinoye, Timothy Oyetunde; Adetoye, Adedapo Omowonuola; Osho, Patrick Olanrewaju


    This report describes the multidisciplinary management of a 35-year-old female sickle-cell anemia patient who had unilateral bony ankylosis of the left temporomandibular joint secondary to septic arthritis. She was managed by a team comprising of maxillofacial surgeons, anesthetists, otorhinolaryngologist, and hematologist. Unilateral left interpositional arthroplasty and ipsilateral coronoidectomy through a postrami approach were done and followed by aggressive jaw physiotherapy in the postsurgical period. No perioperative morbidity was encountered. Mouth opening of 3.5 cm was achieved and maintained 7 months after surgery. Challenges and rationale for the use of a multidisciplinary team approach in treatment of such cases were discussed.

  4. The application of distraction osteogenesis in the temporomandibular joint ankylosis and secondary dentofacial deformities%牵张成骨在颞下颌关节强直及其继发畸形矫治中的应用

    Institute of Scientific and Technical Information of China (English)

    祝颂松; 胡静


    Temporomandibular joint ( TMJ) ankylosis is a joint disorder which refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. When it occurs in children, it can cause secondary dentofa-cial deformities with physical and psychological disability. Correction of TMJ ankylosis and secondary deformities remains a great challenge for oral and maxillofacial surgeons. Distraction osteogenesis ( DO) has been used for the treatment of TMJ ankylosis and secondary deformities with satisfactory outcomes. An average of 50-60 patients with TMJ ankylosis is referred to our department annually. In this review, we summarized the characteristics of DO and discussed some factors involved in the treatment of TMJ ankylosis with dentofacial deformities.%儿童时期发生的颞下颌关节强直可以导致不同程度的颌面部骨骼发育障碍,并引起自卑、社交障碍等一系列心理问题,其矫治是口腔颌面外科医生面临的一大挑战. 牵张成骨( distraction osteogenesis,DO)一直被国内外学者用于颞下颌关节(temporomandibular joint,TMJ)强直及其继发畸形的矫治,并取得了良好的临床效果.笔者所在科室每年大概收治50~60例TMJ强直患者,对DO技术在TMJ强直及其继发畸形矫治中的应用积累了较为丰富的临床经验. 本文中,笔者对DO技术在TMJ强直及其继发畸形矫治中的优缺点及相关问题进行述评.

  5. Effect of distraction osteogenesis combined with postoperative rehabilitation nursing on obstructive sleep apnea syn-drome after ankylosis of temporomandibular joint%牵张成骨并术后康复护理对颞凳关节强直后睡眠呼吸暂停综合征的作用

    Institute of Scientific and Technical Information of China (English)

    于擘; 刘彦普; 侯锐; 史亮


    @@ INTRODUCTION Ankylosis of temporomandibular joint can cause severe mandibofacialasymmetry, postmandibular stenosis. Ankylosis of temporomandibularjoint(TMJ) in infants can lead to obstruction of upper airway due toinfluencing on development of mandible and obstructive sleep apncasyndrome(OSAS) is caused. Previous surgical treatment of ankylosisof temporomanibular joint needs large scope with big trauma andhigh relapse rate. Distraction osteogenesis technique can simplifysurgical operation, decrease operation risk and relapse rate and theeffect definitive.

  6. 创伤性颞下颌关节强直临床分析%A clinical study of post-traumatic temporomandibular joint ankylosis

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    秦力铮; 邓沫宏; 程勇; 蔡恒星; 龙星


    目的 分析引发创伤性颞下颌关节(temporomandibular joint,TMJ)强直的高风险髁突骨折类型,初步探讨TMJ强直发生的可能性机制.方法 对18例创伤性TMJ强直进行临床、影像学检查及评估.取纤维性强直外侧变性的关节囊、关节间的致密纤维组织及骨性强直关节外侧骨块和内侧骨块,HE染色,光镜观察.结果 发展为强直的18例患者(24侧关节)中,16侧为5型髁突骨折,6侧为6型髁突骨折,2侧为3型髁突骨折,未发展成为强直的4侧骨折分别为2型和4型骨折.纤维性强直关节囊与关节腔内纤维组织不同程度的软骨化及散在骨化.骨性强直外侧的骨块为强直骨块,内侧骨块为髁突残留.结论 高位伴有骨折块脱位的髁突横行及矢状骨折是导致创伤性TMJ强直的高危骨折类型.%Objective To investigate the high risk types of condylar fracture developing to temporomandibular joint (TMJ) ankylosis. Methods The clinical and radiographic data of 18 cases of post-traumatic TMJ ankyloses were evaluated. The biopsy was taken from lateral capsules and fibrous tissues in joint spaces of 5 fibrous ankyloses, and lateral and medial bones of 8 bony ankyloses. Histological sections of 5 |xm thickness were made and stained with hematoxylin-eosin (HE) for light microscope observation. Results Of the 18 cases (24 TMJs) of joint ankylosis, 16 TMJs were 5th type condylar fracture, 6 were 6th type fracture, 2 were 3rd type fracture. The lateral capsulae and fibrous tissues in joint spaces of fibrous ankyloses showed different degreed of chondrification and diffused ossification. The lateral osseous fusions showed the mixed construction consisting of fibre, cartilage and bone. The medial bones were the remainders of fractured condyles. Conclusion The high-risk types of condylar fracture developing to TMJ ankylosis were high level transversal condylar fracture and sagittal fracture with fragment dislocation.


    Institute of Scientific and Technical Information of China (English)

    于擘; 顾晓明; 张良; 门志光


    Objective To evaluate orthognathic surgery in the treatment of sleep apnea syndrome (SAS) resulted from ankylosis of TMJ. Methods Firstly, the arthroplasty was carried out to relieve the TMJ ankylosis and to open mouth according to design. The mandibles of 14 patients with SAS were advanced by "L"-osteotomy of ramus at the affected side and a sagittal split ramus osteotomy at normal side combined with TMJ arthroplasty. Results After operation, maximal mouth opening of the 14 patients reached 2.5cm-3.5cm. The follow-up 2 years later showed the maximal mouth opening was kept between 2.5cm and 3.2cm. AHI of all the patients were less than 20 postoperatively. Snoring while asleep disappeared in 12 patients and their SaO2 increased by 18.45% in average (P<0.01), which fell into the normal range. No patients were waken up by suffocation. Continuous SaO2 increased from 58% to over 95% in average. Conclusion The obstruction of the upper airway can be relieved through orthognathic surgery. Thus the hypoxemia of the patients was relieved or corrected. This technique is effective in the treatment of SAS due to TMJ ankylosis.%目的评估正颌外科技术矫治14例颞颌关节强直所致OSAS的效果.方法手术采用患侧关节成形,下颌升支、体部的"L"形半层截骨及健侧矢状截骨术,将患侧下颌升支加高固定,下颌前部整体前移.结果 14例颞颌关节强直伴OSAS患者术后张口度达2.5~3.5cm,术后2年随访张口度仍维持在2.5~3.2cm之间.所有患者的AHI指数下降了20以上,12例患者的打鼾症状消失,持续血氧饱和度平均提高了18.45%(P<0.01),达到了正常人的范围,持续血氧饱和度最低值由术前的58%提高至术后的95%以上,OSAS得以治愈.结论颞颌关节强直伴OSAS患者通过正颌外科手术可以在关节成形的同时,解决患者下颌后缩的缺陷,解除上气道狭窄,从而缓解或纠正患者的低氧血症.

  8. [Long-term results of mobilization by bone resection in patients with post-traumatic total stiffness and ankylosis of the elbow. Study and results of 39 operations]. (United States)

    Baciu, C C; Dobre, I; Mîrsu, F; Duma, A


    Thirty patients with post-traumatic stiffness and ankylosis of the elbow were treated operatively at the Colentina Clinical Hospital, from 1970-1986. They were treated by 39 surgical mobilisation using Ollier technique. In eleven patients with a persisting functional amplitude of the prono-supination, the resections have been effected on the distal end of the humerus and on the olecranon, and in nineteen with a limited prono-supination too, it was added a resection of the radial head. The mobilisations were realised without interposition. At follow-up the patients were evaluated after 1 to 8 years, using the pre- and post- operative Rocher's indices and the Kerboull's classification. The flexion-extension was improved by 55 per cent, the pronation by 55.3 per cent and the supination also with 55.3 per cent. The results plead for the maintaining of this type of surgical treatment for the treatment of post-traumatic stiffnesses and ankyloses of the elbow, though there are not complete satisfactory, especially for the joint stability.

  9. Tratamiento de anquilosis tempomandibular en la infancia mediante artroplastia y distracción de tejidos blandos Management of temporomandibular ankylosis during childhood by means of arthroplasty and soft tissue distraction

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    M.A. Morey Mas


    Full Text Available Los traumatismos que afectan a los cóndilos mandibulares pueden ocasionar una anquilosis de la articulación temporomandibular que, si se produce en edad de crecimiento, puede dar lugar a una deformidad facial con asimetría o retrognatia. Entre los diferentes tratamientos utilizados, la distracción osteogénica ofrece unas ventajas, entre ellas la posibilidad de aplicación en la infancia y la elongación de tejidos blandos. Presentamos un caso de anquilosis temporomandibular bilateral en una niña de 9 años, que tratamos con distracción extraoral tras resección del bloque anquilótico, pero sólo con la finalidad de elongar los tejidos blandos y mantener el espacio en la nueva cavidad glenoidea para evitar la reanquilosis y favorecer la remodelación del cóndilo.Condylar damage can produce temporomandibular joint ankylosis. If ankylosis ocurrs in early childhood can develope facial asymmetry or mandibular hypoplasia. In these cases, several therapeutic options have been used, but distraction osteogenesis offers a new excellent alternative because it allows elongation of soft tissues and can be performed in childhood. We present a bilateral temporomadibular joint ankylosis in a 9 years old girl, who was treated by means an arthroplasty and extraoral distraction devices, only for elongation of soft tissues and keeping space between skull base and mandibula to avoid reankylosis and to allow condylar remodelation.

  10. Spontaneous arthritis and ankylosis in male DBA/1 mice: further evidence for a role of behavioral factors in “stress-induced arthritis”

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    Braem Kirsten


    Full Text Available Abstract Background Ageing male DBA/1 mice spontaneously develop arthritis in the hind paws. We and others have demonstrated that this model shares striking features with human spondyloarthritis, in particular entheseal involvement, progressive ankylosis but also dactylitis. Here, we report on our recent experience with this model highlighting how changes in the animal facility affect the development of the disease. Findings Ageing male DBA/1 mice from different litters were caged together (6 mice per cage at the age of 10 weeks. The mice were checked twice a week for clinical signs of arthritis. Disease severity was assessed in further detail post-mortem by scoring for histomorphological characteristics. DBA/1 mice spontaneously develop macroscopically detectable arthritis, presenting as joint swelling or toe stiffness. Standard settings with open cages lead to an almost 100% incidence by the age of 26 weeks. The introduction of larger cages and filter tops reducing exposure to other cages dramatically affected incidence. Other negative factors include excess bedding material reducing the impact of walking and running. Switching back to the original conditions resulted again in a high incidence, further optimized by sensory exposure to female mice. We also showed that the related DBA/2 strain is sensitive to the disease. Conclusions Changing environmental factors in the housing conditions of DBA/1 mice severely affects the spontaneous development of arthritis. This points out that the model is very sensitive to external stress and sensory factors that are likely affecting the behavior of the male mice and that the model needs to be optimized in different situations.

  11. Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome. (United States)

    Bansal, V; Singh, S; Garg, N; Dubey, P


    This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients.

  12. Experimental establishment of animal model of temporomandibular joint ankylosis secondary to condylar sagittal fracture%髁突矢状骨折继发颞下颌关节强直动物模型的建立

    Institute of Scientific and Technical Information of China (English)

    王霄; 张益; 李江明


    目的:建立髁突矢状骨折继发颞下颌关节强直动物模型,为进一步研究创伤性颞下颌关节强直发生机制提供实验载体.方法:小尾寒羊4只,双侧关节互为对照.实验侧通过手术造成髁突矢状骨折,破坏关节窝表面软骨,切除外侧1/2关节盘;对照侧仅造成髁突矢状骨折.术后6个月,通过CT检查和组织学观察评价实验侧颞下颌关节强直的形成.结果:4只小尾寒羊的实验侧关节均发生混合性强直,CT检查发现,关节结构消失,关节间隙变窄,周缘出现不规则增生或吸收,上、下关节面被若干上、下贯通的高密度影像所分隔,呈骨痂样改变.组织学观察可见,实验侧关节窝与髁突之间散在有骨与骨样的基质,部分区域可分辨出强直骨桥的形成.对照侧未出现强直迹象.结论:本研究中的动物实验重现了临床髁突矢状骨折继发颞下颌关节强直的发生过程,实验具有可重复性,可作为动物模型用于对创伤性关节强直的研究载体.%Objective: To experimentally develop an animal model of traumatic temporomandibular joint ankylosis secondary to condylar fracture in small Tail Han sheep. Methods: Four sheep were used to make sagittal fracture of condyles. The cartilage layer of articular surface was damaged and lateral half of articular disc was removed in the right side and conserved in the left side as a control. All animals were sacrificed at the end of 6 months postoperatively. CT observation and histological examination were carried out to evaluate the formation of ankylosed joints. Results: All of the animals showed a change of mixed ankylosis on the right sides. On the CT image, the joint space became narrow and the articular surfaces became irregular with high-density callus formation. Histological observation validated that the bone-like and the cartilage-like matrix scattered between the condyle and temporal fossa. The ankylosis bone bridge could be figured out in

  13. 全髋关节置换术治疗强直性脊柱炎髋关节强直%Total hip arthroplasty in the treatment of ankylosing spondilitis with hip ankylosis

    Institute of Scientific and Technical Information of China (English)

    王贵清; 蔡显义; 汤勇智; 杨立群; 黎昭华; 利洪艺


    目的 探讨全髋关节置换术治疗强直性脊柱炎髋关节强直的临床效果.方法 对11例强直性脊柱炎髋关节强直患者(22髋)进行全髋关节置换术,术后行踝关节及足趾屈伸等功能锻练.结果 术后髋关节活动度明显改善,屈曲畸形基本矫正.11例均获随访,时间2~6年.未出现关节脱位和假体松动.Harris评分由术前9~58(36±9.8)分提高到末次随访时64~94(81.2±10.6)分,优13髋,良6髋,中3髋.结论 全髋关节置换术治疗强直性脊柱炎髋关节强直能显著改善髋关节功能,矫正髋关节畸形,近期疗效满意.%Objective To study the curative effect of total hip arthroplasty( THA )in the treatment of ankylosing spondilitis with hip ankylosis.Methods 11 cases of ankylosing spondilitis with hip ankylosis( 22 hips ) were performed by THA and ankle and foot exercises were done after operation.Results Function of hip joint improved evidently after operation, and flexion deformity disappeared basically.After following up for 2 ~ 6 years, there was no sign of loosening, dislocation.The clinical results were evaluated by the Harris hip scoring system.Harris hip score improved from 9 ~58( 36 ±9.8 ) points preoperatively to 64 ~ 94( 81.2 ± 10.6 ) points at the final postoperatively evaluation.13 hips were excellent effect, 6 good and 3 fair.Conclusions THA can greatly improve the function and rectify deformity of hip joint of patients with ankylosing spondilitis with hip ankylosis.The short term curative effect is satisfactory.

  14. Prosthetic replacement of condylar head for management of traumatic temporomandibular joint ankylosis%髁突置换治疗创伤性颞下颌关节强直五例

    Institute of Scientific and Technical Information of China (English)

    安金刚; 张益; 何锦泉; 贺洋; 李江明


    Objective To preliminarily evaluate the method of using titanium condylar protheses in management of traumatic temporomandibular joint ankylosis.Methods Between August 2006 and April 2008,titanium condylar replacement was performed in 5 male patients.Preoperative CT datum of patient was obtained and a resin model was then produced and used as a reference to select a suitable titanium condyle for reconstruction of the joint.In the operation,the bony ankylosis was removed.According to the preoperation planning,the selected prosthesis was inserted and fixed to the distal mandibular segment.The results were assessed by means of examinations and measurements postoperatively and during follow-up.Results The 5 patients received alloplastic replacement of 6 condyles.Three patients were under follow-up and follow-up time ranged from 8 months to 2 years and 6 months.The mean mouth opening was 30 mm.Two patients had good occlusion and one patient developed a slight open bite.Conclusions Prosthetic condylar replacement can provide a choice for management of traumatic temporomandibular joint ankylosis.%目的 总结用人工髁突置换治疗创伤性颞下颌关节强直(temporomandibular joint ankylosis,TMJA)的临床效果.方法 2006年8月至2008年4月北京大学口腔医学院·口腔医院口腔颌面外科共5例创伤性TMJA患者接受人工髁突置换手术,患者均为男性.术前行CT检查后,用快速成形技术制作三维头模,在头模上模拟切除关节骨球、关节成形、选择适宜的人工髁突,术中依术前设计安放并固定人工髁突.术后1周和复查时评价手术效果.结果 5例共植入6侧人工髁突(1例为双侧).3例复查时间为术后8~30个月,另外2例失访.复查时张口度平均为30 mm,2例咬合关系良好,1例前牙区有约1 mm的开骀.结论 人工髁突置换可以作为创伤性TMJA手术治疗的方法之一,其临床效果还需进一步验证.

  15. Hip replacement for bony ankylosis of the hip following ankylosing spondylitis%髋关节置换术治疗强直性脊柱炎髋关节骨性强直

    Institute of Scientific and Technical Information of China (English)

    周胜虎; 甄平; 高明暄; 田琦; 李旭升


    Objective To investigate the clinical significance and effect of total hip arthroplasty (THA) in treatment of bony ankylosis of the hip in patients with ankylosing spondylitis (AS).Methods The study enrolled 23 patients (35 hips) undergone THA for bony ankylosis of the hip in AS between March 2008 and November 2012.Postoperative outcome was measured based on Harris hip score and Xray images.Results Preoperative Harris hip score of (27.6 ± 2.3) points increased to (86.7 ± 2.6)points postoperatively.Hip flexion and adduction deformity presented correction postoperatively.Total hip range of motion (flexion,adduction,abduction,and external rotation) improved from (45.7 ±5.3) o preoperatively to (206.9-±4.7) °postoperatively and mean hip flexion activity was 81 °.Hip activity achieved significant improvement and pain was relieved.X-ray films revealed proper position of prostheses without the presence of loosening or subsidence.Two patients (3 hips) experienced mild pain after a long period of walking.Four patients had heterotypic ossification including Brooker grade Ⅱ in one patient and Brooker grade Ⅰ in three.Conclusion THA is an effective treatment for bony ankylosis of the hip in AS,for it rebuilds joint function,relieves pain of the hip and improves patients' quality of life.%目的 探讨全髋关节置换术(total hip arthroplasty,THA)在治疗强直性脊柱炎(an-kylosing spondylitis,AS)髋关节骨性强直中的临床意义及疗效评价. 方法 选择2008年3月-2012年11月收治的AS髋关节骨性强直患者23例(35髋),行THA手术.术后以Harris评分和X射线评估疗效. 结果 术后Harris评分由术前(27.6±2.3)分增加到术后的(86.7±2.6)分.髋关节屈曲和内收畸形较术前纠正,术前髋关节总活动度(屈伸、内收、外展、内外旋)为(45.7±5.3)°,术后为(206.9±4.7)°,平均髋关节屈伸活动度为81°,髋关节活动度明显改善,疼痛缓解.X线片示假体位置良好,未见松动或下沉.2例(3

  16. Condylar fractures, disc injury and development of temporomandibular joint ankylosis: discussion on the related problems%髁突骨折致颞下颌关节强直相关问题的探讨

    Institute of Scientific and Technical Information of China (English)



    @@ 颞下颌关节强直(temporomandibular joint ankylosis,TMJA)是口腔颌面外科的一种常见疾病,其病因包括外伤、感染以及各种系统性疾病,如风湿、类风湿性关节炎等.近年来,创伤已经成为TMJA的主要致病原因,创伤性TMJA的研究日益受到关注.创伤性TMJA比例增多的主要原因有两个:一是随着抗生素的普遍应用和开发,临床对感染的控制能力不断增强而使得感染性TMJA日益少见;二是随着交通事故的增多,髁突骨折的发生率逐年增多,创伤性TMJA相应增多.

  17. 创伤性颞下颌关节强直的分类和治疗-84例临床资料分析%Classification and treatment of traumatic temporomandibular joint ankylosis:An analysis of 84 consecutive patients

    Institute of Scientific and Technical Information of China (English)

    杨驰; 何冬梅; 陈敏洁; 张晓虎; 邱亚汀; 杨秀娟; 李凌志


    PURPOSE: This study was to investigate the classification of traumatic temporomandibular joint ankylosis (TMJA) based on coronal CT sean and to present our treatment experience in the TMJ division of Shanghai Ninth People's Hospital. METHODS: From 2001 to 2009, 130 patients diagnosed of TMJA were treated in TMJ division. Among them,84 patients with 124 joints were caused by trauma and treated first by our group of surgeons. They were included in this study. All of them had CT scan, especially coronal reconstruction through the TMJ area before and after surgery. A new classification based on the coronal CT scan was proposed. The treatment protocol for Type A 1 ankylosis was fibrous tissue release or condylar head resection with costochondral graft (CCG) and temporalis myofascial flap (TMF). For Type A2 and A3 ankylosis, the lateral bony fusion was resected while the intact residual condylar fragment displaced medially was remained. The operation was named "lateral arthroplasty" (LAP). TMF or masseter muscle flap (MMF) was used as a barrier in the lateral gap between temporomandibular joint fossa and stump of the mandibular ramus, If the medial condylar fragment in Type A3 ankylosis was too small to bear the load, it was resected with the bony mass. The joint was then reconstructed with CCG and TMF or MMF. For Type A4 ankylosis, the bony fusion was completely removed and the joint was reconstructed with CCG and TMF or MMF. The result of the treatment were evaluated by CT scan and clinical follow-up. RESULTS: Among the 124 ankylotic joints, 14 were Type Al ankylosis (11.3%); 43 were Type A2 (34.7%);46 were Type A3 (37.1%) and 21 were Type A4 ankylosis (16.9%). Part of Type Al, all Type A2 and A3 ankylosis had residual condylar head displaced medially which accounted for 75% (93/124) of the TMJ ankylosis. Treatment according to the classification was: LAP for 82 joints (66.1%); CCG for 33 joints (26.6%); and other treatment for 9 joints (7.3

  18. A anquilose tíbio-társica e sua importância na insuficiência venosa crônica Ankle ankylosis and its importance in chronic venous insufficiency

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    Jorge Ribas Timi


    Full Text Available CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle, 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54; a do grupo C3 foi de 37,9º (variação de 10-61; e a do grupo C4 foi de 24,5º (variação de 8-50. A diferença das médias de C4 e C3 foi de 36%, e a de C3 comparada com o grupo-controle (C0, de 11%, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males with a mean

  19. Tooth ankylosis in deciduous teeth of children with cleft lip and/or palate Anquilose dentária na dentição decídua em crianças com fissura de lábio e/ou palato

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    Andreza Maria Fábio Aranha


    Full Text Available The present study aimed at evaluating the prevalence of tooth ankylosis in deciduous molars of Caucasian children with cleft lip and/or palate aged 5 to 12 years, of both genders. A total of 330 patients seen at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo for routine treatment were clinically evaluated. The prevalence of ankylosis was analyzed in relation to gender, age range (5-7, 8-10, 11-12 years, type of cleft, affected tooth and arch. The total group showed a prevalence of 18%, with no statistical difference between genders and among types of cleft; ankylosis was more often in the mandibular arch, lower first molars and among children in the age ranges 8-10 and 11-12 years. The results agreed with those observed in the related literature for patients without clefts, pointing out the absence of influence of the cleft on the prevalence of ankylosis. This reinforces the importance of early diagnosis of this anomaly and of the treatment of choice, which are similar in patients with or without clefts.Este estudo avaliou a prevalência de anquilose dentária em molares decíduos de portadores de fissura de lábio e/ou palato, brancos, de ambos os sexos, com idade entre 5 e 12 anos. Um total de 330 pacientes atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo para tratamento de rotina foi clinicamente avaliado. A prevalência de anquilose foi analisada em relação a gênero, idade (5-7; 8-10; 11-12 anos, tipo de fissura, dente e arco afetados. O grupo total demonstrou prevalência de 18%, sem diferença estatística entre gêneros e tipos de fissura, sendo mais acometido o arco mandibular, o primeiro molar inferior e as faixas etárias de 8 a 10 e de 11 a 12 anos. Os resultados estão de acordo com aqueles observados na literatura para pacientes sem fissuras, destacando a ausência da influência das fissuras na prevalência de anquilose. Isso reforça a

  20. 颞肌筋膜瓣转移治疗颞下颌关节强直的临床研究%Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

    Institute of Scientific and Technical Information of China (English)

    朱志军; 邢树忠; 万林忠; 陶震江; 吴煜农


    目的:观察颞肌筋膜瓣转移治疗下颌关节真性强直的临床疗效.方法:采用颞肌筋膜瓣移植治疗颞下颌关节真性强直17例,通过测量术前、术后开口度,摄全景片及关节片测量关节间隙大小,术后随访等综合评价疗效.结果:全部病例均痊愈出院,开口度在30 mm以上,咬(牙合)关系恢复良好.12例经6个月~3年随访观察,张口度均在22 mm以上,手术效果稳定,令人满意.结论:颞肌筋膜瓣转移是治疗颞下颌关节真性强直的一种比较理想的方法.%Objective:To study the effects of temporalis myofascial flap (TMF) trans-ferred to treat the long ankylosis of temporomandibular joint (TM J). Methods : Seventeen cases withankylosed condyles received arthroplasty. The degrees of mouth opening pre- and post-operation were e-valuated, and the spaces of joints in the X-ray films were also measured. The evaluation of the resultsof the surgical treatment was based on the TMJ functions. Results:Following up 0. 5-3. 0 years, in12 of 17 cases the degree of mouth opening improved up to 27 mm. The doctors and the patients wereboth satisfied with the results. Conclusion:The use of TMF in arthroplasty of temporomandibularjoint is a good approach in the treatment of TMJ.

  1. Total hip arthroplasty in treatment of serious hip fusion ankylosis deformity%严重髋关节融合强直畸形的全髋关节置换术

    Institute of Scientific and Technical Information of China (English)

    乐国平; 张明


    Objective To investigate the surgical methods and clinical efficacy of total hip arthroplasty (THA) for the serious hip fusion ankylosis deformity.Methods Forty eight patients(57 hips) with serious hip fusion ankylosis deformity were treated with THA.All patients were treated with fullmottled plug or nose plug,graded unilateral THA.The lateral incision was used,twice osteotomy of the femoral neck and pelvis tendency cephaliccaudal acetabuloplasty were performed,the acetabular cup abduction angle were correctly positioned,femoral stem and acetabular anteversion adjustment was used to correct ipsilateral flexion deformity.Results All patients were followed up for 12~36 months (mean 28.5 months).One case had prosthesis sinking 4 mm,one case had periprosthetic fracture,one case had proximal femoral splitting and one case had traction injury of the sciatic nerve.At the last follow-up,the Harris score improved from an average of 16.3 points to improve to 85.6 points.The hip preoperative activity improved from 0° to the average postoperative total activity of 152.5°,the average hip flexion of 91.4°.Hip flexion deformity,preoperative average improved from 25.6° to postoperative average of 5.1°.Postoperative hip pain disappeared; the operative side gait returned to normal,no serious complications occurred.Conclusion THA in treatment of the serious fusion ankylosis hip flexion deformity can not be dealt with conventional manner.The true acetabulum bottom should be exposed and good accurate anteversion and abduction angle should be taken according to preoperative internal rotation of the limb or external rotation.This is the key to successful operation.%目的 探讨采用全髋关节置换术(THA)治疗严重髋关节融合强直畸形的手术方法及临床疗效.方法 对48例(57髋)严重髋关节融合强直畸形分次行单侧THA,均采用外侧切口,通过对股骨颈2次截骨后,根据骨盆倾向头侧还是尾侧进行髋臼成形,正确定位臼杯的

  2. 伸直位骨性强直膝的全膝关节置换术%Total knee arthroplasty in the treatment of knees with bony ankylosis in extension

    Institute of Scientific and Technical Information of China (English)

    童培建; 何帮剑; 储小兵; 厉驹; 叶福生; 肖鲁伟


    Objective To explore the clinical results of total knee arthroplasty (TKA) in the treatment of knees with bony ankylosis in extension.Methods From June 2000 to June 2007,10 patients had knees with bony ankylosis in extension were treated with TKA,including 4 males and 6 females,with an average age of 49 years (range,29 to 63 years).The primary diseases were as follows:ankylosing spondylitis in 3 cases,rheumatoid arthritis in 2 cases,hemophilic arthritis in 1 care,traumatic arthritis in 3 cases and pyogenic arthritis in 1 case.The range of motion (ROM) was 0° in all knees,and the average HSS (the Hospital for Special Surgery) score before operation was 32.5±10.26.Two patients underwent bilateral TKA,and 8 underwent unilateral TKA.Results All patients were followed up for 3 to 10 years (average,5.3 years).The average HSS score was improved to 87.75±6.45 at the last follow-up,and there was significant difference compared with that before operation (t=18.668,P=0.000).The average ROM was improved to 97.08°±11.57°at the last follow-up,and there was remarkable difference compared with that before operation (t=29.063,P=0.000).The postoperative complications included cutaneous necrosis in 2 cases,deep venous thrombosis of lower limb in 1 case,periprosthetic fracture in 1 case,and deep prosthetic infection in 1 case who underwent revised TKA later.The postopertative X-ray showed no looseness of the prostheses.Conclusion TKA through medial parapatellar approach,with dissection of the rectus femoris,secondary osteotomy and soft tissue balance intraoperatively is effective in the treatment of knees with bony ankylosis in extension,which can correct the ankylosed knee deformitis successfully.Combining with the correct rehabilitation exercise,it is possible to improve significantly the function of knee and life quality in these patients.%目的 探讨伸直位骨性强直膝全膝关节置换术的手术方法与临床疗效.方法 2000年6月至2007年6月,对10例伸直

  3. Total knee arthroplasty for extension ankylosis of the knee:an analysis of 1 3 cases%膝关节置换治疗膝关节伸直位强直13例

    Institute of Scientific and Technical Information of China (English)

    张有伟; 郭礼跃


    Objective:To investigate the treatment method and curative effect of total knee arthroplasty for extension ankylosis of the knee. Methods:Total knee arthroplasty was performed to 13 patients with extension anky-losis of the knee from March 2008 to February 2014,including 6 male and 7 female patients with an average age of 41.4 years(36.0 -63.0 years),among whom 3 patients had rheumatoid arthritis and 10 patients had trauma around the knee joint. Before surgery,the range of motion was (0 ±0)°,the score of HSS and the Lysholm function score were(38 ±13.80)points and (15 ±13.29)points. Results:All of the 13 patients received total knee arthroplasty.The average follow-up was 48.7 months (9.0 -78.0 months). In the last follow-up,the range of motion was (96 ±12.17)°,the score of HSS and the Lysholm function score were (85 ±7.15)points and (82 ±6.94)points, indicating there were statistically significant differences before and after operation. The postoperative complications included patellar fracture in 1 patient,patellar tendon avulsion in 1 patient,part of incision necrosis in 2 patients and superficial infection in 1 patient. They were all cured after treatment,however,extension lag occurred in 3 pa-tients with degrees of 5°,10°and 15°respectively.Conclusion:Total knee arthroplasty for extension ankylosis of the knee can achieve satisfactory clinical results,but the operation is difficult and the chance of complications is high, and rehabilitation exercise is very important.%目的:探讨膝关节置换治疗膝关节伸直位强直的方法和疗效。方法:2008年3月至2014年2月,笔者采用膝关节置换治疗膝关节伸直位强直患者13例,男6例,女7例,平均年龄41.4岁(36.0~63.0岁),其中类风湿性关节炎3例,膝关节周围创伤10例;术前膝关节活动度(0±0)°,HSS评分(38±13.80)分,膝关节功能Lysholm评分(15±13.29)分。结果:全部病例行膝关节置换,平均随访48.7

  4. 颞下颌关节继发性强直与幼年期髁状突纵行骨折的关系%Relationship between secondary ankylosis of temporomandibular joint and childhood longitudinal fracture of mandibular condyle

    Institute of Scientific and Technical Information of China (English)

    姚军; 周继林; 胡敏; 洪民; 王燕一


    论:幼年期髁突纵行骨折对TMJ造成严重继发性损伤,髁突纵行骨折与关节强直关系密切.%BACKGROUND: Much attention has been focused on mandibular condyle fracture, which has long been considered as a severe injury to the temporomandibular joint(TMJ). Restricted by diagnostic methods, many studies have been conducted on transverse fracture whereas little attention has been paid to longitudinal fracture of the mandibular condyle. Even less is known about longitudinal fracture in young children.OBJECTIVE: To evaluate the effects of childhood longitudinal fracture of the mandibular condyle on secondary ankylosis of TMJ.DESIGN: A randomized controlled study.SETTING: Department of Stomatology, General Hospital of Chinese PLA.MATERIALS: The experiment was completed in the Center for Experimental Animals, General Hospital of Chinese PLA. Twelve young Chinese experimental miniature pigs bred by the Institute of Experimental Animals, Beijing Agriculture University, aged 2 -3 months and weighing(5 -5.5) kg, were used and raised with mixed feed, and then divided into 3 groups randomly.METHODS: Food and water was forbidden for the miniature pigs 12 hours before operation. Under anesthesia with(5.0 - 15.0) mg/kg ketamine/xylazine abdominally injected, conventional disinfection was performed in the right lateral decubitus position and layer-by-layer preauricular incisions were made on the left side of the miniature pigs. The joint cyst was incised transversely and the lower cavity of TMJ was exposed and dragged downwards. The mandibular condyle was cleaved into two vertically along the inner 1/3 part of it with a 5.0 mm-wide bone chisel to cause inferior and posterior sagittal fractures. The miniature pigs were executed 3 months and 6 months after operation, and their condyles were cut for observation.MAIN OUTCOME MEASURES:①The morphological changes of mandibular condyle specimens in the three groups observed with the naked eyes.②The pathological

  5. 髁突骨折与颞下颌关节强直临床治疗与研究进展——全国第二次髁突骨折及关节强直专题研讨会有感%Condylar fracture and temporomandibular joint ankylosis

    Institute of Scientific and Technical Information of China (English)



    在全国第二次髁突骨折及关节强直专题研讨会报告和讨论内容的基础上,总结国内近5年来在颞下颌关节外科领域的临床与研究方面的进展.相关内容包括:儿童髁突骨折保守治疗与远期效果;髁突骨折手术入路的改进和关键技术;关节盘的重要性及与矢状骨折的同期复位方法;创伤性关节强直的发生机制类似于肥大性骨不连;在关节外科中运用数字外科技术可提高手术的安全性和有效性.%This article summarized the advances in treatment and research of temporomandibular joint surgery in the last 5 years which was presented in "The 2nd Condyle Fracture and Temporomandibular Joint Ankylosis Symposium".The content includes 5 parts:non-surgical treatment of children condyle fracture and long-term follow-up,the improvement of operative approach for condyle fracture and key techniques,the importance and the method for the simultanesous reduction of disc in condylar fracture treatment,the development of traumatic temporomandibular joint ankylosis similar to hypertrophic non-union and the improved safety and accuracy by applying digital surgery in joint surgery.

  6. 人工全髋关节置换在骨性强直髋治疗中的临床及放射学评估%Clinical and radiographic evaluation for total hip arthroplasty in treatment of bony ankylosis of hips

    Institute of Scientific and Technical Information of China (English)

    冯卫; 刘建国; 齐欣; 李冬松; 杨晨; 李叔强; 付莉


    目的:对人工全髋关节置换(THA)在骨性强直髋治疗中的临床及放射学效果进行评估.方法:自2003年1月至2009年8月,20例(30髋)骨性强直的髋关节患者采用THA治疗,其中男12例,女8例;平均年龄36岁.术后临床随访根据Harris评分、患者疼痛缓解满意度、肢体长度差异、髋关节活动范围以及髋关节外展肌力进行评价.X线影像学随访包括对髋臼及股骨柄假体周围骨溶解、假体松动、透光线及异位骨化进行评价.术后平均随访时间为4年.结果:Harris评分由术前的平均(40.75±6.52)分提高至术后平均(86.40±5.42)分;邻近受累关节疼痛完全缓解13例,部分缓解7例;13例外展肌力量恢复满意,跛行症状明显缓解,肢体短缩下降至小于0.5 cm;髋关节活动范围较术前显著改善.放射学评估发现2例髋关节周围异位骨化,1例股骨假体周围透光线,无关节假体脱位及翻修的病例.结论:近期随访发现THA在治疗骨性强直的髋关节中可以获得满意的临床疗效,矫正髋关节畸形,恢复髋关节功能,减轻患髋邻近关节的疼痛,改善患者的生活质量.%Objective;To evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips. Methods: From January 2003 to August 2009,20 patients (30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females,with an average age of 36 years old. After operation,the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score, satisfaction of pain relief, limb length discrepancy, ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis, prosthesis loosening, radiolucent and hetcrotopic ossification. Re-SultS:The average following-up was 4 years. The mean preoperative Harris score was (40

  7. Anquilose intencional dos caninos decíduos como reforço de ancoragem para a tração reversa da maxila: estudo cefalométrico prospectivo Intentional ankylosis of the deciduous canines to enhance maxillary protraction: a prospective cephalometric analysis

    Directory of Open Access Journals (Sweden)

    Omar Gabriel da Silva Filho


    Full Text Available OBJETIVO: o presente trabalho de pesquisa analisou os efeitos da tração reversa da maxila associada à anquilose intencional dos caninos decíduos superiores, mediante o emprego da cefalometria. METODOLOGIA: o protocolo de tratamento incluiu: 1 anquilose intencional dos caninos decíduos superiores; 2 expansão rápida da maxila e 3 tração reversa da maxila, imediatamente após o término da fase ativa da expansão. A amostra foi composta de 18 crianças nos estágios de dentadura decídua e dentadura mista, com idade média inicial de 7 anos e 1 mês. O intervalo médio de tratamento com a tração reversa da maxila foi de 1 ano e 1 mês. As telerradiografias laterais foram obtidas na documentação inicial e após a correção da Classe III. RESULTADOS E CONCLUSÕES: os resultados demonstram que os ângulos representativos da convexidade facial, NAP e ANB, aumentaram de 0º para 6,6º e 3,5º, respectivamente. Isso significa dizer que a face transformou-se de reta ou côncava, peculiar na Classe III, para uma face convexa, característica de normalidade no estágio avaliado. Essa melhora na convexidade facial é atribuída ao avanço da maxila, registrado tanto na região alveolar (ângulo SNA e as distâncias Co-A e NPerp-A como na região basal (ângulo SN.ENA. A maxila deslocou-se para frente, enquanto a redução do ângulo SNB de 80,56º para 79,61º demonstrou um retroposicionamento mandibular. Além da mudança no sentido sagital, houve rotação da mandíbula no sentido horário, com aumento dos ângulos SN.GoGn e SN.Gn. Somado aos efeitos ortopédicos, houve inclinação vestibular dos incisivos superiores.AIM: the current article analyses the effects of maxillary protraction associated to the intentional ankylosis of the deciduous canines on the basis of cephalometric measurements. METHODS: the treatment protocol included: 1 intentional ankylosis of the upper deciduous canines; 2 rapid palatal expansion and 3 maxillary

  8. Pseudo-ankylosis caused by osteoma of the coronoid process (United States)

    da Costa Araújo, Fábio Andrey; Melo Barbalho, Jimmy Charles; de Farias, Orley Nunes; de Vasconcellos, Ricardo José Holanda; do Egito Vasconcelos, Belmiro Cavalcanti


    Osteoma of the coronoid process is a rare, slow-growing tumor that can lead to restrictive mandibular movements. This paper describes a case of osteoma of the right coronoid process in a 45-year-old woman who reported progressive facial asymmetry and the loss of mandibular movements. Aspects regarding the differential diagnosis, treatment, surgical access, possible complications and postoperative follow up of the case are also discussed. The osteoma of the coronoid process is a benign tumor that can reach a significant size, causing an increase in volume, facial asymmetry, limited mouth opening and fracture of the zygomatic complex in some cases. The combination of extraoral and intraoral accesses is useful in the case of large tumors of difficult access, such as in this case reported. PMID:25593877

  9. Autosomal recessive mental retardation, deafness, ankylosis, and mild hypophosphatemia associated with a novel ANKH mutation in a consanguineous family

    NARCIS (Netherlands)

    Morava, E.; Kuhnisch, J.; Drijvers, J.M.; Robben, J.H.; Cremers, C.W.R.J.; Setten, P. van; Branten, A.J.W.; Stumpp, S.; Jong, A. de; Voesenek, K.E.J.; Vermeer, S.; Heister, A.; Claahsen-van der Grinten, H.L.; O'Neill, C.W.; Willemsen, M.H.; Lefeber, D.J.; Deen, P.M.T.; Kornak, U.; Kremer, J.M.J.; Wevers, R.A.


