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A multidisciplinary approach to the management of temporomandibular joint ankylosis in a sickle-cell anemia patient in a resource-limited setting

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ABSTRACT

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.

No MeSH data available.


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(a) Postrami surgical incision. (b) Gap arthroplasty of about 1 cm. (c) Interposition of masseter muscle
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Figure 3: (a) Postrami surgical incision. (b) Gap arthroplasty of about 1 cm. (c) Interposition of masseter muscle

Mentions: She was preoxygenated and intravenous (IV) line was inserted for medication delivery. Patient had tracheostomy under local anesthesia and sedation on the operating table by the ENT surgeons. She had left TMJ ankylosis release via a postrami incision [Figure 3a] by gap arthroplasty of 1 cm [Figure 3b]. About 1 cm of mouth opening was achieved, and ipsilateral coronoidectomy was performed to further improve the mouth opening. Following ipsilateral coronoidectomy, about 1.5 cm mouth opening was achieved intraoperatively. The gap was then interposed with a strip of the masseter muscle [Figure 3c]. Contralateral coronoidectomy was re-scheduled as a stage 2 surgery following the advice of the anesthetists that patient had stayed 2 h 15 min under GA. Estimated blood loss was 350 ml (70 ml from tracheostomy and 280 ml from surgery). She was transfused with another pint of whole blood at the end of surgery. Final tracheostomy tube removal was performed by the ENT team after reversal of GA. She was thereafter transferred to ICU where the following medications were administered:


A multidisciplinary approach to the management of temporomandibular joint ankylosis in a sickle-cell anemia patient in a resource-limited setting
(a) Postrami surgical incision. (b) Gap arthroplasty of about 1 cm. (c) Interposition of masseter muscle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979329&req=5

Figure 3: (a) Postrami surgical incision. (b) Gap arthroplasty of about 1 cm. (c) Interposition of masseter muscle
Mentions: She was preoxygenated and intravenous (IV) line was inserted for medication delivery. Patient had tracheostomy under local anesthesia and sedation on the operating table by the ENT surgeons. She had left TMJ ankylosis release via a postrami incision [Figure 3a] by gap arthroplasty of 1 cm [Figure 3b]. About 1 cm of mouth opening was achieved, and ipsilateral coronoidectomy was performed to further improve the mouth opening. Following ipsilateral coronoidectomy, about 1.5 cm mouth opening was achieved intraoperatively. The gap was then interposed with a strip of the masseter muscle [Figure 3c]. Contralateral coronoidectomy was re-scheduled as a stage 2 surgery following the advice of the anesthetists that patient had stayed 2 h 15 min under GA. Estimated blood loss was 350 ml (70 ml from tracheostomy and 280 ml from surgery). She was transfused with another pint of whole blood at the end of surgery. Final tracheostomy tube removal was performed by the ENT team after reversal of GA. She was thereafter transferred to ICU where the following medications were administered:

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus