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Interpositional gap arthroplasty has shown good results; however, these techniques could be improved by taking into account the biological bases of the tissue used. Therefore, we suggest the pedicled tragal chondral flap as a safe, simple, and low-morbidity alternative.

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BACKGROUND: There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. CASE PRESENTATION: In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. CONCLUSIONS: The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.

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ABSTRACT: Temporomandibular joint (TMJ) ankylosis in children can alter facial development and affect oral hygiene and function. Surgical release of the ankylosis is the mainstay of treatment. The authors hypothesize that preoperative arterial coil embolization is safe and effective in preventing major blood loss during TMJ surgery (loss prompting blood transfusion or hemodynamic instability requiring vasoactive medication administration) in children with TMJ ankylosis. Patients < 16 years who were diagnosed with TMJ ankylosis (<15 maximal interincisal opening) and had embolization before surgery in the last 5 years were included. Out of 9 initial search results, 3 patients were excluded (age > 16). Information gathered were patient demographics, diagnostic imaging, procedural details, complications, and clinical outcomes. Six patients, mean age 11.14 years (range 7-15 years) year and a mean weight of 40.8 ± 19 kg were included. Underlying etiologies for TMJ ankylosis: Pierre Robin Syndrome (n = 2), juvenile rheumatoid arthritis (n = 1), Goldenhar's syndrome (n = 1), trauma (n = 1), and micrognathia (n = 1). Neck computed tomography angiogram before embolization demonstrated an intimate approximation between the internal maxillary artery (IMAX) and/or external carotid artery and ankylotic mass in all patients. Eight successful embolizations were performed without procedural complication. In 1 patient with angiographic evidence of surgical internal maxillary artery ligation, embolization was performed via collaterals. Surgery was performed within 48 hours of embolization. Airway access during surgery was via nasal intubation (n = 4), oral intubation (n = 3). The estimated blood loss (EBL) during surgery was 78.33 ± 47.08 ml. Three patients had subsequent TMJ surgery with a mean estimated blood loss of 73.33 ± 46.18 ml. After a mean follow-up of 17 ± 15 months, patients showed a 13.8mm mean increment of maximal interincisal opening with 95% CI (5.74-21.9), P < 0.007.

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O Schistosomus reflexus (SR) é uma anomalia congênita fatal de baixa incidência observada principalmente em ruminantes. O objetivo deste estudo foi relatar a ocorrência de SRem uma vaca com um quadro de distocia, multípara e de partos anteriores normais, atendida em uma propriedade localizada em Irati, região Centro-Sul do Paraná, Brasil. Durante a anamnese, foi relatado que o trabalho de parto ocorreu normalmente, com dilatação cervical e rompimento da bolsa alantoidiana e amniótica. Contudo, não ouve exteriorização do feto. Devido à inviabilidade da tração forçada observada no exame físico, optou-se pela cesariana. O feto extraído era disforme, apresentando dorsoflexão da coluna vertebral, órgãos abdominais expostos, anquilose de membros e face deformada, as quais são alterações anatômicas compatíveis com as características de Schistosomus reflexusdescritas na literatura. O caso apresentado contribui de forma relevante para o aprimoramento da compreensão e estudos sobre esse distúrbio, uma vez que sua ocorrência é rara.

Schistosomus reflexus (SR) is a fatal congenital anomaly of low incidence mainly observed in ruminants. This study aimed to report the occurrence of SR in a cow with dystocia, multiparous, and normal previous deliveries, treated in a property located in Irati, south-central region of Paraná, Brazil. During anamnesis, it was reported that labor occurred normally, with cervical dilation and disruption of the allantoic and amniotic stalk. However, there was no externalization of the fetus. Due to the infeasibility of the forced traction observed in the physical examination, a cesarean was performed. The extracted fetus was misshaped, presenting dorsiflexion of the spine, exposed abdominal organs, ankylosis of limbs, and deformed face, which are anatomical alterations compatible with the characteristics of Schistosomus reflexus described in the literature. The case reported contributes significantly to the improvement of understanding and studies on this disorder, since its occurrence is rare.