    CONTEXT: Mutations in ANKH cause the highly divergent conditions familial chondrocalcinosis and craniometaphyseal dysplasia. The gene product ANK is supposed to regulate tissue mineralization by transporting pyrophosphate to the extracellular space. OBJECTIVE: We evaluated several family members of

  10. Congenital bony fusion (absence) of the knee: a case report. (United States)

    Madadi, F; Kahlaee, A H; Sarmadi, A; Madadi, Fi; Sadeghian, R; Emami, T M M; Abbasian, M R


    Congenital knee ankylosis is a rare condition which might be accompanied with other abnormalities or not. To our knowledge, there is no report on true bony ankylosis of the knee. The only ones in the literature include fibrous knee ankylosis. Thus this seems to be the first presentation of true congenital bony fusion of the knee joint.

  11. CPM机预防股骨髁上、髁间骨折术后膝关节僵直调查%Survey of CPM for Treatment of Knee ankylosis after Supracondylar and Intercondylar Fracture of Femur

    Institute of Scientific and Technical Information of China (English)




  12. 创伤性颞下颌关节强直的病程特点与分类治疗%Posttraumatic temporomandibular joint ankylosis:clinical development and surgical management

    Institute of Scientific and Technical Information of China (English)

    张益; 何冬梅; 马绪臣


    目的 调查创伤性颞下颌关节强直(TMJA)的髁突骨折类型及病程特点;探讨各分类治疗.方法 及疗效.方法 31例42侧创伤性TMJA,按Sawhney分类分成4型.Ⅰ型和Ⅱ型强直分别行关节松解和融合骨切除术+关节盘复位术;Ⅲ型和Ⅳ型强直分别行全关节切除和全关节扩大切除术+颞肌筋膜瓣衬垫术、选择性下颌支后缘垂直骨牵引及颏成形术.术后复查9~54个月(平均30个月),评价治疗效果.回顾调查引起强直的髁突骨折类型和强直发生的过程.手术与CT及MRI对照观察早期骨化部位、关节盘移位和关节残余运动方式.结果 创伤性TMJA均继发于髁突矢状和粉碎性骨折,且关节盘发生移位者.Ⅰ型(纤维性)强直通常出现在伤后4~5个月,平均张口度18.3 mm.术中探及的关节盘全部发生移位,早期强直骨化发生在无关节盘区域.随诊期内,2例(6.45%)复发,其他患者张口度均稳定维持在30 mm以上.结论 髁突矢状和粉碎性骨折是最容易导致关节强直的骨折类型.关节盘移位是强直形成的重要因素.早期手术可以复位关节盘,避免后期强直时必须切除全关节.

  13. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis. (United States)

    Lories, Rik J U; Luyten, Frank P; de Vlam, Kurt


    Targeted therapies that neutralize tumour necrosis factor are often able to control the signs and symptoms of spondyloarthritis. However, recent animal model data and clinical observations indicate that control of inflammation may not be sufficient to impede disease progression toward ankylosis in these patients. Bone morphogenetic proteins and WNTs (wingless-type like) are likely to play an important role in ankylosis and could be therapeutic targets. The relationship between inflammation and new bone formation is still unclear. This review summarizes progress made in our understanding of ankylosis and offers an alternative view of the relationship between inflammation and ankylosis.

  14. Treatment of replacement resorption by intentional replantation, resection of the ankylosed sites, and Emdogain--results of a 6-year survey. (United States)

    Filippi, Andreas; Pohl, Yango; von Arx, Thomas


    The present clinical study investigated the outcome of intentional replantation using resection of the ankylosed sites of the root, extraoral endodontic treatment using titanium posts and Emdogain for periodontal healing following trauma-related ankylosis. During an evaluation period of 6 years, 16 ankylosed teeth affected by replacement resorption were treated as described. Evaluation parameters before treatment and during the follow-up period included Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. In a second accident, one tooth was lost after 7 months and was excluded as a dropout. Ankylosis did not recur in seven replanted teeth, which were observed for an average of 52.3 months (range: 24-68 months). Ankylosis recurred in eight teeth after an average period of 12 months (range: 4-26 months). An infraocclusion, normal or only slightly reduced Periotest scores and normal percussion sound were preoperatively found in six of seven successfully replanted teeth, which corresponded to a relatively small area of ankylosis. The majority of the teeth showing recurrent ankylosis preoperatively presented with normal position, negative Periotest scores and a high percussion sound which corresponded to an extended area of ankylosis. Statistically significant relationship between preoperative findings and the treatment outcome (P = 0.031) have become apparent. The results indicate that the treatment of minor areas of ankylosis by intentional replantation, resection of the ankylosed sites and Emdogain appeared to prevent or delay the recurrence of ankylosis in 7 of 15 teeth.

  15. Emdogain does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study. (United States)

    Schjøtt, M; Andreasen, J O


    Emdogain has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis. The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain was not able to prevent or cure ankylosis.

  16. Failures in the treatment of pseudoarthroses; Problem niepowodzen w leczeniu stawow rzekomych

    Energy Technology Data Exchange (ETDEWEB)

    Konarski, K.; Piotrowski, W.; Trubisz, L.; Michalski, S. [Szpital im. J. Jonstona, Lublin (Poland)


    Failure analysis in the treatment of pseudoarthroses has been presented. It was noted that ankylosis within adjacent joints may lead to nonunion or refracture. Vascular disorders of various origins remain the dominant cause of failure. (author). 5 refs, 10 figs.

  17. AcEST: BP921008 [AcEST

    Lifescience Database Archive (English)

    Full Text Available RAJU Cysteine synthase OS=Brassica juncea PE=2 ... 30 4.3 sp|P58366|ANKH_RAT Progressive ankylosis protein h...omolog OS=Ratt... 30 4.3 sp|Q9JHZ2|ANKH_MOUSE Progressive ankylosis protein OS=Mu...s muscul... 30 4.3 sp|Q9HCJ1|ANKH_HUMAN Progressive ankylosis protein homolog OS=Ho... 30 4.3 sp|Q9W7R4|TEN3...1_ARATH Cysteine synthase OS=Arabidopsis thaliana ... 30 5.6 sp|P58367|ANKH_XENLA Progressive ankylosis prot...K 345 P IWK GK+DG I G T+ A K +K Sbjct: 165 PEIWKGTEGKIDGFISGIGTGGTITGAGKYLK 196 >sp|P58366|ANKH_RAT Progress

  18. 髋关节表面置换治疗强直性脊柱炎合并髋关节强直围术期护理%Perioperative Nursing of Hip Resurfacing Arthroplasty for Ankylosing Spondylitis combined with Hip Ankylosis

    Institute of Scientific and Technical Information of China (English)

    吴文萍; 傅利勤; 王国瑞; 孙徐妹; 王小艺; 王天真


    @@ 强直性脊柱炎(ankylosing spondylitis,AS)极易造成严重的关节畸形[1-2].该病是一种血清阴性型脊柱关节病,以骶髂关节、脊柱关节和外周关节炎症为典型特征[2-5].Kubiak等[1]报道,30%~50%的强直性脊柱炎患者存在髋关节病变.

  19. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis



    Targeted therapies that neutralize tumour necrosis factor are often able to control the signs and symptoms of spondyloarthritis. However, recent animal model data and clinical observations indicate that control of inflammation may not be sufficient to impede disease progression toward ankylosis in these patients. Bone morphogenetic proteins and WNTs (wingless-type like) are likely to play an important role in ankylosis and could be therapeutic targets. The relationship between inflammation an...

  20. Superficial temporal myofascial flap application in temporomandibular joint arthroplasty in a cat

    Directory of Open Access Journals (Sweden)

    Lisa A Mestrinho


    Full Text Available Case summary A 2-year-old, intact female domestic longhair cat was referred for surgical treatment after diagnosis of closed jaw locking secondarily to right temporomandibular joint ankylosis and left pseudoankylosis. The animal underwent successful surgical management with bilateral excision arthroplasty followed by interposition of a temporal superficial myofascial flap. Immediately after surgery, the full range of lower jaw movement was achieved and normal occlusion was maintained. Ankylosis did not recur in the 1 year postoperative follow-up period. Relevance and novel information A temporal myofascial flap could be considered as interposition material after temporomandibular joint arthroplasty to avoid postoperative re-ankylosis and mandibular drift. The main advantages of this flap are its autogenous origin, and the ability to maintain separation between the two bones, preserve mobility and disrupt new bone formation.

  1. Transarticular invasion of the sacroiliac joints by malignant pelvic bone tumors

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hwang Woo; Huh, Jin Do; Kim, Seong Min; Cho, Young Duk [College of Medicine, Kosin Univ., Pusan (Korea, Republic of); Cho, Kil Ho [College of Medicine, Yeungnam Univ., Daegu (Korea, Republic of)


    To describe modes of transarticular invasion, with reference to the size and location of a tumor, the anatomic characteristics of invaded cartilage,and the existence of ankylosis in SI joint. Eleven histologically confirmed malignant pelvic bone tumors involving transarticular invasion of sacroiliac joints, were retrospectively analysed. Transarticular invasion of a joint was defined as involvement of its opposing bones. The anatomic site and size of the tumors were analysed, and invaded sacroiliac joint was divided into upper, middle and lower parts on the basis of the anatomic characteristics of the intervening cartilage: synovial hyaline or fibrous ligamentous. the existence of ankylosis was determined, and transarticular invasion directly across a joint was classified as direct invasion. Extension of tumors around a joint from its periphery to the opposing bone were considered as indirect invasion. All tumors were located near the sacroiliac joint, eight at the ilium and three at the sacrum. Six invasions were indirect and five were direct. Average tumor area was larger in indirect cases than in direct: 191.8 cm{sup 2} vs. 69.6 cm{sup 2}. In all indirect invasions, a huge soft tissue mass abutted onto the peripheral portion of the sacroiliac joint. In five of six cases of indirect transarticular invasion, the upper part of the joint posteriorly located fibrous ligamentous cartilage. In the other, the lower part was invaded, and this involved a detour around the joint space, avoiding the invasion of intervening cartilage. Ankylosis occurred in one of the indirect cases. Among the five cases of direct invasion, there was invasion of the posteriorly located ligamentous fibrous cartilage in three without ankylosis. In the other two cases, involving ankylosis, the synovial hyaline cartilage was invaded directly at the lower part of the joint. Transarticular invasions of sacroiliac joint via fibrous cartilage are most common. Ankylosis of the sacroiliac joint

  2. Central incisor loss after delayed replantation following avulsion: a contemporary restorative and adjunctive orthodontic management approach. (United States)

    Savi, Andrea; Turillazzi, Oliviero; Cocconi, Renato; Bonanini, Mauro; Pizzi, Silvia; Manfredi, Maddalena


    Delayed replantation of an avulsed tooth may result in rapid root resorption or, more frequently, dental ankylosis with subsequent bone substitution. If this process develop slowly, it is possible to observe that tooth loss is characterized by a well conserved alveolus with regard to bone preservation, particularly in vertical dimension. This clinical case reports a dental trauma of a central incisor in a young boy characterized by tooth avulsion and its delayed replantation. After 10 years, dental ankylosis of the incisor was recorded and the patient underwent a prosthetic-orthodontic rehabilitation using CAD-CAM technology and no-prep veneers.

  3. Functional exercise after high temporomandibular joint plastic surgery%高位颞下颌关节成形术后的功能康复

    Institute of Scientific and Technical Information of China (English)

    洪霞; 羊玉荣; 赵丽


    Objective To investigate the impact of functional exercise following high temporomandibular joint plastic surgery on functional recovery.Methods High temporomandibular joint plastic surgery was performed on 31 patients suffered from temporomandibular ankylosis.Titanium fragment and pedicle fascia were inserted.Functional exercise as well as locally hot compress and healthy education were carried out after operation.Results 29 subjects showed favorable functional recovery.Results showed 2 subjects developed ankylosis again due to poor mouth opening training (2/31).Conclusion Functional exercise after high temporomandibular joint plastic surgery is effective for recovery of temporomandibular joint functional.

  4. Bamboo spine – X-ray findings of ankylosing spondylitis revisited

    Directory of Open Access Journals (Sweden)

    Antoinette Reinders


    Full Text Available Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions, florid diskitis (Andersson lesions, early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures. Typical radiological abnormalities are pointed out on conventional X-rays and reviewed for early diagnosis and prompt treatment of patients at risk.

  5. On the biology of the bony otic capsule and the pathogenesis of otosclerosis

    DEFF Research Database (Denmark)

    Bloch, Sune Land


    In human otosclerosis, focal pathological bone remodeling occurs in significant amounts inside the normally anti-resorptive perilabyrinthine domain of the bony otic capsule. Otosclerosis causes hearing loss in 0.2-0.5% of the population by ankylosis of the footplate. The disease cannot be predicted...

  6. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove


    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify...

  7. The efficacy of early functional exercise in burns patients%烧伤病人早期功能锻炼体会

    Institute of Scientific and Technical Information of China (English)

    吴俊波; 孔繁英; 杨梅


    @@ Background:Scar and hyperplasia will lead to contracture malformation and dysfunction following severe burn of face,neck and joints of limbs.Functional exercise should be carried out in the early phase to prevent ankylosis,soften scar and reduce malformation positively.

  8. Actis Total Hip System 2 Year Follow-up (United States)


    Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital and Femoral Neck Fractures in the Elderly

  9. Clinical Outcomes Study of the Nexel Total Elbow (United States)


    Elbow Joint Destruction; Post-traumatic Lesions; Ankylosed Joints; Advanced Rheumatoid Arthritis; Joint Instability or Loss of Motion; Acute Comminuted Articular Fracture of Elbow Joint Surfaces; Bone Loss Contributing to Elbow Instability; Bilateral Ankylosis From Causes Other Than Active Sepsis; Post-traumatic, or Degenerative Arthritis With Incapacitating Pain

  10. 下肢骨折后膝关节的功能锻炼%Functional training of knee joint after fracture of lower limb

    Institute of Scientific and Technical Information of China (English)



    @@ BACKGROUND:In treatment of fracture of lower limb, clinical healing of fracture needs a long time after replace and immobilization. But clinical healing does not represent complete recovery of joint function.Knee ankylosis or stiffness could happen if not treated properly in this term.

  11. 77 FR 19293 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Meeting (United States)


    ... osteoarthritis, avascular necrosis, post-traumatic arthritis, ankylosis, protrusio acetabuli, and painful hip...: a. Non-inflammatory degenerative arthritis such as osteoarthritis, traumatic arthritis, avascular... Panel of the Medical Devices Advisory Committee beginning on March 30, 2012, and closing on May 9,...

  12. Combination therapy for pain management in inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)

    NARCIS (Netherlands)

    S. Ramiro; H. Radner; D. van der Heijde; A. van Tubergen; R. Buchbinder; D. Aletaha; R.B.M. Landewé


    Despite optimal therapy with disease-modifying antirheumatic drugs, many people with inflammatory arthritis (IA) continue to have persistent pain that may require additional therapy. To assess the benefits and safety of combination pain therapy for people with IA (rheumatoid arthritis (RA), ankylosi

  13. Multidisciplinary Treatment Options of Tooth Avulsion Considering Different Therapy Concepts (United States)

    Kostka, Eckehard; Meissner, Simon; Finke, Christian H; Mandirola, Manlio; Preissner, Saskia


    Background: Avulsion of permanent front teeth is a rare accident, mostly affecting children between seven and nine years of age. Replanted and splinted, these teeth often develop inflammation, severe resorption or ankylosis affecting alveolar bone development and have to be extracted sooner or later. Objectives: The purpose of this study was to evaluate different therapy concepts to create a structured concept for the treatment of avulsions. Results: Based on existing therapy concepts, a concept for different initial conditions (dry time, age, growth, tooth, hard and soft tissues) was developed and is presented here. Conclusion: A great deal of research has been performed during recent years and guidelines for the management of avulsions have been published. With the help of this literature it is possible to identify the best treatment procedure for each tooth. Clinical Relevance: The prognosis of avulsed teeth can be improved by considering evidence-based therapy concepts. Resorption, ankylosis and tooth loss could be minimized. PMID:25352922

  14. First experiences with simultaneous skeletal and soft tissue reconstruction of noma-related facial defects. (United States)

    Giessler, Goetz A; Borsche, André; Lim, Paul K; Schmidt, Andreas B; Cornelius, C-Peter


    Noma victims suffer from a three-dimensional facial soft-tissue loss. Some may also develop complex viscerocranial defects, due to acute osteitis, chronic exposure, or arrested skeletal growth. Reconstruction has mainly focused on soft tissue so far, whereas skeletal restoration was mostly avoided. After successful microvascular soft tissue free flap reconstruction, we now included skeletal restoration and mandibular ankylosis release into the initial step of complex noma surgery. One free rib graft and parascapular flap, one microvascular osteomyocutaneous flap from the subscapular system, and two sequential chimeric free flaps including vascularized bone were used as the initial steps for facial reconstruction. Ankylosis release could spare the temporomandibular joint. Complex noma reconstruction should include skeletal restoration. Avascular bone is acceptable in cases with complete vascularized graft coverage. Microsurgical chimeric flaps are preferable as they can reduce the number and complexity of secondary operations and provide viable, infection-resistant bone supporting facial growth.

  15. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Wichuk, Stephanie; Chiowchanwisawakit, Praveena


    INTRODUCTION: Radiography is an unreliable and insensitive tool for the assessment of structural lesions in the sacroiliac joints (SIJ). Magnetic resonance imaging (MRI) detects a wider spectrum of structural lesions but has undergone minimal validation in prospective studies. The Spondyloarthritis...... Research Consortium of Canada (SPARCC) MRI Sacroiliac Joint (SIJ) Structural Score (SSS) assesses a spectrum of structural lesions (erosion, fat metaplasia, backfill, ankylosis) and its potential to discriminate between therapies requires evaluation. METHODS: The SSS score assesses five consecutive coronal...... slices through the cartilaginous portion of the joint on T1-weighted sequences starting from the transitional slice between cartilaginous and ligamentous portions of the joint. Lesions are scored dichotomously (present/absent) in SIJ quadrants (fat metaplasia, erosion) or halves (backfill, ankylosis...

  16. Remodelación ósea en espondiloartritis


    Bautista-Molano,Wilson; Romero-Sánchez,Consuelo; De Ávila,Juliette; Londoño,John; Valle-Oñate, Rafael


    Spondyloarthritis is a group of several related but phenotypically distinct chronic inflammatory diseases, characterized by progressive new bone formation which leads to ankylosis and functional disability. Radiographic images evidence not only erosive changes but also overgrowth of bony structures called syndesmophytes. These inflammation, bone destruction and new bone formation are located in the entheses, which constitutes the primary organ of the disease. As a consequence, the inflammator...

  17. Pierre Robin Sequence: A Familial, Clinical, and Pathoanatomical Record of an Affected Dachshund. (United States)

    Moura, Enio; Wagner, José L; Cirio, Silvana M; Pimpão, Cláudia T


    This study describes a spontaneous case of Pierre Robin sequence in a nonhuman animal species. A miniature dachshund with micrognathia developed glossoptosis, respiratory distress, dysphagia, temporomandibular ankylosis, and a misaligned upper jaw. The severity of this condition resulted in death by obstructive apnea at the age of 8 mo. Dogs with Pierre Robin sequence can provide further knowledge and a greater understanding of this abnormality, leading to better management of affected individuals and improvement of therapeutic methods.

  18. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Kundan Sandugir Gosavi


    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  19. [Dento-alveolar injuries]. (United States)

    Voorsmit, R A; Kuijpers-Jagtman, A M


    Most dento-alveolar traumas can be managed by the dentist-general practitioner. Still, there are some specific injuries which should be treated by dental specialists. Some specific guidelines are given for the combined surgical-orthodontic treatment of fracture of the coronal part of the root, intrusive luxation, abnormal position of the permanent tooth due to traumatic displacement of the deciduous tooth, ankylosis and tooth loss.

  20. Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach

    Directory of Open Access Journals (Sweden)

    Neeraj Patni


    Full Text Available Patients with ankylosing spondylitis (AS are at an increased risk of spinal fractures due to the altered spinal biomechanics. Moreover, it is difficult to treat these fractures due to the combination of ankylosis and osteoporosis. We report successful management of a C6-C7 vertebral fracture in a patient with AS. The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

  1. 强直性脊柱炎胸腰段后凸畸形矫形设计的关键问题%Key points in the design of deformity correction of thoracolumbar kyphosis with ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)



    For patients of thoracolumbar kyphosis with ankylosing spondylitis ( AS ), it is signiifcant to reconstruct the sagittal balance and the chin-brow vertical angle by spinal osteotomy. Relocation of the center of gravity to pelvic neutral positional line is the key to reconstruct sagittal balance. In addition, chin-brow vertical angle is also important for patients with cervical ankylosis. Better outcomes depend on the selection of optimal osteotomy level.

  2. Arthrogryposis multiplex congenita - a rare congenital stiff joints syndrome


    Velisavljev-Filipović Gordana


    Introduction: Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of...

  3. Ankylosing Spondylitis: a Reflection and a Question

    Directory of Open Access Journals (Sweden)

    Annia Deysi Hernández Martín


    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question.

  4. Prevalence of CT features of axial spondyloarthritis in patients with Crohn's disease. (United States)

    De Kock, Isabelle; Hindryckx, Pieter; De Vos, Martine; Delrue, Louke; Verstraete, Koenraad; Jans, Lennart


    Background The sacroiliac joint and spine are seen on abdominal computed tomography (CT) and may show structural lesions as part of spondyloarthritis. Purpose To determine the prevalence of CT features of spondyloarthritis in patients with Crohn's disease (CD). Material and Methods A retrospective study of structural lesions of spondyloarthritis on abdominal CT was performed. The sacroiliac joints and spine of 120 patients were studied: study group I consisted of 40 patients with known CD and inflammatory back pain, group II involved 40 patients with CD without inflammatory back pain, and group III consisted of 40 patients without known joint or inflammatory bowel disease. Recorded CT features included sclerosis, erosions or ankylosis of the sacroiliac joint, enthesopathy, spinal syndesmophytes, and costovertebral joint lesions. Results CT showed structural lesions of the sacroiliac joints in 19/40 (48%) patients with CD and inflammatory back pain (sclerosis [n = 14; 35%], erosions [n = 14; 35%], ankylosis [n = 3; 8%]), in 8/40 (8%) patients with CD without inflammatory back pain (sclerosis [n = 3; 8%], erosions [n = 4; 10%], ankylosis [n = 3; 8%]), and in 3/40 (8%) patients without known joint or bowel disease (sclerosis [n = 2; 5%], ankylosis [n = 1; 3%]). Syndesmophytes were exclusively seen in group I (n = 6; 15%). Conclusion CT of the abdomen in patients with CD and inflammatory back pain shows structural lesions of the sacroiliac joint, entheses, or spine in almost half of the patients. Awareness and knowledge of these findings may guide the referring clinician to further clinical evaluation, imaging, and biomarker evaluation of the disease.

  5. Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis


    Kim, Do Youn; Lee, Seok Jeong; Ryu, Yon Ju; Lee, Jin Hwa; Chang,Jung Hyun; Kim, Yookyung


    Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosi...

  6. Analysis of Miscellaneous Human Osteological Remains Recovered from Multi-County Areas of South Dakota (United States)


    concentration was derived by dividing the skeleton into four parts: the skull (and hyoid) accounting for 15%; the axial and thoracic skeletons accounting for...There is no evidence of osteophytosis, nor of the "dripping candle wax" effect associated with ankylosing spondylitis . Ankylosis is complete...or DJD) or vertebral osteophytosis ( spondylitis deformans) (Gregg and Gregg 1987; Ortner and Putscar 1981; Steinbock 1976). Seven individuals displayed



    Сидоренко, А.; Петросов, Ю.; Сеферян, К.; Калпакьянц, М.


    The daili of long standing observation of children and adolescents having fibrous ankylosis of temporomandibular joint are given in the article. Orthopedic apparatuses aimed at stretching and breaking of fibrous adhesions have been developed. The methods of intergrated treatment using various orthopedic appararares are described in detail (intraoral flexing apparatus, the apparatus with a sloping plane, etc). The advantage offered method in comparison with the surgical one is preserving of th...

  8. Arthrogryposis Multiplex: A Case Report La artrogriposis múltiple: a propósito de un caso



    Congenital muscular dystrophies appear from birth or early infancy with hypotonia and loss of proximal or generalized muscle strength. Contractures at birth are called arthrogryposis. Arthrogryposis multiplex is a disorder that is identified by congenital stiffness of one or more joints, caused by hypoplasia of the muscles in the region and also by an incomplete fibrous ankylosis. Some experts have attributed the disease to a prolonged intrauterine compression, but others propose that it is m...

  9. Cementable implant-supported prosthesis, serial extraction, and serial implant installation: case report. (United States)

    Rosen, Harry; Gornitsky, Mervyn


    Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.

  10. Late reconstruction of condylar neck and head fractures. (United States)

    Davis, Ben


    Condyle fractures are a common injury, but only a few of these injuries require immediate or late reconstruction. The complications that most frequently necessitate condylar reconstruction include proximal segment degeneration, malunion, and ankylosis. Costochondral grafts and total joint prostheses, both stock and custom, remain the most common methods of reconstruction. Reconstruction plates with condylar extensions should only be used temporarily as an unacceptable number cause serious complications. Distraction osteogenesis may have an occasional role in reconstructing the posttraumatic condyle.

  11. Cell Therapy To Obtain Spinal Fusion (United States)


    peritoneal perforation, sacroiliac joint instability, and herniation of abdominal contents through defects in the ilium [8]. Furthermore, the volume of...M, Zhang Y, Senitzer D, Forman SJ, Emerson SG 2007 Hematopoietic stem-cell contribution to ectopic skeletogenesis. J Bone Joint Surg Am 89(2):347...becomes weight bearing. It readily fuses to the skeletal bone, and often leads to ankylosis of the joints . Harnessing this capacity in a targeted

  12. Septic arthritis of the temporomandibular joint caused by Aspergillus flavus infection as a complication of otitis externa. (United States)

    Varghese, Lalee; Chacko, Rabin; Varghese, George M; Job, Anand


    Septic arthritis of the temporomandibular joint (TMJ) is a very rare complication of otitis externa that can lead to ankylosis and destruction of the joint. We report the case of a 74-year-old man who developed aspergillosis of the TMJ following otitis externa. To the best of our knowledge, this is the first reported case of TMJ septic arthritis secondary to otitis externa caused by Aspergillus flavus. The patient was successfully managed with condylectomy, debridement, and drug treatment with voriconazole.

  13. Perosomus elumbis in a day old udah neonate lamb in Sokoto, Nigeria

    Directory of Open Access Journals (Sweden)

    A. Bello


    Full Text Available Perosomus elumbis is a rare congenital anomaly of unknown aetiology. It is characterized by errors of morphogenesis resulting in multi-organs malformations that produce a deformity of the caudal one third of the foetus. Spinal and pelvic malformations are evident, structural anomalies such as arthrogryposis of the hind limbs, ankylosis of joints, with associated malformations of the musculature. This is a case of a new born Uda lamb, with the Chief complaint of inability to stand two hours after lambing. History revealed that the dam delivered them as twins, one of which was normal. On clinical examination the lamb was recumbent but alert. The fore limbs were well developed and appeared normal. The lumbo-sacral area was excessively narrow, with a skin fold attaching the crus (Tibia and Fibula. There was an ankylosis of the stifle and hock joint and were maintained in a flexed position. The response to pin prick on the hind limb was poor. However, both anal and vulval openings were patent. Radiography revealed hypoplasia of the lumbar vertebrae, pelvic girdle, the iliac wing, the ischium and the pubis. There is a convergence of the lschial arches towards the public symphisis; the wing of the ischium is absent bilaterally. There is an ankylosis of the stifle and tarsal joints in flexed position. However, all the bones of the hind limbs are present.

  14. Bone pathology inpsoriatic arthritis

    Directory of Open Access Journals (Sweden)

    V. V. Badokin


    Full Text Available Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA. Results. Different types of osteolysis were revealed in 80 (21,6% pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively. Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

  15. Post-traumatic bifid mandibular condyle: A case report and literature review (United States)

    Woo, Min-Ho; Yoon, Kyu-Ho; Park, Jae-An


    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC. PMID:27672618

  16. Canine transmigration accompanying mandibular retrognathism secondary to osteitis

    Directory of Open Access Journals (Sweden)

    Koszowski Rafał


    Full Text Available Transmigration is a tooth pathology in which the migrating tooth bud passes the median plane. Methods: This study is a presentation of the diagnostic and therapeutic outcomes in the cases of 4 stomach teeth transmigrations diagnosed in 3 patients with mandibular retrognathia which was a complication after osteitis in the postnatal period and infancy. Results: Extending imaging diagnostics to include CT, most preferably CBCT, makes it possible to precisely evaluate a transmigrated canine’s position and to plan a course of treatment. Conclusions: Planning of the treatment of teeth in transmigration in patients with temporomandibular ankylosis should be done by a team consisting of an orthodontist and a surgeon.

  17. Medial talo-calcaneal coalition. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Daly, B.D.; Towers, M.J.; Hamilton, S.


    Medial talo-calcaneal coalition is an uncommon developmental anomaly consisting of a bony projection arising from the postero-medial aspect of the sustentaculum tali, which may articulate with another bony projection from the medial aspect of the talus. Fibrous, cartilaginous or bony ankylosis may occur. It usually presents in adolescents, and causes pain following exercise. It may cause a lump, and can predispose to flat foot and early osteoarthrosis. This condition is easily overlooked on routine views of the ankle, and may require oblique views and tomography for its detection and clarification.

  18. Resection arthroplasty of the hip in paralytic dislocations. (United States)

    Kalen, V; Gamble, J G


    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  19. 股骨髁上骨折应用L形加压钢板内固定后的早期康复治疗%The early rehabilitation intervention after internal fixation English Column with L-shaped compression armor plate for supracondylar fracture of femur

    Institute of Scientific and Technical Information of China (English)

    岳红卫; 李国顺


    Background: The thickness and width of L shaped armor plate can antagonize muscle traction with the ability of anti inflecting, anti torsion and anti shearing force, which overcomes the weakness of common armor plate and osseous pin that have weaker fixation force and need external fixation. The fixation can satisfy the request of early functional training. And the functional training can be performed on the continuous passive movement (CPM) instrument 1 week after operation to prevent adhesion of knee joint, elasticity losing in soft tissue around joint, ankylosis, osteoporosis and osteoarthritis.

  20. Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento-osseous osteotomy, vertical alveolar distraction osteogenesis, and mini-implant anchorage. (United States)

    Senışık, Neslihan Ebru; Koçer, Gülperi; Kaya, Bulem Üreyen


    Dentoalveolar ankylosis interferes with the vertical growth of the alveolar process, which can lead to an open bite, an unesthetic smile, and occlusal disharmony. This case report presents a new treatment protocol for an ankylosed tooth with severe root resorption using a combined surgical orthodontic management protocol involving a single-tooth dento-osseous osteotomy and vertical alveolar distraction osteogenesis with intraoral elastics and mini-implant anchorage. After distraction and active orthodontic treatment, the patient's anterior open bite was corrected. A Class I dental relationship was achieved, overjet was decreased, and a normal incisor relationship was obtained.


    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin


    Progression of RA leads to articular cartilage and bone destruction and ligament and tendon damage over time. Incompetence of the ligamentous apparatus may cause dorsal subluxation of the radius. In late RA, bone erosions are detectable in practically all patients. This is the most characteristic X-ray symptom of polyarthritis. Extensive and multiple destructive changes in the joints are accompanied by the development of their multiple subluxations, dislocations, and contractures. In addition to destructive changes in the joints, most deformities are associated with their tendinous and liga-mentous looseness and ruptures and with the rearrangement of normal muscle tension around one joint or more. Articular ankylosis occurs in late RA

  2. Management of Mandibular Hypoplasia Using Distraction Osteogenesis Technique

    Institute of Scientific and Technical Information of China (English)

    陶学金; 樊敏; 凌翔; 陈卫民


    Summary: By using distraction osteogenesis technique, 3 cases of mandibular hypoplasia were treated by home-made and German-made jaw distractors: including one patient suffered from bilateral ankylosis of temporo-mandibular joint and 2 patients from deficiency of mandible. The duration of distraction osteogenesis was one month. The bone distractor was removed 3 months after operation. Satisfactory results were obtained in all 3 cases. Distraction osteogenesis can successfully be used in mandibular functional reconstruction and has much more advantages than traditional technique.

  3. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V


    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  4. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V


    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  5. Management of a Severely Submerged Primary Molar: A Case Report

    Directory of Open Access Journals (Sweden)

    Iman Parisay


    Full Text Available Ankylosis is a condition frequently associated with primary molars, wherein the ankylosed primary teeth remain in a fixed position, while the adjacent teeth continue to erupt, moving occlusally. In this case report, a five-year-old boy, who had a retained and submerged left lower second primary molar, was presented. Luxation of ankylosed primary molar was considered as a treatment approach. After four months, the tooth erupted to the occlusal level, and there was evidence of further development of a permanent successor in radiographic evaluation. After one year, tooth mobility, bone formation, and development of a permanent successor were in good condition.

  6. Post-traumatic bifid mandibular condyle: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Min Ho; Yoon, Kyu Ho; Park, Kwan Soo; Park, Jae An [Dept. of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of)


    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC.

  7. [Textual research on "Chigu Decoction" in Wooden Slips from the Site of the Ancient People's Dike in Zhangjiajie]. (United States)

    Ding, Yuan; Zhang, Ru-Qing


    In 1987, wooden slips named Zhi Chigu Fang (Chigu Decoction) were discovered on the site of the Ancient People's Dike in Zhangjiajie, Hunan Province. 15 drugs with dosage were listed on the front of the wooden slip and processing on the reverse side. Though there are two academic opinions about Chigu Decoction neither of them is convincing. Zhi means treatment and Chigu is the name of an ancient exogenous febrile disease with the symptoms of aversion to cold, fever, headache and neck pain, ankylosis, cough and asthma or cold pain in the gastric area and diarrhea. Chi is a descriptive word describing the appearance of exogenous febrile fever.

  8. Schistosomus reflexus in a red sokoto doe

    Directory of Open Access Journals (Sweden)

    A. Bello


    Full Text Available Dystocia was observed in a primiparous One year old Red Sokoto Doe and was relieved manually, the fetus was observed to be monstrous and gross pathological examination showed; cleft sternum, scoliosis, abdominal and thoracic evisceration, absence of diaphragm, pulmonary hypoplasia, malpositioned kidney and heart, spinal inversion and limb ankylosis. The digestive, respiratory, cardiovascular, urogenital and skeletal system anomalies were observed in this report. Many of the malformations and malpositioning have been previously reported. The above clinical findings suggest Schistosomus Reflexus. 

  9. Comparison between conventional tomography and computer tomography in diseases of the sacroiliac joints. Vergleich von konventioneller Tomographie und Computertomographie bei Erkrankungen der Sakroiliakalgelenke

    Energy Technology Data Exchange (ETDEWEB)

    Moritz, J.D.; Ganter, H.; Winter, C. (Bundeswehrkrankenhaus, Giessen (Germany, F.R.). Roentgenabteilung Evangelisches Krankenhaus, Giessen (Germany, F.R.). Roentgenabteilung)


    16 patients with diseases of the sacroiliac joints were examined both with computer tomography and with conventional tomography. Both techniques were characterized by a high sensitivity. Computer tomography was superior in exactly delineating the extent of the pathologic changes. In conventional tomography the joint surface was more blurred, erosions were larger, and signs of ankylosis were more expanded, so that the joints seemed to be more altered in 8 cases than demonstrated by computer tomography. Very accurate changes like subchondral cysts were recognized only in the computer tomograms. In all cases in which anteroposterior radiographs revealed no clear result, the authors recommend to additionally employ computer tomography. (orig.).

  10. Chronic sclerosing osteomyelitis of the iliac bone. Etiological possibilities

    Energy Technology Data Exchange (ETDEWEB)

    Jurik, A.G.; Moeller, S.H.; Mosekilde, L.


    An adolescent with chronic recurrent multifocal osteomyelitis located to both iliac bones and an adult with pustulotic arthro-osteitis, involving the left iliac bone, an invertebral space, and the sternoclavicular, first sternocostal, manubriosternal and single peripheral joints are described. Their iliac bone changes were identical, except for the occurrence of bilateral changes in the adolescent, and ankylosis of the sacroiliac joint in the adult. It is suggested that chronic recurrent multifocal osteomyelitis and pustulotic arthro-osteitis may be related diseases with age-dependent differences.

  11. The biomechanical role of periodontal ligament in bonded and replanted vertically fractured teeth under cyclic biting forces

    Institute of Scientific and Technical Information of China (English)

    Ya-Nan Zhu; Wei-Dong Yang; Paul V Abbott; Nicolas Martin; Wen-Jia Wei; Jing-Jing Li; Zhi Chen; Wen-Mei Wang


    After teeth are replanted, there are two possible healing responses:periodontal ligament healing or ankylosis with subsequent replacement resorption. The purpose of this study was to compare the fatigue resistance of vertically fractured teeth after bonding the fragments under conditions simulating both healing modes. Thirty-two human premolars were vertically fractured and the fragments were bonded together with Super-Bond C&B. They were then randomly distributed into four groups (BP, CP, CA, BA). The BP and CP groups were used to investigate the periodontal ligament healing mode whilst the BA and CA groups simulated ankylosis. All teeth had root canal treatment performed. Metal crowns were constructed for the CP and CA groups. The BP and BA groups only had composite resin restorations in the access cavities. All specimens were subjected to a 260 N load at 4 Hz until failure of the bond or until 23106 cycles had been reached if no fracture occurred. Cracks were detected by stereomicroscope imaging and also assessed via dye penetration tests. Finally, interfaces of the resin luting agent were examined by scanning electron microscope. The results confirmed that the fatigue resistance was higher in the groups with simulated periodontal ligament healing. Periodontal reattachment showed important biomechanical role in bonded and replanted vertically fractured teeth.

  12. [Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma]. (United States)

    Lin, S; Fuss, Z; Wigler, R; Karawani, M; Ashkenazi, M


    Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated

  13. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process. (United States)

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin


    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

  14. Guided tissue regeneration (GTR) versus cementum-impregnated gelatine membrane (CGM) techniques: a histologic comparison of relative effectiveness in promoting periodontal attachment. (United States)

    Suwa, K


    Some prior reports have suggested that guided tissue regeneration (GTR) procedures achieve only partial regeneration and induces the ankylosis rather than true attachment. Accordingly, others have developed an alternative procedure employing gelatine membrane compounded with bovine cementum particles (CGM) which has proven effective in stimulating a more physiologic form of attachment. This study was undertaken to perform a direct comparison of histological results when CGM and GTR membrane were used at comparable sites in the same monkey. Three monkeys with no periodontal disease were used. Following flap surgery, recession type defects were created on the buccal side of the maxillary lateral incisors and second premolars, and the cementum was removed from the root surface at an area corresponding to the bone crest. The right and left lateral incisors and second premolars were covered with CGM and GTR membrane, respectively. The GTR membranes were removed after 4 weeks. At 6 wks, the animals were sacrificed, and specimens were prepared for histological examination. More coronally placed true new attachment was observed following application of CGM to the planed root surfaces. Application of the GTR membrane resulted in formation of bone-like cementum and ankylosis, whereas CGM established true periodontal regeneration.

  15. SAPHO syndrome with TMJ involvement: review of the literature and case presentation. (United States)

    McPhillips, A; Wolford, L M; Rodrigues, D B


    Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare group of sterile, inflammatory osteoarticular disorders classically associated with skin manifestations. The etiology is unknown but probably involves genetic, infectious, and immunological components. The characteristic feature of the disease is found in the bone lesions, which typically involve the anterior chest wall and axial skeleton. In the literature review, six case reports discussed involvement of the TMJ. Treatment of SAPHO is geared toward symptom management as there is no cure. Surgery for mandibular lesions is usually a last resort as results are reported to be temporary with symptoms recurring within a year. Surgery appears to be performed early after diagnosis of TMJ related pathology; probably because lesions affecting the TMJ involve some limitation in mouth opening with varying degrees of ankylosis. The authors provide a literature review and describe a case of SAPHO syndrome with ankylosis of the left TMJ. The patient was treated with joint reconstruction using a patient-fitted total joint prosthesis (TMJ Concepts Inc., Ventura CA) in single stage surgery. This paper is the first to report maxillary involvement in SAPHO syndrome.

  16. Hyperplastic conditions of the mandibular condyles

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Kyung Soo [Pusan National University College of Medicine, Busan (Korea, Republic of)


    To evaluate the clinical and radiographic features of unilateral hyperplastic mandibular condyles for some useful preliminary diagnostic recommendations. Clinical records, radiographs and histologic diagnoses of 35 cases with asymmetric mandibular condyles due to apparent unilateral condylar hyperplasia were evaluated retrospectively. Among 35 cases, 28 were true hyperplastic conditions of condyles whereas the remaining 7 were unilateral internal derangement occurring on the short side. 17 of the 28 hyperplastic condyles showed a mass or irregular radiographic shadow with histologic diagnosis including osteochondroma and osteoma. Only 5 of these cases showed facial asymmetry. 2 out of ths 17 cases showed hyperplastic round shaped irregular condyles consistent with ankylosis and their histologic diagnoses were osteochondromas. 11 of the 28 cases showed smooth enlargement of condylar head with elongation of the neck causing facial asymmetry, but histologic diagnoses were not available because the surgical operation conserved the condyles. The hyperplastic conditions of the mandibular condyles include not only true hyperplasia, osteochondroma, osteoma, and ankylosis, but also unilateral internal derangement occurring on the short side.

  17. Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patients treated with Biomet(®) total joint prostheses. (United States)

    Westermark, A


    12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8mm preoperatively to 30.2mm 1 year after surgery, and in most of those patients the opening capacity remained stable over the years. The other patients maintained a mean opening capacity of more than 35 mm. Joint related pain and interference with eating were eliminated after TMJ reconstruction. There were no permanent facial nerve disturbance, no postoperative infections and no device related complications. The outcome supports prosthetic TMJ reconstruction as a useful treatment modality in patients with advanced TMJ disease.

  18. Imaging of connective tissue diseases of the head and neck. (United States)

    Abdel Razek, Ahmed Abdel Khalek


    We review the imaging appearance of connective tissue diseases of the head and neck. Bilateral sialadenitis and dacryoadenitis are seen in Sjögren's syndrome; ankylosis of the temporo-mandibular joint with sclerosis of the crico-arytenoid joint are reported in rheumatoid arthritis and lupus panniculitis with atypical infection are reported in patients with systemic lupus erythematosus. Relapsing polychondritis shows subglottic stenosis, prominent ear and saddle nose; progressive systemic sclerosis shows osteolysis of the mandible, fibrosis of the masseter muscle with calcinosis of the subcutaneous tissue and dermatomyositis/polymyositis shows condylar erosions and autoimmune thyroiditis. Vascular thrombosis is reported in antiphospholipid antibodies syndrome; cervical lymphadenopathy is seen in adult-onset Still's disease, and neuropathy with thyroiditis reported in mixed connective tissue disorder. Imaging is important to detect associated malignancy with connective tissue disorders. Correlation of the imaging findings with demographic data and clinical findings are important for the diagnosis of connective tissue disorders.

  19. Calprotectin in rheumatic diseases: a review. (United States)

    Kopeć-Mędrek, Magdalena; Widuchowska, Małgorzata; Kucharz, Eugeniusz J


    Calprotectin also known as MRP8/14 or S100A8/A9 is a heterodimeric complex of two S100 calcium-binding proteins: myeloid-related protein 8 (MRP-8 or S100A8) and MRP-14 (or S100A9). At present, according to many authors, it is considered that calprotectin MRP8/14 is a potentially more sensitive biomarker of disease activity in rheumatoid disease than conventional inflammatory indices such as the erythrocyte sedimentation rate, C-reactive protein and others. A review of the literature on concentration of calprotectin in patients with some rheumatic diseases (rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still's disease, systemic vasculitis, polymyalgia rheumatica, ankylosis spondylitis, systemic lupus erythematosus, and primary Sjögren's syndrome) is presented.


    Directory of Open Access Journals (Sweden)



    Full Text Available Anaesthesiologists will be facing difficult intubating conditions, anticipated or unanticipated, quite frequently, whenever they anaesthetize patients with facio- maxillary injuries, temporo mandibular joint ankylosis, obesity, pregnancy, congenital air-way abnormalities, etc. A large number of aids are available now for intubating in such difficult situations and a lot of techniques have been described in literature for giving anaesthesia for such patients. (1 Use of Bullard laryngoscope in difficult air-way situation was described by Dullenkopf et al 2003, (2 Lighted Wand by Agro et al 2004, (3 Shikani flexible seeing stylet by Agro et al 2005(4 Blind nasal intubation, L M A, Fiber optic laryngoscope by Levitan et al1999. (5 Glydoscope by Lim et al 2005(6 . In this case report, we have given one more alternate solution for this problem

  1. Clinical indications for digital imaging in dento-alveolar trauma. Part 2: root resorption. (United States)

    Cohenca, Nestor; Simon, James H; Mathur, Aeshna; Malfaz, Jose Maria


    Common complications of dento-alveolar trauma are pulp necrosis, pulp canal obliteration, periapical pathosis and root resorption. Different types of root resorption have been identified with traumatic injuries. Repair-related (surface), infection-related (inflammatory), ankylosis-related (osseous replacement) or extraradicular invasive cervical resorption are among the most common. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. The diagnosis and three-dimensional imaging assessment of the resorption is important in order to determine the treatment complexity and expected outcome based on the location and extension of the root defect. This article discusses and illustrates the clinical application of cone beam computed tomography for diagnosis and treatment plan of root resorption. Four clinical cases are presented to illustrate the potential use of the NewTom 3G for root resorption.

  2. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas


    for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine......Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed....... A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained....

  3. Maxillo-dental lesions produced in cats, after gamma and fast neutron irradiation. Radiographical and microradiographical study

    Energy Technology Data Exchange (ETDEWEB)

    Dambrain, R.; Dhem, A.; Meulders, J.P.; Wambersie, A.


    Gamma doses of 50 Gy, in 5 fractions over 29 days, induce severe modifications of the irradiated jaw in the cat, as shown by radiographical and microradiographical techniques. Four out 5 animals could survive up to one year; a fifth one died as a consequence of osteoradionecrosis. In addition, 2 animals, on which a tooth extraction was performed, died from osteoradionecrosis (role of trauma). Similar irradiations were performed with fast neutrons d(50) + Be at a total dose of 16.1 Gy in 5 fractions over 29 days. The ratio 50 Gy/16.1 Gy = 3.1 is the CNPF adopted for neutrontherapy applications at Louvain-la-Neuve. This irradiation was well tolerated by 7/7 animals. Only alveolodental ankylosis was observed in 3 cases, as well as a slight reduction in bone vitality in the dorsal part of the jaw. An eighth animal died from osteoradionecrosis induced by tooth extraction.

  4. Complications associated with cheek tooth extraction in the horse. (United States)

    Earley, Edward T; Rawlinson, Jennifer E; Baratt, Robert M


    Common indications for cheek tooth extraction in the horse include dental fracture, periodontal disease, severe decay/ caries, mandibular fracture with alveolar/tooth involvement, and periapical abscess. Complications secondary to extraction of cheek teeth are prevalent. Typical complications may include retained root tip(s), collateral damage of neighboring teeth and alveolar bone, mandibular fracture non-union or delayed union, cemental ankylosis, dilacerated root(s), oroantral/oronasal fistula, palatal deviation of cheek teeth, bone sequestration, sinus involvement, alveolar plug failure, and palatine artery laceration. This paper presents a series of cases that had complications following cheek tooth extraction. Anticipation of problematic extractions, recognition of complications, and appropriate treatment will aid the clinician in managing the inevitable cheek tooth extraction complication.

  5. Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case. (United States)

    Yonezawa, Hisanobu; Yanamoto, Souichi; Hoshino, Tomonori; Yamada, Shin-Ichi; Fujiwara, Taku; Umeda, Masahiro


    An 11-year-old male who injured his maxilla and right maxillary central incisor and lip during a fall was presented to our hospital. His lower lip and upper gingiva were lacerated with swelling and epistaxis, and he had a maxillary alveolar bone fracture and severe intrusion of the right maxillary central incisor, which had penetrated the floor of the nasal cavity with avulsion. Under local anesthesia, we repositioned the incisor and bone segment and fixed them with a titanium micromesh plate and self-tapping screws and splints. The incisor was also treated by root canal 3 days after the operation and was restored with a crown. We performed root canal filling 1 month later. Five months later, the plate and screws were removed. In prognosis of our case, no symptoms of inflammatory root resorption or ankylosis have observed for more than 1 year and 6 months of follow up based on both clinical and radiographic findings.

  6. The manubriosternal joint in rheumatoid disease. (United States)

    Sebes, J I; Salazar, J E


    Manubriosternal joint abnormalities are often undetected causes of chest pain. Twenty-five normal patients and 40 cadaver specimens were evaluated to establish the normal radiographic anatomy of this articulation. Analysis of the manubriosternal joint was carried out in rheumatoid diseases in order to ascertain the incidence and variety of abnormalities. Twenty-seven of 100 manubriosternal joints were abnormal in rheumatoid arthritis. Of 25 patients with ankylosing spondylitis 20 (80%) revealed abnormalities either with erosions or fusion. None of 25 patients with psoriatic arthritis and none of 20 with Reiter syndrome showed erosions or ankylosis. The articulation should be evaluated in rheumatoid diseases and in non-arthritic patients with chest and/or shoulder pain.

  7. Treatment of a Vertical Root Fracture Using Dual-Curing Resin Cement: A Case Report

    Directory of Open Access Journals (Sweden)

    Nima Moradi Majd


    Full Text Available Introduction. Vertical root fracture (VRF is one of the most frustrating complications of root canal treatment. The prognosis of the root with VRF is poor therefore tooth extraction and root amputation are usually the only treatment options. However, bonding of the fracture line with adhesive resin cement during the intentional replantation procedure was recently suggested as an alternative to tooth extraction. Methods. A vertically fractured left maxillary incisor was carefully extracted, fracture line was treated with adhesive resin cement, a retrograde cavity was produced and filled with calcium-enriched mixture (CEM cement, and tooth was replanted. Results. After 12 months the tooth was asymptomatic. The size of periapical radiolucency was noticeably reduced and there was no clinical sign of ankylosis. Conclusion. Using adhesive resin cement to bond the fracture lines extraorally in roots with VRF and intentional replantation of the reconstructed teeth could be considered as an alternative to tooth extraction, especially for anterior teeth.

  8. Excellent Functionality Despite Clinico-Radiological Deformity in Osteomyelitis Variolosa - A Case Report. (United States)

    Mugalur, Aakash; Shahane, Sunil M; Samant, Ashwin; Pathak, Aditya C; Reddy, Rajeev


    Despite the eradication of smallpox from the world in 1980 the osteo-articular sequelae of smallpox are still occasionally noticed in previously endemic areas. The sequelae of osteomyelitis variolosa may raise a diagnostic challenge to the untrained eyes of the surgeon. We present a case of "osteomyelitis variolosa" in a 70 years old patient. The patient had bilateral dislocation of the elbow joint with multidirectional instability. There was distortion of the articular surfaces and ankylosis of the bilateral proximal radio-ulnar joint. Hypoplasia of the right ulna with short fourth and fifth metacarpals of the left hand and hypoplasia of right fourth metacarpal with cortical thickening was noted radiologically. The patient had minimal disability of his elbows despite the striking radiological abnormality and was functionally independent.

  9. Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols (United States)

    Clauser, Luigi C.; Consorti, Giuseppe; Elia, Giovanni; Tieghi, Riccardo; Galiè, Manlio


    Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. PMID:24624260

  10. Radiological changes of the symphysis in ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Jajic, Z.; Jajic, I.; Grazio, S. [Univ. Hospital Sestre Milosrdnice, Zagreb (Croatia). Dept. for Rheumatology, Physical Medicine and Rehabilitation


    Purpose: To evaluate the symphyseal changes in patients with ankylosing spondylitis. Material and Methods: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years. Results and Conclusion: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphysis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.

  11. Radiological residua of healed diabetic arthropathies

    Energy Technology Data Exchange (ETDEWEB)

    Reinhardt, K.


    Diabetic arthropathy is a relatively rare manifestation of neuropathic disease, occurring in fewer than 5% of cases. Abnormalities of this type are confined largely to the small joints of the feet, although the larger joints of the lower limbs and the spine occasionally are affected. Some lesions, particularly in the feet, repair spontaneously, leaving radiological residua sufficiently characteristic to prompt suspicion of an unrecognised diabetic state. These include deformity of the head of the second metatarsal (akin to a Freiberg lesion), shortening of the great toe, painless deforming arthrosis of the knee, and ankylosis of interphalangeal joints. In the presence of these signs the patient should be interrogated concerning diabetes and blood sugar estimates, with provocation if necessary, obtained. Should such a diagnosis be sustained, appropriate protective measures may be undertaken to avoid a relapse of the arthropathy.

  12. Jaw locking after maxillofacial trauma

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    David B. Kamadjaja


    Full Text Available The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right gap arthroplasty was done and resulted in normal mouth opening.

  13. Hearing loss in the Saethre-Chotzen syndrome. (United States)

    Ensink, R J; Marres, H A; Brunner, H G; Cremers, C W


    A three-generation family with Saethre-Chotzen syndrome and an isolated case are presented. The proband presented with conductive hearing loss. His mother and grandmother showed minor features of the syndrome including conductive hearing loss. Symptoms of the craniosynostosis syndromes can include stapes ankylosis, a fixed ossicular chain in a too small epitympanum, and small or even absent mastoids. The proband was treated with a bone-anchored hearing aid (BAHA) instead of reconstructive middle ear surgery. Current literature on the results of ear surgery is reviewed. In general, reconstructive middle ear surgery should be considered if congenital anomalies of the middle ear are the only presenting symptom. In cases with additional anomalies such as atresia of the ear canal or damage due to chronic ear infections, the outcome of reconstructive surgery to correct the anomalous ossicular chain is unsatisfactory. In such cases of the BAHA is probably the best solution.

  14. Temporomandibular Joint Septic Arthritis and Mandibular Osteomyelitis Arising From an Odontogenic Infection: A Case Report and Review of the Literature. (United States)

    Gams, Kevin; Freeman, Phillip


    Septic arthritis of the temporomandibular joint (TMJ) has been infrequently reported in the literature. Some investigators believe that this condition is under-reported because it is underdiagnosed. Misdiagnosis or late diagnosis of this condition can lead to serious morbidity, including fistula formation, intracranial abscess, fibrous or bony ankylosis, temporal bone or condylar osteomyelitis, growth alteration, and several others. This report describes a case of septic TMJ arthritis arising from direct spread of an odontogenic infection with subsequent development of mandibular osteomyelitis. The purpose of this case report is to 1) increase awareness of an underdiagnosed condition, 2) establish the seriousness of this infection, 3) for the first time report on a case of TMJ septic arthritis caused by Bacteroides infection, and 4) provide a review of the relevant literature.

  15. Septic arthritis of the distal interphalangeal joint in 12 horses. (United States)

    Honnas, C M; Welch, R D; Ford, T S; Vacek, J R; Watkins, J P


    The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.

  16. Severe destruction of the temporomandibular joint with complete resorption of the condyle associated with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. (United States)

    Kodama, Yasumitsu; Tanaka, Ray; Kurokawa, Akira; Ohnuki, Hisashi; Sultana, Sara; Hayashi, Takafumi; Iizuka, Tateyuki; Takagi, Ritsuo


    The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome consists of a combination of inflammatory bone disorders and dermatologic pathology. Bone lesions as a form of diffuse sclerosing osteomyelitis in the mandible occur in the posterior body and ramus. Bone lesions rarely spread to the temporomandibular joint (TMJ) where ankylosis may result. Herein we present an unusual case of SAPHO syndrome with TMJ involvement in which severe destruction of the TMJ occurred. We observed an extension of the invasive soft tissue lesion into the infratemporal fossa from the TMJ with complete resorption of the condyle. In contrast to other previously reported cases, in our case the condyle was strongly suspected as the primary site of the bone lesion with subsequent extension to the ramus and infratemporal fossa. The destructive nature and related symptoms resembled a malignant tumor.

  17. Wnt/β-catenin signaling plays a key role in the development of spondyloarthritis (United States)

    Xie, Wanqing; Zhou, Lijiang; Li, Shan; Hui, Tianqian; Chen, Di


    Spondyloarthritis (SpA) is a group of diseases consisting of psoriatic arthritis (PsA), reactive arthritis, arthritis related to inflammatory bowel disease (a subgroup of juvenile idiopathic arthritis), and ankylosing spondylitis (the prototype of SpA). Axial bone formation and the combination of concurrent erosion and new bone formation are specific characteristics of SpA disease. The use of anti-proinflammatory cytokines, such as inhibitors of tumor necrosis factor α (TNF-α), appears to be the greatest advance in the treatment of SpA over the past 20 years. However, TNF-α blockers do not halt new bone formation. Recent clinical observations and animal studies demonstrate that Wnt signaling proteins and natural Wnt inhibitors, such as DKK1 and sclerostin, are likely to play important roles in the process of ankylosis in SpA, and could potentially serve as therapeutic targets for the treatment of SpA. PMID:26629686

  18. [Inflammatory spinal diseases: axial spondyloarthritis : Central importance of imaging]. (United States)

    Baraliakos, X; Fruth, M; Kiltz, U; Braun, J


    The diagnosis of axial spondyloarthritis (axSpA) includes classical ankylosing spondylitis (AS) as well as earlier stages and abortive courses of the disease, in which structural alterations have not yet occurred. These are classified as non-radiographic axSpA (nr-axSpa). Inflammatory changes in the entire axial skeleton are characteristic for axSpA and can be visualized by magnetic resonance imaging (MRI), while in most patients structural alterations, such as new bone formation with syndesmophytes and ankylosis develop in the later course of the disease. These bony alterations can best be visualized by conventional radiography and by computed tomography. Certain MRI sequences are nowadays considered as the standard method for depiction of inflammatory changes in axSpA. The introduction of MRI has led to a paradigm shift for this disease because the inflammatory lesions characteristic for the disease can be visualized at an early stage using appropriate MRI sequences.

  19. Wnt/β-catenin signaling plays a key role in the development of spondyloarthritis. (United States)

    Xie, Wanqing; Zhou, Lijiang; Li, Shan; Hui, Tianqian; Chen, Di


    Spondyloarthritis (SpA) is a group of diseases consisting of psoriatic arthritis (PsA), reactive arthritis, arthritis related to inflammatory bowel disease (a subgroup of juvenile idiopathic arthritis), and ankylosing spondylitis (the prototype of SpA). Axial bone formation and the combination of concurrent erosion and new bone formation are specific characteristics of SpA disease. The use of antiproinflammatory cytokines, such as inhibitors of tumor necrosis factor α (TNF-α), appears to be the greatest advance in the treatment of SpA over the past 20 years. However, TNF-α blockers do not halt new bone formation. Recent clinical observations and animal studies demonstrate that Wnt signaling proteins and natural Wnt inhibitors, such as DKK1 and sclerostin, are likely to play important roles in the process of ankylosis in SpA, and could potentially serve as therapeutic targets for the treatment of SpA.

  20. Several early interventions for ectopic maxillary canines.

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    Carlos Astorga


    Full Text Available Maxillary canine impactation is often encountered in orthodontic clinical practice and the aetiology is associated to genetic factors as well as local space factors. If preventive treatment is not started in ectopic maxillary canines, some possible consequences may occur, such as resorption of the roots of the neighboring permanent teeth, cysts, ankylosis and expensive surgical and orthodontic treatment. The aim of this review was to preset several early treatment modalities for ectopic maxillary canines based on recent scientific evidence. Four are the most important: Only extractions intervention, extraction of deciduous canines with cervical pull headgear, active intervention in late mixed dentition and active intervention in early mixed dentition. These different modalities showed a greater increasing the rate of normal eruption of ectopic canines ( 80-97%. The extraction of primary canine alone is still an effective method to prevent canine impactation, whose success rate would be increased if some other method interceptive is added.

  1. Etiology, Classification and Management of Ectopic Eruption of Permanent First Molars. (United States)

    Hsiao, Chu-Chun; Boynton, James R


    Ectopic eruption of a permanent tooth involves abnormal resorption of a portion or all of the adjacent primary tooth. Among the most commonly ectopically erupted teeth are the permanent first molars. Ectopically erupting molars may require intervention to allow for full eruption, or they may spontaneously self-correct and erupt into occlusion. Decisions regarding the necessity of intervention, its ideal timing, and intervention type are multifactorial. Treatment options for the ectopically erupting permanent first molar include the elastomeric separator, brass wire, pre-fabricated clip separator, custom made appliances (Humphrey appliance, Halterman appliance), or extraction of the primary molar. Early intervention when indicated can ensure proper full eruption of the permanent first molar and prevent mesial angulation, arch perimeter loss, tooth impaction and ankylosis. Two cases are described that manage ectopic eruption of the permanent first molar.

  2. [Influence of implant position of a hip prosthesis on alignment exemplified by the CLS shaft]. (United States)

    Schneider, U; Breusch, S J; Thomsen, M; Wirtz, D C; Lukoschek, M


    We performed a clinical and radiological analysis to evaluate the significance of the stem position of cementless CLS components with respect to function and survival. We used patient material from a multi-center study of 3,732 CLS stems with a mean follow-up of 43 months (range: 12-142 months). The clinical outcome was assessed using Merle D'Aubigné Scores and stem alignment was determined as the deviation of the longitudinal stem axis from the longitudinal femur axis. We found no correlation between stem alignment and function, survival, implant migration or periprosthetic radiolucent lines. In patients with rheumatoid arthritis and hip ankylosis the neutral stem position was less often achieved than in patients with other diagnoses. The results of our study cast doubt on whether the varus position of the femoral component of cementless tapered CLS-type stem designs is as critical as in cemented total hip arthroplasty.

  3. The natural history of ankylosing spondylitis in the 21st century

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    C. Campana


    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the axial skeleton and evolves in stiffnes followed by ankylosis and disability. However, it may be difficult to exactly establish the natural history of the disease and the influence of risk factors of progression, since most patients are treated with various pharmacologic or non-pharmacologic agents, which may potentially influence the natural progression of the disease. In this context, we report here a very interesting case of a 40 year old man, presented to our outpatient clinic, 28 years after the onset of AS. Previously for personal reasons, did not choose not to undergo any treatment. This case allows us to evaluate the natural radiological progression of the disease and the influence of predictive risk factors.

  4. The treatment of condylar fractures: to open or not to open? A critical review of this controversy

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    Renato VALIATI, Danilo IBRAHIM, Marcelo Emir Requia ABREU, Claiton HEITZ, Rogério Belle de OLIVEIRA, Rogério Miranda PAGNONCELLI, Daniela Nascimento SILVA


    Full Text Available The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF, but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.

  5. The unerupted maxillary canine - a post-surgical review.

    LENUS (Irish Health Repository)

    O'Dowling, Ian


    The orthodontic records of 685 patients referred for surgical exposure of an unerupted impacted maxillary canine tooth were examined. The condition was more common among females than males, slightly less than 2:1. The impacted teeth had a palatal-labial ratio of 3:1. All of the teeth were exposed using the open surgical technique and in 98% of cases the tooth erupted and was orthodontically aligned. In 2% of cases ankylosis occurred and the teeth were subsequently extracted. The presence of peg-shaped lateral incisors associated with the impacted maxillary canine tooth was 3.4% of the total number of impacted teeth and congenital absence was found in 1.7% of impacted teeth.

  6. Pierre Robin sequence and obstructive sleep apnea

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    Rubens Reimão


    Full Text Available The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT perfomed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

  7. Treatment of inflammatory root resorption using mineral trioxide aggregate: A case report

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    Roohollah Sharifi


    Full Text Available Introduction: This report presents a case to show inflammatory root resorption can be successfully treated by using mineral trioxide aggregate (MTA. Case Report: A central maxillary incisor of an eight-year-old boy was avulsed associated with crown fracture secondary to a fall. The tooth was stored in ice. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful. To stop inflammatory root resorption, long-term calcium hydroxide therapy was employed. Despite the use of calcium hydroxide, resorption continued. Subsequent to the failure of that treatment, MTA was used as a root canal filling material. At 20-month follow-up, the tooth was asymptomatic and had clinical signs of ankylosis but external inflammatory root resorption had stopped. Discussion: MTA may be considered as an alternative option for the treatment of continuous external inflammatory root resorption.


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    Full Text Available A case of extensive ossification around the left hip joint involving lesser trochanter of the femur leading to ankylosis of left hip joint in a 60 years male is being reported. The diagnosis of moyamoya disease was made , which is a rare form of occlusive cerebrovasc ular disorder. Occlusion of an artery may present with Transient Ischemic Attacks , headaches , stroke and seizures. Surgical management is the only option in these cases. This 60 years male had an acute onset hemiplegia 4 ½ years back and at present came wit h complaints of pain and swelling over the left hip. Surgical excision was done and histopathological examination revealed extensive ossification of skeletal muscle. A diagnosis of Moyamoya disease complicated with heterotopic ossification was made. There was no recurrence after 8 months of follow up.

  9. Management of fused supernumerary teeth in children using guided tissue regeneration: long-term follow up of 2 cases. (United States)

    Olsen, Christopher B; Johnston, Timothy; Desai, Mala; Peake, Gregory G


    Surgical separation of supernumerary teeth fused to permanent incisor teethhas typically given rise to residual post surgical periodontal defects, induding loss of attachment and deep periodontal pocketing with persistent inflammation. Other complications include devitalisation of the retained tooth section, ankylosis, external and replacement resorption. A unique technique of using guided tissue regeneration has been successfully employed to promote periodontal healing, after 2 cases of surgical removal of a supernumerary tooth fused to a permanent maxillary lateral incisor tooth. In the first case, a 2-stage guided tissue regeneration technique was completed with a nonresorbable Gor-Tex membrane, and was followed up after 9 years. The second case was completed using a resorbable Vicryl membrane, in a single-stage guided tissue regenerative technique; and was followed up after 5 years.

  10. Influence of enamel matrix derivative (Emdogain) and sodium fluoride on the healing process in delayed tooth replantation: histologic and histometric analysis in rats. (United States)

    Poi, Wilson Roberto; Carvalho, Roberta Martinelli; Panzarini, Sônia Regina; Sonoda, Celso Koogi; Manfrin, Thais Mara; Rodrigues, Thais da Silveira


    Although it has already been shown that enamel matrix derivative (Emdogain) promotes periodontal regeneration in the treatment of intrabony periodontal defects, there is little information concerning its regenerative capacity in cases of delayed tooth replantation. To evaluate the alterations in the periodontal healing of replanted teeth after use of Emdogain, the central incisors of 24 Wistar rats (Rattus norvegicus albinus) were extracted and left on the bench for 6 h. Thereafter, the dental papilla and the enamel organ of each tooth were sectioned for pulp removal by a retrograde way and the canal was irrigated with 1% sodium hypochlorite. The teeth were assigned to two groups: in group I, root surface was treated with 1% sodium hypochlorite for 10 min (changing the solution every 5 min), rinsed with saline for 10 min and immersed in 2% acidulated-phosphate sodium fluoride for 10 min; in group II, root surfaces were treated in the same way as described above, except for the application of Emdogain instead of sodium fluoride. The teeth were filled with calcium hydroxide (in group II right before Emdogain was applied) and replanted. All animals received antibiotic therapy. The rats were killed by anesthetic overdose 10 and 60 days after replantation. The pieces containing the replanted teeth were removed, fixated, decalcified and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The use of 2% acidulated-phosphate sodium fluoride provided more areas of replacement resorption. The use of Emdogain resulted in more areas of ankylosis and was therefore not able to avoid dentoalveolar ankylosis. It may be concluded that neither 2% acidulated-phosphate sodium fluoride nor Emdogain were able to prevent root resorption in delayed tooth replantation in rats.

  11. Mutations in ANKH cause chondrocalcinosis. (United States)

    Pendleton, Adrian; Johnson, Michelle D; Hughes, Anne; Gurley, Kyle A; Ho, Andrew M; Doherty, Michael; Dixey, Josh; Gillet, Pierre; Loeuille, Damien; McGrath, Rodney; Reginato, Antonio; Shiang, Rita; Wright, Gary; Netter, Patrick; Williams, Charlene; Kingsley, David M


    Chondrocalcinosis (CC) is a common cause of joint pain and arthritis that is caused by the deposition of calcium-containing crystals within articular cartilage. Although most cases are sporadic, rare familial forms have been linked to human chromosomes 8 (CCAL1) or 5p (CCAL2) (Baldwin et al. 1995; Hughes et al. 1995; Andrew et al. 1999). Here, we show that two previously described families with CCAL2 have mutations in the human homolog of the mouse progressive ankylosis gene (ANKH). One of the human mutations results in the substitution of a highly conserved amino acid residue within a predicted transmembrane segment. The other creates a new ATG start site that adds four additional residues to the ANKH protein. Both mutations segregate completely with disease status and are not found in control subjects. In addition, 1 of 95 U.K. patients with sporadic CC showed a deletion of a single codon in the ANKH gene. The same change was found in a sister who had bilateral knee replacement for osteoarthritis. Each of the three human mutations was reconstructed in a full-length ANK expression construct previously shown to regulate pyrophosphate levels in cultured cells in vitro. All three of the human mutations showed significantly more activity than a previously described nonsense mutation that causes severe hydroxyapatite mineral deposition and widespread joint ankylosis in mice. These results suggest that small sequence changes in ANKH are one cause of CC and joint disease in humans. Increased ANK activity may explain the different types of crystals commonly deposited in human CCAL2 families and mutant mice and may provide a useful pharmacological target for treating some forms of human CC.

  12. Endoscopic quadricepsplasty: A new surgical technique. (United States)

    Blanco, C E; Leon, H O; Guthrie, T B


    We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.

  13. Optimizing the MRI protocol of the sacroiliac joints in Spondyloarthritis: which para-axial sequence should be used?

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    Giraudo, Chiara; Weber, Michael; Platzgummer, Hannes; Kainberger, Franz; Schueller-Weidekamm, Claudia [Medical University of Vienna, Vienna General Hospital, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Vienna (Austria); Magnaldi, Silvia [Fondazione Poliambulanza Istituto Ospedaliero, Dipartimento di Radiologia e Diagnostica per Immagini, Brescia (Italy); Puchner, Antonia [Medical University of Vienna, Vienna General Hospital, Division of Rheumatology, Department of Internal Medicine III, Vienna (Austria)


    To assess the diagnostic value of para-axial T2w-TSE (paT2) and fat-suppressed proton density (paPD-FS) MRI sequences for the evaluation of the sacroiliac joint (SIJ) of patients with axial Spondylarthritis (SpA). One hundred and six patients with clinical findings suggestive of SpA underwent an MR protocol of the SIJ with additional paPD-FS (41 patients) and paT2 (105 patients). Acute (bone marrow oedema [BME], enthesitis, capsulitis, synovitis) and chronic findings (erosions, ankylosis) were assessed by paPD-FS and compared with the gold standard post-contrast sequences, whereas chronic features (because of the lack of fat suppression) were evaluated on paT2 and compared with pcT1. paPD-FS demonstrated high sensitivity (98.9 %) and specificity (99.1 %) for BME; sensitivity and specificity for synovitis and enthesitis were 100 %; 85.7 % and 100 %, respectively, for capsulitis. paPD-FS and paT2 showed 100 % sensitivity and specificity for ankylosis; for erosions, paT2 demonstrated 85.3 % sensitivity and 100 % specificity, whereas paPD-FS, respectively, 98 % and 100 %. PaT2 and paPD-FS provided precious information enabling an accurate interpretation of the heterogeneous findings of SpA. paPD-FS showed good results in detecting acute and chronic lesions and its inclusion in a routine MR examination of the SIJ could increase the diagnostic performance of a pre-contrast protocol. (orig.)


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    R. M. Tikhilov


    Full Text Available A distinctive feature of patients with ankylosing spondylitis is the formation of hip ankylosis in an extremely unfavorable functional position combined with upset of sagittal balance of the body along with a thoracolumbar kyphosis. Treatment of these patients poses considerable technical difficulties and is often associated with complications. The authors report a clinical case of a female 40 years old patient with confirmed rhizomelic spondylitis. The patient mainly complained of fixed malposition of the right lower extremity (hip ankylosis in extreme 1450 flexion and 1500 abduction combined with a severe fixed spine deformity (thoracic kyphosis 920, lumbar lordosis 170. Considering significant sagittal balance disorder it was decided to go for a two-stage procedure. Total hip arthroplasty of the right joint was performed at the first stage. At the second stage the authors corrected thoracolumbar spinal deformity by Th12 (type PSO 4 and L2 (type PSO 3 wedge resections and converging resected vertebral bodies by a multilevel fixation system with transpedicular support elements. The interval between the stages was 11 months. Two-stage treatment of this patient al-lowed to avoid adverse postoperative complications and to achieve a significant functional improvement in one year after treatment started. The sum of points before and after the treat-ment amounted respectively to 46 and 79 on Harris Hip Score, 17 and 38 points on Oxford Hip Score (OHS. To summarize, comprehensive treatment with planning of all subsequent steps prior to hip replacement is the method of choice for avoidance of postoperative complications in patients with ankylosing spondylitis accompanied by a significant upset of sagittal balance.

  15. Do costochondral grafts have any growth potential in temporomandibular joint surgery? A systematic review (United States)

    Kumar, Praveen; Rattan, Vidya; Rai, Sachin


    Purpose of the study To assess the growth potential of costochondral graft in temporomandibular joint reconstruction in patients with temporomandibular ankylosis and hemifacial microsomia. Method Systematic review after inclusion of articles fulfilling the following criteria: (1) only human studies; (2) patients of temporomandibular joint ankylosis and hemifacial microsomia; and (3) studies with minimum of five cases and with a minimum follow-up for a period of 5 years. The primary outcome measure was the percentage of patients with optimum growth of costochondral graft. Secondary outcomes were any abnormal growth and restoration of function. Delphi's criteria were used for assessing the quality of the included studies. Result Only three studies satisfied all the inclusion criteria. A total of 96 costochondral grafts were placed in the included studies. Optimum growth was reported in 54 grafts, undergrowth in 1 graft, overgrowth in 7 grafts, lateral overgrowth in 1 graft and no growth in 1 graft. Graft resorption, reankylosis and sequestration were seen in 21, 8 and 3 cases, respectively. When the Delphi's criteria were applied to the case series for the assessment of quality, majority of the studies could be considered as satisfying at least 50% of the criteria. Conclusion There are no randomised clinical trials and the only evidence is in the form of case series that is considered as the lowest level of evidence for any study. No inference can be interpreted regarding growth potential of costochondral graft. Thus, on the basis of available evidence, it can be concluded that use of costochondral graft for temporomandibular joint reconstruction lacks scientific evidence. PMID:26605146

  16. Predictors of Switching Anti-Tumor Necrosis Factor Therapy in Patients with Ankylosing Spondylitis.

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    Jeong-Won Lee

    Full Text Available The aim of this study was to investigate the potential predictors of switching tumor necrosis factor (TNF-α inhibitors in Korean patients with ankylosing spondylitis (AS. The patients who had been treated with TNF-α inhibitors were divided into two groups depending on whether they had switched TNF-α inhibitors. Demographic, clinical, laboratory, and treatment data at the time of initiation of TNF-α inhibitor treatment were compared between switchers and non-switchers, and within switchers according to the reasons for switching. Of the 269 patients, 70 (23% had switched TNF-α inhibitors once; of these, 11 switched again. The median follow-up time was 52.7 months. Three- and five-year drug survival rates were 52%/48% for infliximab, 62%/42% for etanercept, and 71%/51% for adalimumab, respectively. Switchers were more likely to be prescribed disease-modifying anti-rheumatic drugs than non-switchers. A history of joint surgery and complete ankylosis of the sacroiliac joint was more frequent in switchers. Multivariate Cox's proportional hazard analysis showed that the use of adalimumab as the first TNF-α inhibitor was less likely to lead to switching and complete ankylosis of the sacroiliac joints was more likely to lead to switching. The principal reasons for switching were drug inefficacy and adverse events, but the differences in the clinical data of these two groups of switchers were not significant. In AS patients who are candidates for TNF-α inhibitor therapy, switching may improve the therapeutic outcome based on clinical information.

