Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2025
Does Lateral Pterygoid Muscle Reattach After Ramus-Condyle Unit Reconstruction in Temporomandibular Joint Ankylosis Patients?
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Kaur Kamalpreet, Bhutia Ongkila, Manchanda Smita, Bhalla Ashu Seith, Yadav Rahul, Bhatt Krushna, Roychoudhury Ajoy
Аннотация
BACKGROUND: The removal of ankylotic bone requires detachment of lateral pterygoid muscle (LPM) from the ankylosed condyle. Whether spontaneous reattachment of LPM occurs or not following autogenous ramus-condyle unit (RCU) reconstruction in temporomandibular joint ankylosis (TMJA) is not yet known.
PURPOSE: The study purpose was to measure and compare the incidence of spontaneous LPM reattachment following 2 RCU reconstruction techniques-costochondral graft (CCG) and transport disc distraction osteogenesis (TDDO) and its implications on postoperative jaw motion.
STUDY DESIGN, SETTING, SAMPLE: A double-blind randomized clinical trial was implemented. Pediatric TMJA patients aged 3 to 16 years who consented for ankylosis release and RCU reconstruction were included. Patients were excluded if they had diagnosis other than TMJA, had bilateral/recurrent TMJA, underwent RCU reconstruction using modality other than CCG or TDDO, or did not give consent to come for follow-up/participate in this study.
PREDICTOR VARIABLE: The primary predictor variable was the RCU reconstruction method (CCG or TDDO).
OUTCOME VARIABLE: Primary outcome variables included the presence (yes/no) and anatomical site of LPM reattachment. Secondary outcomes were anatomic (reconstituted condyle formed, volume of LPM, temporalis muscle reattachment and its site) and functional (laterotrusion and maximal interincisal opening).
COVARIATES: The covariates included demographics (age, sex) and perioperative (ankylosis classification, etiology, magnetic resonance imaging evaluation time).
ANALYSES: Nonparametric continuous variables were analyzed using the Wilcoxon rank-sum test, categorical variables with the χ2 test, and within-group comparisons using the signed-rank test. A P value <.05 was considered statistically significant.
RESULTS: The study sample had 12 subjects (median age = 11.5 years (interquartile range (IQR) = 4.5); M:F = 7:5). RCU reconstruction was done with CCG (n = 5 (41.7%)) or TDDO (n = 7 (58.3%)). On magnetic resonance imaging evaluation at median 237 days, the LPM (n = 12/12,100%) and temporalis muscles (n = 11/11,100%) showed spontaneous reattachment. Different sites of LPM reattachment were noticed, ie, on reconstituted condyle neck [n = 3 (25%),CCG = 1 (20%),TDDO = 2 (28.6%)], on reconstituted condyle head [n = 4 (33.3%),CCG = 1 (20%),TDDO = 3 (42.9%); no resorption], and on ramal cut surface [n = 5 (41.7%),CCG = 3 (60%),TDDO = 2 (28.6%) (P = .8)], with lower ipsilateral side volume. At 3 years follow-up, an improvement in median maximal interincisal opening (Preoperative = 9.5 mm (IQR = 2.5),Follow-up = 35 mm (IQR = 6), (P = .002)) and laterotrusion (Ipsilateral:Preoperative = 3 mm (IQR = 10),Follow-up = 10 mm (IQR = 5), (P = .9); Contralateral:Preoperative:0 mm (IQR = 0),Follow-up = 2 mm (IQR = 5), (P = .01)) were noted.
CONCLUSION AND RELEVANCE: LPM showed spontaneous reattachment and resulted in improved laterotrusion. The site of reattachment has a role in reconstituted condyle and coronoid remodeling.
PURPOSE: The study purpose was to measure and compare the incidence of spontaneous LPM reattachment following 2 RCU reconstruction techniques-costochondral graft (CCG) and transport disc distraction osteogenesis (TDDO) and its implications on postoperative jaw motion.
STUDY DESIGN, SETTING, SAMPLE: A double-blind randomized clinical trial was implemented. Pediatric TMJA patients aged 3 to 16 years who consented for ankylosis release and RCU reconstruction were included. Patients were excluded if they had diagnosis other than TMJA, had bilateral/recurrent TMJA, underwent RCU reconstruction using modality other than CCG or TDDO, or did not give consent to come for follow-up/participate in this study.
PREDICTOR VARIABLE: The primary predictor variable was the RCU reconstruction method (CCG or TDDO).
OUTCOME VARIABLE: Primary outcome variables included the presence (yes/no) and anatomical site of LPM reattachment. Secondary outcomes were anatomic (reconstituted condyle formed, volume of LPM, temporalis muscle reattachment and its site) and functional (laterotrusion and maximal interincisal opening).
COVARIATES: The covariates included demographics (age, sex) and perioperative (ankylosis classification, etiology, magnetic resonance imaging evaluation time).
ANALYSES: Nonparametric continuous variables were analyzed using the Wilcoxon rank-sum test, categorical variables with the χ2 test, and within-group comparisons using the signed-rank test. A P value <.05 was considered statistically significant.
RESULTS: The study sample had 12 subjects (median age = 11.5 years (interquartile range (IQR) = 4.5); M:F = 7:5). RCU reconstruction was done with CCG (n = 5 (41.7%)) or TDDO (n = 7 (58.3%)). On magnetic resonance imaging evaluation at median 237 days, the LPM (n = 12/12,100%) and temporalis muscles (n = 11/11,100%) showed spontaneous reattachment. Different sites of LPM reattachment were noticed, ie, on reconstituted condyle neck [n = 3 (25%),CCG = 1 (20%),TDDO = 2 (28.6%)], on reconstituted condyle head [n = 4 (33.3%),CCG = 1 (20%),TDDO = 3 (42.9%); no resorption], and on ramal cut surface [n = 5 (41.7%),CCG = 3 (60%),TDDO = 2 (28.6%) (P = .8)], with lower ipsilateral side volume. At 3 years follow-up, an improvement in median maximal interincisal opening (Preoperative = 9.5 mm (IQR = 2.5),Follow-up = 35 mm (IQR = 6), (P = .002)) and laterotrusion (Ipsilateral:Preoperative = 3 mm (IQR = 10),Follow-up = 10 mm (IQR = 5), (P = .9); Contralateral:Preoperative:0 mm (IQR = 0),Follow-up = 2 mm (IQR = 5), (P = .01)) were noted.
CONCLUSION AND RELEVANCE: LPM showed spontaneous reattachment and resulted in improved laterotrusion. The site of reattachment has a role in reconstituted condyle and coronoid remodeling.