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JM N UNIVERSITY OFSCIENCE ND TECHNOLOGY
Treatment Planning And Seminars
Anmar BasilThar Hayder
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43 years lady from Niger presented with inability to close
mouth or bring teeth together over the last 2 years.
OPG : both condyles were anterior to the articular
eminences
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Dislocation
Acute Chronic(persist >1month)
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Subluxation is self-reducing, patient is able to close hisor her mouth without assistance.
true dislocation(or luxation) is a condition in which ajoint is displaced from its articulations and requiresmanipulation by another individual.
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Chronic bilateral anterior dislocation
It is characterised by inability to close the mouth with or withoutpain
Dislocation can occur in any direction with anterior dislocation
being the commonest one
Trauma
Steep eminence
Habitual subluxation
Syndrome associated
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Ehler-danlos syndrome (EDS)
Is an inherited CT disorder with different presentations
that have been classified into several primary types
EDS is caused by the defect in the synthesis of collagen
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Types of EDS
Hypermobility
Classical
Vscular
Kyphoscoliosis
Arthrochalasia
Dermatosparaxis
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Hypermobility type
Joint hypermobility is the hallmark of this type , with less
severe skin manifestations.
Patients with the Hypermobility Type experience frequentjoint dislocation and subluxations
By ethnic i ty, JHM is observed in up to
3557% in A fr icans
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Treatment
Surgical (open)
Non Surgical (closed)
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surgical open reduction:
1968, Rowe and Killeybone hook which was passed over the Sigmoid Notch
through a small incision below the angle of mandible and
downward traction was applied on condyle
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1976, Adekeya et al
occlusion was restored by means of inverted L shaped
osteotomy of ramus.
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Bone grafts to be used in such
surgeries :
Iliac bone graft was seen to have resorption whereas in
case of the calvarial graft complication was seen in the
donor site with the occurrence of dural tears, arachnoidal
bleeding hematoma formation and scalp infections. Since
the iliac graft showed remarkable degree of resorption
bovine cartilages were tried. Cartilage were found to be
dimensionally stable in terms of resorption which was
further enhanced by their calcification.
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Lewis,1981technique in which the Bristows elevator was passed
through the temporal fascia as in Gillies technique ofelevation of depressed zygomatic bone. The tip of the
rowe elevator was used and force was applied in
downward and posterior direction. This method also
facilitates open reduction by extending the incision asused for preauricular approach to the joint
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Augmentation of the articular
eminence displacement of the zygomatic arch and obstructing the
path of the Condylar translation has been first described
by Mayer in 1933
it has been modified by Dautrey25 in which the green
stick fracture was performed at zygomaticotemporal
suture, which provides the rebound elasticity and provide
stability in the altered position. It cannot be performed in
elder people due to the brittleness of the bone;so i t isrestr ic ted to young indiv idual .
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eminectomy Myrhaug in 1951
Removal of eminence will facilitate the return of thecondyle without any interference into the glenoid fossa.
Although dislocation takes place, painless reduction will
occurs automatically
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Implants
Various other materials have also been used like L-
shaped pins, vitallium mesh implants, and mini implants to
enhance the eminence. Uses of these materials have
been reported with increase incidence of fracture and
loosening under functional loads. Silicon blocks used inthe shape of wedge has been reported to evoke immune
reaction and also showed displacement as a result of
functional movement.
Among al l di f ferent treatment modali t ies s tudied inthe l i terature, a rate of 95% o f cases w ithout
recurrence bo th after eminectom y and use of metal l ic
implant over the art icu lar em inence
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Closed
reduction
Avoid excessive
force
Sedation
Extraoral route
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Thank You