  17. Periodontal repair in dogs: histologic observations of guided tissue regeneration with a prostaglandin E1 analog/methacrylate composite. (United States)

    Trombelli, L; Lee, M B; Promsudthi, A; Guglielmoni, P G; Wikesjö, U M


    This report describes observations of healing following guided tissue regeneration (GTR) including surgical implantation of the prostaglandin E1 analog misoprostol with calcium-layered methacrylate particles. Critical size, supra-alveolar periodontal defects were surgically created around the 3rd and 4th mandibular premolar teeth in 4 beagle dogs. Wound management included soaking with a 24 microg/ml misoprostol solution and implantation of the misoprostol/methacrylate composite. One jaw quadrant per animal was prepared for GTR using expanded polytetrafluoroethylene membranes. The gingival flaps were coronally advanced and sutured to submerge the teeth. The tissues covering the surgical sites daily received topical misoprostol in an oral adhesive over the 4-week healing interval. Upon euthanasia, tissue blocks were prepared for histometric analysis of regeneration of alveolar bone and cementum, root resorption and ankylosis. The defect area underneath the membrane and the density of methacrylate particles were recorded for the GTR defects. The methacrylate particles appeared encapsulated in a dense connective tissue without signs of an inflammatory reaction, some in contact to newly formed bone. Alveolar bone regeneration height averaged (+/-SD) 1.2+/-1.0 and 1.0+/-0.6 mm for GTR and non-GTR defects, respectively. Corresponding values for bone regeneration area were 1.3+/-1.0 and 0.7+/-0.5 mm2. Cementum regeneration was confined to the apical aspect of the defects. Small areas of root resorption and ankylosis were observed for all teeth. Bone regeneration area correlated positively to the defect area and negatively to the density of methacrylate particles in the GTR defects. The histologic observations suggest that the methacrylate composite has marginal potential to promote bone and cementum regeneration under provisions for GTR.

  18. Avaliação radiográfica e de função de vôo após fixação de osteotomias distais do úmero em pombas (Columba livia, com modelo de fixador externo articulado Radiologic and flight function evaluation after fixation of distal humeral osteotomies in pigeons, with model of articulated external fixator

    Directory of Open Access Journals (Sweden)

    Vanessa C.M. Ferraz


    viabilidade de músculos e tendões, e assim, garantindo a capacidade de vôo das aves tratadas, sendo um método adequado para a reparação de fraturas distais de úmero em aves quando se pretende a reabilitação destes animais.The treatment of distal humeral fractures in birds is very difficult, technically and for consolidation and maintenance of normal function of the wing, because theses bones are pneumatic, and its cortices very thin. The ankylosis of the humerus-radius-ulnar joint with external fixator is unviable for birds intended for rehabilitation and release. In all animals, the experimental fixator was placed over the humerus, with its articulation over the humerus-radial-ulnar joint e the extension of the fixator was placed over the ulna. The animals were divided in two groups: bilateral surgeries with ankylosis in one wing (static wing and maintenance of the joint function in the other (dynamic wing (Group 1, and unilateral surgery, with maintenance of the joint function (dynamic wing (Group 2. The bonny callus was evaluated with radiographs: post-surgical, at 3, 6 and 9 weeks. The birds in Group 2 were evaluated as of their flight abilities between 11 and 15 weeks after surgery. The wing amplitude and humeral length was evaluated in all animals, after euthanasia. At 6 weeks, all the animals in Group 2, that underwent unilateral surgery, without ankylosis, and four animals in Group 1, that underwent bilateral surgeries: ankylosis of one elbow (static wing and not of the other (dynamic wing, presented radiographic and clinical consolidation of the fractures. Two animals in Group 1 only presented consolidation of the dynamic wing at 9 weeks and of the static wing at 12 weeks. All the animals in Group 2 presented adequate flight capacity, in at least 13 weeks after surgery. There are few published papers on bird osteosynthesis, and therefore we studied the use of articulated external fixator for the stabilization of distal humeral fractures, avoiding ankylosis

  19. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar


    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  20. MR imaging features of foot involvement in ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Erdem, C. Zuhal E-mail:; Sarikaya, Selda; Erdem, L. Oktay; Ozdolap, Senay; Gundogdu, Sadi


    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  1. Arthrogryposis multiplex congenita - a rare congenital stiff joints syndrome

    Directory of Open Access Journals (Sweden)

    Velisavljev-Filipović Gordana


    Full Text Available Introduction: Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of disorders with the incidence rate of 6.2/100000 liveborn infants. The true incidence cannot be established, because many cases result in spontaneous miscarriages or stillbirth. More than 90% of cases are associated with birth defects. The cause of this syndrome is unknown. Many forms are not hereditary, though there are hereditary forms as well. Case report. This paper presents a case with arthrogryposis multiplex congenita. The pregnancy was not controlled regularly. During the pregnancy, oligohydramnion was detected. Due to contractures, labor ended is cesarean section. The child was born in the 34th week of gestation. Flexion and extension joint contractures were observed. Active and passive mobility of the afflicted joints was reduced. There was a limited motor function in the shoulder, elbow and wrist joints with a slight internal rotation of the shoulder joint and lower arm joints during pronation. The hips were subluxated; the feet were in equinovarus position and the fingers in ulnar deviation with partial syndactyly of the 4th and 5th fingers on the left hand. The infant had abnormal dermatoglyphics. The neck was short, and the 2nd and 3rd cervical vertebrae were fused. There was also a slight left-sided thoracic scoliosis. Trismus was present due to the existing ankylosis of the temporomandibular joint. The karyotype was normal. The serum creatinine phosphokinase was slightly elevated. The electromyographic picture indicate non-specific signs of

  2. Imaging features of SAPHO syndrome%SAPHO综合征的影像表现

    Institute of Scientific and Technical Information of China (English)

    刘记存; 陈勇; 崔建岭


    Objective To explore the imaging features of patients with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Methods Imaging features of 20 patients with SAPHO syndrome were retrospectively analyzed. Results Nineteen patients had anterior chest wall involvement, which showed bone sclerosis, hyperostosis, costal cartilage sclerotic hyperostosis, joint destruction and ankylosis on plain X-ray films and CT images. The medial end of clavicle, ma-nubrium and the first costal cartilage were affected in 19 cases. Among them, bilaterally asymmetrical involvements were found in 8 cases, bilaterally symmetrical in 7 cases and unilateral in 4 cases, respectively. Manubriosternal junctions and the second costal cartilages were affected in 10 and 6 cases, respectively. Five patients had spinal involvement which showed endplate erosion, sclerosis, paravertebral ossification, narrowed disc space, wedged body on plain film and CT, in-homogeneous long Tl and long T2 signal intensities on MRI. Three patients also had sacroiliac joint involvement which showed joint destruction and ankylosis on plain film and CT. Conclusion Anterior chest wall lesions are the typical imaging features of SAPHO syndrome.%目的 探讨SAPHO综合征的影像学表现.方法 回顾性分析20例SAPHO综合征患者的影像学表现.结果 19例病变累及前上胸壁,X线、CT表现为骨及肋软骨硬化、肥厚,关节破坏、强直,胸骨柄、锁骨近端和第1肋软骨受累,其中双侧不对称受累8例,双侧对称性受累7例,单侧受累4例.10例柄胸联合受累,6例第2肋软骨受累.5例伴有脊柱病变,X线、CT表现为多发椎体终板侵蚀、硬化,椎旁骨化,椎间隙变窄,椎体楔形变;MRI表现为椎体不均匀长T1长T2信号.3例伴骶髂关节受累,X线和CT表现为关节破坏、强直.结论 前上胸壁病变是SAPHO综合征最具特征性的影像学表现.

  3. 下颌骨髁状突骨折56例疗效分析%Retrospective study of treatments for 56 condylar fractures

    Institute of Scientific and Technical Information of China (English)

    曲昌锋; 郭哲; 陆平; 周晓南; 汪崇


    [ Objective] To investigate the treatments and curative effects for different types of condylar fractures. [ Methods] There were 56 condylar fractures presented with expectant treatments, condylar removal, arthroplasty, rigid fixation and evaluated the clinical effects. [Results] The curative effects were satisfactory but some patients suffered with complications such as injury of facial nerve, limitation of mouth opening, ankylosis of temporo - mandibular joint and absorption of condyle. [ Conclusion ] Miniplate rigid fixation based on anatomical reduction is an effective procedure in treating condylar neck and subcondylar fractures. Post - mandibular approach could significantly reduce the probability of facial nerve injury. Ankylosis of temporo - mandibular joint could happen if the serious dislocation of articular disc and comminuted fractures of condyle head.%[目的]探讨不同类型髁状突骨折的治疗方法和临床效果.[方法]回顾性分析大连市中心医院56例髁状突骨折病例,分别采用保守治疗及髁状突摘除、关节成形和小型钛板坚固内固定,并评价其临床效果.[结果]随访47例,所有病例均一期愈合,无感染,无涎瘘.但部分病例出现面神经损伤(5例)、张口受限(3例)、颞下颌关节强直(1例)、髁状突吸收(2例)等并发症.[结论]切开复位及小型钛板坚固内固定是治疗髁颈和髁颈下骨折的有效方法,但应保留翼外肌附着.经颌后区入路可明显降低面神经损伤的几率.囊内粉碎性骨折和髁状突骨折伴关节盘明显移位如处理不当易发生颞下颌关节强直.

  4. [Immediate and long-term results of surgical treatment of patients for traumatic mandibular fracture]. (United States)

    Kopchak, A V


    The analysis of immediate and long-term results of the surgical treatment of 286 patients, operated for traumatic mandibular fractures in the Department of Oral and Maxillofacial Surgery, National O. O. Bogomolets Medical University. In 67% of patients the anatomical shape of the bone was adequately restored. The presence of residual displacements in other cases was determined by the fracture type and localization, the technical complexity of the surgical intervention, lack of fixation rigidity under certain functional load conditions. In long terms of observation the infection and inflammatory complications were observed in 13.4% of patients, delayed unition and non-unition of bone fragments occurred--in 4.7%, arthosis with persistent dysfunction of the temporomandibular joint--in 6.7%, fibrous ankylosis--in 1.3%. Secondary displacement of fragments was observed in 23.5% of patients due to insufficient stiffness and reliaability of the bone-fixatorsystem. The non-precise reposition of fragments and secondary displacements in the early and late postoperative period were the main cause of occlusal disturbances of various severities, noted in 28% of operated patients, limitation of mouth opening (10%), TMJ disorders and changes in masticatory stereotype (33%), the sensation of pain and discomfort in tough food chewing (35%). A statistical analysis of the effectiveness of different osteosynthesis methods depending on the type and localization of the fracture was carried out and recommendations for usage of fixation devices in clinical practice were given.

  5. One-year prospective outcome analysis and complications following total replacement of the temporomandibular joint with the TMJ Concepts system. (United States)

    Sidebottom, A J; Gruber, E


    Total replacement of the temporomandibular joint (TMJ) is increasingly accepted as the gold standard for reconstruction of irreparably damaged or ankylosed joints. The TMJ Concepts system (TMJ Concepts, Ventura, USA) has the longest follow-up of the 2 systems used in the UK. A total of 74 patients had placement of TMJ Concepts prostheses. The primary diagnoses were degenerative disease, multiple previous operations, injury, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ankylosis. Of these, 12 were revisions of previous replacements (3 after multiple operations). Over the year there was a significant mean (SD) reduction in pain score (10 cm visual analogue scale) from 72 (2.5) to 8 (1.7) (pTMJ replacement gives good early improvements in function and pain with few complications. Of the 74 patients, 71 were very pleased to have had the procedure. One was dissatisfied despite complete pain relief and improvement in mouth opening from 3 to 30 mm, and 2 were ambivalent (one had infection, revision, and permanent weakness of the temporal branch of the facial nerve).

  6. Replantation of permanent incisors in children using Emdogain. (United States)

    Barrett, Edward J; Kenny, David J; Tenenbaum, Howard C; Sigal, Michael J; Johnston, Douglas H


    The aim of this study was to determine whether application of an enamel matrix protein derivative, Emdogain (Biora AB Malmo, Sweden) to the root surface of avulsed permanent incisors would improve postreplantation outcomes in a pediatric population. Between June 1999 and May 2002, 25 avulsed permanent maxillary incisors (22 centrals and three laterals) were treated with Emdogain and followed for up to 32 months, mean duration 20.6 months (range: 6.9-32.5 months). Mean patient age at the time of treatment was 12.0 years (range: 7.7-17.6 years) and mean extra-alveolar duration was 185 min (range: 100-300 min). At the end of their follow-up each of the replanted incisors demonstrated radiographic evidence of replacement root resorption and clinical evidence of ankylosis. None of the replanted teeth were affected by inflammatory root resorption and there was no evidence of infection. When compared with the control samples from Barrett and Kenny (Endod Dent Traumatol 1997;15:269-72.) and Andersson et al. (Endod Dent Traumatol 1989;5:38-47.) this sample treated with the Emdogain protocol demonstrated significantly less root resorption than either of the control samples (anova, P Emdogain protocol did not produce periodontal regeneration, it did eliminate inflammatory resorption and infection and led to significantly less root resorption compared with the two historical controls.

  7. [Purine metabolism in ankylosing spondylitis: clinical study]. (United States)

    Jiménez Balderas, F J; Robles, E J; Juan, L; Badui, E; Arellano, H; Espinosa Said, L; Mintz Spiro, G


    We undertook a prospective study of 23 male patients with Ankylosing Spondylitis (AS) (New York Criteria), 18 HLA-B27 positive and 5 HLA-B27 negative, five of them had hyperuricemia. The following data of evolution were taken into consideration: age at onset of disease, time course of the disease, presence of urolithiasis, heart disease, flares of uveitis. Clinical activity and degree of disability were evaluated every one to 3 months; on each visit, every patient had determinations of serum and urinary uric acid levels, serum and phosphorus, erythrocyte sedimentation rate (ESR), serum protein electrophoresis, as well as X-ray films of the vertebral spine and pelvis. Three groups of patients were detected, all of them with equal age at onset, duration of disease, frequency of B27, peripheral arthritis, and leukocytosis. One group had hyperuricemia (5 of 23 patients, 80% of them HLA-B27 positive) and a lesser degree of clinical activity of the disease (p less than .001, a higher frequency of uveitis (40%, lower levels of serum gammaglobulins (p less than 0.05) and ESR (p less than 0.05), a lesser degree of ankylosis of the spine, and a better functional prognosis than the other groups. Another group (8 of 23 patients, 75% of them were HLA-B27 positive) had normouricemia and hyperuricosuria, and showed a higher frequency of fever (50%), an abnormal urinalysis, and urolithiasis (25%).

  8. Osteoarthrosis of Temporomandibular Joint Related to the Defects of Posterior Dentition: A Retrospective Study. (United States)

    Levorová, Jitka; Machoň, Vladimír; Guha, Anasuya; Foltán, René


    Osteoarthrosis (OA) of temporomandibular joint (TMJ) is a progressive degenerative disease, gradually affecting cartilage, synovial membrane and bone structures. OA of TMJ clinically manifests with joint noises, pain and restricted mouth opening. In late stages, it results in severe damage of TMJ structures and development of ankylosis. Osteoarthrosis is a multifactorial disease; the occurrence is associated with TMJ overloading. The cohort included 619 patients [538 women (87%) and 81 men (13%), with average age 40.6 years (age range 8-89 years)] with TMJ disorder, who were examined in the year 2014 in Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic. The aim of this retrospective study was to analyse, if the lack of posterior teeth (supporting teeth zones) is the main etiologic factor of osteoarthrosis of TMJ. Diagnosis of OA was established on the clinical signs and the panoramic X-ray signs. Simultaneously other etiologic factors of OA were assessed. The presence of OA changes on X-ray had 171 patients (i.e. 27.6% of the total number of 619). 17.5% from these patients with OA had defect in posterior dentition. Other aetiological factors (stress, skeletal or vertebrogenous disorders) showed higher incidence of OA changes on X-ray. Defect of posterior dentition is not negligible, but it is not the main aetiological factor for osteoarthrosis of TMJ.

  9. Systemic inflammation and pain sensitization in knee osteoarthritis

    DEFF Research Database (Denmark)

    Neogi, Tuhina; Frey-Law, Laura; Misra, Devyani


    , enthesitis and ankylosis in advanced disease. Studies using seromarkers which reflect extracellular matrix constituent metabolism may provide insight into the activity and dynamics of connective remodeling and thereby pave the way for improved diagnostics and management. The aims of this investigation were...... to study C1M and C3M, which reflect the turnover of collagen I and III, in order to assess their utility as diagnostic and disease activity markers. Methods: Ninety-nine patients with PsA, 110 with axSpA and 120 healthy control subjects were included. Demographic and clinical disease measures were recorded...... of both C1M (p=0.001) and C3M (p=0.006) compared to HLAB-27- SpA patients. C1M was significantly correlated with DAS28 (PsA: r=0.22, p=0.028, SpA: r=0.40, p0.0001 in all groups) but they did not correlate with demographics including age, BMI or gender. Segregation between healthy and diseased based on C1M...

  10. [Chronic prostatitis and Bechterew's disease]. (United States)

    Kohlicek, J; Svec, V


    A group of patients between 35 and 65 years old with chronic prostatitis were examined for the presence of Becherew's disease. In this connection the New York and Roman criterions for morbus Bechterew were applied. There were found one ankyosing spondylarthritis, one ankylosis of the sacroiliac joint, and 11 times a tentative sacroileitis were stated. Altogether the proved and tentative findings were only 3.68 per cent of all examinations. In our countries the morbus Bechterew is found in 0,21 per cent of the normal population. So the protion of the Bechterew's disease in patients with chronic prostatitis is indeed a little higher than average, but not so frequent as often pretended in recent times. After a second series 58 patients being treated because of Bechterew's disease of different stages and different terms were examined for the possibility of a simultaneously elapsing chronic prostatitis. A chronic prostatitis was found in 38 per cent of these patients which correspondents to the incidence published in literature for the medium-age manhood. Nobody of the test persons had complaints on the part of the urologenital tract.

  11. Mandibular distraction: evolution of treatment protocols in hemifacial microsomy. (United States)

    Cascone, P; Gennaro, P; Spuntarelli, G; Iannetti, G


    Osteodistraction is currently used in those disorders presenting with osseus tissue deficit, excellent results having been obtained in the craniofacial complex. The factors contributing to the success of this procedure are a thin layer of subcutaneous tissue, minimum movement of the cutis, good vascularization of the soft tissues, and the good healing that ensues. The good plastic effects on the soft tissues and the possibility of constantly modulating the strength and monitoring the results have led to distraction osteogenesis gaining increasing consensus in the treatment of congenital and acquired deformities and in some selected cases, for the treatment of osseous deficits caused by trauma, postsurgical outcomes, or even severe alveolar deficits. Furthermore, in the last few years, this surgical technique has been successfully used in the treatment of pediatric deformities such as hemifacial microsomia, some severe class II skeletal deformities, and some syndromic cases, such as the treatment of temporomandibular ankylosis outcomes. In our opinion, guidelines in the indications for distraction are mandatory to select the procedure best suited to the pathologic situation of each individual patient.

  12. Biphasic calcium phosphate ceramic combined with fibrillar collagen with and without citric acid conditioning in the treatment of periodontal osseous defects. (United States)

    Nery, E B; Eslami, A; Van Swol, R L


    The purpose of this study is to determine whether the combination of biphasic calcium phosphate ceramic (BCP) and collagen and citric acid root conditioning would promote accelerated new attachment of periodontal tissue to the root surface in dogs. Intrabony defects were surgically produced for each animal and were made chronic for 16 weeks. These defects were assigned to two study treatment and one control group: ceramic-collagen without citric acid (CO-CE); ceramic-collagen with citric acid (CO-CE-CA); and control (surgical debridement and root planing only). Results showed that all groups gained new attachment level as demonstrated both clinically and histometrically. The treatment groups showed a significant mean gain greater than the control (P less than .005), but no significant difference was found between treatment groups. Small areas of ankylosis was also found in both treatments but there was no evidence of active root resorption. It is concluded that the use of combined BCP and fibrillar collagen is beneficial in promoting new attachment of periodontal tissues to the root surface in dogs. Although citric acid root conditioning did as well or better than ceramic and collagen alone, its benefits are still speculative and need further experimentation.

  13. Serotonin Is Involved in Autoimmune Arthritis through Th17 Immunity and Bone Resorption. (United States)

    Chabbi-Achengli, Yasmine; Coman, Tereza; Collet, Corinne; Callebert, Jacques; Corcelli, Michelangelo; Lin, Hilène; Rignault, Rachel; Dy, Michel; de Vernejoul, Marie-Christine; Côté, Francine


    Rheumatoid arthritis is a chronic disease that results in a disabling and painful condition as it progresses to destruction of the articular cartilage and ankylosis of the joints. Although the cause of the disease is still unknown, evidence argues that autoimmunity plays an important part. There are increasing but contradictory views regarding serotonin being associated with activation of immunoinflammatory pathways and the onset of autoimmune reactions. We studied serotonin's involvement during collagen-induced arthritis in wild-type and Tph1(-/-) mice, which have markedly reduced peripheral serotonin levels. In wild-type mice, induction of arthritis triggered a robust increase in serotonin content in the paws combined with less inflammation. In Tph1(-/-) mice with arthritis, a marked increase in the clinical and pathologic arthritis scores was noticed. Specifically, in Tph1(-/-) mice with arthritis, a significant increase in osteoclast differentiation and bone resorption was observed with an increase in IL-17 levels in the paws and in Th17 lymphocytes in the draining lymph nodes, whereas T-regulatory cells were dampened. Ex vivo serotonin and agonists of the 5-HT2A and 5-HT2B receptors restored IL-17 secretion from splenocytes and Th17 cell differentiation in Tph1(-/-) mice. These findings indicate that serotonin plays a fundamental role in arthritis through the regulation of the Th17/T-regulatory cell balance and osteoclastogenesis.

  14. Decoronation for the management of an ankylosed young permanent tooth. (United States)

    Sapir, Shabtai; Shapira, Joseph


    Replacement resorption rate is a variable process, and is dependent on age, basal metabolic rate, extra-alveolar time, treatment prior to replantation, amount of root dentin, severity of trauma, and extent of periodontal ligament necrosis. In patients 7-16 years old a tooth is lost 3-7 years after the onset of root resorption. The complications that may develop as a consequence of ankylosis of a permanent incisor in children are due to the inevitable early loss of the traumatized tooth and local arrest of alveolar bone development. An ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The treatment options may involve: interceptive regenerative treatment, early extraction of the ankylosed tooth, orthodontic space closure, intentional replantation, extraction of the ankylosed tooth followed with immediate ridge augmentation/preservation, auto-transplantation, single tooth dento-osseous osteotomy, and decoronation. The purpose of this article was to review the considerations involved in the decision-making concerning the use of the decoronation technique for the treatment of a permanent incisor diagnosed as ankylosed.

  15. Advances of Chinese and Western Medicine on Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Na-na HE


    Full Text Available Rheumatoid arthritis (RA is a kind of chronic general immunological disease with primary clinical characteristic being joint synovitis, and no specific treatment has been found at present. In China, its morbidity is in an increasing trend, and also shows a trend of getting younger. RA is complicated in symptoms and chronic disease course, leading to joint ankylosis, deformity and even disability, which seriously threaten patients' psychological and physical health as well as the quality of life (QOL. RA, which belongs to “ Bi” symdrome, is termed as “arthroncus of knee” or “severe and migratory arthralgia” in traditional Chinese medicine (TCM, for which TCM focuses on expelling wind to remove cold, tonifying qi to activate blood and dispelling dampness to smooth collaterals while the western medicines mainly based on the principles of anti-inflammation, analgesia and inhibiting autoimmune response. However, both Chinese and western medicines have certain advantages in treating RA. Therefore, this study primarily reviewed the advances of Chinese and western medicines in RA treatment in the hope of providing theoretical basis for the clinical treatment of RA.

  16. The Effect of Root Coating with Titanium on Prevention of Root Resorption in Avulsed Teeth: An Animal Study (United States)

    Heydari, Azar; Tahmasbi, Soodeh; Badiee, Mohammadreza; Izadi, SeyedSadra; Mashhadi Abbas, Fatemeh; Mokhtari, Sepideh


    Introduction: Tooth avulsion is a real dental emergency. If immediate replantation is not performed, the avulsed tooth may be lost due to inflammatory or replacement resorption. This animal study aimed to evaluate the bone response to the titanium coating of the root surface as an artificial barrier, and prevention of resorption of avulsed teeth. Methods and Materials: This experimental study was conducted on four male dogs. The dogs were randomly divided into two groups for assessment at two and eight weeks. Four teeth were extracted in each animal. The root surfaces of the test group were coated with a titanium layer using the Electron Beam Deposition system. After 24 h, replantation of the teeth was performed. Two animals were sacrificed after two weeks and the remaining dogs were killed after eight weeks. The presence of inflammation, inflammatory resorption, replacement resorption, periodontal regeneration, periapical granuloma and ankylosis were evaluated through histological analyses. Results: Inflammatory root resorption was not present in any tooth except one tooth in the coated group after eight weeks. Replacement resorption was noted just in three of the non-coated teeth after two weeks and two teeth after eight weeks. The McNemar's test revealed that the frequency of replacement resorption in the non-coated group was significantly higher than the coated group (P=0.031). Conclusion: Based on the results of this study, it seems that coating the root surfaces of avulsed teeth with titanium may control the replacement root resorption. PMID:27790261

  17. Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report. (United States)

    Doğramaci, Esma J; Rossi-Fedele, Giampiero; Jonest, Allan G


    This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

  18. Acute trauma induced disc displacement without reduction and its sequelae (United States)

    He, DongMei; Yang, XiuJuan; Wang, FeiYu; Yang, Chi; Dong, MinJun


    Acute traumatic temporomandibular joint disc displacement (ATDD) and its sequelae are not familiar for most surgeons. This study is to discuss its sequelae in cases without disc reduction after failed conservative treatment. From 2010 to 2015, 26 patients with 34 joints were included in the study. All patients had at least 3 months conservative treatment. Their maximal incisor opening (MIO) was measured during follow-ups and MRI examination was used to check the condylar bone degeneration. The mean follow-up for conservative treatment after admission was 8.69 months, the patients reached an average of 25.7 mm MIO. MRI showed condylar bone intact in 8 joints (23.5%), condylar surface bone destruction (Wilks IV, V stages) in 14 joints (41.2%), and severe bone resorption in 12 joints (35.3%). 15 patients with 23 joints were asked for surgical treatment after a mean conservative treatment of 5.4 months (3–12 months) to improve mouth opening and relieve chronic pain. 12 joints had total joint replacement (TJR). 11 joints had disc repositioning. Their mean MIO before operation was 19.8 mm and significantly improved to 33.9 mm after operation (p = 0.0000). ATDD may cause severe osteoarthritis or ankylosis. Disc repositioning and TJR could significantly improve MIO. PMID:27582054

  19. [Manubriosternal dislocation caused by indirect flexion-compression trauma. A case report and review of the literature]. (United States)

    Kälicke, T; Feil, E; Steuer, K; Hansis, M


    Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.

  20. Facet joint laser radiation: tissue effects of a new clinical laser application (United States)

    Werkmann, Klaus; Thal, Dietmar R.


    Chronic unilateral and bilateral back pain with pseudoradicular symptoms, is a common clinical syndrome, which in many cases can be related to the facet joint syndrome. The pain is caused by mechanical affection of synovial and capsular nerve terminals. Therefore, current therapeutical attempts including physical therapy, intra-articular injection of local anesthetics and steroids and thermocoagulation of the facet joint with a thermocoagulator, are performed. We confirmed laser coagulation of the facet joint. Porcine cadaveric spines were treated immediately after death by intra-articular facet joint laser radiation. With the pulsed Nd:YAG laser (1064 nm) altogether 600 J were applied in three different places 4 mm apart at the top of the facet joint. The results showed that facet joint laser radiation leads to a small (about 1 - 2 mm diameter) lesion restricted to the facet joint cavity and its synovia. Histologically, we found a central carbonization zone and necrosis, including almost the whole cartilage and approximately 0.2 mm of the adjacent bone. These changes are similar to Nd:Yag-laser applications in other skeletal regions. It is suggested that these changes may lead to facet joint denervation by coagulation of the synovial nerve terminals. Cicatration of the laser lesion might cause ankylosis of this joint. In sum, facet joint laser radiation could be an alternative therapeutical tool for lower back pain of the facet joint syndrome type. Therefore, future clinical application of this technique seems to be very promising.

  1. Mucopolysaccharidosis VI in a Siamese/short-haired European cat. (United States)

    Macrì, B; Marino, F; Mazzullo, G; Trusso, A; De Maria, R; Amedeo, S; Divari, S; Castagnaro, M


    A 3-year-old Siamese/short-haired European cat was referred for clinical disease characterized by dwarfism, facial dysmorphia, paralysis, small and curled ears, corneal clouding and large areas of alopecia. X-ray examination showed multiple bone dysplasia. On the basis of clinical features a form of mucopolysaccharidosis was suspected. The cat, killed at the owner's request, presented several severe skeletal deformities such as long caudal limbs, enlarged thorax with sunken breastbone, vertebral ankylosis in many spinal segments and visceral involvement. Histologically, the cat showed diffuse vacuolization and enlargement of cells in cartilage, bone and visceral organs. Ultrastructurally, membrane-bound vacuoles were filled with fibrillar and fluffy-material or concentrically whorled lamellae. Arylsulphatase B activity was 3.24 nm/mg/h in the affected cat and 30.6 in a normal age-matched control (NC). The L-iduronidase activity was slightly increased. Quantitation of total glycosaminoglycans (GAGs) revealed a 4.5-fold increase in the affected cat as compared with NC, while electrophoretic run of specific GAGs [chondroitin sulphate (CA); hyaluronan (HA); heparan sulphate (HS); dermatan sulphate (DS); keratan sulphate (KS)] performed on a cellulose acetate sheet, showed a striking increase in the DS band. On densitometric analysis of the electrophoretic run stained with Alcian Blue 8GX, the absorption of DS was eight-fold increased as compared with NC. The clinical and morphological features, and the biochemical findings, were consistent with the diagnosis of feline mucopolysaccharidosis VI.

  2. Osteogenesis imperfecta type V: clinical and radiographic manifestations in mutation confirmed patients. (United States)

    Kim, Ok-Hwa; Jin, Dong-Kyu; Kosaki, Keisuke; Kim, Jung-Wook; Cho, Sung Yoon; Yoo, Won Joon; Choi, In Ho; Nishimura, Gen; Ikegawa, Shiro; Cho, Tae-Joon


    Osteogenesis imperfecta (OI) type V is a specific OI phenotype with interosseous membrane calcification of the forearm and hyperplastic callus formation as typical features. The causative gene mutation for OI type V has been recently discovered. The purpose of this report is to review the clinical and radiographic characteristics of mutation confirmed OI type V in detail. Sixteen (nine familial and seven sporadic) patients were enrolled in the study. Blue sclera and dentinogenesis imperfecta were not evident in any patient. However, hypodontia in the permanent teeth, ectopic eruption, and short roots in molars were additionally observed in 11 patients. Of the radiographic abnormalities, cortical thickening and bony excrescence of interosseous margin of the ulna was the most common finding, followed by overgrowth of the olecranon and/or coronoid process of the ulna. Slender ribs and sloping of the posterior ribs with or without fractures were also a consistent finding. Hyperplastic callus was detected in 75% of patients and was commonly encountered at the femur. Heterotopic ossification in the muscles and tendon insertion sites were noted in four patients, which resulted in bony ankylosis or contracture of joints. The current study confirms common clinical and radiographic findings of OI type V and reports additional phenotypic information. These observations provide clues to recognize OI type V more promptly and guide to direct targeted molecular study. © 2013 Wiley Periodicals, Inc.

  3. Type 2 Pfeiffer syndrome. Report of a case and review of the literature

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    Roldán Arce Jorge


    Full Text Available Pfeiffer syndrome is a rare autosomal dominant disease that affects almost 1 out of every 100,000 live newborns, and it is associated with craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly in hands and feet. Three types of this syndrome have been described based on the presence of other abnormalities and the severity of the condition. “Classic” type 1 consists of mild severity with normal to near-normal intelligence and generally a good prognosis. Type 2 is characterized by a cloverleaf skull, severe proptosis, elbow ankylosis or synostosis, growth retardation and life-threatening neurological and respiratory complications. Type 3 is similar to type 2 but without the cloverleaf cranium. This syndrome is genetically heterogeneous, it is caused by mutations in the fibroblast growth factor receptor genes FGFR- 1 or FGFR-2. Occasionally Pfeiffer syndrome can be diagnosed prenatally by sonography or molecularly if the causative mutation is known. Management must be multidisciplinary and it includes multiple-staged surgery. In this report we present the clinical and radiographic findings in female newborn, whose clinical features were consistent with Pfeiffer syndrome type 2. A brief updated review of the literature is included.

  4. Pfeiffer syndrome

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    Fryns Jean-Pierre


    Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

  5. Fragility Fractures in Patients with Psoriatic Arthritis. (United States)

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele


    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile.

  6. Overexpression of Shox2 Leads to Congenital Dysplasia of the Temporomandibular Joint in Mice

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    Xihai Li


    Full Text Available Our previous study reported that inactivation of Shox2 led to dysplasia and ankylosis of the temporomandibular joint (TMJ, and that replacing Shox2 with human Shox partially rescued the phenotype with a prematurely worn out articular disc. However, the mechanisms of Shox2 activity in TMJ development remain to be elucidated. In this study, we investigated the molecular and cellular basis for the congenital dysplasia of TMJ in Wnt1-Cre; pMes-stop Shox2 mice. We found that condyle and glenoid fossa dysplasia occurs primarily in the second week after the birth. The dysplastic TMJ of Wnt1-Cre; pMes-stop Shox2 mice exhibits a loss of Collagen type I, Collagen type II, Ihh and Gli2. In situ zymography and immunohistochemistry further demonstrate an up-regulation of matrix metalloproteinases (MMPs, MMP9 and MMP13, accompanied by a significantly increased cell apoptosis. In addition, the cell proliferation and expressions of Sox9, Runx2 and Ihh are no different in the embryonic TMJ between the wild type and mutant mice. Our results show that overexpression of Shox2 leads to the loss of extracellular matrix and the increase of cell apoptosis in TMJ dysplasia by up-regulating MMPs and down-regulating the Ihh signaling pathway.

  7. Arthroscopic tibiotalar and subtalar joint arthrodesis. (United States)

    Roussignol, X


    Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is reserved only for cases in which arthroscopy is contraindicated: material ablation after consolidation failure, osteophytes precluding a work chamber, excentric talus, severe malunion, bone defect requiring grafting, associated midfoot deformity, etc. The first reports of arthroscopic tibiotalar and subtalar arthrodesis date from the early 1990s. Consolidation rates were comparable to open surgery, but with significantly fewer postoperative complications: infection, skin necrosis, etc. Arthroscopy was for many years reserved to moderate deformity, with frontal or sagittal deviation less than 10°. The recent literature, however, seems to extend indications, the only restriction being the surgeon's experience. Tibiotalar arthrodesis on a posterior arthroscopic approach remains little used. And yet the posterior work chamber is much larger, and initial series showed consolidation rates similar to those of an anterior approach. The surgical technique for posterior tibiotalar arthrodesis was described by Van Dijk et al., initially using a posterior para-Achilles approach. This may be hampered by posterior osteophytes or ankylosis of the subtalar joint line (revision of non-consolidated arthrodesis, sequelae of calcaneal thalamus fracture) and is now used only by foot and ankle specialists. Posterior double tibiotalar-subtalar arthrodesis, described by Devos Bevernage et al., is facilitated by transplantar calcaneo-talo-tibial intramedullary nailing.

  8. Novel biologics in treatment of psoriatic arthritis%新型生物制剂在关节病型银屑病中的应用

    Institute of Scientific and Technical Information of China (English)

    周炯; 郑敏


    Psoriatic arthritis is an inflammatory joint disease associated with psoriasis.Due to difficulty for early diagnosis and lack of effective therapy,the disease leads to chronic course and frequent relapse.Patients may suffer from ankylosis,disability and even death.The past treatments neither can control the disease effectively,nor be capable of inhibiting the development of structural joint damage.Based on the current psoriasis pathogenesis,novel biologics have been developed,which can aim the specific targets,resulting in more effective and safer management for psoriatic arthritis.%关节病型银屑病是一种与银屑病相关的炎性关节病.该疾病早期诊断困难,而且缺乏有效药物;晚期患者可出现关节强直而致残,甚至死亡.传统药物在阻止关节损害方面效果不佳,毒副作用大.新型生物制剂作为一种基于银屑病发病机制中的免疫关键步骤而研发的新药,为关节病型银屑病的治疗提供了较为有效的方案.


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    Purushottam Rao


    Full Text Available INTRODUCTION: Rheumatoid arthritis is a chronic systemic inflammatory disorder that affects many tissue organs such as skin, blood vessels, heart, lungs and muscles but principally affects joints producing synovitis that often progress to tissue destruction of articular cartilage and ankylosis of joints. Pulmonary manifestations in rheumatoid arthritis are varied as the pleura, lung, parenchyma, airways and pulmonary vasculature all can be involved. AIM AND OBJECTIVES : To study the incidence of pleuropulmonary manifestations of Rheumatoid Arthritis in patients who were confirmed to have rheumatoid arthritis by 2010 ACR criteria . 6 METHODOLOGY : This prospective study was carried out at King George Hospital, Visakhapatnam, Andhra Pradesh. It is a Tertiary Care Hospital. The study was conducted from January 2013 to December 2014. RESULTS: A total of sixty patients who were confirmed to have rheumatoid arthritis were included in this study. Of these, female patients were 34 (56.66% and males were 26 (43.33%. In this study, out of sixty patients of rheumatoid arthritis 24 patients (40% had pleuropulmonary manifestations. CONCLUSION : Rheumatoid Arthritis is prevalent in females but pleuropulmonary manifestations are common in males. Prevalence of pleuropulmonary manifestations is independent of duration of rheumatoid arthritis. But presence of pleuropulmonary manifestations indicate the severity of disease process

  10. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

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    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)


    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  11. Extensive heterotopic ossification in patient with tubercular meningitis

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    Vijai Prakash Sharma


    Full Text Available Tubercular meningitis is a severe form of central nervous system tuberculosis with high morbidity and mortality. Apart from neurological deficits, musculoskeletal involvement is also seen in very few cases in the form of heterotopic ossification around immobile joints. A 35-year-old male case of tubercular meningitis with left hemiparesis presented with multiple joint restriction of range of motion. On clinical examination, palpable firm masses around multiple joints with painful restriction of movements were seen. X-ray films of multiple joints revealed heterotopic ossification over left shoulder, hip and knee joint with bony ankylosis of left hip and soft tissue contractures. Very few reports have been published in the literature for association of heterotopic ossification with tubercular meningitis with such extensive joint involvement which compels us to report this clinical association of tubercular meningitis. This report is intended to create caution among physicians and other caregivers for this debilitating complication of tubercular meningitis and in face of high prevalence of tuberculosis and tubercular meningitis, employ methods to prevent and treat.

  12. Additional phenotypic features of Muenke syndrome in 2 Dutch families. (United States)

    de Jong, Tim; Mathijssen, Irene M J; Hoogeboom, A Jeannette M


    In about 30% of the patients with syndromal craniosynostosis, a genetic mutation can be traced. For the purpose of adequate genetic counseling and treatment of these patients, the full spectrum of clinical findings for each specific mutation needs to be appreciated. The Pro250Arg mutation in the FGFR3 gene is found in patients with Muenke syndrome and is one of the most frequently encountered mutations in craniosynostosis syndromes. A number of studies on the relationship between genotype and phenotype concerning this specific mutation have been published. Two Dutch families with Muenke syndrome were screened for the reported characteristics of this syndrome and for additional features. New phenotypical findings were hypoplasia of the frontal sinus, ptosis of the upper eyelids, dysplastic elbow joints with restricted elbow motion, and mild cutaneous syndactyly. Incidentally, polydactyly, severe ankylosis of the elbow, fusion of cervical vertebrae, and epilepsy were found. Upper eyelid ptosis is thought to be pathognomonic for Saethre-Chotzen syndrome but was also observed in our series of patients with Muenke syndrome. Because Muenke and Saethre-Chotzen syndrome can have similar phenotypes, DNA analysis is needed to distinguish between these syndromes, even when a syndrome diagnosis is already made in a family member.

  13. Fluorosis

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    Fallahian F. MD- Internist


    Full Text Available The health of habitants, living in un-fluoridated drinking water areas, can be endangered"nthrough fluoride intake from food, beverages, tooth paste and dentistry products. Fluoride is used in"nmouthwash, toothpaste, juice fruits, conserved foods and Teflon dishes. Water exposure to fluoride"noccurs through fertilizers, aluminum industries, insecticides, pesticides, herbicides and fungicides used"nfor fruits and vegetables which ultimately lead to environmental fluoride pollution. Some side effects."ncaused by chronic fluoride intake are as follows: decrease of hemoglobin concentration, gastrointestinal"ndisorders, and tooth loss at young age, osteofluorosis, hip fracture among aged people, osteosclerosis,"nosteoporosis, special forms of arthritis and joint ankylosis, metaphysial osteomalacia, mottling and weak"nstructure of tooth, insulin secretion and glucose tolerance test disorders, decrease of urine concentration,"nimmune system disorders, genetic defects and cancer, learning disabilities and IQ(intelligence quotient"ndeficits and thyroid dysfunction The present article was to investigate the side effect of excessive"nfluoride intake and to discuss different preventive and diagnostic ways.

  14. Fractures of the mandibular coronoid process: a two centres study. (United States)

    Boffano, Paolo; Kommers, Sofie C; Roccia, Fabio; Gallesio, Cesare; Forouzanfar, Tymour


    The aim of this study was to assess the characteristics of patients with coronoid fractures treated in two European centres over 10 years and to briefly review the literature. This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures and surgically treated in two European centres between 2001 and 2010. During the 10 years, 1818 patients and 523 patients with maxillofacial fractures were admitted to the two centres respectively: 21 patients (16 males, 5 females) were admitted with 21 coronoid fractures and 28 associated maxillofacial fractures. A mean age of 42.1 years was observed. The fractures were mainly the result of motor vehicle accidents, followed by assaults and falls. The most frequently observed associated maxillofacial fracture was a zygomatic fracture (13 fractures). In both centres, mandibular coronoid fractures are treated unless a severe dislocation of the fractured coronoid is observed or a functional mandibular impairment is encountered. Conservative treatment can be used, together with the open reduction and internal fixation of associated fractures. The crucial point is to prevent ankylosis, which may be prevented by correct and early postoperative physiotherapy and mandibular function.

  15. Anchoretic Infection

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    S. Gokkulakrishnan


    Full Text Available Active and passive mouth opening exercises are a very common practice in oral and maxillofacial surgery especially for various conditions causing limited mouth opening like space infections, trauma, and ankylosis. But most of the practitioners do not follow basic principles while advocating these active mouth opening exercises and also take it for granted that it would benefit the patient in the long run. Because of this, the mouth opening physiotherapy by itself can at times lead to unwanted complications. We report a case wherein due to active physiotherapy, the patient had complications leading to persistent temporal space infection which required surgical intervention and hospitalization. This could have been because of hematoma formation during physiotherapy which got infected due to anchoretic infection of unknown etiology and resulted in temporal space infection. Hence, our conclusion is that whenever mouth opening exercises are initiated, it should be done gradually under good antibiotic coverage to avoid any untoward complications and for optimum results. According to the current English literature, such a complication has not been documented before.

  16. Dupuytren’s disease. State of the art and therapeutic perspectives

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    F.P. Cantatore


    Full Text Available Dupuytren’s disease is a benign fibroproliferative disorder characterised by the sclerosis and the retractile thickening of the medial palmar aponeurosis and digital aponeurosis, which can lead to the progressive and irreversible finger flexion. Genetic, metabolic and environmental factors are involved in the pathogenesis of Dupuytren’s disease, but their role is not clearly established. Different medical therapies have been proposed for Dupuytren’s disease treatment, but their real effectiveness has not been shown. Surgical therapy (fasciectomy is the most used treatment, whose purpose is to correct finger deformity and to avoid joint ankylosis. A team of French rheumatologists has developed a non-surgical approach, the percutaneous needle fasciotomy (PNF, whose results in less aggressive forms of Dupuytren’s disease are comparable to traditional surgery. PNF can be rapidly performed, presents a low cost and a low rate of complications and represents a valid alternative to surgical treatment of Dupuytren’s disease. In this review we report our results on 24 patients treated with PNA for Dupuytren’s contracture.

  17. A functional interpretation of the varanid dentition (Reptilia, Lacertilia, Varanidae). (United States)

    Rieppel, O


    A cinéradiographic analysis of the feeding movements in Varanus bengalensis produced the following results. The mouth is opened by raising the head (upper jaw) rather than by lowering the lower jaw. Starting from the resting position, the muzzle unit is elevated around 9 degrees relative to the rest of the skull during jaw opening; the quadrate swings anteriorly around 21 degrees. During jaw closure, the snout is depressed around 15 degrees relative to the rest of the skull, hence 6 degrees beyond the resting position. The quadrate swings backwards around 27 degrees. Amphikinesis is interpreted as allowing a stronger posterior recurvature of the maxillary teeth in Varanus. This increases the holding effect of the teeth without increasing their length, an adaptation of Varanus to capture relatively large prey. The formation of plicidentine (dentine infolding) in the teeth of Varanus increases the surface of attachment of the teeth on the supporting bone. Moreover, the dentine lamellae take up tensile and compressive stresses along their long axes upon axial or vertical loading of the teeth. The slope of pleurodonty is modelled so as to minimalize shear stress on the surface of ankylosis upon axial or vertical loading of the teeth.

  18. Fibroblast-like synoviocytes induce calcium mineral formation and deposition. (United States)

    Sun, Yubo; Mauerhan, David R; Franklin, Atiya M; Zinchenko, Natalia; Norton, Harry James; Hanley, Edward N; Gruber, Helen E


    Calcium crystals are present in the synovial fluid of 65%-100% patients with osteoarthritis (OA) and 20%-39% patients with rheumatoid arthritis (RA). This study sought to investigate the role of fibroblast-like synoviocytes (FLSs) in calcium mineral formation. We found that numerous genes classified in the biomineral formation process, including bone gamma-carboxyglutamate (gla) protein/osteocalcin, runt-related transcription factor 2, ankylosis progressive homolog, and parathyroid hormone-like hormone, were differentially expressed in the OA and RA FLSs. Calcium deposits were detected in FLSs cultured in regular medium in the presence of ATP and FLSs cultured in chondrogenesis medium in the absence of ATP. More calcium minerals were deposited in the cultures of OA FLSs than in the cultures of RA FLSs. Examination of the micromass stained with nonaqueous alcoholic eosin indicated the presence of birefringent crystals. Phosphocitrate inhibited the OA FLSs-mediated calcium mineral deposition. These findings together suggest that OA FLSs are not passive bystanders but are active players in the pathological calcification process occurring in OA and that potential calcification stimuli for OA FLSs-mediated calcium deposition include ATP and certain unidentified differentiation-inducing factor(s). The OA FLSs-mediated pathological calcification process is a valid target for the development of disease-modifying drug for OA therapy.

  19. Fibroblast-Like Synoviocytes Induce Calcium Mineral Formation and Deposition

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    Yubo Sun


    Full Text Available Calcium crystals are present in the synovial fluid of 65%–100% patients with osteoarthritis (OA and 20%–39% patients with rheumatoid arthritis (RA. This study sought to investigate the role of fibroblast-like synoviocytes (FLSs in calcium mineral formation. We found that numerous genes classified in the biomineral formation process, including bone gamma-carboxyglutamate (gla protein/osteocalcin, runt-related transcription factor 2, ankylosis progressive homolog, and parathyroid hormone-like hormone, were differentially expressed in the OA and RA FLSs. Calcium deposits were detected in FLSs cultured in regular medium in the presence of ATP and FLSs cultured in chondrogenesis medium in the absence of ATP. More calcium minerals were deposited in the cultures of OA FLSs than in the cultures of RA FLSs. Examination of the micromass stained with nonaqueous alcoholic eosin indicated the presence of birefringent crystals. Phosphocitrate inhibited the OA FLSs-mediated calcium mineral deposition. These findings together suggest that OA FLSs are not passive bystanders but are active players in the pathological calcification process occurring in OA and that potential calcification stimuli for OA FLSs-mediated calcium deposition include ATP and certain unidentified differentiation-inducing factor(s. The OA FLSs-mediated pathological calcification process is a valid target for the development of disease-modifying drug for OA therapy.

  20. The Role of MicroRNAS in Ankylosing Spondylitis. (United States)

    Li, Zheng; Wong, Sunny H; Shen, Jianxiong; Chan, Matthew T V; Wu, William Ka Kei


    Ankylosing spondylitis (AS) is a common and genetically heterozygous inflammatory rheumatic disease characterized by new bone formation, ankylosis and inflammation of hip, sacroiliac joints and spine. Until now, there is no method for early diagnosis of AS and the effective treatment available for AS patients remain largely undefined.We searched articles indexed in PubMed (MEDLINE) database using Medical Subject Heading (MeSH) or Title/Abstract words ("microRNA" and "ankylosing spondylitis") from inception up to November 2015.Genetic polymorphisms of miRNAs and their targets might alter the risk of AS development whereas certain miRNAs exhibit correlation with inflammatory index.Let-7i and miR-124 were upregulated whereas miR-130a was downregulated in circulating immune cells of AS patients. These deregulated miRNAs could modulate key immune cell functions, such as cytokine response and T-cell survival.miRNA deregulation is key to AS pathogenesis. However, clinical utilization of miRNAs for management of AS patients requires further support from future translational studies.

  1. Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report. (United States)

    Espandar, Ramin; Haghpanah, Babak


    Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space) and fixation of both knees in extension; so, there is little experience in operative management of such a problem.Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique.

  2. Physiotherapy treatments in musculoskeletal pathologies associated with haemophilia. A literature review. (United States)

    Guodemar-Pérez, Jesús; Ruiz-López, Montserrat; Rodríguez-López, Elena; García-Fernández, Pablo; Hervás-Pérez, Juan Pablo


    The aim of this study is to offer physiotherapists a synthesis of the main therapeutic tools available for the treatment of musculoskeletal pathologies in patients with haemophilia, according to the scientific literature. Although bleeds are recognised as no longer being a cause of death for people with haemophilia, the accompanying musculoskeletal injuries now represent the main problem associated with this disorder. There is a lack of clear guidelines to date regarding the physiotherapy treatment of these disorders. We performed a keyword searches of Pubmed, Scopus, Sciencedirect, Cochrane and PEDro databases. In total, 555 references were retrieved, of which only 55 fulfilled the inclusion criteria. Publications were grouped by the main symptoms caused by haemophilia and the physiotherapy treatments available. The literature reviewed shows that physiotherapists have a range of therapeutic tools at their disposal for the treatment of the main musculoskeletal disorders suffered by patients with haemophilia. Physiotherapy interventions act upon inflammation and pain, as well as favouring the reabsorption of haematomas, preventing muscle fibrosis and joint ankylosis and recovering the joint range from prior to the lesions. Also, these interventions help prevent muscle atrophy and provide patients with the optimal physical conditions for facing the small and repetitive injuries that, over time, can have a detrimental effect on their quality of life.

  3. Radiologic comparison of erosive polyarthritis with prominent interphalangeal involvement

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    Gold, R.H.; Bassett, L.W.; Theros, E.G.


    Psoriatic arthritis, Reiter's disease, and multicentric reticulohistiocytosis may manifest prominent interphalangeal joint and cutaneous involvement. All three disorders may also affect the sacroiliac joints and spine. Despite these similarities, there are basic radiologic differences enabling distinction between the three disorders. Erosive osteoarthritis must also be considered in the differential diagnosis of interphalangeal erosive arthritis. Psoriatic erosions are characteristically ill defined, often bilaterally asymmetrical, usually unaccompanied by significant osteoporosis, and frequently associated with florid proliferation of subperiosteal new bone. An unilateral polyarticular pattern, which often occurs in a single ray, is the most prevalent of several patterns of involvement. Reiter's disease exhibits many clinical and radiologic similarities to psoriatic arthritis, but in the former there tends to be selective involvement of the joints of the lower limbs and particularly the feet, with relative sparing of the hands and wrists, while in the latter the joints of the upper and lower limbs tend to be involved to an equal extent. Multicentric reticulohistiocytosis (MR). Lesions predominate in skin and synovium and result in sharply circumscribed, rapidly progressive, strikingly bilaterally symmetrical erosions spreading from joint margins to articular surfaces. Most or all of the diarthrodial joints may be affected, but interphalangeal joint predominance and early and severe atlanto-axial involvement are characteristic. Erosive osteoarthritis is characterized by interphalangeal subchondral erosions, accompanying periosteal new bone that is more subtle than that of psoriatic arthritis, and interphalangeal bony ankylosis that occurs with the same frequency as that of psoriatic arthritis.

  4. [General anesthesia for a pregnant patient with PAPA syndrome]. (United States)

    Ohno, Seika; Ariyama, Jun; Tsujita, Miki; Ueshima, Hironobu; Imanishi, Hirokazu; Terao, Kazuhisa; Mieda, Tsutomu; Kitamura, Akira


    A 31-year-old female, with 22 weeks of pregnancy, presented with sudden onset of severe headache. CT scan showed diffuse subarachnoid hemorrhage. A cerebral angiogram showed dissecting aneurysm of right cerebral artery. To obliterate the aneurysm and prevent rupture, the patient underwent coil embolization via an endovascular approach under general anesthesia because the procedure under sedation with local anesthesia was too risky for re-bleeding. The patient has been diagnosed as PAPA syndrome. Although the arthritis was now stable and she was taking no drug, remarkable osteoarthritis was observed. The cervical spine X ray demonstrated no cervical ankylosis. As patient was sedated with propofol, airway examination could not be done except noticing thyromental distance of seven centimeters. Patient's trachea was intubated using Macintosh size #3 laryngoscope blade and a 7.0 non-styletted tracheal tube at the first attempt without any problems (Cormack grade I). Anesthesia was maintained with sevoflurane, fentanyl and remifentanil. After the end of endovascular surgery, the patient was transferred to the intensive care unit under mechanical ventilation. She was weaned from mechanical ventilation 2 days later but consciousness was unclear. Right incomplete paralysis was also observed. MRI revealed vasospasm on the bilateral internal carotid artery. The patient underwent percutaneous tansluminalangioplasty coil and intraarterial injection of fasudil hydrochloride under local anesthesia. The consciousness recovered fully and the paralysis was improved. The patient delivered the baby by Caesarean sections under combined spinal and epidural anesthesia at 36 weeks without any problems with both the mother and baby.

  5. CT and MR Imagings of Semicircular Canal Aplasia

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    Shin, Chung Hee; Hong, Hyun Sook; Yi, Beom Ha; Cha, Jang Gyu; Park, Seong Jin; Kim, Dae Ho; Lee, Hae Kyung; Kim, Shi Chan [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)


    To evaluate the clinical, CT and MR imaging findings of semicircular canal (SCC) aplasia and to evaluate if a correlation exists between these findings and the associated anomalies or syndromes. This study retrospectively reviewed the CT and MRI findings of five patients with SCC aplasia. The CT and MR findings were analyzed for SCC, direction of facial nerve canal, cochlea, vestibule, oval or round window, middle ear ossicles, and internal auditory canal (IAC). The subjects included three boys and two girls ranging in age from one to 120 months (mean age; 51 months). Four of the subjects had the CHARGE syndrome, and one had the Goldenhar syndrome. Moreover, four subjects had sensorineural hearing loss and one had combined hearing loss. The course of the facial nerve canal was abnormal in all five cases. Moreover, trapped cochlea and dysplastic modiolus were each observed in one case. Four subjects had atresia of the oval window; whereas ankylosis of the ossicles was present in three subjects. IAC stenosis was present in one patient with the CHARGE syndrome. The aberrant course of the facial nerve canal, atresia of the oval window, and abnormal ossicles were frequently associated in patients with SCC aplasia. In addition, the Goldenhar and CHARGE syndromes were also commonly associated syndromes.

  6. An evaluation of factors associated with persistent primary teeth. (United States)

    Aktan, Ali Murat; Kara, Isa; Sener, Ismail; Bereket, Cihan; Celik, Salih; Kirtay, Mustafa; Ciftçi, Mehmet Ertugrul; Arici, Nursel


    The aim of the present study was to investigate the reasons for the persistence of primary teeth and also use panoramic radiography to determine the characteristics of persistence teeth. Four-hundred and twenty-six panoramic radiographies, which diagnosed one or more retained primary teeth, were selected from 100,577 panoramic radiographic image files from nine clinics and six different cities in Turkey. The selected radiographies were evaluated to determine the reasons for the persistence of primary teeth; furthermore, this study analyzed the characteristics of the retained primary teeth including tooth type, number, location, and root resorption, and whether, or not, the primary teeth showed evidence of pathological conditions, such as periodontal problems, caries, ankylosis, infra-occlusions, or tipping of the adjacent permanent teeth. Six hundred and seventy-seven retained primary teeth were determined in 426 patients (148 males and 278 females). Retained primary teeth were found most frequently in the mandible rather than the maxilla and the left side was more frequently affected than the right side. Level 1 was found as a most frequently encountered root resorption level. Within the limitation of the present study, the most common type of persistent primary teeth seen on the dental arch were mandibular primary second molars, followed by maxillary primary canines. The most frequent reason for the persistence was the congenital absence of successors to the primary teeth, followed by impaction of the successor teeth.

  7. Occult radiological effects of lipomatosis of the lumbosacral plexus

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    Mahan, Mark A. [Barrow Neurological Institute, Phoenix, AZ (United States); Howe, B.M.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States)


    Lipomatosis of nerve (LN) is a condition of massive peripheral nerve enlargement frequently associated with hypertrophy within the distribution of the nerve, and most commonly affecting the distal limbs. We sought to understand if LN of the lumbosacral plexus would be associated with the trophic effects of LN on surrounding tissue within the pelvis, which may be clinically occult, but present on MRI. Fifty-one cases of LN, confirmed by pathology or pathognomonic appearance on MRI, were reviewed. Patients with LN of the sciatic nerve were investigated for radiological signs suggestive of overgrowth. Five patients had involvement of the sciatic nerve, 4 of whom had MR imaging of the pelvis. Three patients had LN involving the lumbosacral plexus, and one patient had isolated involvement of the sciatic nerve. All patients with involvement of the lumbosacral plexus demonstrated previously unrecognized evidence of nerve territory overgrowth in the pelvis, including: LN, profound adipose proliferation, muscle atrophy and fatty infiltration, and bone hypertrophy and ankylosis. The patient with LN involving the intrapelvic sciatic nerve, but not the lumbosacral plexus did not demonstrate any radiological evidence of pelvic overgrowth. LN is broader in anatomical reach than previously understood. Proximal plexal innervation may be involved, with a consequent effect on axial skeleton and intrapelvic structures. (orig.)

  8. Temporomandibular disorders due to improper surgical treatment of mandibular fracture: clinical report. (United States)

    Mortellaro, Carmen; Rimondini, Lia; Farronato, Giampietro; Garagiola, Umberto; Varcellino, Vittorio; Berrone, Mattia


    A case of mandibular fracture surgically consolidated in a wrong position resulting in craniomandibular disorders is reported. The inadequate surgical alignment of the healed bony segments caused a malocclusion. This changed the original neuromuscular system such that compensatory mechanisms began to change the whole balance of the organism. The patient presented a mandibular crossbite, an asymmetry of the face, and extensive alteration of muscular, articular, and postural function. The bony malunion and malocclusion were treated using an interdisciplinary surgical-orthodontic treatment for correcting functional disorders and aesthetic deformity. Electromyography and computerized mandibular scanning were used to evaluate improvement of the muscular activity, during rest and function, and of the mandibular kinesiology. Timing of surgical treatment and adequate fixation and immobilization of fracture segments are very important to avoid complications such as infection, delayed union, nonunion, malunion, skeletal discrepancies, nerve injury, and (rarely) ankylosis. The surgical approach should be based on the general criteria of traumatologic therapy, restoring the original bone shape and the right occlusal relations as soon as possible.

  9. Pathogenesis of ligaments ossification in spondyloarthritis: insights and doubts. (United States)

    Neve, Anna; Maruotti, Nicola; Corrado, Addolorata; Cantatore, Francesco Paolo


    Despite intensive research in spondyloarthritis pathogenesis, some important questions still remain unanswered, particularly concerning enthesis new bone formation. Several evidences suggest that it prevalently occurs by endochondral ossification, however it remains to identify factors that can induce and influence its initiation and progression. Recent progress, achieved in animal models and in vitro and genetic association studies, has led us to hypothesize that several systemic factors (adipokines and gut hormones) and local factors (BMP and Wnt signaling) as well as angiogenesis and mechanical stress are involved. We critically review and summarize the available data and delineate the possible mechanisms involved in enthesis ossification, particularly at spinal ligament level. KEY MESSAGES Complete understanding of spondyloarthritis pathophysiology requires insights into inflammation, bone destruction and bone formation, which are all located in entheses and lead all together to ankylosis and functional disability. Several factors probably play a role in the pathogenesis of bone formation in entheses including not only cytokines but also several systemic factors such as adipokines and gut hormones, and local factors, such as BMP and Wnt signaling, as well as angiogenesis and mechanical stress. Data available about pathophysiology of new bone formation in spondyloarthritis are limited and often conflicting and future studies are needed to better delineate it and to develop new therapeutic approaches.

  10. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis. Correlation with anatomy and histology

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    Hermann, K.G.A. [Charite Medical School, Campus Mitte, Berlin (Germany). Dept. of Radiology; Bollow, M. [Augusta Hospital, Bochum (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclear Medicine


    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. (orig.)

  11. Efficacy and safety of adalimumab in ankylosing spondylitis

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    Mounach A


    Full Text Available Aziza Mounach, Abdellah El MaghraouiRheumatology Department, Military Hospital Mohammed V, Rabat, MoroccoAbstract: Ankylosing spondylitis (AS is the most common and most severe subtype of spondyloarthritis. It also may be an outcome of any of the other spondyloarthritis subtypes. AS preferentially affects the sacroiliac joints and the tip of the column, with a tendency to later ankylosis. Peripheral joints, enthesis, and other extra-articular involvement may be observed. Tumor necrosis factor (TNF inhibitors are now well-established, effective drugs in the treatment of AS symptoms. Adalimumab, which is a fully human monoclonal antibody that binds to and neutralizes TNF, has demonstrated efficacy in treating AS symptoms, including axial involvement, peripheral arthritis, enthesitis, uveitis, gut involvement, and psoriasis. Furthermore, adalimumab has showed an overall acceptable safety profile. In this paper, we review the efficacy and safety profile of adalimumab in the treatment of AS, and discuss its differences from the other anti-TNF drugs reported in the literature.Keywords: ankylosing spondylitis, spondyloarthritis, adalimumab, tumor necrosis factor-α

  12. [Numerical variants and congenital fusions of carpal bones]. (United States)

    Senecail, B; Perruez, H; Colin, D


    The number of carpal bones may be increased or decreased by the fact of anatomical variants or true congenital anomalies. Numerical increment arises from additional or from split bones. Over twenty accessory carpal bones have been described but the commonest are the os centrale carpi, the os radiale externum, the triangular bone and the styloideum bone. Additional carpal bones usually result from a failure of fusion of their ossification centers. A congenital origin is not clearly established for all these ossicles. The scaphoid and lunate may split into two or three bones and several cases of bipartite hamulus of the hamatum have been reported. A carpus with only seven bones results from the congenital absence of a normal bone, which mainly affects the scaphoid, lunate and triquetrum, or from a synostosis between two carpal bones, usually the lunate and triquetrum. Congenital fusions originate from an absence of joint cavitation into the embryo and chondrification of the joint interzone. Numerical carpal variants are uncommon as independent entities but occur with a relative high frequency in association with complex malformations of the hand. These anomalies are detectable on plain radiographs of the wrist, but CT-scan and MR-Imaging are useful to differentiate bipartite and accessory bones from carpal fractures or posttraumatic injuries, carpal fusions having to be distinguished from bony ankylosis.

  13. Increased risk of temporomandibular joint closed lock: a case-control study of ANKH polymorphisms.

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    Boyen Huang

    Full Text Available OBJECTIVES: This study aimed to carry out a histological examination of the temporomandibular joint (TMJ in ank mutant mice and to identify polymorphisms of the human ANKH gene in order to establish the relationship between the type of temporomandibular disorders (TMD and ANKH polymorphisms. MATERIALS AND METHODS: Specimens from the TMJ of ank mutant and wild-type mice were inspected with a haematoxylin and eosin staining method. A sample of 55 TMD patients were selected. Each was examined with standard clinical procedures and genotyping techniques. RESULTS: The major histological finding in ank mutant mice was joint space narrowing. Within TMD patients, closed lock was more prevalent among ANKH-OR homozygotes (p = 0.011, OR = 7.7, 95% CI 1.6-36.5 and the elder (p = 0.005, OR = 2.4, 95% CI 1.3-4.3. CONCLUSIONS: Fibrous ankylosis was identified in the TMJ of ank mutant mice. In the human sample, ANKH-OR polymorphism was found to be a genetic marker associated with TMJ closed lock. Future investigations correlating genetic polymorphism to TMD are indicated.

  14. Matrix stiffness promotes cartilage endplate chondrocyte calcification in disc degeneration via miR-20a targeting ANKH expression. (United States)

    Liu, Ming-Han; Sun, Chao; Yao, Yuan; Fan, Xin; Liu, Huan; Cui, You-Hong; Bian, Xiu-Wu; Huang, Bo; Zhou, Yue


    The mechanical environment is crucial for intervertebral disc degeneration (IDD). However, the mechanisms underlying the regulation of cartilage endplate (CEP) calcification by altered matrix stiffness remain unclear. In this study, we found that matrix stiffness of CEP was positively correlated with the degree of IDD, and stiff matrix, which mimicked the severe degeneration of CEP, promoted inorganic phosphate-induced calcification in CEP chondrocytes. Co-expression analysis of the miRNA and mRNA profiles showed that increasing stiffness resulted in up-regulation of miR-20a and down-regulation of decreased ankylosis protein homolog (ANKH) during inorganic phosphate-induced calcification in CEP chondrocytes. Through a dual luciferase reporter assay, we confirmed that miR-20a directly targets 3'-untranslated regions of ANKH. The inhibition of miR-20a attenuated the calcium deposition and calcification-related gene expression, whereas the overexpression of miR-20a enhanced calcification in CEP chondrocytes on stiff matrix. The rescue of ANKH expression restored the decreased pyrophosphate efflux and inhibited calcification. In clinical samples, the levels of ANKH expression were inversely associated with the degeneration degree of CEP. Thus, our findings demonstrate that the miR-20a/ANKH axis mediates the stiff matrix- promoted CEP calcification, suggesting that miR-20a and ANKH are potential targets in restraining the progression of IDD.

  15. Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

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    Haghpanah Babak


    Full Text Available Abstract Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space and fixation of both knees in extension; so, there is little experience in operative management of such a problem. Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique.

  16. Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss

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    Kanavaros Panagiotis


    Full Text Available Abstract Background The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss. Methods The study involved 464 healthy Greek university students (156 men and 308 women with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests. Results The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 Conclusions TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

  17. Donor's age and replicative senescence favour the in-vitro mineralization potential of human fibroblasts. (United States)

    Boraldi, Federica; Bartolomeo, Angelica; Di Bari, Caterina; Cocconi, Andrea; Quaglino, Daniela


    Aberrant mineralization of soft connective tissues (ectopic calcification) may occur as a frequent age-related complication. Still, it remains unclear the role of mesenchymal cell donor's age and of replicative senescence on ectopic calcification. Therefore, the ability of cells to deposit in-vitro hydroxyapatite crystals and the expression of progressive ankylosis protein homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), tissue non specific alkaline phosphatase (TNAP) and osteopontin (OPN) have been evaluated in human dermal fibroblasts derived from neonatal (nHDF) and adult (aHDF) donors (ex-vivo ageing model) or at low and high cumulative population doublings (CPD) up to replicative senescence (in-vitro ageing model). This study demonstrates that: 1) replicative senescence favours hydroxyapatite formation in cultured fibroblasts; 2) donor's age acts as a major modulator of the mineralizing potential of HDF, since nHDF are less prone than aHDF to induce calcification; 3) donor's age and replicative senescence play in concert synergistically increasing the calcification process; 4) the ANKH+ENPP1/TNAP ratio, being crucial for pyrophosphate/inorganic phosphate balance, is greatly influenced by donor's age, as well as by replicative senescence, and regulates mineral deposition; 5) OPN is only modulated by replicative senescence.

  18. Histology of tooth attachment tissues and plicidentine in Varanus (Reptilia: Squamata), and a discussion of the evolution of amniote tooth attachment. (United States)

    Maxwell, Erin E; Caldwell, Michael W; Lamoureux, Denis O; Budney, Lisa A


    Few recent studies have examined the histological basis for tooth attachment in squamates. In the past few years, a surge of interest in this topic has led to the intriguing suggestion that the major tissues derived from the tooth germ (enamel, dentine, cementum and alveolar bone), are conservative and are present in all amniotes. In this study, we describe the histology and development of the tooth attachment complex in Varanus rudicollis, the rough-neck monitor. We provide the first published evidence for the role of cementum and alveolar bone in tooth attachment in varanoid lizards. In Varanus, cementum is deposited on the external surface of the tooth root as well as at the base of the tooth, where it plays a role in the attachment of the tooth to the jawbone. Alveolar bone is also involved in tooth ankylosis. Our results support the hypothesis that the major tooth germ tissues are found in all amniotes. We provide insights into the structure and development of plicidentine, defined as infolding of the dentine around the tooth base. This feature is unique to varanoids among extant tetrapods and is the third tissue implicated in tooth attachment in Varanus. Plicidentine develops asymmetrically along the labial-lingual axis of a tooth. Varanus is characterized by the presence of both primary and higher-order lamellae, which anastomose to form a honeycomb-like surface that then interacts with the more basal attachment tissues.

  19. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology. (United States)

    Hermann, K-G A; Bollow, M


    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings.

  20. Talonavicular joint abnormalities and walking ability of patients with rheumatoid arthritis.

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    Miyamoto N


    Full Text Available Rheumatoid arthritis (RA is often associated with deformities of the feet, and foot pain often arises in the talonavicular joint of patients with RA. The object of this study was to assess the relationship between magnetic resonance imaging (MRI findings of the talonavicular joint and walking ability. The subjects were 35 RA patients (10 feet in 5 males and 56 feet in 30 females aged 34-87 years (mean: 70 years +/- 12.1, with a disease duration from 1-54 years (mean: 14 years +/- 12.1. MRI findings were classified as follows: Grade 1, almost normal; Grade 2, early articular destruction; Grade 3, moderate articular destruction; Grade 4, severe articular destruction; and Grade 5, bony ankylosis dislocation. Walking ability was classified into one of 9 categories ranging from normal gait to bedridden status according to the system of Fujibayashi. As the grade of MRI images became higher the walking ability decreased, and these parameters showed a correlation by Spearman's rank correlation coefficient analysis (P = 0.003. Thus, in the present cohort group of patients with RA, the deterioration of walking ability increased with the severity of destruction of the talonavicular joint.

  1. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

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    Sandén Bengt


    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  2. Biological Activities of Phosphocitrate: A Potential Meniscal Protective Agent

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    Yubo Sun


    Full Text Available Phosphocitrate (PC inhibited meniscal calcification and the development of calcium crystal-associated osteoarthritis (OA in Hartley guinea pigs. However, the mechanisms remain elusive. This study sought to examine the biological activities of PC in the absence of calcium crystals and test the hypothesis that PC is potentially a meniscal protective agent. We found that PC downregulated the expression of many genes classified in cell proliferation, ossification, prostaglandin metabolic process, and wound healing, including bloom syndrome RecQ helicase-like, cell division cycle 7 homolog, cell division cycle 25 homolog C, ankylosis progressive homolog, prostaglandin-endoperoxide synthases-1/cyclooxygenase-1, and plasminogen activator urokinase receptor. In contrast, PC stimulated the expression of many genes classified in fibroblast growth factor receptor signaling pathway, collagen fibril organization, and extracellular structure organization, including fibroblast growth factor 7, collagen type I, alpha 1, and collagen type XI, alpha 1. Consistent with its effect on the expression of genes classified in cell proliferation, collagen fibril organization, and ossification, PC inhibited the proliferation of OA meniscal cells and meniscal cell-mediated calcification while stimulating the production of collagens. These findings indicate that PC is potentially a meniscal-protective agent and a disease-modifying drug for arthritis associated with severe meniscal degeneration.

  3. Management of traumatically intruded permanent maxillary lateral incisor - Case report and review of literature

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    Deepak Sharma


    Full Text Available Primary etiologic factors of trauma in the permanent dentition are bicycle accidents, sports accidents, falls, and fights. From the standpoint of therapy, anatomy, and prognosis, five different types of luxation lesions are recognized: Concussion, subluxation, extrusive luxation, lateral luxation, and intrusive luxation. Intrusive luxation is apical displacement of tooth into the alveolar bone. The tooth is driven into the socket, compressing the periodontal ligament, and commonly causes a crushing fracture of the alveolar socket. It is considered one of the most severe luxation injuries to affect permanent teeth. Intrusion injuries are often associated with severe damage to the tooth, periodontium, and pulpal tissue. The rare occurrence of this injury, 0.3–1.9% in the permanent dentition, has resulted in limited studies to support suggested treatment regimens. Clinical treatment for intrusion is especially difficult because of the severe complications accompanying it. These complications include pulp necrosis or obliteration, inflammatory root resorption, ankylosis, replacement root resorption, and loss of marginal bone support. Hence, the aim of presenting this case report of intrusive luxation is to highlight the importance of prompt care and root canal dressing and discuss the several treatments proposed to reposition the intruded teeth.

  4. Apicotomy as Treatment for Failure of Orthodontic Traction

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    Leandro Berni Osório


    Full Text Available Objective. The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique. Case Report. A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test. Conclusion. Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.

  5. Advances of Chinese and Western Medicine on Rheumatoid Arthritis

    Institute of Scientific and Technical Information of China (English)

    HE Na-na; WU Zhi-sen; XING Zhen-long; ZHANG Zhi-gang; SUN Shi-xuan; LIN Fa-cai


    Rheumatoid arthritis (RA) is a kind of chronic general immunological disease with primary clinical characteristic being joint synovitis, and no speciifc treatment has been found at present. In China, its morbidity is in an increasing trend, and also shows a trend of getting younger. RA is complicated in symptoms and chronic disease course, leading to joint ankylosis, deformity and even disability, which seriously threaten patients’ psychological and physical health as well as the quality of life (QOL). RA, which belongs to“Bi”symdrome, is termed as“arthroncus of knee”or“severe and migratory arthralgia”in traditional Chinese medicine (TCM), for which TCM focuses on expelling wind to remove cold, tonifying qi to activate blood and dispelling dampness to smooth collaterals while the western medicines mainly based on the principles of anti-inflammation, analgesia and inhibiting autoimmune response. However, both Chinese and western medicines have certain advantages in treating RA. Therefore, this study primarily reviewed the advances of Chinese and western medicines in RA treatment in the hope of providing theoretical basis for the clinical treatment of RA.

  6. Pathological changes after the surgical creation of a vertical intracapsular condylar fracture. (United States)

    Long, X; Goss, A N


    The aim of this study was to create in a sheep model an intracapsular oblique vertical split fracture, and observe the histopathological changes in the temporomandibular joint (TMJ) condylar head. In 10 sheep, the right TMJ was operated through the preauricular region. The anterior and posterior attachments of the disc were cut; an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of condylar neck. The condylar fragment was pushed anteriorly, inferiorly and medially together with the disc. The non-operated left TMJ served as control. Two sheep were killed at 1 week and four at both 4 and 12 weeks. Computed tomography scans were taken and histopathological changes of the joint observed. There was severe bone erosion and a new bony outgrowth on the lateral side of the condylar stump and temporal bone. The joint spaces were filled with fibrous tissue, cartilage tissue and bone in the 4 and 12 weeks operated groups. These results show that an oblique vertical intracapsular fracture through the lateral condylar pole, combined with an anteriorly and medially displaced condylar fragment and disc and damaged lateral capsule, are likely to result in the pathological changes of osteoarthritis, and the progressive development of ankylosis in a sheep TMJ.

  7. Psoriatic arthritis: imaging techniques

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    E. Lubrano


    Full Text Available Imaging techniques to assess psoriatic arthritis (PsA include radiography, ultrasonography (US, magnetic resonance imaging (MRI, computed tomography (CT and bone scintigraphy. The radiographic hallmark of PsA is the combination of destructive changes (joint erosions, tuft resorption, osteolysis with bone proliferation (including periarticular and shaft periostitis, ankylosis, spur formation and non-marginal syndesmophytes. US has an increasing important role in the evaluation of PsA. In fact, power Doppler US is useful mainly for its ability to assess musculoskeletal (joints, tendons, entheses and cutaneous (skin and nails involvement, to monitor efficacy of therapy and to guide steroid injections at the level of inflamed joints, tendon sheaths and entheses. MRI allows direct visualization of inflammation in peripheral and axial joints, and peripheral and axial entheses, and has dramatically improved the possibilities for early diagnosis and objective monitoring of the disease process in PsA. MRI has allowed explaining the relationships among enthesitis, synovitis and osteitis in PsA, supporting a SpA pattern of inflammation where enthesitis is the primary target of inflammation. CT has little role in assessment of peripheral joints, but it may be useful in assessing elements of spine disease. CT accuracy is similar to MRI in assessment of erosions in sacroiliac joint involvement, but CT is not as effective in detecting synovial inflammation. Bone scintigraphy lacks specificity and is now supplanted with US and MRI techniques.

  8. Tooth Germ-Like Construct Transplantation for Whole-Tooth Regeneration: An In Vivo Study in the Miniature Pig. (United States)

    Yang, Kai-Chiang; Kitamura, Yutaka; Wu, Chang-Chin; Chang, Hao-Hueng; Ling, Thai-Yen; Kuo, Tzong-Fu


    The purpose of this study was to demonstrate the feasibility of whole-tooth regeneration using a tooth germ-like construct. Dental pulp from upper incisors, canines, premolars, and molars were extracted from sexually mature miniature pigs. Pulp tissues were cultured and expanded in vitro to obtain dental pulp stem cells (DPSCs), and cells were differentiated into odontoblasts and osteoblasts. Epithelial cells were isolated from gingival epithelium. The epithelial cells, odontoblasts, and osteoblasts were seeded onto the surface, upper, and lower layers, respectively, of a bioactive scaffold. The lower first and second molar tooth germs were removed bilaterally and the layered cell/scaffold constructs were transplanted to the mandibular alveolar socket of a pig. At 13.5 months postimplantation, seven of eight pigs developed two teeth with crown, root, and pulp structures. Enamel-like tissues, dentin, cementum, odontoblasts, and periodontal tissues were found upon histological inspection. The regenerated tooth expressed dentin matrix protein-1 and osteopontin. All pigs had regenerated molar teeth regardless of the original tooth used to procure the DPSCs. Pigs that had tooth germs removed or who received empty scaffolds did not develop teeth. Although periodontal ligaments were generated, ankylosis was found in some animals. This study revealed that implantation of a tooth germ-like structure generated a complete tooth with a high success rate. The implant location may influence the morphology of the regenerated tooth.

