Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy

Abstract

Background

The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ.

Methods

Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6–8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (JFLS) and the maximum mouth opening were measured. Two-sample Hotelling T²t-test was performed to determine the significance of the morphological and clinical outcomes' differences between the two groups.

Results

The two-sample Hotelling T²t-test showed significant differences (T² (df1,df2) = 0.97 (5,26), p <0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (p <0.05). However, the condylar displacement was not significantly different between the two groups (p =0.3). The average of the JFLS score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (p < 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery.

Conclusion

The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.

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Next step: functional studies on hypertension, lichen planus and TRPA1 connections

Abstract

We would like to thank for the invaluable insights of Shan and colleagues (Shan et al, 2017). They put forward a most logical hypothesis for a link between Koebner phenomenon and the mechanoreceptor Transient Receptor Potential Ankyrin 1 (TRPA1). As suggested, TRPA1 expression in non-lesion mucosal areas of oral lichen planus (OLP) patients should also be investigated. Furthermore, buccal samples form people displaying mursicatio buccarum may be used to test if prolonged mechanical stimuli alone upregulate TRPA1 in the oral mucosa.

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Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Marc Hamoir, Emma Holvoet, Jerôme Ambroise, Benoît Lengelé, Sandra Schmitz
ObjectiveSalvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence.Materials and methodsSingle-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS).ResultsThe following factors showed a significant impact on DFS: Disease-free interval >6months [HR 0.53; p=0.04], age>70years [HR 0.26; p=0.03], primary chemoradiotherapy [HR 2.39; p<0.01] compared to radiotherapy, oropharynx [HR 5.46; p<0.01] and hypopharynx [HR 3.92; p=<0.01] sites, compared to larynx, initial stage III [HR 7.10; p<0.01] and stage IV [HR 4.13; p<0.01], compared to stage I, locoregional recurrence [HR 4.57; p<0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p<0.01], postoperative complications [HR 2.09; p=0.01], positive margins [HR 3.64; p<0.01] and close margins [HR 3.83; p<0.01]. On multivariate analysis, oropharynx site [HR 3.98; p<0.01], initial stage III [HR 5.93; p<0.01] and locoregional recurrence [HR 2.93; p=0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p=0.04], close margins [HR 2.94; p=0.02], extracapsular spread (ECS) [HR 4.04; p=0.03] and postoperative complications [HR 3.64; p<0.01] were independent postoperative prognostic factors.ConclusionsPatients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed.



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Isolated tracheoesophageal fistula versus esophageal atresia – Early morbidity and short-term outcome. A single institution series

Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): R.B. Tröbs, W. Finke, M. Bahr, C. Roll, M. Nissen, M.R. Vahdad, G. Cernaianu
PurposeWe compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF).MethodsTwenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19). Results. A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA).ConclusionDevelopmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.



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Urine cysteinyl leukotriene levels in children with sleep disordered breathing before and after adenotonsillectomy

Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): A. Satdhabudha, P. Sritipsukho, S. Manochantr, W. Chanvimalueng, U. Chaumrattanakul, P. Chaumphol
ObjectivesObstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA.MethodsChildren under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO2 monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again.ResultsThirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE4 levels decreased from 961.9 (684.8–1438.2) to 708.6 (538.2–1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children.ConclusionsAdenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.



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