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ABSTRACT: Ankylosis of the temporomandibular joint is a disorder resulting from fibrous, osseous, or fibro-osseous adhesion that directly affects the quality of life of the individual. The authors present a case of unilateral temporomandibular joint ankylosis treated by condilectomy and ipsilateral sliding vertical ramus osteotomy associated with contralateral sagittal osteotomy aiming to restore function and to correct dentofacial deformity class II. A 31-year-old female patient presented with a history of facial trauma and major complaint of oral opening limitation. Physical examination revealed hypoplasia of the lower third of the face, facial pattern type II, anterior open bite, and maximum mouth opening of 22.5 mm. Computed tomography showed an ankylotic mass in the right mandibular condyle with deformity of the condylar structure and fusion to the right zygomatic arch and a contralateral condylar fracture sequel. It was proposed to perform a condilectomy of the right mandibular condyle for the removal of the bone mass concomitant to the sliding vertical ramus osteotomy of the mandibular ramus for condylar reconstruction by rhytidectomy approach and the sagittal osteotomy of the left mandibular aiming the reestablishment of occlusion and the correction of dentofacial deformity. The condylar fracture was not operated because the condyle was remodeled. The patient is in her fourth year postoperative presenting satisfactory esthetic-functional re-stabilization, without clinical signs of recurrence. In conclusion, the authors believe that combined sliding vertical ramus osteotomy and sagittal osteotomy can bring satisfactory results in complex cases.

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Dinosaurs possess a form of tooth attachment wherein an unmineralized periodontal ligament suspends each tooth within a socket, similar to the condition in mammals and crocodylians. However, little information is known about tooth attachment and implantation in their close relatives, the silesaurids. We conducted a histological survey of several silesaurid taxa to determine the nature of tooth attachment in this phylogenetically and paleoecologically important group of archosaurs. Our histological data demonstrate that these early dinosauriforms do not exhibit the crocodilian/dinosaur condition of a permanent gomphosis, nor the rapid ankylosis that is plesiomorphic for amniotes. Instead, all sampled silesaurids exhibit delayed ankylosis, a condition in which teeth pass through a prolonged stage where the teeth are suspended in sockets by a periodontal ligament, followed by eventual mineralization and fusion of the tooth to the jaws. This suggests that tooth attachment in crocodylians and dinosaurs represent the further retention of an early ontogenetic stage compared to silesaurids, a paedomorphic trend that is mirrored in the evolution of synapsid tooth attachment. It also suggests that the dinosaur and crocodylian gomphosis was convergently acquired via heterochrony or, less likely, that the silesaurid condition represents a reversal to a plesiomorphic state. Moreover, if Silesauridae is nested within Ornithischia, a permanent gomphosis could be convergent between the two main dinosaur lineages, Ornithischia and Saurischia. These results demonstrate that dental characters in early archosaur phylogenies must be chosen and defined carefully, taking into account the relative duration of the different phases of dental ontogeny.

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OBJECTIVE: This study aimed to investigate genetic variations in the osteoprotegerin-encoding gene (TNFRSF11B) in patients with temporomandibular joint ankylosis (TMJA). STUDY DESIGN: The sample comprised 17 patients diagnosed with TMJA, of both sexes with ages ranging from 6 to 57 years old. TNFRSF11B mutational analysis was performed using the Sanger sequencing method with DNA extracted from oral cells, and the functional impact prediction of the variants was assessed using bioinformatic analysis. RESULTS: Sequencing analysis identified 15 (88.23%) patients that presented at least 1 genetic variant in TNFRSF11B. The mutation rs202090603 (p.E33K) was found in 6 individuals, and rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) were identified in 1 subject each. According to the pathogenicity potential of mutations, 3 variants were considered of low impact (rs2073618, rs202090603, and rs2228568) and 3 as disease causing (rs140782326, rs11573942, and rs1375250340). The variant rs202090603 (p.E33K) was found in the first cysteine domain with differences in the loop positions of p.E33K mutated the 3D structure of osteoprotegerin. CONCLUSION: Two polymorphisms (rs2073618 and rs2228568) and the mutations rs202090603 (p.E33K), rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) in the TNFRSF11B gene may be associated with TMJA.

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Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

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