  9. Comprehensive outpaitent treatment for advanced stage patients with ankylosing spondylitis%进展期强直性脊柱炎患者的门诊综合治疗

    Institute of Scientific and Technical Information of China (English)

    李永军; 刘明勋


    Objective:To explore the efficacy and comprehensive outpatient treatment progression in patients with ankylosing spondyli-tis. Methods:From 2000 March to 2012 March, 365 cases of ankylosing spondylitis patients in outpatient treatment mandatory progress pe-riod, of which 264 cases were male, 101 female;age 15 ~ 42 years, average 29 years;the course of disease was 5 to 9 years, average 6. 3 years;to give psychological counseling education, pay attention to functional exercise, the necessary physical therapy, standard drug treatment, with small needle knife used for treatment. By using visual analogue scale ( Visual Analogue Scale, VAS) , curative effect was evaluated. Results:All cases were followed up, the follow-up time ranged from 24 to 120 months, 17 patients developed fibrous ankylo-sis, 2 patients had bilateral hip bony ankylosis, femoral head necrosis, bilateral total hip arthroplasty. The rest of the patients showed no deformity and dysfunction, VAS first diagnosed by averaging 6. 13 points down to the last follow-up 3. 16 points. Conclusion:Advanced ankylosing spondylitis patients can effectively control the progression of the disease through reasonable comprehensive outpatient treatment.%目的::探讨进展期强直性脊柱炎患者的门诊综合治疗方法及疗效。方法:自2000年3月~2012年3月,门诊治疗进展期强直脊柱炎患者365例,其中男264例,女101例;年龄15~42岁,平均29岁;病程5~9年,平均6.3年;给予心理辅导教育,重视功能锻炼,必要物理治疗,规范药物治疗,配合小针刀应用进行治疗。采用视觉模拟评分法( Visual Analogue Scale,VAS)评价疗效。结果:所有病例均得到长期随访,随访时间24~120个月,17例患者发展为纤维性强直,2例患者出现双侧髋关节骨性强直,股骨头坏死,行双侧人工全髋置换术。其余患者未出现畸形及功能障碍, VAS由初次确诊平均得分6.13分降为末次随访3.16分。结论:进展期强直性

  10. Clinical retrospective analysis on 127 cases of condylar fractures%127例髁状突骨折临床病例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    后军; 薛浩伟; 杨文宇; 胡玉坤; 孙明; 张令达


    目的 探讨髁状突骨折的发病特点及治疗方案的选择.方法 收集127例髁状突骨折患者的病案资料,从发病人群的年龄结构、性别差异、致伤因素、骨折部位及类型、是否合并伤、治疗方法 与时机、并发症及后遗症等方面进行回顾性分析.结果 髁状突骨折好发于20~39岁人群,发病率男性高于女性,主要致伤因素为交通事故(55.90%),骨折线多位于髁突中上部,尤其是颈部(57.48%),且多合并下颌骨其他部位骨折(74.01%).儿童选择保守治疗、成人选择手术治疗效果较理想.127例中5例患者分别在伤后1~5年发生关节强直.结论 髁状突骨折好发于青壮年男性,交通事故为主要致伤因素,髁突颈部是好发部位,儿童宜选用保守治疗,成人可手术干预,适宜的治疗可减少关节强直等严重并发症.%Objective To explore the characteristics and treatment options of condylar fractures. Methods 127 cases of condylar fractures from 2001 to 2012 in the First Affiliated Hospital of Anhui Medical University were collected, then we retrospectivly analyzed the cases on the age structure, gender difference, injury-factors, fracture sites and types, concomitant injuries, treatment methods and time, complications and sequelaes. Results Condylar fracture occurred mainly in male more than famale, especially those who were 20 ~ 39 years old. Traffic accident was the main injury factor ( 55. 90% ). The fracture lines mostly located in the upper part of the condylar,especially in the neck( 57. 48% ), with fractures of other parts ( 74. 01% ), mainly the other parts of the mandible. The conservative treatment was advised for children, but the surgical treatment was suitable for adults. Among the 127 patients, five suffered the onset of joint ankylosis respectively in 1 ~ 5 years. Conclusion Condylar fracture happens especially on 20 ~ 39 years old male, and the main injury factor is traffic accident. Condyle neck is the

  11. Medium-term outcomes and complications after total replacement of the temporomandibular joint. Prospective outcome analysis after 3 and 5 years. (United States)

    Gruber, E A; McCullough, J; Sidebottom, A J


    In this prospective analysis, we assess the medium-term benefits, efficacy, and safety of the TMJ Concepts joint replacement system in the United Kingdom. Outcome measures of pain, maximum mouth opening, and diet were recorded preoperatively and at intervals up to 3 and 5 years. All patients who had replacement temporomandibular joints (TMJ) within a 6-year period were included. A total of 58 patients (84 joints) were followed up for 3 years (mean age 47, range 19-72) and 26 (42 joints) for 5 years (mean age 46, range 27-70). The female to male ratio was 52:6 at 3 years and 23:3 at 5 years. The most common diagnosis was degenerative disease, and the mean number of previous TMJ procedures was 2.4 (range 0-14). There were significant improvements in pain scores (7.4 reduced to 0.6 at 3 years and 0.8 at 5 years), maximum mouth opening (21.0-35.5mm at 3 years and 23.8-33.7mm at 5 years), and dietary scores (4.1-9.7 at 3 years and 3.7-9.6 at 5 years). Revision operations were required in 2 patients (not included in the outcome data) for biofilm infection of the prosthesis secondary to local infection in the head and neck. One patient had weakness of the temporal branch of the facial nerve that needed correction. TMJ replacement is an effective form of management for an irreparably damaged joint, particularly in cases of ankylosis. It lessens pain and improves function with minimal long-term morbidity.

  12. Temporomandibular joint reconstruction with total alloplastic joint replacement. (United States)

    Jones, R H B


    This paper is a preliminary paper which presents the early findings of an ongoing prospective trial on the use of the TMJ Concepts and Biomet Lorenz total joint replacement systems for the reconstruction of the temporomandibular joint (TMJ). Total alloplastic replacement of the TMJ has become a viable option for many people who suffer from TMJ disease where surgical reconstruction is indicated. Degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, TMJ ankylosis, malunited condylar fractures and tumours can be successfully treated using this technique. There are a number of TMJ prostheses available. Two of the joint replacement products, which have been found to be most reliable and have FDA approval in the United States, are the TMJ Concepts system and the Biomet Lorenz system, and for this reason they are being investigated in this study. This study presents the findings of seven patients with a total of 12 joint replacements using either the TMJ Concepts system or the Biomet Lorenz joint system. Two patients (3 joints) had the TMJ Concepts system and five patients (9 joints) had the Biomet Lorenz system. Although still early, the results were generally pleasing, with the longest replacement having been in position for three years and the most recent six months. The average postoperative mouth opening was 29.7 mm (range 25-35 mm) with an average pain score of 1.7 (range 0-3, minimum score of 0 and maximum 10). Complications were minimal and related to sensory disturbance to the lip in one patient and joint dislocation in two patients.

  13. Gross and Histomorphological Studies of Femoral Head Resurfacing in Dog

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    D. Sharifi


    Full Text Available The foetal skull bone as a biological graft was investigated. This study was conducted on Fifteen adult mixed - breed normal dogs 12 to 24 months with weighing 21.4=3.6 Kg .Dogs were randomly divided into 3 groups of 5 animals each. The foetal skull bone of 45 days old was collected from one pregnant bitch via cesarean method. The right femoral head cartilage was removed completely in all dogs of 3 groups.. Group I acted as control one, whereas in II group, resurfacing was done by using foetal skull bone which was fixed by using 0.8 mm cerclage wire in criss-cross fashion, but in III group, it was done similar to II group and the hip joint additionally was fixed by using 2 mm steinmenn pin.The clinical observations was made accordingly for 60 days in all groups. The gross changes of femoral head in group I & II were quite smooth and slippy, but in III group were uneven and rough due to secondary changes and ankylosis, but on micropscopic interpertation there was a remarkable compatibility of the graft with femoral head.The reconstruction of articular cartilage was faster in group II and even group III animals than group I animals. There was single row of chondrocyte in scatter area of samples in group . The complete and uniform hyaline cartilage in group II and fibro - cartilage and mixture of connective tissues in group III animals were observed. The results indicated that the foetal skull bone due to its pleuripotent calvarium easily can orient itself into the chondrocytes and cartilagenous tissues in articular surface of the hip joint, if there is suitable enviroment before complete ossification,so that normal joint motion could expect.

  14. Arthroscopic intervention in early hip disease. (United States)

    McCarthy, Joseph C; Lee, Jo-Ann


    Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship

  15. Histological assessment of pulp condition after apical vital root transection in one root of multirooted teeth in dogs: a preliminary study. (United States)

    Yaghmaiee, Massoud; Yavari, Amir Saeed; Mashhadiabbas, Fatemeh; Bahrami, Afshin; Farnia, Pupak; Sharifi, Davoud; Ghanavi, Jalaledin; Eslami, Behnan


    One of the most important aspects in surgery is the healing process after the periapical surgery. Past studies have shown occasional encounters with vital root resection and have noted varying degrees of pulpal response after root resection in periodontal disease. The purpose of this investigation was to observe the pulpal and periapical responses to intentional apical vital root transection in one root of multirooted teeth of German-Canadian dogs over a 6-month postoperative period. This is an experimental study performed on left maxillary and mandibular quadrants of four adult German-Canadian dogs after a 3- and 6-month period. Four teeth were assessed in each interval. One of the roots of multirooted teeth in the left quadrant of both maxillary and mandibular jaws was surgically transected. Tissue blocks were prepared by routine histological methods after 12 and 24 weeks after the surgery. The results showed a disruption of the normal pulpal architecture, with initial pulpal degeneration and subsequent early replacement by the periodontal ligament tissue after 24 weeks. Hypercementosis was seen around the apical portion of the root in all specimens. Pulpal regeneration was seen in the both upper and lower molars (p = 0.03). Resorption took place only in two specimens (p = 0.46). The inflammation in the 12th week was more than the 24th week. The pulp of multirooted teeth remains vital after transection of the apical part of the root in dogs. Longer follow-up periods are recommended because root canal therapy or extraction is indicated if resorption, necrosis, or ankylosis is seen.

  16. Impacted maxillary canines and root resorption of adjacent teeth: A retrospective observational study (United States)

    Cavallini, Costanza; Vernucci, Roberto; Vichi, Maurizio; Leonardi, Rosalia; Barbato, Ersilia


    Background The prevalence of impacted maxillary canine is reported to be between 1% and 3%. The lack of monitoring and the delay in the treatment of the impacted canine can cause different complications such as: displacement of adjacent teeth, loss of vitality of neighbouring teeth, shortening of the dental arch, follicular cysts, canine ankylosis, recurrent infections, recurrent pain, internal resorption of the canine and the adjacent teeth, external resorption of the canine and the adjacent teeth, combination of these factors. An appropriate diagnosis, accurate predictive analysis and early intervention are likely to prevent such undesirable effects. The objective is to evaluate, by means of a retrospective observational study, the possibility of carrying out a predictive analysis of root resorption adjacent to the impacted canines by means of orthopantomographs, so as to limit the prescription of additional 3D radiography. Material and Methods 120 subjects with unilateral or bilateral maxillary impacted canine were examined and 50 patients with 69 impacted maxillary canine (22 male, 28 female; mean age: 11.7 years) satisfied the inclusion criteria of the study. These patients were subjected to a basic clinical and radiographic investigation (orthopantomographs and computerized tomography). All panoramic films were viewed under standardized conditions for the evaluation of two main variables: maxillary canine angulations (a, b, g angles) and the overlapping between the impacted teeth and the lateral incisor (Analysis of Lindauer). Binary logistic regression was used to estimate the likelihood of resorbed lateral incisors depending on sector location and angle measurements. Results Results indicated that b angle has the greatest influence on the prediction of root resorption (predictive value of b angle = 76%). If β angle resorption is 0.06. Conclusions Evaluation of b angle and superimposition lateral incisor/impacted canine analysed on orthopantomographs could

  17. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis. (United States)

    Isaacson, R J; Strauss, R A; Bridges-Poquis, A; Peluso, A R; Lindauer, S J


    When a dentist replants an avulsed tooth, the repair process sometimes results in the cementum of the root and the alveolar bone fusing together, with the replanted tooth becoming ankylosed. When this occurs, the usual process of tooth movement with bone deposition and bone resorption at the periodontium cannot function. If dental ankylosis occurs in the maxillary incisor of a growing child, the ankylosed tooth also cannot move vertically with the subsequent vertical growth of the alveolar process. This results in the ankylosed tooth leaving the plane of occlusion and often becoming esthetically objectionable. This report describes a 12-year-old female with a central incisor that was replanted 5 years earlier, became ankylosed, and left the occlusal plane following subsequent normal vertical growth of the alveolar process. When growth was judged near completion, the tooth was moved back to the occlusal plane using a combination of orthodontics, surgical block osteotomy, and distraction osteogenesis to reposition the tooth at the proper vertical position in the arch. This approach had the advantage of bringing both the incisal edge and the gingival margin of the clinical crown to the proper height in the arch relative to their antimeres. Previous treatment procedures for ankylosed teeth have often involved the extraction of the affected tooth. When this is done, a vertical defect in the alveolar process results that often requires additional bone surgery to reconstruct the vertical height of the alveolar process. If the tooth is then replaced, the replacement tooth must reach from the final occlusal plane to the deficient ridge. This results in an excessively long clinical crown with a gingival height that does not match the adjacent teeth.

  18. Indications and outcome of mandibular condylar and ramus surgeries

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    Babatunde O Akinbami


    Full Text Available Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry and function (occlusion, Jaw movements. Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100% patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6% patients, 14 (60.9% patients had Ameloblastoma, 1 (4.3% had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6% patients, five procedures for ankylosis in 3 (13.0% patients and four procedures were done for dislocation in 2 (8.6% patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

  19. Identification of the inorganic pyrophosphate metabolizing, ATP substituting pathway in mammalian spermatozoa.

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    Young-Joo Yi

    Full Text Available Inorganic pyrophosphate (PPi is generated by ATP hydrolysis in the cells and also present in extracellular matrix, cartilage and bodily fluids. Fueling an alternative pathway for energy production in cells, PPi is hydrolyzed by inorganic pyrophosphatase (PPA1 in a highly exergonic reaction that can under certain conditions substitute for ATP-derived energy. Recombinant PPA1 is used for energy-regeneration in the cell-free systems used to study the zymology of ATP-dependent ubiquitin-proteasome system, including the role of sperm-borne proteasomes in mammalian fertilization. Inspired by an observation of reduced in vitro fertilization (IVF rates in the presence of external, recombinant PPA1, this study reveals, for the first time, the presence of PPi, PPA1 and PPi transporter, progressive ankylosis protein ANKH in mammalian spermatozoa. Addition of PPi during porcine IVF increased fertilization rates significantly and in a dose-dependent manner. Fluorometric assay detected high levels of PPi in porcine seminal plasma, oviductal fluid and spermatozoa. Immunofluorescence detected PPA1 in the postacrosomal sheath (PAS and connecting piece of boar spermatozoa; ANKH was present in the sperm head PAS and equatorial segment. Both ANKH and PPA1 were also detected in human and mouse spermatozoa, and in porcine spermatids. Higher proteasomal-proteolytic activity, indispensable for fertilization, was measured in spermatozoa preserved with PPi. The identification of an alternative, PPi dependent pathway for ATP production in spermatozoa elevates our understanding of sperm physiology and sets the stage for the improvement of semen extenders, storage media and IVF media for animal biotechnology and human assisted reproductive therapies.

  20. It costs to be clean and fit: energetics of comfort behavior in breeding-fasting penguins.

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    Vincent A Viblanc

    Full Text Available BACKGROUND: Birds may allocate a significant part of time to comfort behavior (e.g., preening, stretching, shaking, etc. in order to eliminate parasites, maintain plumage integrity, and possibly reduce muscular ankylosis. Understanding the adaptive value of comfort behavior would benefit from knowledge on the energy costs animals are willing to pay to maintain it, particularly under situations of energy constraints, e.g., during fasting. We determined time and energy devoted to comfort activities in freely breeding king penguins (Aptenodytes patagonicus, seabirds known to fast for up to one month during incubation shifts ashore. METHODOLOGY/PRINCIPAL FINDINGS: A time budget was estimated from focal and scan sampling field observations and the energy cost of comfort activities was calculated from the associated increase in heart rate (HR during comfort episodes, using previously determined equations relating HR to energy expenditure. We show that incubating birds spent 22% of their daily time budget in comfort behavior (with no differences between day and night mainly devoted to preening (73% and head/body shaking (16%. During comfort behavior, energy expenditure averaged 1.24 times resting metabolic rate (RMR and the corresponding energy cost (i.e., energy expended in excess to RMR was 58 kJ/hr. Energy expenditure varied greatly among various types of comfort behavior, ranging from 1.03 (yawning to 1.78 (stretching times RMR. Comfort behavior contributed 8.8-9.3% to total daily energy expenditure and 69.4-73.5% to energy expended daily for activity. About half of this energy was expended caring for plumage. CONCLUSION/SIGNIFICANCE: This study is the first to estimate the contribution of comfort behavior to overall energy budget in a free-living animal. It shows that although breeding on a tight energy budget, king penguins devote a substantial amount of time and energy to comfort behavior. Such findings underline the importance of comfort

  1. Tuberculosis of hip in children: A retrospective analysis

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    Myung-Sang Moon


    Full Text Available Background: Tuberculosis (TB of hip constitutes nearly 15% of all cases of osteoarticular tuberculosis. We report a retrospective study carried out on 43 children with hip TB. Materials and Methods: Forty-three children of TB hip treated between 1971 and 2000 were analysed. Twenty-four children of the early series were treated with streptomycin (S, isoniazid (H and PAS (Pa for 18 months (3HPaS, 15 HPa, while 19 children in the later series were treated with isoniazid (H, rifampicin (R and ethambutol (E or pyrazinamide (Z for 12 months [(12 RHE(Z]. Five out of 18 children with radiologically normal appearing type hip TB were treated with chemotherapy alone and 38 children were subjected to surgery; simple synovectomy alone in 31 hips, joint debridement in six hips, and proximal femoral varisation osteotomy in one. After surgery hips were immobilized in cast for one to three months according to the severity of the disease and patients pain tolerance, and then were mobilized under leg traction in bed gradually till pain subsided completely. Results: TB of hip healed with minimum sequelae in all children. In 18 Type one hip TB, normal hip (synovial form anatomy was maintained, and in 25 patients with advanced lesions some defect in the femoral head and acetabulum was noticed, though painless good hip motion was maintained. Excellent to good results were obtained in 31 children (73.1%, fair in eight (18.6%, and poor in four (9.3%. In four patients with poor results, there was some residual morphological defect in the hip. None developed ankylosis of hip. Conclusion: We achieved good outcome with minimum sequelae in this series. The management goal should be aimed not only to heal the disease but also to maintain a painless mobile hip and anatomical cephalocotyloid relationship until maturity, and retard the development of secondary osteoarthritis.

  2. Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

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    Y. Ragab


    Full Text Available Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6% and 32 females (44.4] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3% cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%, septic arthritis in 10 (13.9%, tuberculous arthritis in 4 (5.6%, sickle-cell disease in 7 (9.7%, complicated with septic arthritis in 3 (4.2%, transient bone marrow edema (BME in 3 (4.2%, osteomyelitis in 2 (2.8%, osteosarcoma in 2 (2.8%, sciatic nerve injury in 1 (1.4%, leukemia with BME in 1 (1.4%, coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%, and a benign bone cyst in 1 (1.4%. MRI studies showed hip effusion in a total of 51 patients (70.8%, joint space narrowing in 9 (12.5%, and BME in 15(20.8%. MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.

  3. Health assessment of captive tinamids (Aves, Tinamiformes) in Brazil. (United States)

    Marques, Marcus Vinícius Romero; Ferreira Júnior, Francisco Carlos; Andery, Danielle de Assis; Fernandes, André Almeida; de Araújo, Alessandra Vitelli; de Resende, José Sérgio; Donatti, Rogério Venâncio; Martins, Nelson Rodrigo da Silva


    Ninety-five (95) captive tinamids (Aves, Tinamiformes) of species Crypturellus obsoletus (brown tinamou), Crypturellus parvirostris (small-billed tinamou), Crypturellus tataupa (Tataupa tinamou), Crypturellus undulatus (undulated tinamou), Rhynchotus rufescens (red-winged tinamou), and Tinamus solitarius (solitary tinamou) were evaluated for diseases of mandatory control in the Brazilian Poultry Health Program (PNSA). Antibodies were detected by serum agglutination test (SAT) in 4 birds for Mycoplasma gallisepticum (MG) and in 27 birds for Salmonella Pullorum (SP) and Salmonella Gallinarum (SG). However, by hemagglutination inhibition (HI), sera were negative to MG and Mycoplasma synoviae (MS). Bacteriology was negative for SP and SG. No antibody was detected by HI to avian paramyxovirus type 1. However, antibodies to infectious bursal disease virus were detected in 9.4% (9/95) by ELISA. Fecal parasitology and necropsy revealed Capillaria spp. in 44.2% (42/95), Eimeria rhynchoti in 42.1% (40/95), Strongyloides spp. in 100% (20/20), Ascaridia spp., and unknown sporozoa in small-billed tinamou. Ectoparasites were detected in 42.1% (40/95) by inspection, and collected for identification. The louse Strongylocotes lipogonus (Insecta: Phthiraptera) was found on all Rhynchotus rufescens. An additional four lice species were found on 14 individuals. Traumatic lesions included four individual R. rufescens (4/40, 10%) with rhinotheca fracture, one with mandible fracture and three with posttraumatic ocular lesions (3/40, 7.5%). One C. parvirostris had phalangeal loss, another had tibiotarsal joint ankylosis and another had an open wound on the foot. Results suggest that major poultry infections/ diseases may not be relevant in tinamids, and that this group of birds, as maintained within distances for biosecurity purposes, may not represent a risk to commercial poultry. Ecto- and endoparasites were common, disseminated, and varied; regular monitoring of flocks is recommended

  4. The value of {sup 99m}Tc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae General Hospital, Seoul (Korea, Republic of)


    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes {sup 99m}Tc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole {sup 99m}Tc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone.

  5. JNK phosphorylation promotes degeneration of cervical endplate chondrocytes through down-regulation of the expression of ANK in humans

    Institute of Scientific and Technical Information of China (English)

    XU Hong-guang; SONG Jun-xing; CHENG Jia-feng; ZHANG Ping-Zhi; WANG Hong; LIU Ping; L(U) Kun


    Background C-Jun N-terminal kinase (JNK) signaling pathway and ankylosis gene (ANK) play a critical role in endplate chondrocytes degeneration.The purpose of this study was to investigate whether the expression levels of ANK was associated with the activation of JNK.Methods Cartilage endplates of 49 patients were divided into the control group (n=19) and the experimental group (n=30).The patients in the control group were graded 0 and those in the experimental group were graded Ⅰ-Ⅲ according to Miller's classification.Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro.The inverted phase contrast microscope,teluidine blue staining,HE staining,real time RT-PCR,and MTT were used to observe morphological appearances,biological characteristics,and growth curve of endplate chondrocytes from the cartilage endplate of the two groups.Real time RT-PCR and Western blotting were used to analyze the mRNA and protein expression levels of associated factors in the degeneration process in the cultured endplate chondrocytes with or without subjected SP600125.Results The expression levels of type Ⅱ collagen,aggrecan,and ANK in endplate chondrocytes of experimental group were lower than that of control group and phosphorylation level of JNK in the experimental group which was higher than that in the control group.Application of JNK phosphorylation inhibitor to degeneration chondrocytes resulted in a marked decrease in the phosphorylation level of JNK and a significant increase in the expression levels of type Ⅱ collagen,aggrecan,and ANK.Conclusion The degeneration of the human cervical endplate chondrocytes might be promoted by JNK phosphorylation by down-regulating the expression of ANK

  6. Effects of concomitant use of fibroblast growth factor (FGF)-2 with beta-tricalcium phosphate ({beta}-TCP) on the beagle dog 1-wall periodontal defect model

    Energy Technology Data Exchange (ETDEWEB)

    Anzai, Jun, E-mail: [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Kitamura, Masahiro, E-mail: [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nozaki, Takenori, E-mail: [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nagayasu, Toshie, E-mail: [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Terashima, Akio, E-mail: [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Asano, Taiji, E-mail: [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Murakami, Shinya, E-mail: [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan)


    Research highlights: {yields} Concomitant use of FGF-2 and {beta}-TCP (an osteo-conductive scaffold) significantly promotes periodontal regeneration in the severe periodontitis model (1-wall defect model) of beagle dog. {yields} FGF-2 enhanced new bone formation via {beta}-TCP at the defects. {yields} In particular, FGF-2 dramatically regenerated new periodontal ligament and cementum formations at the defects, that is one of the most important healing outcomes during the process of periodontal regeneration. {yields} Epithelial downgrowth (undesirable wound healing) was decreased by administration of FGF-2. {yields} This manuscript indicates for the first time that concomitant use of FGF-2 and {beta}-TCP is efficacious in regenerating periodontal tissue following severe destruction of the tissue by progression of periodontitis. -- Abstract: The effects of concomitant use of fibroblast growth factor-2 (FGF-2) and beta-tricalcium phosphate ({beta}-TCP) on periodontal regeneration were investigated in the beagle dog 1-wall periodontal defect model. One-wall periodontal defects were created in the mesial portion of both sides of the mandibular first molars, and 0.3% FGF-2 plus {beta}-TCP or {beta}-TCP alone was administered. Radiographic evaluation was performed at 0, 3, and 6 weeks. At 6 weeks, the periodontium with the defect site was removed and histologically analyzed. Radiographic findings showed that co-administration of FGF-2 significantly increased bone mineral contents of the defect sites compared with {beta}-TCP alone. Histologic analysis revealed that the length of the regenerated periodontal ligament, the cementum, distance to the junctional epithelium, new bone height, and area of newly formed bone were significantly increased in the FGF-2 group. No abnormal inflammatory response or ankylosis was observed in either group. These findings indicate the efficacy of concomitant use of FGF-2 and {beta}-TCP as an osteoconductive material for periodontal

  7. Replantation after extended dry storage of avulsed permanent incisors: report of a case. (United States)

    Cobankara, Funda Kont; Ungor, Mete


    A 15-year-old boy lost his maxillary right and left central incisor teeth in a bicycle accident. He was referred to our clinic 1 week after the injury. The crown-root integrities of both the teeth were not damaged. Although the teeth were stored under dry conditions for 1 week, reimplantation of the teeth was planned to retain the teeth in the mouth for as long a period as possible because of the patient's age. Following the debridement and sterilization of root surfaces in 2.5% NaOCl, root canals were prepared and filled with calcium hydroxide. Then, about 2 mm of the apexes were resected to ensure that the roots easily seated in the alveolar socket and the prepared cavities in root ends were obturated with the amalgam. The teeth were placed into their respective sockets and splinted temporarily. The root canal therapy was completed 5 weeks later. Ankylosis was observed radiographically after 10 months. The patient is now 23 years old and he is still able to use both the central incisors functionally. However, there is a pink appearance on the cervical buccal surface of left central incisor because of progressive replacement resorption. In this case, the new treatment plan is to perform a permanent restoration with dental implants following the extraction of both teeth. Even though the long-term prognosis is uncertain, this treatment technique has provided an advantage for the patient in his adolescent period by maintaining the height of alveolar bone and making the provision of an aesthetically acceptable permanent restoration at a later age possible.

  8. 严重僵硬型颈椎后凸畸形的手术入路选择%Surgical approach of severe fixed cervical kyphosis

    Institute of Scientific and Technical Information of China (English)

    李方财; 陈其昕; 陈维善


    Objective To investigate the radiographic features and surgical approach of severe fixed cervical kyphosis.Methods Seventeen cases of severe fixed cervical kyphosis from January 2007 to January 2012 were studied retrospectively.There were 8 males and 9 females,with an average age of 49.7 years.The etiologies were 3 cases of infection,3 cases of degeneration,3 cases of neurofibromatosis,3 cases of prior laminectomy,2 cases of idiopathic,2 cases of trauma and 1 case of neuromuscular disease.The average length of kyphosis was 4.3 ± 1.2 segments.All patients complained of severe neck pain (visual analogue scale,VAS,7.6±1.5) or progressive cervical kyphosis.There were 4 cases with myelopathy,2 with radiculopathy,3 with difficulty of forward gaze and 1 with difficulty of swallowing.All patients were underwent dynamic flexion-extension radiographs and traction views.CT scans were carried out to identify the sites of fixed kyphosis.Continuous traction was performed after general anesthesia,and the surgical approach was decided according to spinal cord compression,length of kyphosis and the cause of fixed kyphosis.Surgical outcomes were assessed in terms of correction of Cobb angle and Odom criteria.Results All patients were followed-up for 2 to 5 years.According to the CT scans,the sites of fixed kyphosis were identified:anterior bony ankylosis in 7 cases,posterior in 6 cases and both anterior and posterior in 4 cases.The surgical approach were as following:anterior only in 4 cases,posterior only in 2 cases,anterior-posterior in 5 cases,posterior-anterior in 3 cases,anterior-posterior-anterior in 1 case and posterior-anterior-posterior in 2 cases.The Cobb angle was corrected from 49.3°± 14.6° preoperation to 2.1 °±6.8° at the latest follow-up,with an average correction of 47.2°.According to Odom criteria,there were 7 excellent outcome,8 good,2 fair and none poor outcome.Revision surgery was performed in 1 case due to proximal junctional kyphosis.At the latest

  9. Analysis of meniscal degeneration and meniscal gene expression

    Directory of Open Access Journals (Sweden)

    Norton James H


    Full Text Available Abstract Background Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1 to determine the prevalence of meniscal degeneration in OA patients, and 2 to examine gene expression in OA meniscal cells compared to normal meniscal cells. Methods Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens, and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR. Results The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P HLA-DPA1, integrin, beta 2 (ITGB2, ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1, ankylosis, progressive homolog (ANKH and fibroblast growth factor 7 (FGF7, were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5 and prostaglandin E synthase (PTGES, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific. Conclusion Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel

  10. Periodontal ligament, cementum, and alveolar bone in the oldest herbivorous tetrapods, and their evolutionary significance. (United States)

    LeBlanc, Aaron R H; Reisz, Robert R


    Tooth implantation provides important phylogenetic and functional information about the dentitions of amniotes. Traditionally, only mammals and crocodilians have been considered truly thecodont, because their tooth roots are coated in layers of cementum for anchorage of the periodontal ligament, which is in turn attached to the bone lining the alveolus, the alveolar bone. The histological properties and developmental origins of these three periodontal tissues have been studied extensively in mammals and crocodilians, but the identities of the periodontal tissues in other amniotes remain poorly studied. Early work on dental histology of basal amniotes concluded that most possess a simplified tooth attachment in which the tooth root is ankylosed to a pedestal composed of "bone of attachment", which is in turn fused to the jaw. More recent studies have concluded that stereotypically thecodont tissues are also present in non-mammalian, non-crocodilian amniotes, but these studies were limited to crown groups or secondarily aquatic reptiles. As the sister group to Amniota, and the first tetrapods to exhibit dental occlusion, diadectids are the ideal candidates for studies of dental evolution among terrestrial vertebrates because they can be used to test hypotheses of development and homology in deep time. Our study of Permo-Carboniferous diadectid tetrapod teeth and dental tissues reveal the presence of two types of cementum, periodontal ligament, and alveolar bone, and therefore the earliest record of true thecodonty in a tetrapod. These discoveries in a stem amniote allow us to hypothesize that the ability to produce the tissues that characterize thecodonty in mammals and crocodilians is very ancient and plesiomorphic for Amniota. Consequently, all other forms of tooth implantation in crown amniotes are derived arrangements of one or more of these periodontal tissues and not simply ankylosis of teeth to the jaw by plesiomorphically retaining "bone of attachment", as

  11. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. (United States)

    Westerveld, L A; Verlaan, J J; Oner, F C


    The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may

  12. Role of the epithelial cell rests of Malassez in the development, maintenance and regeneration of periodontal ligament tissues. (United States)

    Xiong, Jimin; Gronthos, Stan; Bartold, P Mark


    Periodontitis is a highly prevalent inflammatory disease that results in damage to the tooth-supporting tissues, potentially leading to tooth loss. Periodontal tissue regeneration is a complex process that involves the collaboration of two hard tissues (cementum and alveolar bone) and two soft tissues (gingiva and periodontal ligament). To date, no periodontal-regenerative procedures provide predictable clinical outcomes. To understand the rational basis of regenerative procedures, a better understanding of the events associated with the formation of periodontal components will help to establish reliable strategies for clinical practice. An important aspect of this is the role of the Hertwig's epithelial root sheath in periodontal development and that of its descendants, the epithelial cell rests of Malassez, in the maintenance of the periodontium. An important structure during tooth root development, the Hertwig's epithelial root sheath is not only a barrier between the dental follicle and dental papilla cells but is also involved in determining the shape, size and number of roots and in the development of dentin and cementum, and may act as a source of mesenchymal progenitor cells for cementoblasts. In adulthood, the epithelial cell rests of Malassez are the only odontogenic epithelial population in the periodontal ligament. Although there is no general agreement on the functions of the epithelial cell rests of Malassez, accumulating evidence suggests that the putative roles of the epithelial cell rests of Malassez in adult periodontal ligament include maintaining periodontal ligament homeostasis to prevent ankylosis and maintain periodontal ligament space, to prevent root resorption, to serve as a target during periodontal ligament innervation and to contribute to cementum repair. Recently, ovine epithelial cell rests of Malassez cells have been shown to harbor clonogenic epithelial stem-cell populations that demonstrate similar properties to mesenchymal stromal

  13. The influence of root surface distance to alveolar bone and periodontal ligament on periodontal wound healing (United States)


    Purpose The purpose of this animal study was to perform a 3-dimensional micro-computed tomography (micro-CT) analysis in order to investigate the influence of root surface distance to the alveolar bone and the periodontal ligament on periodontal wound healing after a guided tissue regeneration (GTR) procedure. Methods Three adult Sus scrofa domesticus specimens were used. The study sample included 6 teeth, corresponding to 2 third mandibular incisors from each animal. After coronectomy, a circumferential bone defect was created in each tooth by means of calibrated piezoelectric inserts. The experimental defects had depths of 3 mm, 5 mm, 7 mm, 9 mm, and 11 mm, with a constant width of 2 mm. One tooth with no defect was used as a control. The defects were covered with a bioresorbable membrane and protected with a flap. After 6 months, the animals were euthanised and tissue blocks were harvested and preserved for micro-CT analysis. Results New alveolar bone was consistently present in all experimental defects. Signs of root resorption were observed in all samples, with the extent of resorption directly correlated to the vertical extent of the defect; the medial third of the root was the most commonly affected area. Signs of ankylosis were recorded in the defects that were 3 mm and 7 mm in depth. Density and other indicators of bone quality decreased with increasing defect depth. Conclusions After a GTR procedure, the periodontal ligament and the alveolar bone appeared to compete in periodontal wound healing. Moreover, the observed decrease in bone quality indicators suggests that intrabony defects beyond a critical size cannot be regenerated. This finding may be relevant for the clinical application of periodontal regeneration, since it implies that GTR has a dimensional limit. PMID:27800213

  14. 颌后入路治疗髁突颈部骨折%Retromandibular Approach for Condylar Neck Fracture Reduction

    Institute of Scientific and Technical Information of China (English)

    马旭亮; 王超


    目的:探讨颌后入路治疗下颌骨髁突颈骨折的治疗方法及效果。方法:对23例单侧成人下颌骨中低位髁突颈骨折患者,经颌后入路,术中保护腮腺及面神经,行切开解剖复位坚强内固定术。结果:23例患者均取得良好解剖复位,无1例出现涎瘘,无1例出现面神经麻痹,咬合关系恢复良好,通过早期锻炼张口,均能恢复术前张口度,无关节强直出现。结论:颌后入路治疗下颌骨中低位髁突颈骨折,有术野暴露充分、操作方便、有效保护面神经及腮腺等优点。%Objective: To discuss the beneficiaries of a novel retromandibular approach for mandibular condyle neck fracture reduction. Methods:23 patients were consisted in this study. Operative procedures without injury of parotid gland and facial nerve. Open anatomic reduction and rigid internal fixation were retained. Results: All 23 cases achieved good anatomic reduction, without occurrence of salivary fistula, facial palsy, and ankylosis. Occlusal relationship was in good recovery, and degree of mouth opening restored to preoperative level. Conclusion: Retromandibular approach is conve-nient and effective in condyle neck fracture reduction.

  15. Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report

    Directory of Open Access Journals (Sweden)

    Luca Guarda-Nardini


    Full Text Available Background: The literature on total alloplastic temporomandibular joint (TMJ reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant. Methods: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries. Results: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion. Conclusions: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated should be better standardized and define in future studies.

  16. The lameness of King Philip II and Royal Tomb I at Vergina, Macedonia. (United States)

    Bartsiokas, Antonis; Arsuaga, Juan-Luis; Santos, Elena; Algaba, Milagros; Gómez-Olivencia, Asier


    King Philip II was the father of Alexander the Great. He suffered a notorious penetrating wound by a lance through his leg that was nearly fatal and left him lame in 339 B.C.E. (i.e., 3 y before his assassination in 336 B.C.E.). In 1977 and 1978 two male skeletons were excavated in the Royal Tombs II and I of Vergina, Greece, respectively. Tomb I also contained another adult (likely a female) and a newborn skeleton. The current view is that Philip II was buried in Tomb II. However, the male skeleton of Tomb II bears no lesions to his legs that would indicate lameness. We investigated the skeletal material of Tomb I with modern forensic techniques. The male individual in Tomb I displays a conspicuous case of knee ankylosis that is conclusive evidence of lameness. Right through the overgrowth of the knee, there is a hole. There are no obvious signs that are characteristic of infection and osteomyelitis. This evidence indicates that the injury was likely caused by a severe penetrating wound to the knee, which resulted in an active inflammatory process that stopped years before death. Standard anthropological age-estimation techniques based on dry bone, epiphyseal lines, and tooth analysis gave very wide age ranges for the male, centered around 45 y. The female would be around 18-y-old and the infant would be a newborn. It is concluded that King Philip II, his wife Cleopatra, and their newborn child are the occupants of Tomb I.

