Kondilektomi ve silikon interpozisyonu ile tedavi edilen 32 çene ankilozunun uzun takip sonuçları

Temporomandibuler eklem ankilozları ağız açma kapama fonksiyonunu önemli ölçüde kısıtlayarak hasta için ciddi sağlık problemlerine neden olmaktadır. Bu olguların tedavisinde kondilektomi, gap artroplasti, ve otolog ya da alloplastik materyallerle yapılan interpozisyonel artroplasti teknikleri kullanılmaktadır. Bu çalışmada 1988 ve 1998 yılları arasında kondilektomi ve silikon interpozisyonu ile tedavi edilen 11 çift, 10 tek taraflı toplam 32 TME eklem ankilozunun uzun takip sonuçları sunulmaktadır. Olguların hiçbirisinde cerrahi yara problemleri ve yerleştirilen silikon implanta ait komplikasyonlar görülmemiştir. Hastaların bir tanesi hariç hepsinde ameliyat sonrası elde edilen ağız açıklığı nüks gelişmeden korunmuştur. Nüks gelişen bir hastada ise aynı tekniğin uygulandığı ikinci bir cerrahi girişim ile ağız açıklığı fonksiyonu tekrar sağlanmıştır. Bir hastada ankiloz girişiminden 2 yıl sonra uygulanan ortognatik cerrahi ile mandibulomaksiller deformite düzeltilmiştir. Elde edilen sonuçlar; erişkin, nüks ile başvuran uzun süreden beri devam eden TME ankilozlarının cerrahi tedavisinde en az 3.5 cm lik ağız açıklığını sağlayacak şekilde uygulanan kondilektomi, gerektiğinde koronoidektomi ile beraber yumuşak dokuların serbestleştirilmesi ve silikon interpozisyonunun oldukça etkili bir teknik olduğunu göstermektedir.

Long term results in 32 temporomandibular joint ankylosis treated with condilectomy and silicon interposition

Background.- Temporomandibular joint ankylosis usually secondary to trauma, leads to both functional and aesthetic problems. The surgical treatment of such cases is usually challenging problem to the reconstructive surgeon. The main goals of treatment are to restore Temporomandibular joint function so that patients would be able to open their mouths in order to maintain essential functions such as nutrition, oral hygiene, chewing, and speech and to prevent patients from recurrence. Condilectomy, condilectomy with coronoidectomy, and silicone interpositon are commonly used to treat this pathology. Design.- 11 bilateral and 10 unilateral temporomandibular joint ankylosis were treated with condilectomy and silicone interposition between 1988 and 1998. The surgical goal was to achieve at least 3.5-cm.of interincisal opening. For this purpose, all patients underwent condilectomy. When condilectomy was inefficient, coronoidectomy with/without soft tissue stripping was performed. Resultant defect was filled with custommade silicone bloc. Results.- Patients were followed 12 years (mean 7 years). No complication was seen during the follow-up period. The overall resuits were satisfactory in all patients. Only one patient who had undergone three unsuccessful surgical interventions before our treatment necessitated second surgical correction with the same technique due to the recurrence. Conclusion.- Condilectomy, if necessary, coronoidectomy combined with silicone interposition is highly effective surgical technique to treat TMJ ankylosis especially in adult patients presenting recurrent disease and having this pathology for a long time. We also suggest that at least 3.5 cm interincisal opening be obtained in operation to ensure the satisfactory result.

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