  17. Central role of pyrophosphate in acellular cementum formation.

    Directory of Open Access Journals (Sweden)

    Brian L Foster

    Full Text Available BACKGROUND: Inorganic pyrophosphate (PP(i is a physiologic inhibitor of hydroxyapatite mineral precipitation involved in regulating mineralized tissue development and pathologic calcification. Local levels of PP(i are controlled by antagonistic functions of factors that decrease PP(i and promote mineralization (tissue-nonspecific alkaline phosphatase, Alpl/TNAP, and those that increase local PP(i and restrict mineralization (progressive ankylosis protein, ANK; ectonucleotide pyrophosphatase phosphodiesterase-1, NPP1. The cementum enveloping the tooth root is essential for tooth function by providing attachment to the surrounding bone via the nonmineralized periodontal ligament. At present, the developmental regulation of cementum remains poorly understood, hampering efforts for regeneration. To elucidate the role of PP(i in cementum formation, we analyzed root development in knock-out ((-/- mice featuring PP(i dysregulation. RESULTS: Excess PP(i in the Alpl(-/- mouse inhibited cementum formation, causing root detachment consistent with premature tooth loss in the human condition hypophosphatasia, though cementoblast phenotype was unperturbed. Deficient PP(i in both Ank and Enpp1(-/- mice significantly increased cementum apposition and overall thickness more than 12-fold vs. controls, while dentin and cellular cementum were unaltered. Though PP(i regulators are widely expressed, cementoblasts selectively expressed greater ANK and NPP1 along the root surface, and dramatically increased ANK or NPP1 in models of reduced PP(i output, in compensatory fashion. In vitro mechanistic studies confirmed that under low PP(i mineralizing conditions, cementoblasts increased Ank (5-fold and Enpp1 (20-fold, while increasing PP(i inhibited mineralization and associated increases in Ank and Enpp1 mRNA. CONCLUSIONS: Results from these studies demonstrate a novel developmental regulation of acellular cementum, wherein cementoblasts tune cementogenesis by modulating

  18. Temporomandibular joint changes after acute trauma to the mandible without condylar fracture: radiographic and surgical findings%无髁突骨折颞下颌关节急性创伤后的变化:影像学和手术所见

    Institute of Scientific and Technical Information of China (English)

    何冬梅; 杨驰; 陈敏洁; 杨秀娟; 李凌志


    PURPOSE: To demonstrate temporomandibular joint (TMJ) changes after acute trauma to the mandible without condylar fracture by radiography and surgical exploration. METHODS: Seven patients with 11 joints who had acute trauma to the mandible without condylar fracture complained of mouth opening limitation from 1 month to 1 year after trauma were treated in the temporomandibular joint (TMJ) division of Shanghai Ninth People's Hospital from 2009 to 2010. Six patients had combined facial fractures which were treated in other hospitals or by other surgeons in this hospital before. CT scans with coronal reconstruction through the condyle immediately after injury and few months later when they came to the TMJ division for treatment were compared. MRI was taken before treatment to check the TMJ changes. Surgical treatment was performed for all patients. RESULTS: CT scan showed 87.5% (7/8) of the joints with "intact" condylar surface bone immediately after injury developed bone destruction 1 month to 1 year later. MRI showed all 11 joints had TMJ disc displaced anteriorly. Ninety percentage (10/11) of the joints also had condylar surface bone destruction. Surgical exploration showed bony ankylosis in 2 joints; fibrous ankylosis with destroyed condyle stuck to the fossa in 3 joints; TMJ osteoarthritis with degenerated condylar surface bone and fibrous adhesion in 5 joints; and internal derangement with relatively normal condylar surface cartilage and disk shape in 1 joint. CONCLUSIONS: Acute trauma to the mandible without condylar fracture may develop TMJ ankylosis and/or osteoarthritis when the disc is displacedanteriorly. Supported by National Natural Science Foundation of China(81070848),Scientific Research Foundation for theReturned Overseas Chinese Scholars and Research Fund of Science and Technology Commission of Shanghai Municipality(08DZ2271100).%目的:通过CT、MRI及手术探查观察无髁突骨折颞下颌关节急性创伤后的变化,为该疾患的早期诊

  19. Kaks luustikku Tartu toomkirikust: arheoloogia ja osteoloogia andmed / Two skeletons from the Tartu Cathedral Cemetery: archaeological and osteological data

    Directory of Open Access Journals (Sweden)

    Martin Malve


    from slight forms of various spinal diseases, which include Schmorl’s nodes, spondyloarthrosis, and spondylosis. The fourth and fifth cervical vertebrae had ankylosis, the cause of which is unknown. Signs of osteoartrosis, a joint disease, were also noticed. Traumas recorded in the skeleton include a healed fracture of a rib and vertebral compression. The man’s head was decapitated with a sharp blade between the sixth and seventh cervical vertebrae (fig. 7.

  20. Complications after tibia plateau fracture surgery%胫骨平台骨折术后并发症

    Institute of Scientific and Technical Information of China (English)

    卢志强; 杜胜利(通讯作者)


    High-energy tibial plateau fractures is often result of blunt trauma and is associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients. This paper is according to the fracture of tibial plateau postoperative complications do a system review.%  高强度的胫骨平台骨折往往是由于顿挫伤引起的,同时伴有严重的软组织的损伤。固定技术需要临床医师具备熟练的手术技巧和准确的判断力。有效的外科手术并不一定总能达到良好的临床效果。手术治疗的方法包括内固定、外固定、混合固定和关节镜辅助技术。有效的高强度骨折术后管理仍然是困难的,富有挑战性的,因为术后会伴有严重的并发症,例如:关节僵硬、关节强直、深部的感染、创伤性关节炎、骨的畸形愈合和骨不连。对这些高强度胫骨平台骨折的病人及早的预防并发症的出现能够优化临床治疗效果。本文就是针对胫骨平台骨折术后的并发症做一系统的综述。

  1. The Results of Fetal Chondrocytes Transplantation in Patients with Rheumatoid Arthritis

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    Natalya Krivoruchko


    .03. Furthermore, patients in the second group had 2.7 times higher risk of ankylosis compared to the first group. We did not observe any complications of fetal chondrocytes transplantation.Conclusions. Application of fetal chondrocytes therapy had the desired clinical effect, which was confirmed by reduction of the RA activity and decrease of cartilage and bone destruction. 

  2. Surgical outcome after spinal fractures in patients with ankylosing spondylitis

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    Brilakis Emmanuel


    Full Text Available Abstract Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement

  3. Hemophilic arthropathy. A scoring system for magnetic resonance imaging

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    Soler, R.; Rodriguez, E.; Marini, M. [Department of Radiology, Hospital Juan Canalejo, Coruna (Spain); Lopez-Fernandez, F. [Department of Hematology, Hospital Juan Canalejo, Coruna (Spain)


    The aim of this study was to define a system for scoring hemophilic arthropathy (HA) based on MR findings, providing for objective evaluation of the degree of joint involvement and evolution after on-demand administration of FVIII substitutional therapy or prophylactic treatment. A total of 133 MR examinations (89 basal and 44 during follow-up) were performed in 25 patients. Patients were divided in two groups depending on the therapy received and the length of time that the disease had been evolving at the start of the study. Group I was composed of 10 patients with secondary prophylaxis and group II was composed by 15 treated on demand. T1-weighted and T2*-weighted images performed on a 0.5-T unit were prospectively evaluated. The joint involvement was established on a scale of 0 (no abnormalities), I (minimal amount of hemosiderin), II (large amount of hemosiderin and isolated cartilaginous erosion), III (cartilage destruction, bone erosions, and subchondral cysts) to IV (large internal joint derangement, secondary osteoarthritis and/or ankylosis). At basal MR examination, patients of group I showed no abnormalities (n=28, 75.6%), grade I (n=3), and grade II (n=6) of HA. Patients of group II corresponded to MR grades III (n=21) and IV (n=11) of HA. The MR follow-up showed improvement in three joints of group I and worsening in 5 joints in group I and 2 joints in group II. Early signs of HA were detected in 10 joints with MR imaging but were underestimated on plain radiographs. Advanced degrees of HA were classified as severe under both imaging techniques. Magnetic resonance is the preferred imaging technique to assess HA. The earliest signs of joint damage, detected by MR, are overlooked by plain radiography. The MR scoring system can be used for evaluating HA. Follow-up MR should be performed to evaluate regression or worsening of the abnormalities, primarily in the case of patients with prophylaxis who usually suffer normal or early joint involvement not

  4. Psoriatic arthritis: immunologic mechanisms and biological therapy%银屑病性关节炎免疫机制及生物制剂治疗的进展

    Institute of Scientific and Technical Information of China (English)

    赵伟; 龚瑜; 史玉玲


    银屑病性关节炎是一种与银屑病相关的炎症性关节病,病程迁延反复,晚期可致关节强直甚至致残,严重影响患者的生活质量.因此,早期诊断,早期干预以及制定有效的治疗方案改善患者的关节症状,缓解其心身的双重压力是银屑病性关节炎面临的挑战.银屑病性关节炎的发病机制十分复杂,有多种免疫细胞和免疫分子参与,异常T细胞的活化、增殖、分化是发病的主要原因.此外,肿瘤坏死因子α和白细胞介素12、23、17等为主要的炎症介质靶点.针对发病机制中不同炎症因子的靶向治疗药物,为银屑病性关节炎的治疗带来了革命性的变化.目前,一些新型的生物靶向药物正在研究中,有希望成为银屑病性关节炎患者未来治疗的新选择.%Psoriatic arthritis (PsA),a psoriasis-associated inflammatory arthropathy with a chronic and recurrent clinical course,may lead to ankylosis and even disability at late stage,and seriously affects the quality of life in patients.It remains a challenge to improve joint symptoms and relieve physical and mental stress by early diagnosis,early intervention and effective therapeutic strategies.The pathogenesis of PsA is very complicated with the involvement of various immunocytes and immune molecules,in which the abnormal activation,proliferation and differentiation of T-lymphocytes may play a key role.Additionally,tumor necrosis factor alpha (TNF-α),interleukin 12 (IL-12),IL-23 and IL-17 are the main targets for inflammatory mediators.Aiming directly at different inflammatory cytokines in the pathogenesis of PsA,targeted drugs have brought revolutionary changes for the treatment of PsA.At present,some novel targeted biological drugs are under investigation,and may bring novel choices for the treatment of PsA.

  5. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

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    A. D. Kaprin


    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  6. Diversas modalidades de intervención temprana de caninos ectópicos.

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    Carlos Astorga


    Full Text Available RESUMEN La impactación del canino permanente se encuentra a menudo en la práctica ortodóncica y su etiología se asocia a factores locales de espacio y genéticos. El no intervenir a tiempo trae como consecuencia la reabsorción de raíces de dientes vecinos, desarrollo de quistes, anquilosis y necesidad de tratamientos ortodóncicos complejos y costosos. El objetivo de esta revisión fue recoger las distintas modalidades publicadas en los últimos años para prevenir este fenómeno. Son cuatro las más importantes: Intervención solo basadas en extracciones, extracción de caninos temporales más contención (arco de tracción cervical, intervención activa en dentición mixta tardía, intervención activa en dentición mixta temprana. Estos distintos tipos de intervención muestran un mayor porcentaje de éxito eruptivo del canino permanente maxilar (80 - 97%. La extracción del canino temporal sigue siendo un método efectivo para evitar la impactación palatina del canino, cuya tasa de éxito se vería aumentada sí además se complementa con otro método interceptivo. Abstract: Maxillary canine impactation is often encountered in orthodontic clinical practice and the aetiology is associated to genetic factors as well as local space factors. If preventive treatment is not started in ectopic maxillary canines, some possible consequences may occur, such as resorption of the roots of the neighboring permanent teeth, cysts, ankylosis and expensive surgical and orthodontic treatment. The aim of this review was to preset several early treatment modalities for ectopic maxillary canines based on recent scientific evidence. Four are the most important: Only extractions intervention, extraction of deciduous canines with cervical pull headgear, active intervention in late mixed dentition and active intervention in early mixed dentition. These different modalities showed a greater increasing the rate of normal eruption of ectopic canines ( 80- 97

  7. Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida: Planificación quirúrgica virtual Post-traumatic reconstruction with custom prosthesis of the temporomandibular joint: Computerized surgical planning

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    Aitor García Sánchez


    surgical execution of three cases of bilateral articular ankylosis (6 joints is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction.

  8. Gömülü süt ikinci azı dişine bağlı olarak meydana gelen perikoronitis vakası

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    Fatih Sari


    Full Text Available

    Primary tooth impaction has been reported to be very rare and studies report prevalence rates of impaction to be form 1:10.000. Primary tooth impactions can occur because of various reasons, including ankylosis, congenitally missing permanent teeth, defects in periodontal membrane, trauma, injury of the periodontal ligament, precocious eruption of the first permanent molar, defective eruptive force, or a combination of these factors. In this article we present a case of impacted mandibular second deciduous molar tooth with pericoronitis and discuss the etiology and its management by surgical intervention in an 8 year old girl.



    Gömülü süt dişlerine ait çok az sayıda rapor vardır ve bu çalışmalarda süt dişlerinin gömülü kalma insidansı 10.000’de 1 olarak belirtilmiştir. Çeşitli nedenler süt dişlerinin gömülü kalmasına neden olabilmektedir. Bunlar; ankiloz, konjenital olarak daimi diş eksikliği, periodontal membranda defekt, travma, periodontal ligamentte yaralanma, erken süren daimi birinci molar, hatalı sürme kuvvetleri ya da bu faktörlerin kombinasyonlarıdır. Bu raporda 8 yaşındaki bir kız çocuğunun gömülü süt alt ikinci azı dişine bağlı olarak gelişen perikoronitis vakası sunulmuş, etyolojik faktörler ve cerrahi tedavi seçeneği tartışılmıştır.

    Anahtar Kelimeler: Gömülü süt dişi, perikoronitis, ankiloz


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    Sunil Kumar


    Full Text Available INTRODUCTION: Otosclerosis is one of the commonest non infective causes of acquired deafness in adults’. ‘Otosclerosis’ literally means hardening of the ear. It is a primary and exclusive disease of otic capsule of human temporal bone. Otosclerosis is characterised by alternate phases of bone resorption and formation. If the location of bony changes produces evident clinical manifestations term “C linical Otosclerosis” is used. If bony changes are not translated into clinical manifestations, the term used is “histologica l Otosclerosis”. Antonio Valsalva in 1735 gave first description of ankylosis of stapes to margins of oval window. Von Troltsch in 1881 coined the term ‘Otosclerosis’. Politzer in 1893 first described Otosclerosis as a primary disease of otic capsule. Alth ough the clinical course of the disease is well documented, its aetiology remains unclear; thus, multiple theories are available. But none of them has established a definite cause. Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. The clinical diagnosis of Otosclerosis, as clarified by Bezold in 1908, requires a careful history, physical examination, tuning fork evaluation and audiometric testing. Radiographic examinations can be done as adjuncts when needed. Therapeutic options for Otosclerosis include medical, surgical and use of hearing aids, alone or in combination. Stapes surgery is an effective treatment for hearing loss and tinnitus of Otoscl erosis and stapedectomy is the current treatment of choice for conductive component of Otosclerosis. The first stapes mobilization was employed by Kessel in 1878. The procedure of extracting the stapes for Otosclerosis was first performed by Jack of Boston in 1892 but was beset with obvious difficulties because he lacked proper magnification and antibiotic coverage. In 1956 Dr. John Shea revived the

  10. The clinical and radiological evaluation of pyogenic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Jun; Kim, Kyung Joo; Yoo, Jung Keun; Kim, Young Chul; Hur, Don [Chosun University College of Medicine, Gwangju (Korea, Republic of)


    swelling and the others are include in order of frequency: joint space widening, small erosions in articular cortex, subchondral osteoporosis. The common radiological findings of symptom duration more than 31 days in 6 cases were lost of entire cortex, ankylosis and joint space narrowing.

  11. Autocrine stimulation of osteoblast activity by Wnt5a in response to TNF-α in human mesenchymal stem cells

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    Briolay, A. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Lencel, P. [Physiopathology of Inflammatory Bone Diseases, EA4490, ULCO. Quai Masset, Bassin Napoléon BP120, 62327 Boulogne/Mer (France); Bessueille, L. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Caverzasio, J. [Service of Bone Diseases, Department of Internal Medicine Specialties, University Hospital of Geneva, CH-1211 Geneva 14 (Switzerland); Buchet, R. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Magne, D., E-mail: [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France)


    Highlights: ► Ankylosing spondylitis (AS) leads to bone fusions and ankylosis. ► TNF-α stimulates osteoblasts through growth factors in AS. ► We compare the involvement of canonical vs non-canonical Wnt signaling. ► Canonical Wnt signaling is not involved in TNF-α effects in differentiating hMSCs. ► TNF-α stimulates osteoblasts through Wnt5a autocrine secretion in hMSCs. -- Abstract: Although anti-tumor necrosis factor (TNF)-α treatments efficiently block inflammation in ankylosing spondylitis (AS), they are inefficient to prevent excessive bone formation. In AS, ossification seems more prone to develop in sites where inflammation has resolved following anti-TNF therapy, suggesting that TNF-α indirectly stimulates ossification. In this context, our objectives were to determine and compare the involvement of Wnt proteins, which are potent growth factors of bone formation, in the effects of TNF-α on osteoblast function. In human mesenchymal stem cells (MSCs), TNF-α significantly increased the levels of Wnt10b and Wnt5a. Associated with this effect, TNF-α stimulated tissue-non specific alkaline phosphatase (TNAP) and mineralization. This effect was mimicked by activation of the canonical β-catenin pathway with either anti-Dkk1 antibodies, lithium chloride (LiCl) or SB216763. TNF-α reduced, and activation of β-catenin had little effect on expression of osteocalcin, a late marker of osteoblast differentiation. Surprisingly, TNF-α failed to stabilize β-catenin and Dkk1 did not inhibit TNF-α effects. In fact, Dkk1 expression was also enhanced in response to TNF-α, perhaps explaining why canonical signaling by Wnt10b was not activated by TNF-α. However, we found that Wnt5a also stimulated TNAP in MSCs cultured in osteogenic conditions, and increased the levels of inflammatory markers such as COX-2. Interestingly, treatment with anti-Wnt5a antibodies reduced endogenous TNAP expression and activity. Collectively, these data suggest that increased

  12. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial. (United States)

    Roşu, Mihaela Oana; Ţopa, Ionuţ; Chirieac, Rodica; Ancuta, Codrina


    The optimal management of ankylosis spondylitis (AS) involves a combination of nonpharmacologic and pharmacologic treatment aiming to maximize health-related quality of life. The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates, McKenzie and Heckscher techniques on pulmonary function in patients with AS, while secondary objectives were to demonstrate the benefits of the same program on function and disease activity. This is a randomized controlled study on ninety-six consecutive patients with AS (axial disease subset), assigned on a 1:1 rationale into two groups based on their participation in the Pilates, McKenzie and Heckscher (group I) or in the classical kinetic program (group II). The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks. Standard assessments were done at week 0 and 48 and included pain, modified Schober test (mST) and finger-floor distance (FFD), chest expansion (CE) and vital capacity (VC), as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional Bath Ankylosing Spondylitis Functional Index (BASFI) and metrology index Bath Ankylosing Spondylitis Metrology Index (BASMI). Groups were comparable at baseline; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups. However, significant improvement was found in pain, lumbar spine motility (mST, FFD), BASFI, BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study (p = 0.001). Although there were significant improvements in CE in both groups as compared to baseline (group I, p = 0.001; group II, p = 0.002), this parameter increased significantly only in group I (p = 0.001). VC measurements were not significantly changed at the end of the study (group I, p = 0.127; group II, p = 0.997), but we found significant differences

  13. Surgical Management of Temporomandibular Joint Disease%颞下颌关节疾病的外科治疗

    Institute of Scientific and Technical Information of China (English)



    A variety of disorders affect temporomandibular joint (TMJ) including temporomandibular disorders (TMD), trauma, dislocations, ankylosis, congenital and growth abnormalities, infections and tumors. Temporomandibular joint diseases should be managed by conservative treatment and/or surgical treatment. Achievements in basic research has led to an improved understanding of the etiology and pathogenesis of TMJ disease,which, in turn, has provided critical support for the role of the management of TMJ disease. Controversies still exist. Through the further understanding of TMJ pathology, modified diagnostic imaging, TMJ arthroscopy and sophisticated surgical techniques, the more reliable and practical of TMJ surgery has been enhanced.%颞下颌关节疾病(temporomandibular joint disease,TMD)包括颢下颌关节紊乱病、颢下颌关节损伤、颢下颌关节脱位、颞下颌关节强直、先天性或后天性畸形、炎性疾病以及肿瘤等,治疗方法有保守治疗和外科治疗.基础研究有助于了解颞下颌关节疾病的致病机理,并为颢下颌关解疾病的治疗提供理论依据.虽然颞下颌关解疾病的治疗多年来存在争议,但随着对颞下颌关节疾病了解的加深,以及影像学的发展、关节镜和手术方法的改进,颢下颌关节疾病的外科治疗有了明显进步.本文对颞下颌关节紊乱病、颞下颌关节脱位、髁突骨折、颞下颌关节强直、先天性或后天性畸形以及肿瘤等颞下颌关节疾病的外科治疗现况及进展进行了阐述.


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    D. I. Abdulganieva


    Full Text Available There is much evidence that ankylosing spondylitis (AS is a disease that is also much older than early human civilizations and man as a whole. Until now, the Russia's earliest (14th c ntury archaeological finding of such a patient remains a Volga Bulgaria inhabitant suffering with AS during his life. In the Republic of Tatarstan, at the site of an ancient Bulgar settlement appearing in the early ninth century, archaeologists have discovered an unusual grave: the deceased sitting with his back against the western wall of a tomb pitand having a bronze crosslet under his fingers. According to a historical source, it was the way of burying Christian hierarchs as pastors sitting on the altar and anticipating the great assize during which the destinies of human souls should be ruled. Anthropological analysis showed that the bones belonged to a 35–45-year-old man who was 158–163 cm tall. During the examination of the remains,attention was called to the following features of the spinal structure: ankylosis of the inferior cervical and superior thoracic vertebrae (СV–ThI and inferior thoracic and lumbar spine (ThIV–LII predominantly due to ossification of the anterior longitudinal ligament. Facet vertebral joints and costotransverse joints were also ankylosed at the same levels. The man's neck was fixed in a bent-over position with the head down, the chin touching the breast bone – the socalled soliciting posture. By and large, the vertebral changes are characteristic of late (X-ray stage III spondylitis. Spinal and pelvic photos and X-films are given for demonstration. The studies conducted by historical scientists and forensic medical experts suggest that the found remains are most likely to belong to Christian Theodore nicknamed Jerusaleman, also further known as Holy Theodore philosopher Kamsky (Bulgarian, who was mentioned in the Nikon chronicle in 1323.

  15. Clinical effects of total knee arthroplasty in the treatment of ankylosed knee%全膝关节置换术治疗膝关节强直的临床研究

    Institute of Scientific and Technical Information of China (English)

    冷重光; 李忠强; 陈崇民; 刘灿祥; 赵江涛; 范树枫; 张红娜; 常鸣


    Objective To investigate the clinical effects of total knee arthroplasty in treatment ofankylosed knee caused by various reasons. Methods Four patients with 7 ankylosed knees, caused byankylosing spondylitis in 1 case, septic arthritis with bony ankylosis in 1 case, and rheumatoid arthritis in 2cases, underwent artificial knee replacement. Before the operation joint activity was 0°, Knee Society score(KSS) was 42 (11 - 63), and the function score was 17. Follow-up was conducted for 5 - 27months. Results Follow-up showed that the average joint activity was raised to 83° (60° - 110°) ,KSSscore to 83 (64 -91) points,and function score to 77 points. No infectious case was found. Conclusion Totalknee arthroplasty has a satisfactory effect in treatment of ankylosed knee. Computer assisted navigationsystem is helpful in femoro-tibial osteotomy and soft tissue balance. Individualized and directed rehabilitationis a pivotal factor.%目的 探讨各种原因引起膝关节强直采用人工全膝关节置换治疗的手术技巧和临床效果.方法 2005年2月至2007年3月对4例(7膝)膝关节强直的患者施行人工膝关节置换术,其中1例化脓性关节炎骨性强直,2例类风湿性关节炎,1例强直性脊柱炎.术前记录关节活动度均为0°,KSS评分平均为42分(11~63分),功能评分平均17分(0~45分).结果 术后随访5~27个月,术后平均活动度83°(60°~110°),KSS评分平均为83分(64~91分)功能评分平均77分(60~90分),感染例数为0.结论 人工全膝关节置换手术治疗膝关节强直近期随访取得满意疗效,计算机导航辅助下进行股骨胫骨的截骨和软组织松解平衡,术后个体化功能康复训练是关键因素.

  16. Application of Exercise Therapy in Ankylosing Spondylitis (review)%运动疗法在强直性脊柱炎治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    周亚美; 茹晋丽; 赵华明


    Ankylosing spondylitis (AS) is a systemic disease, which mainly causes to axial joint chronic inflammation. Spine, thoracic and peripheral joints may have varying degrees of activity limitation, and somatic activity is also likely to decline. Ankylosis of the spine and movement disorder of hip are the mainly causes of AS patients' disability, which not only affect the patients' motor function, and but al-so affect their social interaction, role affordability, mental state and daily living skills. Exercise therapy is the treatment unarmed or with equipment, for injuries, disease, residual patients, to restore or improve dysfunction. There are a number of studies about exercise therapy for joint function of patients with AS, confirmed that exercise therapy plays a crucial role in the treatment of AS patients, on the basis of the medications control.%强直性脊柱炎(AS)是以中轴关节慢性炎症为主的全身性疾病,脊柱、胸廓及外周关节可有不同程度的活动受限,躯体活动能力亦可能下降。而脊柱的骨性强直和髋关节的活动障碍是AS患者致残的主要原因,不仅影响患者的运动功能,而且影响患者的社会交往能力、角色承担能力、心理状态和日常生活能力等。运动疗法是以徒手及应用器械进行运动训练来治疗伤、病、残患者,恢复或改善功能障碍的方法。已有多项运动疗法对AS患者关节功能影响的研究证实,在药物治疗控制病情的基础上,运动疗法在AS患者的治疗中起到至关重要的作用。

  17. Higher bone turnover is related to spinal radiographic damage and low bone mineral density in ankylosing spondylitis patients with active disease: a cross-sectional analysis.

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    Suzanne Arends

    Full Text Available INTRODUCTION: Ankylosing spondylitis (AS is characterized by excessive bone formation and bone loss. Our aim was to investigate the association of bone turnover markers (BTM with spinal radiographic damage and bone mineral density (BMD in AS patients with active disease. METHODS: 201 consecutive AS outpatients of the Groningen Leeuwarden AS (GLAS cohort were included. Serum markers of bone resorption (C-telopeptides of type-I collagen, sCTX and bone formation (procollagen type-I N-terminal peptide, PINP; bone-specific alkaline phosphatase, BALP were measured. Z-scores were used to correct for the normal influence that age and gender have on bone turnover. Radiographs were scored by two independent readers according to modified Stoke AS Spinal Score (mSASSS. The presence of complete bridging (ankylosis of at least two vertebrae was considered as measure of more advanced radiographic damage. Low BMD was defined as lumbar spine and/or hip BMD Z-score ≤ -1. RESULTS: Of the 151 patients with complete data, 52 (34% had ≥ 1 complete bridge, 49 (33% had ≥ 1 syndesmophyte (non-bridging, and 50 (33% had no syndesmophytes. 66 (44% had low BMD. Patients with bridging had significantly higher sCTX and PINP Z-scores than patients without bridging (0.43 vs. -0.55 and 0.55 vs. 0.04, respectively. Patients with low BMD had significantly higher sCTX Z-score than patients with normal BMD (-0.08 vs. -0.61. After correcting for gender, symptom duration, and CRP, sCTX Z-score remained significantly related to the presence of low BMD alone (OR: 1.60, bridging alone (OR: 1.82, and bridging in combination with low BMD (OR: 2.26. CONCLUSIONS: This cross-sectional study in AS patients with active and relatively long-standing disease demonstrated that higher serum levels of sCTX, and to a lesser extent PINP, are associated with the presence of complete bridging. sCTX was also associated with low BMD. Longitudinal studies are needed to confirm that serum levels of s

  18. Removable appliance and closed of central incisors:report of 48 cases%活动矫治器+封闭式牵引术矫治上颌埋伏倒置弯曲中切牙48例报告

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    邵林琴; 张立霞; 巩若箴; 马缨卫


    PURPOSE: To evaluate the treatment effect of orthodontic traction on embedded and inverted maxillary bending central incisors. METHODS: Fifty-two embedded and inverted maxillary central incisors without-eruption ability in 48 cases were treated by combined orthodontic traction with surgical treatment after spiral CT positioning and expanding the space, the eruption situation, gingival—breaking time and teeth pulp vitality after treatment were recorded, and the treatment effect was evaluated. RESULTS: Forty—eight cases with 52 impacted upper central incisors were treated with surgical and closed orthodontic traction, successful results were achieved in 36 cases, accounting for 69.23%; 15 cases had improvement, accounting for 28.85%; 1 case failed, accounting for 1.9%. Pulp vitality tests were all normal and there was no root absorption and ankylosis. CONCLUSIONS: Selecting appropriate cases, precise positioning with spiral CT, proper space expanding and rational application of removable traction appliance are the keys to successful treatment of impacted and inverted maxillary bending central incisors of children in mixed dentition.%目的:观察上颌埋伏阻生的倒置弯曲中切牙正畸牵引治疗的效果.方法:选择48例、52颗无萌出能力的上颌埋伏阻生倒置弯曲中切牙,分别经螺旋CT定位、拓展间隙后,行手术联合正畸牵引治疗,观察治疗后的萌出状况、破龈时间、牙髓活力等,以成功、有效和失败评判疗效.结果:本组48例、52颗埋伏中切牙中,成功36颗,占69.23%;有效15颗,占28.85%;失败1颗,占1.9%.牙髓活力检测均正常;未见牙根吸收和黏连.结论:对替牙期儿童的上颌埋伏阻生倒置弯曲中切牙,选择合适的适应证、通过螺旋CT精确定位、恰当的间隙拓展以及活动牵引矫治器的合理应用,是治疗成功的关键.

  19. The posttraumatic proximal cross-union of the forearm in childhood: what is recommended?

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    Marcel Dudda


    Full Text Available The posttraumatic proximal cross-union of the forearm in childhood is a rare complication after radial head, neck or proximal forearm fractures and elbow dislocations. There is no standardized treatment. Several surgical procedures with or without interposition techniques are described in the literature. The aim of this study was to analyze all children with cross-unions who underwent surgery over the last 15 years. From 1998 to 2013, 8 children with a posttraumatic proximal cross-union of the forearm (Type 3 according to Vince and Miller received surgical treatment with resection of the cross-union or radial head. Mean age at the time of initial trauma was 9.0±2.56 years (range 6-14 years, age at the time of surgery was 11.9±3.09 years (range 7-16 years. Mean time of resection of the cross-union was 23.2 months. Follow-up time was 10.6 months (range 1-36 months. Five patients had a resection of the cross-union without any interposition techniques, in 2 cases with an additional arthrolysis of the elbow. One patient had an interposition of a local fascia flap. In 2 cases, a primary excision of the radial head, six and seven years, respectively, after trauma, was performed. All patients, except one, had non-steroidal anti-inflammatory drugs therapy after surgery. A post-operative irradiation was performed in 3 cases. The mean postoperative range of motion for pronation/supination was 36/0/53°. Controversy remains about the best procedure to adopt for posttraumatic cross-union in childhood. After analysis of our data and the literature, we recommend the resection of the cross-union within 6-24 months of occurrence without necessarily using any interposition techniques. All patients reported an improvement with regard to ordinary activities. In cases of long-term cross-union for several years with ankylosis of the elbow and bony deformities of the proximal radius, an excision of the radial head as salvage procedure is recommended.

  20. Doença de still do adulto: diagnóstico e evolução Adult-onset still disease: diagnosis and evolution

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    Simone Appenzeller


    clinical manifestations at disease onset and during follow-up of patients with Adult-Onset Still Disease (AOSD in a tertiary university hospital in Brazil. METHODS: Thirteen cases of AOSD were identified in the Arthritis Outpatients Unit - Unicamp. Their clinical records were reviewed retrospectively in order to determine clinical manifestations regarding disease onset, follow-up and prescription. RESULTS: The prevalence of AOSD was 4.3%. The mean age of disease onset was 30.8 years old with a slight prevalence of men (54.2%. Constitutional symptoms, fever and cutaneous rash were observed in all cases. Hepatic involvement was observed in 11 patients, splenomegaly in 4, hematuria in 4, cardiac involvement in 2 and pleuritis in 2. Poliarticular involvement was observed more frequently, and 50% of them presented carpal ankylosis after 3 years of follow-up. Ferritine was elevated in 9 of 13 patients during active disease. All patients used oral non-steroidal anti-inflammatory drugs, steroids and 7 patients needed methotrexate. CONCLUSIONS: Although AOSD is a rare multisystemic rheumatic disorder, it should always be considered in febrile cases with poliarthritis. Neoplasia and infection should always be excluded. Normally it is characterized by a chronic course and carpal ankylosis as the main disabling feature.

  1. Animal experimental study on the role of the lateral pterygoid muscles in healing process of the sagittal fracture of mandibular condyles%翼外肌在髁突矢状骨折愈合过程中对髁突形态改建影响的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    刘昌奎; 胡开进; 刘平; 邓天阁; 江欣; 程鹏


    目的 观察翼外肌在髁突矢状骨折愈合过程中对髁突形态的改建是否有影响以及是否会进一步导致关节强直的发生.方法 将12只健康成年绵羊随机分为2组,均以右侧颞下颌关节作为手术实验侧,人为手术造成髁突矢状骨折.一组保留翼外肌在髁突内极的附丽,行使其功能,另一组切断翼外肌在髁突内极的附丽,阻断其功能,术后即刻行MRI检查,确定翼外肌是否离断.术后1周对动物模型行CT三维检查,测量髁突骨折块的移位距离及髁突内外径的改变,术后4周、12周及24周时处死动物,再次行CT检查,多平面重建后对髁突形态相关参数测量,以观察髁突的形态变化.结果 通过CT三维测量,两组髁突内外径的改变有明显的差异(P<0.05),证实翼外肌对髁突游离骨折端有牵拉作用,保留翼外肌功能组,对髁突矢状骨折后髁突形态的影响更明显.结论 此动物模型的建立,证实翼外肌对髁突矢状骨折后髁突形态改建的确有影响,为进一步研究“翼外肌牵张成骨在创伤性颞下颌关节强直发生中的作用研究”提供研究平台.%Objective To examine whether they may further cause joint ankylosis lateral pterygoid muscles influence the condyle morphology in the healing process of sagittal fracture of mandibular condyles ( SFMC ) . Methods Twelve healthy adult sheep were included in our study, and all the animals were treated with surgery to make the condyles fracture on the right side of the temporomandibu-lar joint. The animals were randomly divided into two groups: the pterygoids of sheep in one group were cut and not able to function. The others in the other group were not cut. They were still on the internal poles of the fractured condyles and their functions remained. We immediately examined whether the pterygoid muscles were cut ( or not) by MRI after the operation. 3D computed tomograms ( CT) were taken 1,4,12 and 24 weeks after the operation

  2. Reimplante intencional en diente geminado con lesión endoperio tipo IV: Reporte de caso Intentional replantation gemina injured in tooth type IV endoperio: Case report

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    R.S. Rodríguez Rodríguez


    , persistent fistula, large periapical lesions, periodontal pocket, root anatomy of the tooth organ palate (palatine canal alleged and that the anatomy tooth is favorable to perform the procedure. The extraction and intentional replantation is the treatment in cases where the endodontic treatment fails and the anomaly dental periapical surgery also fail because only temporarily remove the lesion but not the cause it is the communication between the oral cavity and apical area. However, it is known that this treatment option can have risks and benefits, including tooth loss or possible ankylosis and with a success rate of 42.9%. The present case report describes the extraction and intentional replantation geminate tooth with a persistent periapical lesion of periodontal origin, with symptoms and fistula, after endodontic treatment complex, its evolution and success.

  3. Reimplante mediato de dentes tratados ou não com solução de hipoclorito de sódio a 1% - estudo histomorfométrico em ratos Effects of sodium hypochlorite on periodontal healing after tooth replantation - histomorphometric study in rats

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    Cláudia Misue KANNO


    slices were projected and outlined. The tissues observed on the dental surfaces were measured with an image analysing system (Mini-Mop, Carl Zeiss. In the 10-day treated group, the main characteristic observed was a connective tissue arranged parallelly to the root surface, although not attached to it. After 30 and 60 days, the connective tissue was reduced and an increase of ankylosis was observed, as well as replacement resorption. A limited periodontal ligament reattachment was also observed. In the control group, the periodontal ligament was preserved in about 15% to 17% of the root surface after 30 and 60 days, and the resorption areas were deeper than in the treated group. It was concluded that 1% sodium hypochlorite allowed an increase of the ankylosed root surface and a limited periodontal ligament reattachment, but did not avoid replacement resorption.

  4. 溶酶体相关膜蛋白2基因新突变导致Danon病的临床病理特点%Clinical and pathological features of Danon disease associated with a novel lysosome-associated membrane protein-2B mutation

    Institute of Scientific and Technical Information of China (English)

    洪道俊; 石志鸿; 张巍; 王朝霞; 袁云


    目的 报道1例Danon病患者的临床表现、病理改变特点和基因突变位点.方法 16岁男性患者表现为缓慢进展的骨骼肌无力和萎缩,以近端为主,伴随轻度脊柱强直.心电图示Ⅰ度房室传导阻滞,心脏超声示二尖瓣局限性增厚伴舒张功能损害,肌电图提示神经源性合并肌源性损害.患者左腓肠肌活体组织检查后,进行组织学、酶组织化学、电镜观察及抗肌营养不良素蛋白、层黏连蛋白α2、C5b9等免疫组织化学染色.患者及其父母进行溶酶体相关膜蛋白2(LAMP2)B基因的直接测序.结果 骨骼肌纤维内出现大小不一的自嗜空泡和镶边空泡,空泡内缺乏糖原,免疫组织化学显示多数肌纤维内的空泡边缘出现肌营养不良素蛋白、层黏连蛋白α2和C5b9的表达.电镜显示肌纤维内大量膜性空泡和溶酶体聚集.患者的LAMP2B基因9号外显子存在K402X突变,患者母亲无此突变,50名健康对照无此突变.结论 LAMP2B的9号外显子羧基末端的截断突变可以导致相对良性的Danon病,其心脏损害相对轻微.%Objectives To report the clinical and myopathological features in a case with Danon disease caused by a novel mutation in the lysosome-associated membrane protein-2 ( LAMP2 ) B gene.Methods A 16-year-old boy presenting progressive muscle weakness and atrophy, accompanied with spinal ankylosis was clinically evaluated including electrocardiogram, echocardiogram and electromyogram.Muscle biopsy was carried out in the patient.The histological staining, ultrastructural examination, and immunohistochemical staining with antibodies against dystrophin, merosin and C5b9 were performed in frozen sections.LAMP2B sequence was analyzed in the patient and his parents.Results Electrocardiogram in the patient showed Ⅰ atrioventricular block; echocardiogram revealed focal hypertrophy in mitral valve with mild cardiac diastolic dysfunction; electromyogram indicated myogenic and neurogenic

  5. Magnetic resonance imaging for ankylosing spondylitis; Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Struempell-Marie-Bechterew)

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    Bollow, M. [Augusta-Kranken-Anstalt, Inst. fuer Radiologie, Bochum (Germany)


    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.) [German

  6. Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

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    BACKGROUND: The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed.OBJECTIVE: To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy.DESIGN: A case-controlled analysis.SETTING: Qilu Children's Hospital of Shandong University.PARTICIPANTS: Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0 - 2 years old,47 cases of 2 - 4 years and 36 cases of 4 - 6 years. Informed contents were obtained from relatives of all the children.METHODS: ① Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub,pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was

  7. Utilización del colgajo de músculo temporal en cirugía reconstructiva maxilofacial: Revisión de 104 casos Use of the temporalis muscle flap in maxillofacial reconstruction surgery: A review of 104 cases

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    I. Zubillaga Rodríguez


    . Aims: To show our indications and results using the temporalis flap in craniofacial reconstruction. Material and methods: A retrospective analysis of our experience with temporalis flap along the last decade. Results: A total of 108 flaps have been used in the following situations: postmaxillectomy defect reconstruction (44; cranial base (25 including anterior, middle and posterior cranial fossas; oral cavity and oropharynx (23; orbital exenteration (6; Temporomandibular joint ankylosis (6; others (2 with an overall success rate (no partial or total flap failure over 94 %. Conclussions: Temporalis muscle flap is one of the «first choice» elections in reconstructive craniofacial surgery, for midfacial and cranial base indications. Non-careful surgical dissection and flap suture under tension predispose to complications such as flap necrosis (commonly partial and wound dehiscence.

  8. 使用导杆式矫治器治疗腭侧阻生上中切牙%The orthodontic treatment of palatal impacted maxillary central incisors with guide rod appliance

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    戴微微; 林燕; 孙浩; 孙超凡; 王昕; 胡荣党


    目的 分析上颌腭侧埋伏阻生中切牙的正畸矫治效果及导杆式矫治器的治疗作用.方法 利用导杆式矫治器治疗7例上颌单侧中切牙腭侧埋伏的患牙,以对侧自然萌出中切牙作为对照.矫治前后拍摄全景片,测量矫治后埋伏牙和对照牙的牙全长、解剖牙根长度、解剖牙冠长度、根长/冠长,用SPSS 17.0软件进行成组t检验.结果 6例腭侧埋伏中切牙经牵引萌出后排齐,牙髓和牙周状况良好.萌出后埋伏牙解剖牙根长度比对照组牙根短4.00 mm(P=0.020),根长/冠长值平均为1.36±0.31,小于对照组(P=0.048).其中1例因埋伏牙骨粘连,牵引16个月后无移动而放弃牵引.结论 矫治后腭侧埋伏中切牙有足够的长度,应保留埋伏牙;导杆式矫治器是治疗上颌腭侧埋伏中切牙的一种有效方法.%Objective To analyze the effects and features of guide rod appliance on palatal impacted central incisors.Methods 7 palatal impacted central incisors were treated with guide rod appliance,the normal erupted contralateral central incisors were used as control.Pre-and Posttreatment panoramic radiograph were measured and the following data were collected:(1) The length of the impacted central incisors and the contralateral control teeth; (2) The length of the anatomical roots; (3) The length of the anatomical crowns; (4) Root/Crown length ratio.The measures were compared using two sample t-test with SPSS17.0.Results Six impacted central incisors were treated to normal position.Their pulp and periodontal attachment were normal.The length of the impacted central incisors was 4.00 mm shorter than the control group (P=0.020).The ratio of Root/Crown length is 1.36 ± 0.31,which is smaller than that of the control group (P =0.048).One tooth demonstrated ankylosis for that 16 months of orthodontic extrusion showed no movement and gave up treatment.Conclusions The length of the impacted tooth's root was acceptable after treatment.The guide

  9. Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso Orthodontic treatment in patients with reimplanted teeth after traumatic avulsion: a case report

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    Simone Requião Thá Rocha


    Full Text Available INTRODUÇÃO: a alta prevalência de indivíduos com traumatismo dentário prévio ao tratamento ortodôntico justifica os cuidados a serem observados antes e durante o tratamento, considerando todas as implicações do movimento ortodôntico sobre os dentes traumatizados. Entre as lesões traumáticas dentárias, a avulsão com posterior reimplantação do dente é a que apresenta maior risco de complicações - como necrose pulpar, reabsorção radicular e anquilose -, sendo também a que inspira maiores cuidados pelo ortodontista. OBJETIVO: este trabalho busca, através do relato de um caso clínico, analisar as implicações do reimplante dentário após avulsão traumática, em pacientes que requerem tratamento ortodôntico. CONCLUSÕES: a movimentação ortodôntica de um dente reimplantado, após sua avulsão traumática, é possível desde que não ocorra qualquer sinal de anormalidade. Porém, dentes que sofrem anquilose não são passíveis de movimentação ortodôntica, mas devem ser preservados como mantenedores de espaço, até a reabsorção total da raiz, desde que não apresentem infraposição severa. Ocorrendo infraposição severa do dente anquilosado, é indicada a amputação da coroa e o sepultamento da raiz, como meio de favorecer a manutenção do osso alveolar na região, pois ocorrerá reabsorção por substituição da raiz sepultada, como ocorreu no caso clínico apresentado.INTRODUCTION: The high prevalence of individuals with dental trauma prior to orthodontic treatment justifies the precautions that should be followed before and during treatment, considering all possible effects of orthodontic movement on traumatized teeth. Among the major traumatic dental injuries, avulsion with subsequent tooth reimplantation entails a higher than average risk of complications, such as pulp necrosis, root resorption and ankylosis. Therefore, it gives orthodontists several reasons for concern. OBJECTIVE: This case report sought

  10. 正畸力对自体移植牙牙周愈合影响的实验研究%Effect of orthodontic force on periodontal healing after autotransplantation: an experimental study

    Institute of Scientific and Technical Information of China (English)

    杨芸; 白玉兴; 厉松; 高伟民; 茹楠; 李丽璇


    Objective To investigate the effect of the continuous light force to the donor teeth on the periodontal healing after transplantation.Methods Thirty-two maxillary and mandibular incisors in four 10-month-old male Beagle dogs were autotransplanted.The pulps were removed in all teeth.The teeth were divided into four groups,one control and three experimental groups.In control group ( group 1 ),the teeth were unloaded.In the other three experimental groups,continuous force (0.49 N) was applied in the 1st (group 2),2nd (group 3 ) and 4th (group 4) week,respectively.The dogs were sacrificed in the 8th week.The tissue blocks were demineralized and sectioned perpendicular to the long axis of the teeth.The histological analysis was made. Results Histomophometric analysis revealed a significantly lower occurrence of replacement root resorption in the group 3 (2.1% ) than in the control group( 12.5%,P <0.05 ).The significant lower incidence of replacement root resorption,and a higher surface and inflammatory root resorption were found in group 2(6.3% and 68.8% ) than in the control group( 12.5% and 41.7%,P <0.05).No significant difference was found between group 4 and control group(P >0.05 ).Conclusions The orthodontic force promoted the regeneration of the periodontal ligament and prevented dentoalveolar ankylosis,whereas excessive initial force might cause root and bone resorption.%目的 观察术后施加正畸力时间对犬移植牙牙周愈合的影响,以期为临床提供参考.方法 将4只犬的32颗上下颌切牙进行自体移植手术,分为术后不加力组(对照组)和术后1、2、4周加力4组,术后8周处死动物,将移植牙及牙周组织制作脱钙标本,以垂直于牙长轴方向进行切片,光镜下分别计算每颗牙根表面3种形态:正常牙周膜、牙根吸收和骨性粘连的观察点占全部240个观察点的百分比,比较各组百分比.结果 与对照组相比,术后2周加力组牙根吸收和骨性粘连

  11. 人工颞下颌关节的研究进展%Progress of temporomandibular joint prosthesis

    Institute of Scientific and Technical Information of China (English)

    孙荃; 李恺得; 刘磊


    颞下颌关节结构和功能的复杂性使得其重建成为外科医生所面临的最大挑战之一。人工颞下颌关节是颞下颌关节重建的重要方式之一,主要适用于颞下颌关节强直、无法复位固定的髁突粉碎性骨折、颞下颌关节肿瘤、晚期关节内紊乱及一些先天性颅面综合征等所致的颞下颌关节发育不良等。人工颞下颌关节旨在改善颞下颌关节的功能、减少疼痛并防止严重的并发症。在口腔颌面外科,人工颞下颌关节具有能模仿正常的解剖形态、与宿主贴合、不需另行取材、术后能立即进行功能训练等优点。假体材料在人工颞下颌关节的发展中起着至关重要的作用,优良的设计、牢靠的固定都是人工颞下颌关节能够行使其功能必不可少的条件,当然关节生物力学的研究也是必不可少的。随着材料学、关节生物力学及制作工艺等相关学科的飞速发展,人工颞下颌关节在关节假体的植入材料、假体的设计等方面取得了不少进展。随着人工颞下颌关节的发展,其应用也越来越广泛。本文对人工颞下颌关节的发展及其临床应用作一综述。%The anatomically and functionally complex nature of the temporomandibular joint (TMJ) makes its reconstruction one of the most challenging tasks faced by surgeons who operate in the head and neck. TMJ prosthesis is one of the important techniques in the reconstruction of TMJ. The main indications for TMJ prosthesis include ankylosis, fractures of condylar that can’t be fixed, trauma or tumor, end-stage TMJ disturbance, and TMJ dysplasia caused by Hallermann-Streiff syndrome. TMJ replacement aims to enhance the function of TMJ, alleviate pain, and prevent serious complications. TMJ prosthesis is advantageous in oral and maxillofacial surgery because it can imitate normal anatomic morphology and adhere to the host. Moreover, the use of other materials is no longer

  12. Role of the Lateral Pterygoid Muscle in the Sagittal Fracture of Mandibular Condyle (SFMC) Healing Process%翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响

    Institute of Scientific and Technical Information of China (English)

    刘平; 刘昌奎; 邓天阁; 江欣; 程鹏; 胡开进


    Objective: To examine the effect of the lateral peterygoid muscle in the reconstruct the condylar shape during the sagittal fracture of mandibular condyle (SFMC) healing process. Methods: Twenty梖our adult sheep were divided into 2 groups . All sheep had a unilateral operation on the right side of cuting anterior and posterior attachments of the the discs, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. One group (groupl) of twelve sheep's lateral pterygoid muscle were cut. The other group (group2) weren't cut the lateral pterygoid muscle. Each group sheep was sacrificed at 4 weeks (2 sheep) , 12 weeks (4 sheep), and 24 weeks (4 sheep) after surgery. Computed tomograms (CT) were taken after sacrificed, and the three imensional compute tomographic reconstruction was used to observe condylar shape. Results: In the group without cut the lateral peterygoid muscle, the joints showed greater overgrows of new bone and more advanced ankylosis. Conclusion: This study shows that the lateral pterygoid muscle plays an important part in reconstructing the condylar shape during the sagittal fracture of mandibular condyle (SFMC) healing process.%目的:本实验的目的是检查翼外肌在髁突矢状骨折愈合过程中,对髁突形态改建的影响.方法:20只1岁龄成年绵羊,随机分为两组,每组10只动物,所有绵羊都用超声骨刀造成髁突矢状骨折,剪断关节盘前后附着并将其推向内侧,其中组1动物切断翼外肌,组2动物保留翼外肌功能.每组动物分别在术后4周(各2只)、12周(各4只)、24周(各4只)处死.处死后行CT检查,CT三维重建观察髁突形态,并解剖颞颌关节(TMJ)以观察髁突形态.结果:组2即保留翼外肌功能组,较组1髁突有更多新骨形成,髁突形态改变更严重.结论:翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响起非常重要的作用.

  13. HIPEROSTOSIS ESQUELÉTICA DIFUSA IDIOPÁTICA EN UNA COLECCIÓN OSTEOLÓGICA CONTEMPORÁNEA (LA PLATA, BUENOS AIRES, ARGENTINA / Difusse Idiopathic Skeletal Hyperostosis in a contemporary osteological collection (La Plata, Buenos Aires, Argentina

    Directory of Open Access Journals (Sweden)

    Marcos Plischuk


    Full Text Available La Hiperostosis Esquelética Difusa Idiopática (DISH es una enfermedad caracterizada por provocar anquilosis entre cuerpos vertebrales, sumada a la osificación masiva de ligamentos y tendones en el resto del sistema esqueletal. El objetivo del presente trabajo es establecer la prevalencia de DISH en una colección osteológica documentada contemporánea y discutir rasgos patognomónicos y factores de riesgo asociados. A fin de establecer un diagnóstico se relevó, en 100 individuos adultos, la formación de bloques óseos de al menos tres vertebras fusionadas por la osificación de ligamento vertebral anterior. Se consideró además que no estuvieran comprometidos los espacios intervertebrales y la articulación sacroilíaca. En la zona extra espinal se registraron como evidencia complementaria la presencia de entesopatías. Como resultado del análisis se observaron seis individuos con DISH, sin diferencias significativas entre ambos sexos. El segmento vertebral principalmente afectado fue el torácico, los espacios intervertebrales no se vieron comprometidos en ningún caso y la articulación sacroilíaca tampoco presentó señales de osificación patológica; a la vez que se relevaron numerosas entesopatías. Las prevalencias observadas se deberían a la avanzada edad de los individuos analizados y las características nutricionales de la población de referencia.  Abstract  The diffuse idiopathic skeletal hyperostosis (DISH is a disease characterized by vertebral ankylosis, with massive ligaments and tendons ossification in the rest of the skeletal system. The aim of this study is to establish the prevalence of DISH in a well-documented and contemporary osteological collection, and to discuss pathognomonic features and associated risk factors. In order to establish the diagnosis, we registered, in 100 adults, the formation of bone blocks, with at least three fused vertebrae by ossification of the anterior vertebral ligament. It was

  14. Diagnostic Value of the Application of High-Resolution CT and Curve Reconstruction in Ankylosing Spondylitis of Sacroiliac Joint Disease%强直性脊柱炎骶髂病变的HRCT及曲面重建诊断价值分析

    Institute of Scientific and Technical Information of China (English)

    刘秀华; 赵汗青; 胡敬宏


    joints, sacroiliac ligament calcification and irregular narrowing or even vacuumization of the joint space were found. At the late stage( IV grade) , 14 cases;bony ankylosis of the joints with obliteration of joint space and osteoporosis or sclerosis were found. Conclusion HRCT and curve recon can could clearly depicts subtle changes of aacroiliac joint. It was a sensitive and specific technique in the detection of the wide spectrum of imaging findings,accurate earlier diagnosis and correct grading can gained,which can provide objective evidence for clinical optimized treatment.

  15. 儿童恒牙全脱出牙周组织预后的回顾性研究%Retrospective study about periodontal ligament healing of replanted permanent teeth in children

    Institute of Scientific and Technical Information of China (English)

    白洁; 赵玉鸣; 秦满


    Objective:To analyze the prognosis about periodontal ligament healing of replanted perma-nent teeth in children and to examine the associated factors.Methods: The sample consisted of 49 children with 61 avulsed permanent teeth, whose injuries had been managed in the period from 2000 to 2012.The clinical data of replanted teeth were collected, and the follow-up period was no less than 12 months .The factors were analyzed in relation to postoperative outcomes, classified as functional periodon-tal healing ( FH ) , infection-related ( inflammatory ) resorption ( IRR ) and replacement resorption ( RR) .Results:The functional healing rate was 23.0%, while replacement resorption rate was 72.1%. The replacement resorption ( ankylosis ) was usually observed earlier by clinical examination than by radiographic examination.86.0% (40/47) resorptive processes were diagnosed within the first year. Physiological storages, such as milk, saline and saliva were significantly better to periodontal ligament healing than nonphysiological storages, such as tap water and sterilizing solutions ( chloramine and alco-hol) .Functional healing was found significantly more frequent in canines and premolars.Conclusion:The factor significantly affecting periodontal ligament healing is storage medium.Replacement resorption is the most common type of root resorption.The replacement resorption diagnosis must combine the radio-graphic examination with the clinical examination.It is better to follow up more than 1 year after tooth re-plantation.%目的:对儿童恒牙全脱出后再植的病例进行回顾性研究,观察再植牙的牙周组织预后类型和各类根吸收出现的时间,分析影响再植牙牙周组织预后的可能因素。方法:对2000年至2012年在北京大学口腔医院就诊的儿童恒牙全脱出系统病历进行回顾性研究,要求观察期大于12个月,记录再植牙的预后和各类牙根吸收出现的时间,分析影响再植牙预后的相

  16. The application of internal distraction osteogenesi s of ja ws in correction of difficult and complicated dento-gnatho-facial deformities (report of 88 cases)%内置式颌骨牵引成骨 在疑难牙颌面畸形矫治中的应用 --附88例报告

    Institute of Scientific and Technical Information of China (English)

    王兴; 林野; 伊彪; 周彦恒; 梁成; 王晓霞; 李自力; 张震康


    secondary to cleft palate, 11 cases of hemifacial microsomia, l7 cases of severe micrognathia accompanie d with obstructive sleep apnea syndrome, l4 cases of TMJ ankylosis, 8 cases of r econstruction of jaw defects, 17 cases of alveolar-bone defect treated by verti c al distraction, and 12 cases with upper and lower dental arch constriction for expansion. The youngest patient was 4.5 years of age, and the oldest 54 year s, with a mean of 22.5 years. The Germany Medicon Co. and Martin Co. produced distr actors were used in 22 cases. In other cases, 7 types of distractors designed an d cooperatively developed by the first author were used. The mode of osteotomy, t he selection and placement of distractor, and the modality of distraction depend ed on the types of deformity, the degree of severity, and the sites of the jaws. Results: The distraction distances in maxilla were 7-l5 mm, and 1 2-50 mm in man dible. 3 cases had local chronic infection leading to resorption of a part of th e new bone; other 3 cases had fracture of the mandibular inferior border and the troubles of the distractor; they had had addi tional operations to complete the distraction. The other cases went on with dist racti on osteogenesis smoothly obtaining good bone formation, their dento-gnatho-fac ia l deformities were corrected satisfactorily. Conclusion: The intraor al distract ion osteogenesis for jaws provides a new and effective means for those difficult and complicated dento-gnatho- facial deformities which are hard to be treated b y conventional measures. This is a technique of wide application value and worth y to be spread.


    Institute of Scientific and Technical Information of China (English)

    蒋欣; 唐学阳; 王道喜; 陈小亮; 刘芳; 谢晓丽; 刘利君; 彭明惺


    arthritis of the hip (33 cases) and tuberculosis of the hip (26 cases). The diseases duration ranged from 1 month to 10 years. At preoperation Harris hip score was 43-78 (mean, 61); 14 cases had normal acetabular index (AI), 32 cases had slightly increased AI, and 13 cases had significantly increased AI. The concomitant diseases included acetabular destruction in 28 cases; avascular necrosis of the femoral head in 25 cases, femoral head partial defect in 12 cases, femoral head complete defect in 6 cases, and femoral head and neck defects in 3 cases; 25 cases had increased anteversion angle; and 9 cases had varus deformity. Results Immediately postoperative X-ray films showed center reduction in all the hips. Healing of incision by first intention was achieved in 55 cases, and delayed healing in 4 cases. Fifty-three children were followed up 2 to 5 years (mean, 3 years). No re-dislocation of the hip occurred during follow-up. Thirty-eight cases had normal AI, 15 cases had slightly increased AI. The anteversion angle was 15-25?(mean, 20?; the neck shaft angle was 110-140?(mean, 125?; and the anatomical relation between the head and neck returned to normal. After 2 years, 18 cases had normal function of the hip joint; 30 cases had mild limitation of flexion and rotation; and 5 cases had fibrous ankylosis. The Harris hip score was 62-95 (mean, 87). Conclusion Pathological dislocation caused by neonatal acute suppurative arthritis of the hip and the hip joint tuberculosis is often associated with severe bone destruction and deformity of the acetabular and femoral head and neck. Treatment should strictly follow the principle of individual. Proper acetabular reconstruction should be selected according to pathological changes of the hip; if combined with the femoral head and neck reconstruction processing, the satisfactory results can be obtained.

  18. 翼外肌在髁突矢状骨折愈合中对新生骨形成的影响%Changes of New Bone Trabecular Number,Thickness,Gap Width and Bone Volume Fraction and Its Clinical Significance of Pterygoid Muscle in Condyle Fracture

    Institute of Scientific and Technical Information of China (English)

    李燕波; 何志良; 王承阳; 贺成功; 曹雷; 苏丹妮


    [Objective] To explore the effects of new bone formation of pterygoid muscle in condyle fracture .[Meth‐ods] A total of 8 healthy sheep were randomly divided into observation and control groups ( n=4 each) .Condylar osteot‐omy was used for mimicking mandibular condyle sagittal fracture .Pterygoid muscle function was retained for observation group and blocked for control group .At Weeks 4 ,12 and 24 ,the changes of new bone trabecular number ,thickness ,gap width and bone volume fraction were recorded .Reverse transcription‐polymerase chain reaction (RT‐PCR) and immuno‐histochemistry were used for detecting the changes of osteocalcin (OCN) ,transforming growth factor‐β1 (TGF‐β1) gene and protein .[Results]With elapsing time ,trabecular number ,thickness and bone volume fraction increased significantly while trabecular gap width significantly decreased in observation group as compared to control group ( P0 .05) .In observation group ,the expressions of OCN mRNA and TGF‐β1 mRNA and positive cell percentage increased significantly ( P <0 .05) .As compared with control group ,the expressions of OCN mRNA and TGF‐β1 mRNA and positive cell percentage were significantly higher in observation group during each period ( P<0 .05) .In control group ,the expressions of OCN mRNA and TGF‐β1 mRNA and positive cell percentage peaked during Week 12 and then decreased significantly ( P <0 .05) .[Conclusion] Pterygoid muscle affects remodeling of condyle shape in healing of sagittal condylar fracture .And the mechanism may be due to a formation of new bone and an aggravation of condyle deformity resulting in joint disk or articular fossa adhesion and ankylosis .%【目的】探讨翼外肌在髁突矢状骨折愈合中对新骨形成的影响。【方法】10只健康绵羊随机分为观察组(5只)和对照组(5只),两组绵羊均通过髁突截骨术造成髁突矢状骨折,观察组保留翼外肌功能,对照组阻断翼外肌功

  19. 急性创伤性关节盘前移位的诊断和治疗:附42例临床分析%Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients

    Institute of Scientific and Technical Information of China (English)

    何冬梅; 杨秀娟; 杨驰


    .8 months.Thirty-one cases with 47 joints accepted surgical treatment after injury or conservative treatment.Among them,23 cases with 34 joints had disc reposition,95.5% were effective (15 cases with 22 joints,mean follow-up period of 22 months).Eight cases with 13 end-stage joints accepted condylar resection and joint replacement.Their maximal incisor opening after surgery was significantly increased compared with that before surgery and conservative treatment (P<0.01).CONCLUSIONS:ATDD is easy to lead to osteoarthritis and ankylosis,disc reposition in the acute and sub-acute phases can significantly reduce the occurrence of above sequel;however,in the chronic phase,joint replacement may be necessary in selected patients.

  20. 两种细胞膜片对牙生物性种植体牙周再生影响的动物实验%Periodontal tissue in a bio-implant by periodontal ligament cells sheet and bone marrow stromal cells sheet

    Institute of Scientific and Technical Information of China (English)

    孙传明; 刘宏伟


    each dog),tooth roots were wrapped by PDLC sheets alone (2 samples each dog),tooth roots were wrapped by BMSC sheet alone (2 samples each dog),tooth roots without cell sheet (1 sample each dog).The implants were implanted into the mandibles.The mandibles were dissected 12 weeks later,sliced and stained by HE and Masson dyes for histological examination.Results In the PDLC cell sheet/root implants,histological examination revealed that new periodontal-like tissue including cementum,periodontium and alveolar bone was regenerated.In the BMSC implants,tooth ankylosis was observed.Conclusions PDLC sheet and natural root can be used to fabricate bio-implant.PDLC sheet could promote periodontal regeneration.

  1. 前交叉韧带重建失败后的首次翻修%Primary revision after failure of anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    孔颖; 王国栋; 张元民; 赵晓伟; 张玉革


    , invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision folowing anterior cruciate ligament reconstruction.%背景:前交叉韧带重建失败可由多种因素引起,需要进行翻修手术治疗。国内关于前交叉韧带翻修的报道较少。目的:分析前交叉韧带重建失败后行翻修治疗的主要原因、适应证、方法及效果。方法:前交叉韧带重建后失稳需要接受翻修患者30例,均在关节镜下行探查与翻修治疗。翻修后应用KT-2000、国际膝关节评分委员会评分标准(IKDC)、Lysholm及Tegner评分系统进行评价。结果与结论:30例患者中,初次手术选用自体骨-髌腱-骨移植物9例,自体半腱股薄肌腱14例,同种异体腘绳肌腱7例,翻修原因上、下两端骨道均偏前8例,上骨道偏前12例,下骨道偏前8例,其中1例合并关节强直;自体骨-髌腱-骨重建固定上骨道内骨块的挤压螺钉位置异常1例;内侧副韧带股骨止点撕脱骨折未予修复1例。翻修术中重建的前交叉韧带完全断裂和吸收12例,韧带有部分连接但已明显松弛失张力18例。无骨道骨质严重缺损,均一期行前交叉韧带翻修手术,重建移植物采用同侧腘绳肌腱(STG)10例,对侧腘绳肌腱14例,人工韧带6例。前交叉韧带翻修后KT-2000检查膝关节屈曲90°和30°平均差值,以及IKDC、Tegner和Lysholm评分均较翻修前有明显改善。前交叉韧带重建手术失败的原因较多,但主要与手术骨道位置异常、固定失效、复合韧带损伤处理不当、关节强直等有关。前交叉韧带翻修后膝关节的主观功能和客观稳定性可获得明显改善。

  2. 经皮电刺激治疗外伤性外周神经损伤40例的效果分析%Analysis of the results of percutaneous electrostimulation in 40 cases of traumatic peripheroneural Injury treated

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate the effect of percutaneous electrostimulation on paraneural mi-crocirculation by analyzing the clinical therapeutic effects of percutaneous neuromuscular electrostimulation (PNMES) on peripheral nerve injury. Methods Forty patients with incomplete injury of peripheral nerves in the upper limbs were treated by PNMES with the use of EMG of Dantec Keypoint type (DKT), complemented with kinesitherapy to observe the functional recovery of the injured nerves. During the treatment, laser Doppler flowmetery (LDF) was employed to detect changes in the bloodstream of paraneural micro-circulation before and after the electrostimulation, and to analyze the effect of electrostimulation on micro-circulation. Before and after treatment, comparative analysis of electro-neurophysiology was performed. The comparative analysis of the post-therapeutic effects in patients with different disease durations was also carried out. Results In the 40 patients with insufficiency of brachial plexus nerves, radial nerves, median nerves and ulnar nerves, the curative rate of their injured nerve functions was 63% (25/40), and the effective rate was 90% (36/40) after 2 to 10 therapeutic courses. LDF demonstrated that the bloodstream volume of paraneural microcirculation was increased by 23. 3% to 26. 96%, compared with that before electrostimulation. The local microcirculation of the injured nerves was improved. In the comparison between patients with different disease durations, the shorter the duration, the better the therapeutic effect. Conclusion PNMES can increase the injured neuromuscular excitability, improve the blood circulation in the injured nerve areas, and promote the regrowth of the peripheral nerves. With the supplement of kinesitherapy, it can stop muscular atrophy (myoatrophy), strengthen muscular balance, prevent joint stiffness (ankylosis), keep the activities of the joints, and finally obtain satisfactory therapeutic effect in the treatment of traumatic

  3. Diagnostic value of multi-slice spiral CT post-processing technique on sacroiliac joint lesions in patients with ankylosing spondylitis%多层螺旋CT后处理技术在强直性脊柱炎骶髂关节病变中的诊断价值

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate the diagnostic value of multi-slice spiral CT(MSCT) and its multi-planar reconstruction(MPR) and curved planar reconstruction(CPR) on sacroiliac joint with ankylosing spondylitis(AS).Methods Fifty-six patients with AS proved clinically were examined and analyzed with MSCT and reconstruction.Then the CT manifestations of sacroiliace joints were analyzed.And choose a sagittal image respectively in the margin of the sacrum one-four,one-second and two-four.Then went down the sacrum line trace for CPR technique get double sided sacroiliac joint imaging.The images,MPR transect images and CPR image were analyed.Results Early CT findings included coarsearticular surface,interrupted jiont cortex,vague articular face,subcortical microcysts and sclerotic articular surface,while jiont space was normal.CT findings in progressive stage were uneven articular surface,damaged bony cortex,subcartilaginous bone microcyats,obviously sclerotic articular surface,extended jiontspace.In stable stage,CT findings included joint ankylosis,articular space dsiappearance,and sacroiliac ligament calcification.Fifty-six cases of AS patients,bilateral simultaneous involvement in 47 cases,unilateral involvement in 9 cases,axial image diagnosis,Ⅰ-Ⅱ grade 16 cases,Ⅲ-Ⅳ grade 26 cases.MPR image diagnosis of Ⅰ-Ⅱ grade 24 cases,Ⅲ-Ⅳ Grade 26 cases,CPR class Ⅰ diagnostic images-Ⅱ grade 29 cases,Ⅲ-Ⅳ grade in 26 cases,early diagnosis of axial images and reconstruction images were significantly different (P < 0.05),the late diagnosis rates were not significantly different (P > 0.05).Conclusions It is valuable to use MPR and CPR images to diagnosis sacroiliac joint lesions in patients with ankylosing spondylitis.Especially CPR image can be used to comprehensively observe sacroiliac joint,and it is more meaningful in early diagnosis of sacroiliac joint lesions in patients with AS.%目的 探讨多层螺旋CT(MSCT)多平面重组(MPR)技术和曲面重组(CPR

  4. Repairing of fingertip defect with topographical anterograde flap pedicled with digital artery trunk or branch%带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损

    Institute of Scientific and Technical Information of China (English)

    林宏伟; 吴杰; 江标; 连素文; 邹育才; 肖瑛; 赵资坚; 林丽贤


    branch flaps and 5 digital artery V-Y flaps occurred arterial crisis, 9 digital artery dorsal branch flaps and 5 digital artery volar branch flaps occurred venous crisis within 24 hours of the surgery. Based on the reasons which caused cyclic crisis, such as removing some stitches around and/or in the pedicle of the flap, small incision bleeding, flap massage, changing finger position, braking and so on were used. 4 flaps survived and 8 partial necrosis occurred due to arterial crisis. 8 flaps survived and 6 partial necrosis occurred because of venous crisis. There were 57 in 62 fingers (91.9%) with skin grafts at the donor sites survived completely. 99 fingers in 67 cases were followed-up from 3 to 12 months, average 5.5 months. The color, texture and contour of the flaps were good. There were no bulkiness, no painful scar, no tenderness and no ankylosis. Tow-point discrimination was 8 to 12 mm. Joint movement of the fingers were normal. The patients could adapt to normal work and life. They were satisfied with the exterior and the sensation of the fingertip post-operatively. Based on the upper limb functional assessment criteria issued by the Chinese Medical Association Hand Surgery Society, the results were rated as excellent in 63 fingers, good in 20 finger and fair in 16 finger. The overall satisfactory rate was 83.8%. Conclusion Repairing of fingertip defect with topographical anterograde flap pedicled with digital artery trunk or branch, the surgery operation is simple and safe, does not need complex microsurgical technique. It does little harm to the donor. That is to say, it is an effective, scientific and reliable method worthy of clinical application.

  5. Curative effect of one-stage total hip arthroplasty for advanced tuberculosis of hip%Ⅰ期全髋关节置换术治疗晚期髋关节结核的疗效分析

    Institute of Scientific and Technical Information of China (English)

    邓辉; 梁大伟; 杨毅; 龚跃昆; 马珂; 李彪


    -stage debridement and TKA in our hospital. There were 20 males and 13 females with a mean age of 44.2 years (range, 19-65 years). According to the classification of the hip tuberculosis, there were 4 cases of gradeⅢand 29 cases of gradeⅣ. Meanwhile, there were 2 cases of old pulmonary tuberculosis, 1 case of spinal tuberculosis (L1), 4 cases of the closed sinus tract formation of the hip, and 14 cases of the hip ankylosis. After preoperative anti-tuberculous therapy (42.0 d on average, ranging 21-90 d), the erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) had decreased by the normal level. Bio-based (non-cemented) prosthesis was used in all the patients. Tuberculous infection was proven by postoperative patho-logical test. Anti-tuberculous therapy continued for 9.2 months on average (range, 6-12 months) after surgery. Harris hip score was used to evaluate hip function. Some tests, such as X-ray, CT scan, ESR and CRP were performed after surgery and during follow-up. Results:The incision was healed in all the 33 patients. No prosthesis loosening, subsidence or dislocation was found. The mean duration of follow-up was 61.0 months (range, 5-96 months) in all patients, and no hip pain, functional disorders or tu-berculosis relapse occurred. Harris score was 30.5 on average (range, 20-60) before surgery and 90.4 on average (range, 85-97) at the final follow-up. Conclusions:Under effective preoperative anti-tuberculous therapy, one-stage debridement and TKA for advanced tubercu-losis of the hip can obtain good results and it is safe and feasible.

  6. Dolor osteomuscular y reumatológico Osteomuscular and rheumatic pain

    Directory of Open Access Journals (Sweden)

    J. L. Rodríguez-Hernández


    spondylitis is a chronic systemic inflammatory disease that affects in particular the axial skeleton and rarely the peripheral joints. Most patients are HLA-B27 positive and may present family aggregation. Its onset occurs mainly at the end of the adolescence and most frequently in men. The treatment aims to maintain the spine mobility, in order to avoid ankylosis, pain and inflammation. Gout is a metabolic disease characterized by the deposition of urate monosodium crystals from over-saturated extracellular liquids. Its clinical manifestations range from acute gouty arthritis to intercritical gout and chronic tophaceous gout. The diagnosis is based on the examination of joint fluid. The treatment is based on colchicine, to which NSAIDs and occasionally corticoids or ACTH may be added. Musculotendinous pain syndromes occur at shoulder, elbow, wrist, hip, knee, ankle and foot level. They present local clinical manifestations and the treatment is based in local infiltrations, iontophoresis and sometimes TENS and ultrasounds. Myofascial pain syndrome is a regional pain condition that frequently affects the scapular and pelvic waist. It presents pain triggering points and muscular contracture. Treatment is focused on pain management, recovery of the muscular force and mobility. Fibromyalgia is a chronic generalized non-articular painful condition with predominance of muscular involvement and sensitivity in multiple predefined points. It is more frequently seen in middle-aged women. Its physiopathology is not clear. Low levels of tryptophan and a significant increase of the S/S type of the 5 HT transporting gene have been found. N-methyl-D-aspartate receptors seem also to be involved in this syndrome when they are activated and family aggregation has also been found, probably due to genetic predisposition. Its diagnosis is based on the criteria published by the American College of Rheumatology. This disease requires a pharmacological, physical and rehabilitative treatment, also

  7. 中轴型脊柱关节炎血清Dickkopf-1表达及相关性分析

    Institute of Scientific and Technical Information of China (English)

    崔银风; 张莉芸; 张改连; 许珂; 马丹; 郭东强; 闫俊荣


    -SpA patients and mSASSS score of AS patients (r=-0.581,P=0.023) were negatively correlated, Serum levels of DKK-1 with ax-SpA patients in clinical indicators,inflammatory markers and SPARCC score was no correlation.Conclusion With the severity of progressive ossification, DKK-1 level downward trend that may be an important factor in the occurrence of ankylosis and osteophyte formation of AS; DKK-1 level as one of potential biological markers that can be evaluated ossification degree of AS.

  8. The correlation analysis of the cervical spine alignment, flexion ROM of adjacent segments with the spinal cord atrophy in Hirayama disease%平山病患者颈椎曲度和相邻节段椎体屈曲度与脊髓萎缩的相关性

    Institute of Scientific and Technical Information of China (English)

    刘鑫; 孙宇


    curvature,flexion ROM of adjacent segment with spinal cord atrophy of Hirayama disease,and to provide rationale for its surgical management.Methods:36 consecutive patients underwent flexion X-ray and neutral position cervical MRI.The radiological mcasurement included the cervical spine alignment from C2 to C7 and the arc chord distance (ACD) by the Borden's method,flexion ROM of adjacent segments by calculating the difference between neutral and flexion position of Cobb angle defined as the tangent of the posterior body line of every two adjacent segments from C3-C7,observing spinal cord atrophy on sagittal position MRI and measuring the cross-sectional area of spinal from C3-C7 on neutral position cervical MRI.According to the ACD of cervical curvature,all patients were divided into 4 groups:7mm≤ACD≤17mm,normal cervical spine alignment; 1mm<ACD<7mm,straight or mild kyphosis;-4mm<ACD≤1mm,moderate kyphosis; ACD≤-4mm,severe kyphosis.The correlation analysis was performed between the adjacent vertebral flexion ROM and the cross-sectional area of corresponding cervical spinal cord on neutral position MRI.Results:In the 36 patients,normal cervical alignment accounted for 8 cases,straight or mild kyphosis for 13 cases; moderatc or severe kyphosis for 15 cases,of these 15 patients,14 had apex of kyphosis on C5 and 1 on C44.14 patients showed lower spinal cord atrophy on neutral MRI.13/28 cases with cervical straight or ankylosis presented with spinal cord compression was much higher than 1/8 of cases with normal cervical alignment (P<0.05).There were significant differences among flexion ROM of adjacent segments from C3 to C7 (P<0.05),with a higher flexion ROM of C5-C6 & C6-C7.Significant differences also existed between the cross-sectional area of spinal cord form C3 to C7 (P<0.05),with the lowest value at C5-C6 & C6-C7.Flexion ROM of adjacent segments was negatively correlated with the corresponding cross-sectional area of spinal cord in neutral MRI(r=-0

  9. 复杂肱骨远端骨折手术治疗的临床探讨%Clinical evaluation of operative treatment of complicated distal humerus fractures

    Institute of Scientific and Technical Information of China (English)

    赵龙; 宋有鑫; 崔成喜; 张宇轩; 张宝琦; 龚平; 武云鹤; 尚瑞松; 陈宾


    Background Distal humeral fracture is a severe damage around the elbow joint,and is often seen in young adults.It accounts for 2% of all adult fractures and about 50% of all humerus fractures.It′s one of the fractures that is difficult to deal with.The types of distal humeral fracture are divergent. Distal humerus fractures are often comminuted which make operative reduction difficult.Secondary loss of reduction and elbow ankylosis are common postoperative complications. All these difficulties make the distal humerus fracture one of the unresolved problems in fracture treatment.This study is to evaluate the clinical outcome of complex distal humeral fractures treated by operation.Methods (1)General data:twenty-four cases of operative treated distal humerus fractures in author′s hospital from January 2004 to December 2013 were included in this study.There were 1 5 males and 9 females,aging from 1 7 to 73,averaged 41.AO/OTA Classification:A3:9 cases;B1, B2:6 cases;C3:9 cases.Two cases were combined with nerve injury.Two cases had histories of high blood pressure and diabetes.(2 ) Operative method:The patient was placed in the supine position,and the elbow to be operated on was positioned at 90°of abduction and supported on a lucent operating table.A pneumatic tourniquet was placed as proximally as possible on the arm.With the elbow flexed at about 60°,the first incision was made about 7 cm proximal to the tip of the medial epicondyle.In the initial cases,the ulnar nerve was isolated,released from the ulnar nerve groove, and protected carefully.In later cases,the nerve was only exposed.The medial and anteromedial side of the distal humerus was exposed through the opening between the brachial muscle and the medial intermuscular septum.The common origin of the flexor muscles was partially dissected and reflected distally,leaving a 5-mm strut to be re-sutured in situ at completion of surgery.The anterior capsule was incised.The articular surface of the trochlea was